Anxiety is real, but do you know its source? In addition to my own experience dealing with OCD, obsessive compulsive disorder, and anxiety for many years, that ran my life, literally ran my life. I'm a clinician and researcher, and for the last 17 years, I have found that getting to the source of anxiety, where it's really coming from, understanding it, naming it, helps us to be able to unravel the why and be able to get to the what. What are we feeling anxious about? Getting to an understanding helps the mind be able to find a ground. So once we know the sources of the different anxieties, the different causes that could be there, it's much easier to work with and essentially heal yourself as a healer as well and medical intuitive. I find that all healing is really self healing. I might be a guide on the side that's helping somebody be able to find that within themselves, but essentially all healing is self healing. The professionals that I did and didn't see when I was younger and really dealing with the massive pressures of the OCD and feeling like the walls are crashing in on me a bit. I didn't have the skills and tools of what I needed. So it's my desire to share with you some things that took me a lot of years to figure out, and I'm hoping that it will be helpful. In this video, we're going to go through my checklist of underlying causes, some underlying causes. Some are common, some are maybe less common to you. And what I believe to be a more appropriate definition of anxiety based on my and others experiences, rather than the conventional. I'm Tiffany Barsoe, a spiritual counselor and medical intuitive, a teacher and a guide on the side. Thank you for being present today and let's walk through this together. So first of all, a little disclaimer that this is not medical advice. Please, if you are dealing with something that is a that is a known mental illness, especially if it's suicide. These are very serious things and please seek the help. This is, you know, we sometimes call it University YouTube. And while this can be helpful, it is not meant to replace any sort of medical guidance or advice. I'm certainly not giving you any here. If this is meant to be informative about what I experienced in my own journey, and what I have found to be helpful for other people. So please see a qualified medical practitioner, mental health practitioner, anyone that you may need to support you if you are dealing with something very serious. Anxiety can be very serious. And I'm here to sort of unpack the things that are less discussed. So first of all, I want to look at the definition of what we know to be the classical definition is a little different than my take and what I have found. As I said, anxiety is real. But the definition may need to be questioned. This definition comes from the APA, the American Psychological Association. Anxiety is an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure, or panic attacks, these kinds of things. People with anxiety disorders usually have recurring intrusive thoughts or concerns. My definition is that anxiety is not a single emotion. It's not an emotion unto itself. It's an accumulation of emotions and feelings that haven't been tended to, that haven't been processed. Like experience is just doing a drive by on you but nevertheless landing on your heart, landing in your throat for the things that you couldn't say or wouldn't say, or for many reasons to feel safe in the world. But the emotions are accumulated because there was an action that needed to be taken, but it may not have been appropriate in that time or safe for any of us to have taken that action, or even have known what to do. Experience begets more experience. And experience is our best teacher. I'm not saying I don't know who to attribute credit. Experiences which you get when you didn't get what you wanted. I think it's a great saying. So it's not your fault, but it is our responsibility. So now that anxiety is a reality if it is in your life. It's something that we ultimately have to take responsibility for to shift it to change it. It's not work that somebody else can do for us. It's certainly be helpful, but it's not a load that somebody else or burden that somebody else can usually handle. It's, it's for us it's our teacher, essentially. So, because anxiety may not be exactly what you think it is, or what your health practitioner or medical doctor or whomever may have even diagnosed you with anxiety. So it's nice to use this time together to review this checklist of the uncommon and common traits that we see. And see if there's a resonance see if there's something that strikes a chord with you and hints there's usually more than one. And that's because they've been layered. So the even more reason to get to understanding the source. So see if you recognize yourself in any of these descriptions. The reason I've been on on my list is trauma trauma with or without post traumatic stress trauma is something that could have happened from when we were very young, it gets stored in the unconscious. I use unconscious and subconscious synonymously, they to really mean the same thing. And I do a lot of work based on Jungian psychology and depth psychology as part of my training. And this is, I really don't see a differentiation there. So traumas can be from birth, they can be from an experience from when we were very young, they can be at any time in life. What might be a trauma to one person may not be to another. Some of us have thicker skin when it comes to being able to handle some even looking at a traumatic scene. Some people can keep their cookies down and some people can't. So these kinds of things with the trauma are. We need to refer to ourselves what feels traumatic. And the clue is that you are having recurring visions or recurring thoughts about what it is that you may have witnessed or gone through. And what trauma does is it creates a reaction and a response that embeds the emotions and beliefs that are experienced at that time as being reality as being real. So the next time we're stressed, we may feel exactly those, but not necessarily linking them together exactly those same things that made a traumatic response in our body. And even though it could be a much lighter stress, the stress in stress we all regress, and it can take us back to something that had happened that makes those trauma responses. Each time we're in subsequent stressful or traumatic situations, our body minds can react as though we're experiencing that exact same core event all over again. It's an interesting phenomenon, but there's wisdom in it because what it allows us to do is be able to track it. And since we can track it, that's actually how we can heal it. Let me give you a little clinical pearl here. The subconscious will never, ever bring anything to the surface of our awareness that we can't handle. Never. The prime directive of the subconscious is to keep us alive safe and healthy. So when we have a memory or something come up, it's because we can handle it. We may not think so. And that's what turns things into anxiety because we think we can't handle it. And so therefore it doesn't get processed and things just continue to do a drive by. That's a slippery slope. So, carrying on. Number two on my list is worry. Now there's a few different components of worry. First of all, in stress, stress is caused by looking too far ahead, or paying attention too much to what's in the past. So we have, when worry comes up, we can interview ourselves. What am I worried about? Am I thinking in the future or am I thinking in the past? Because neither one we can do anything about. They are beyond our control. This moment now is the only one that we have. So let's not waste it on worrying about what isn't in our ability to do anything about right now. I have a, in the tool list, I've got a tool kit and a whole bunch of goodies that are available to you after you do go through this checklist. It's available on my website. But suffice it to say, I just want to give a little pearl of some threads of things that might be able to be easy for you to assimilate and start to work with like they were for me. But like I said, it took me a long time to put all these details together. The deal with when worry comes up is we want to ground ourselves in the now. You know, Eckhart totally, God bless his soul, love him as a teacher. The frustration I have with him, to be totally honest, is he just says be in the now but doesn't often give a how. And just a very quick hack right now is look at your feet. Your feet are always in the present moment. And it can create an interrupt of the worry, like a runaway train. So we'll be talking about that again. And then you ask yourself the question, what do I have control over right now. You have control over what you put your mouth, you have control over what you go do next, you have control, ultimately over what it is that you're thinking it may not feel like it, but you do. So say strong. Number three, empathic or codependent habits. So this is a biggie, because I'm a recovering codependent, I am also an empath but I have trained myself to not be overly sensitive to the extent that I am bombarded by everybody else's feelings. We must start to turn on discernment. As empaths, our number one skill is to use discernment. Is this feeling mine, or is it somebody else's. This can begin a self questioning where you can start to really unpack what is relevant for you in that moment. There's all kinds of nuances that I would love to go into but I'm just trying to get through the checklist right now. So empaths tend to be outwardly focused, as in they're looking to be sourced from the outside, rather than being sourced from the inside. And so that can create codependent habits because we habitually look for how it is that we can find our happiness and well being and stability, depending on how other people behave. Woo, that's another slippery slope to so oftentimes in that habit, we're looking to see is everybody else okay because if they're okay then I'm okay. No, self responsibility, that's actually on the list as well so we're going to get there. But number one for empathic habits and codependent habits is to have discernment be aware of what's yours. There's much more that's on the checklist as well, as far as information, but I'm going to keep going through this list. So number four, avoidance. Woo, this is a biggie. So the root cause, ultimately is in fear, fear of doing something wrong or not getting it right and perfectionism. We put off making decisions, or we procrastinate, or we avoid confrontations, or we don't have those crucial conversations that we know that we need to have. Anxiety is actually a mobilizing energy. Anxiety is like a see it as a fast moving river that wants to to move through us it's telling us that there's energy there's creative energy to do something with. And if we haven't if we've been damning it up because it hasn't had a chance to move. Man, this can. It can block so much good. And there's more things related to this on the list, but the aversion to doing the next thing, the avoidance of planning.  That's not exactly you being in the driver's seat the universe responds to our emotions as well to help us create.  It's like the it's the fuel to the car. And if we're driving our vehicle, we are going to be the ones that either need to put our foot on the gas pedal and appropriately take it off that's the parasympathetic and the sympathetic systems. And we can have a whole other discussion about the biggest nerve which is where some of my research lay as well. But the point is for this avoidance pattern is to take any small action you can, you can. There's a great saying that you just iterate, you just continue to iterate. There's no perfection needed, because we're all a work in progress. There's no there. We're a work in progress. It's going to be this way. So meaning that it's going to be this way that there will always be a new height to get to. But if we stay in an avoid it and in a version pattern. We are increasing in anxiety that river is not going to stop. Imagine if you just tell your body, stop making blood. And some people have in their immune system there are people who have allowed stress to actually take them to a place where it turns into autoimmune issues it turns into opportunistic viruses or things that they can take over the body so that's the body mind connection. Let that be a word to the wise. Let's use this creative river. Pay attention to it. Notice when you're avoiding and take any little action you can. Okay, number five on the list. Lack of trust. So the root cause in lack of trust is ultimately a lack of self trust and knowledge and trust with our own wise inner child. Our inner child is a very creative being it seeks to play. And there's a whole I'm, I don't know. So if you don't already have a relationship with your inner child, that can at least start to prime the pumps for you starting to create one. Such an important piece it has been a huge part of my healing journey, and to unlock the mystery of where the OCD and all of that was stemming from and why it was holding me hostage in my life. So really can't stress this enough self trust actually begins with our inner child. And this is just take that at face value there's work to do there but there's only so much that we can do as we're going through this list. In the ages of 18 months and two years we're actually learning whether or not we can trust people in our lives. And that's Eric Erickson's work and a clinical psychologist and did a lot of work in hypnosis. He looked at childhood development patterns. I look at that a lot it is very very helpful, whether you're a parent raising children to pay attention to that, or looking at your own timeline of life and seeing when things key things that have created stress and trauma. So, as, as adults, our first relationship is with that inner child, but we need to cultivate it. So that ultimately is what helps to build self trust. So check out more on the website for those kind of in those details, and it's a lot more about also becoming more in sourced, and once again not looking to the outside world. Number six, creativity, blocked or not pursued. This is also dealing looking at anxiety like a fast moving river that wants to move and depression is actually on the other side of that depression is the dam. And it's, it's where all that fast moving energy is running into, and it doesn't have anywhere to go, because we're got we have there are our foot on the break, we're deciding to avoid, or block our creativity or saying not now to those creative impulses that this is something so important and is so within our ability to say yes, to say yes to our creative nature, we're all creators. I'm not talking about being an artist or, or anything highfalutin that has to do with being a creator like it, you know there's a certain archetype to it. No, by being alive we're all creators we're creating our reality all the time. It just might be the same damn reality. Okay, so this one is about not violating our inspirations. So we really want to pay attention to those inspirations. So just notice, are there a lot of creative projects or things that you've wanted to get to that you haven't given time to, and that can build anxiety. So it's a biggie. Number seven, unprocessed emotions. As I was saying earlier that in the definition of anxiety my definition of anxiety is anxiety is a whole bunch of emotions it's not a singular emotion. And so you could have despair and grief and sadness and you could have a broken heart, you could have excitement you could have anger, you can, the whole gamut of emotions. I love Brene Brown's new book, I think it's The Heart of the Atlas where she's discussing I think it's 85 different emotions. I totally agree I see a whole span and a continuum. And there's feelings and emotions are a little bit different what we feel and the emotion that ultimately gets stored, and then makes a pattern in the brain. Fascinating information and we, with our neuroplasticity with our choices have the ability to repattern. So these unprocessed emotions are these experiences that have just done a drive by and didn't get processed. So, when, once again, when the subconscious brings something to the level of our awareness even if it's in a dream state, that's for us to work with in the next day in the next morning or wake up right then and work with it. Sometimes it's really difficult to go back to sleep after there's been something that really has been experiential in that time of our nighttime or daytime. There are people that also have hypnagogic or hypnopopic times where before you go to sleep and after when you start to wake up there's different ways that the brain is actually giving you information about a question that you may have put forth and also what needs resolving. So that's really important. Those unprocessed emotions are actually looking to be resolved. And remember the subconscious mind will never give you anything that you cannot handle. It's, it's the prime directive. And if you don't trust me check in with your own inner physician in your own self, and figure that out on your own. It's hugely important. Okay, we want to stop the wheel of madness. So let's process these emotions so that we're not handing it down to the next generation. Number eight, inner guidance avoidance. This is kind of goes hand in hand with resisting creative urges and inspiration. But this is a little bit of a nuance it's different because inner people are maybe negotiating I did when I was dealing with the OCD stuff. My ego was running the show I had to tease out the difference between what was intuition what was ego what was fear what was anger what was all mixed up that created this nutty response in my in my body. And it was a nightmare and I really am very compassionate and empathetic for people that are going through that. I know there's a way out you can rewire your nervous system. I am proof of the pudding that it is possible it is doable. Inner guidance avoidance is a big one here, because we need to be paying attention to what it is that that little kernel of insight. If we got programmed either by our religions or by our parents or society or whatever. There's a lot of programs that are coming in from the outside world. I like to have a use a hashtag called believe yourself, and that's really important. We want to ultimately believe ourselves. And this comp this takes confidence. And for us to really trust that inner voice, all of us have an inner voice. And if you don't feel that you immediately have it then this is some homework this is some some cultivation that can be had. It goes hand in hand with pretty much everything that we've been talking about because anxiety is the common theme to the outside that the outcome of all of these things not being realized or processed. And our inner guidance is just. Wow, I actually wouldn't be alive here today. I absolutely can say that if I had violated my inner guidance so many times in my life. I am grateful for that. And my urges is that you find it for yourself. And I bring up religion because this comes up quite a bit. I'm a mass I have a master's in theology. And I jokingly say that I am a theologian with no dogma. The reality is our own relationship with ourselves. It's nobody else's business. What goes on in the inner workings between our heart, our mind and all of our connecting our vertical connection to our higher forces. And we do want to stay grounded. That is key. Okay, moving on. Number nine. So hyper responsibility. This is interesting. I had this as a kid. And this also degrades into codependency as well. If we think that our safety in the world is dependent on controlling all of the conditions and being responsible for everything and everyone in our environment. That is going to degrade into codependency and probably many other things as well. And like I said, I'm a recovering codependent. I have to work on this all the time.  And that was Paul Brenner, my beloved. He was an MD PhD and just did amazing work in the world. And he's retired now but what a gift. I would like to soften that a little bit because it may not kill you, but it'll cause a lot of misery on the way to killing you.  It helped us to be able to cope. But that doesn't necessarily mean that it is wise for us to continue taking hyper responsibility for everything else that goes on.  Okay, so moving on to number 10 repetitive and recurring thoughts. These need some dissection. So, what I inform or what I have done myself and what I've asked my clients to do is to keep a list of what the recurring feelings are. What are the recurring feelings. What are the the intrusive in opportunistic they usually come up when it's just, wow. You know, it's, they're opportunistic. So, make a little note because we won't always need to, we always get to prioritize looking at it and healing it and really processing it, oftentimes while it's happening there's a clue there's gems in there for us to be able to work with. So these, these thoughts can, they can be crazy making and but they're doing you a favor. Because once again the subconscious mind is not going to bring anything to the level of our awareness that we cannot handle. So please rest on that as a truth, a truism and work with it. So, these repetitive thoughts are asking you to look at something that happened in that moment in time that you may not have been able to act upon, but if you were in it again what would you do differently. And time is not linear, especially when it comes to healing in the body mind. Right. I mean we can remember things from we when at early ages, or we remember nothing. It's a whole gamut of things, but it's, it's an interesting thing it's not like in order to think of a thought of when you were five years old, you have to go through the whole chronology of your life in order to get to five. No, it's a nonlinear process. So things will just come up to the surface as needed. So pay attention to those because there's great great wisdom. And the more we do that, the less chances of us getting hit by the proverbial spiritual two by four like what happened to me when I was living across the street from ground zero when they were cleaning up the buildings. So my story is on the website or I think there's another video in this channel. So, anyway, moving on to number 11 biochemical imbalances foods, medicines, heavy metals, a body or mind type that's a dosha in Ayurvedic medicine. So Tibetan medicine also has a similar type of typology for people. So biomedical imbalances can be the result of over supplementing for, you know, trying to do something yourself, or if you know that you've got a genetic propensity to not clear some neurotransmitters clear out toxins or things like that. It can create multiple sensitivities and allergies and in it can also adjust our microbiome. These kinds of things can cause anxiety as well so we want to pay attention to if you are, and also foods, some foods. So I can't as much as probably most of us like chocolate. I can't have it after three o'clock. I, there's a period in time in my day that I can have it but if I have it after three, I get an anxious rush, even really good high quality chocolate which I highly recommend that we all have every once in a while. Many people are not really aware of their constitution or their innate sensitivities and that keeping a food journal would be a good way to or supplement journal for what you're doing and what you're noticing. So we could be doing this to ourselves by some supplements that we're taking people who are GABA sensitive or thyracine or different things. Once again I'm not a medical doctor. I do have a good friend who has a wonderful website who teaches about how to access your own inner physician. And, you know, I, I don't know about you, I've been very misled on the medical journey for my own healing path and really had to go inward myself and figure it out and that's really what took me to graduate seminary and studying with Norm Shealy and Carolyn Mace and Christine Page and Karen Kramask. I mean there are so many people, Marcia Emery, people that I got to study with that are just incredible. So Christiane Northrop. I feel great fortune that I got to study directly with these amazing minds and hearts, and Jess Petrus is very available. Her website is just Dr Jess.com. And she can help with with that and give you a lot of satisfaction with asking certain questions where you may not have been getting the answers that you've been seeking. So we want to think a little bit complimentary, not necessarily alternative, because I believe in integration, I believe in and both. And I believe that a complimentary is definitely the way to go. So, all right, moving on to number 12 manipulations, subtle or overt manipulations, ultimately, it's lacking boundaries. And this means where we are doing the manipulating, or we are being manipulated. So, got to turn on that inner lens of your vision to be able to really see what the heck is happening. This is the drama triangle. I have a lot of resources about this on my website. The drama triangle is victim, rescuer, persecutor, victim, rescuer, persecutor, once you're on this dang thing. Man, it is a very seductive loop, and we all learned it from early on in our life we learned it and being in with in society we've learned it from our politics we've learned it. It's everywhere once you start to see how this works. You can really see it's everywhere and it takes a lot of discernment, and a lot of clarity to state off the drama triangle. So there's a course that I will be offering. I do offer from time to time so just look on my website and sign up on the waitlist if that's something that you are finding resonance with. We are manipulating other people or other people are manipulating us when we are on this drama triangle and figuring out these subtleties is super important for our freedom. I cannot emphasize that enough. So it's something to be aware of. There's a lot of resources like I said on this channel and also on my website heal and thrive. Okay, number 13. Phobias root cause believe that something is wrong with me phobias are usually a learned behavior. Interesting, and they can be traced back to early childhood. They can stem from an event that your parents may have had or something else that you may have observed. There's a, I had a client once whose parents that the mom was definitely afraid of spiders, and the child ended up creating a whole phobia, because her she watched her mom just like go go into a complete frozen state until the dad or somebody else in the household, when got the vacuum, and sucked it up. So now at the site of a spider for that child and into adulthood. That wasn't her reality necessarily. It was something that she observed but she absorbed as a real threat and fear. So we have to question where these phobias really come from, and also whether or not you believe in past lives we have been on a Earth recycling program for close to five billion years. So we've got some stuff of where we come from, and those phobias can be handed down. So it's, it's an interesting thing. I love that on on the website as well. So, pay attention to that, and just see what where the behaviors may have come from if that is something that you deal with, and you may have to work with a professional in order to help with that I have found neural and acoustic programming and LP to be very helpful just work with a qualified person to help get that on patterned for you. I mean, speaking of transgenerational transgenerational how things get handed down. Man, there was a beautiful study done several years ago at the Emory University, and they looked at mice, who were given a scent, and the the scent was during their development, and was fine. No big deal. Well then later on in these mice life, they started introducing shocks at the same time of giving the scent for I think it was five generations it's been a while since I looked at the study but think it was five generations. I don't know, I'd have to look at it again but but several generations, the pups from those mice. If that scent was waft in the air, the mice shuttered. And they were the ones their pups, they weren't the ones that exposed to it, their parents were, or to actually it was just even one the father was, I think that's the way it went. Sorry anyway, don't quote me on that go find that study. Actually I have it on my website as well when I speak about philosophy, but it's interesting because it really speaks to the the transgenerational hand downs of things that did not get healed by the people in our family before. So, please a call to the wise for parents out there, let's do our own work, so that we don't have to hand it to our pups to our children, so that they've got their own contracts they've got their own things to do. They don't need to be healing our stuff for us so free them do your own work and let our ancestral river be what it is, but it doesn't have to have a grave effect on us, because we have awareness to it and we know what thing where things are coming from. There's lots of things that we can do about that. That's Googleable or Internet searchable. And biggest thing about this that I want to say is, one of my main goals in the world is to help end human suffering. We want to end the karmic wheel. I want to end the karmic wheel. I don't want to keep creating the same stuff over and over again. It's time for us to creatively move along on our dharmic path dharma means the direction of life that actually gives us life. So it's a real gift when we can do that and not be living the things of the past. So let's let's work together to help end this karmic wheel and not repeat history. Number 15, situational anxiety. Social anxiety, fear of missing out, perfectionism, bullying, confrontation, overwhelm. These are situational instances where we can see or we can have, especially for a person that's more introverted that processes things more inside than outward, in the process as they speak usually. And so there's a difference in how it is that we move through the world based on how it is that we represent ourselves, introvertedly or extrovertedly. So the, the thing about this is to be aware of what is actually causing it and where it is of things that are going on, and they can set up our patterns. The first thing to begin to start changing it is just to observe yourself. When do these things come up. So it's just another avenue for where anxiety gets to travel in our lives. So but it's an opportunity for healing. Number 16, infantilization and adulting or lack of adulting I should say, it's we call it adulting right like when somebody has a difficult time adulting. It's a resistance to taking on responsibilities. So you can you see how this drama triangle would work out. It would be a rescuers job to take on the responsibility of somebody that would be in the victim role of needing to be taking care of. So it's a back and forth thing, but it's done out of an unhealthy relationship. And this infantilizing thing means that it's really detrimental because it means that we actually may not have had the appropriate boundaries we didn't have the things, the proper boundaries when we were younger growing up or a sense of entitlement or things like that where everything is done for you, and is the person a child or an adult didn't really learn the, the rules the governance of self responsibility. And there's an eternal child archetype that also could be playing out here eternal child it's like the Peter Pan syndrome, the person that just doesn't want to grow up and take responsibility for themselves in their lives. Anyway, there's more information about this in the checklist when you go to the website you can see about that. But just see notice for yourself if that you are in that role or you know other people in that role, because even if you're an empath or a person that is even around your own people are like that. Man, this can be super zapping of energy it's like an energy vampire, and it's something to have awareness of and for you to also have a clear boundary. I had to go through a lot of that myself personally, and still do why it's a constant management. We're alive right it's our lives take management. Okay, number 17 fear of the future mind racing. It's racist to predict what is going to happen in the future. It the root causes once again lack of trust, faith in ourself, or and or the need to control everything and everyone or the environments of the conditions. By the way, the drama triangle is also the blame game and the control game. So you can see the dynamics of how all of this works out. So fear of the future, though, causes this. It's another component of avoidance or an aversion to taking the next step. I have worked with a few people in my practice who are a go, agoraphobic, which means that they have a fear of going outside. And we just have to find where is that original phobia. It's made down, and it's usually early on in life. They feel safer in an environment that they can control. We all do that. That's just human nature. Of course, but when we notice that there's anxiety caused by the fact that we are not taking even a small step of what we can because we have a fear of making a mistake. Then we really need to restore faith in ourselves because it's not about anybody else, but it is about us. Okay. Moving on, number 18, diagnosis. This is really, really important. I work with a lot of people who have had recurring illnesses, chronic illnesses, cancers, etc. And the biggest fear that I have run into in that regard is there's a fear of being rediagnosed or like anxiety about what if it comes back. And it's a very looming anxiety, anxiety provoking feeling also about being out of control, fear of the future, fear of what the future brings, right. So when we think about the word diagnosis. And I've taught this in instances where I'm doing integrative talks with some colleagues. And it's interesting because this really isn't taught in Western medicine schooling. The word of diagnosis is a Latin dia D if we take it apart for the etymology, DIA means to separator to take apart and noses G N O S I S is wisdom. So if we stop in that moment, and we separate the information that we're getting, and we use our own wisdom. We want to come out of the orb of the hypnosis of whenever that diagnostic was given, because it puts us into a fear state. The fear state creates a neutrality in the brain. And it means that anything that anybody says becomes programmable. And so, oftentimes I call it screensaver mode, a person will receive some news and there are many doctors that don't have great bidside manners when it comes time to delivering really important information. And this is a big one. What will happen is the screensaver mode will happen, and it's a hypnotic effect. And everything else like this world just changes it goes into slow motion it, it's shock. And, but now you're not using your ability to separate yourself in that instance because we're in a state of shock when some something has happened. And it's like because the brain goes into neutral. So when we think about diagnosis, what you want to think about is your own innate wisdom. What do you know. I just also want to say, I strongly believe and find evidence for in my life and with all the people with whom I've worked that everything happens in our life to benefit us. And it may not look like it or feel like it, but really illness has been my best teacher, and it's everybody else's best teacher if they can find it. So, and that's really the point of it is, is to get the lesson what is it that was intended, because the illness or sickness or disease, or whatever, didn't happen to us, it happened for us. We are in the driver seat. And if we think that it happened to us, then it means that we're in the victim seat, and that feels so disempowered.  And I'm here to be a guide on the side to help you find them if that has lost its restoration if that needs to be restored with you as well. So number 19, we're getting towards the end here. It's either the past or the future this harkens to some other things I was saying about fear of what the future brings etc but what there's a tool I want to share with you right now which is, it's essentially what's happening in that, because as I said stress is a runaway train of the future or it's a being hung up in things of the past. So, interrupting that pattern of thought where it's like a runaway train. So essentially we've got to get back to the moment of now to eliminate that disruptive and repetitive and negative thinking. So, if a person, and this is it's just a little different than when we've got a repetitive thought because there's something coming up to the surface, living a person who lives in the past or lives in the future is not in the ability of being able to be in the driver seat right now. So that's that is a real need to recognize the difference and see what is preventing is it perfectionism is it something else on this list that we've also covered. So, the tool is to once again, stop, look at your feet. Right now, everything is fine, usually 98% of the time maybe more. Usually we're just fine. I like to say then go to the basics. Okay. I have food in the refrigerator. I have what I need right now. I'm okay right now. And if you're not, you're not in a, in a okay right now, then work to get yourself to that place. So this once again it's not meant to be medical advice because if you're in a really harried situation, please get help but you're probably not watching this video. If that's the case. Okay. All right. 20 self doubt, not knowing your purpose or passion for being here on planet Earth. This is really anxiety provoking. I know there's something for me to do but I just don't know what it is. Well, it's true. I believe that we are all here for some reason and I can tell you, this is tied to the very last one that we're going to be speaking to as well. This wounds, the biggest teachers in my life have been absolutely related to my gifts and my purpose and my passion. My story is a reluctant healers on my website you can watch it I also am on Gaia TV I told pretty much my whole story there. And it's about how I rewired my nervous system for to get rid of anxiety to get rid of OCD. This is something that is so capable of being revealed, but many of us keep blasting ourselves with the wound of what we experienced and not necessarily seeing the gift. Our job. Our mission should we choose to accept it is to find what that gift really is. And sometimes we may have to go deep to find it. We all have a purpose. We all have something that we are here to do to be to experience to offer as a gift. And many people are waking up these days to wanting to be of service and help to others. So if that's you, then let's get to work on it. There's a lot that's out on the net the internet to be able to help find your passions there's something I do called esoteric numerology that can help it looks at the soul number, the birth number the path that we're here to walk the life lessons those kinds of things. And it also looks at cycles. I have another video on that for that topic but there are ways of finding these things out to do self inquiry, even astrology astrology is a beautiful way. I'm starting to access that. If that's not within your cosmology then find something within your belief system, then find something that is, because that that is a very anxiety provoking place to be to feel like there's something I'm supposed to be doing, but I don't have access to it. And I'm here to tell you you do have access to it. And there's little breadcrumbs that just need to be picked up along the way. I have a great saying that I came up with I'm proud of it, that if we follow the breadcrumbs, we end up being well fed. So, in, in all way shape and form. So, take that in. Number 21, the last one on my list and if you have more to add to my list that didn't get covered here you felt like it wasn't addressed please leave me a comment and I want to know I want to know what's, what did I leave off and let's discuss it and let's find a solution. Okay, fear of discovering our wounds. So this is related to what I was just saying so there are some people when I say, hey, well what was the worst pain you've ever been in in your life, because that's what that vortex down. It's like when an addict hits, hits rock bottom, that's when they can really make a difference to get well. They, it's oftentimes takes us being able to hit because we live in a polar universe. There's a contrast that's needed to these experiences so that we can actually challenge our ourselves to be able to find that core gift. So, but sometimes people have a fear of going there. And this is also anxiety producing. So, it's the hero's journey or heroine's journey. This is so important to realize because everyone has a zone of genius. It really may be like a treasure chest in the bottom of the ocean that we have to go to the deeps to be able to find and access and open and be able to reap the rewards. So, that's it on the checklist up like I said please add more and think about what anxiety is costing you. It almost cost me my life. No joke. And for people who are in that position, I have great compassion and empathy for being where you are. And it's all changeable. I am living proof. So, your mission should you choose to accept it is to use this checklist it's on it's available on my website I'll put a link into the into this area where the comments are. To use this checklist to increase the activity of knowing yourself, healing yourself and freeing yourself funny that's my tagline, heal and thrive, know thyself, heal thyself, free thyself truly nobody else can do it for us we are the ones, we have to do it.  So please don't leave your own internal work to the next generation, and allow yourself to be that archaeologist that goes deep that finds which you need to, in order to polish the gold to get to those nuggets. You know, the saying is that you don't get a lotus flower without mud. And boy, that is very true it's been true and evident many factions of my life. So, you got this, we all got this, if we choose it. Thank you. I'm Tiffany Barsotti. I'm a teacher and guide on the side, and I am grateful that you are here listening to this, and I hope that there's been some resonance that there's been something helpful for you to be able to use and utilize immediately in your life. And if there, if there's something that you would like to see addressed or go deeper into. Please leave a comment below. Subscribe if you like and download the checklist and start to put it to work and see see what emerges for you. I want to turn it over to you. What did strike a chord here. What did have resonance. I would love to hear and have that discussion in the comments. I appreciate you going deep being present here. I know it was a longer video, and hopefully there's some gems that actually give back to you as well. All right, over and out for now. Much love.


Hey guys, welcome back to my YouTube channel. This is Daniel Rossell here. For today's video, I want to talk about how to set up audio monitoring in OBS Studio if you are using Ubuntu Linux. Now there is definitely a good number of monitoring tutorials out there on YouTube, less for OBS users on Ubuntu. So I actually did a video like this before, but it was about two years ago and a bit more complicated than it needed to be. So I'm just going to try simplify in this video. As you guys see, I currently have OBS open here on my desktop. And the first thing you want to go do in OBS is configure your audio input source. So I'm going to click on file here on the top menu on the right on the left there and then click down into settings. Now I'm going to click on the audio menu. Now I'm currently recording this live so I'm not able to make adjustments. I've talked before how about when you're using certain audio interfaces like the Beringer Euphoria UM2, you actually need to set the channel to mono rather than stereo. In any event, the microphone I'm using today is the Beringer Euphoria UM2 audio interface. And as you can see, just to keep things simple, I've disabled other non-active audio sources. So that's the first thing I recommend you're doing when you're monitoring because it can get confusing if you have multiple audio streams coming into OBS that you're not using. So this is it PCM2902 audio codec analog stereo. That's what I want to monitor. So I'm going to click OK here. Now coming into the audio mixer, as you can see, the levels are moving. So this only input is the one I want to monitor. I'm going to click on the cog wheel just to the right there. And then I'm going to click on advanced audio properties. Now in advanced audio properties, we have the name of the microphone status, we can configure a gain boost, we can configure the left right balance if we are using stereo, we can configure a sync offset if there are any latency issues. I'm using 60 milliseconds of latency. And finally, we have an audio monitoring tab. Now clicking that open, we have three options. By default, it's not going to monitor. We can monitor only and mute the output, or we can monitor and output. Let me explain what the difference is between the last two because monitor off is self explanatory. If you do monitor only and mute the output, as the name suggests, you're just going to be monitoring that audio stream, and it's not actually going to be making its way into the recording. So the vast majority of times you're going to want monitor and output, you're going to want to monitor the stream, and you're going to want to record it. So I've just clicked monitor and output, and it's a little bit distracting now because I can hear myself speaking as I record because I'm using OBS to record this. So that's pretty much it. Now just one, I'm going to actually turn this off so I don't confuse myself. And that's how you turn it off. Now one thing to say is that if you go into your pulse audio control, as soon as I hit monitoring on, we're going to see this as an audio source. And the one thing that can go wrong is if you have a bunch of audio sources set up, like you might have HDMI output, you want to just make sure that that's going to the right place. But this is more a troubleshooting step. So you're just going to go ahead again and turn monitoring back on. Now I'm going to drag over my pulse audio. And if you go into playback sources, we have a playback channel for OBS monitor, and it's going over built in audio and log stereo. If if I were to send that to the interface, I'd get a loop back, and it would not work out as intended. And that's basically it.  So if you're looking to monitor your audio source in Ubuntu using OBS, that is how it is done. Definitely, this is something really, really worth doing because it's always easier to make sure your audio sounds good before in pre production, rather than trying to fix your audio afterwards in post production. Thank you guys for watching this video. If you'd like to get more videos from me on OBS Linux, technology and other subjects, please subscribe to this YouTube channel. Have a great day.


The Western press are just printing straight-up Nazi propaganda about Middle Easterners now. Mass media editors at outlets like The Guardian, The New York Times, and The Wall Street Journal have been allowing the publication of some amazingly racist pieces these last few days. All are directed at Middle Easterners and those of Middle Eastern descent, just as the Western Empire drops more and more bombs on more and more countries in the Middle East. On Monday, The Guardian published a political cartoon, which would be indistinguishable from Nazi propaganda of the 1930s, except that it happens to depict a Muslim instead of a Jew. The cartoon features Iranian leader Ali Khamenei holding puppet strings to so-called Iranian proxy groups in the Middle East, like the Houthis, Hezbollah, and Hamas, in exactly the same way Nazis used to depict Jews as malignant puppet masters manipulating world affairs. To this day, it's understood by the mainstream press that it's unacceptable to depict any one of the Jewish faith as any kind of puppet master figure in any context at all. Fox News, the Dutch newspaper de Volkskrant, the Indian BJP, and right-wing political cartoonist Ben Garrison have all come under fire in recent years for depicting Jewish people in that way. So it's safe to say that if The Guardian had published a similar cartoon about Israeli influence featuring an Israeli leader, it would have been a massive scandal, subject to international outcry. In fact, the bar is quite a bit lower for what qualifies as an outrageous racist trope when it comes to criticism of Israel. Mainstream platforms like The Guardian, The New York Times, and The Sunday Times have been pressured to remove cartoons critical of Israel which are far less clearly anti-Semitic than cartoons about sinister puppet masters. In 2014, The Sydney Morning Herald was pressured to remove and apologize for a cartoon which was labeled anti-Semitic because it featured, quote, a grotesque stereotype of a Jew using a remote-controlled device to blow up houses and people in Gaza. Something that for the last four months has been a daily occurrence and an objective fact of life. There is zero chance that The Guardian's editors would have even for a second entertained the idea of publishing such a cartoon about Israeli leaders in the year 2024. But apparently publishing the exact same sort of rehashed Nazi propaganda about Iranian leaders is perfectly fine. New York Times columnist Tom Friedman, who has never met a Middle Eastern war that didn't physically arouse him, was somehow permitted to publish an article titled Understanding the Middle East Through the Animal Kingdom, which compares Middle Easterners to insects and parasites. There is, of course, no meaningful analysis in Friedman's piece. He's literally just comparing countries he likes to cool animals and countries he doesn't like to yucky bugs. Hamas is a spider. Iran is a parasitoid wasp. And Lebanon, Yemen, Syria, and Iraq are the caterpillars it lays its eggs in. Netanyahu is a lemur hopping from side to side based on the political demands of the moment. And the United States? You guys, get this. The United States is a lion. Again, there is no mainstream Western outlet in existence who would permit a columnist to compare Israelis to insects or parasites, and rightly so. It's exactly the type of dehumanizing language that was used by the Nazis to pave the way to the Holocaust. But comparing Muslim populations is a-okay in the eyes of the Western press. We have no counter strategy that safely and efficiently kills the wasp without setting fire to the whole jungle, Friedman writes, as though this is a perfectly sane and normal thing to print in the most influential newspaper in the Western world. Sometimes, I contemplate the Middle East by watching CNN. Other times, I prefer Animal Planet, Friedman concludes. Apparently, never having been told that contemplating the Middle East by watching either is an embarrassing admission. And that's it. That's the extent of the analysis here from Mr. Thomas L. Friedman, who has won no fewer than three Pulitzers for this kind of baby brain shtick. And if that isn't an indictment of the state of Western journalism, nothing is. Not to be outdone, the Wall Street Journal has published an article by Stephen Stolinski titled, Welcome to Dearborn, America's Jihad Capital, about the Michigan city which is home to the largest per capita Muslim population in the United States. In recent decades, Dearborn saw a wave of immigration from Palestine and from Muslim-majority nations that the U.S. is currently bombing, like Syria, Iraq, and Yemen. And apparently, Mr. Stolinski finds it outrageous and scandalous that such a population would be opposing Israel's actions in Gaza at this time. He frets over a Palestinian-American Islamist cleric calling President Biden a senile pharaoh, which I think we can all agree is hilarious. Stolinski runs a think tank titled, The Middle East Media Research Institute, Memory, which was literally founded by a former Israeli intelligence officer. Pro-Palestine activist and academic Norman Finkelstein has accused memory of using the same sort of propaganda techniques as the Nazis. And even brazenly unprincipled empire propagandist Brian Whitaker has written that memory, quote, poses as a research institute when it's basically a propaganda operation. In the last few days, The Wall Street Journal has also published editorial board pieces with demented headlines like Chicago Votes for Hamas after the Chicago City Council voted to support a ceasefire in Gaza, and the UN's War on Israel after the since-discredited narrative that UNRES staff are known to have participated in the October 7th attack. And I must say it sure is an interesting coincidence how all this mass media demonizing and dehumanizing of Muslim populations is happening at the exact same time the Western Empire is reigning military explosives upon nations full of Muslims. It's almost like the Western press are trying to manufacture consent for the military aggressions of Western governments. It's almost like they always have.


The current state of Fortnite. I made a video on this last year in 2020 and I wanted to look back and see the state of the game this year. Last year was Fortnite's biggest year in decline in 2021 while it's still near 2020 numbers. So first let's talk about the content and updates. The last 45 seasons have been so boring. They don't add hype to anything. Every season has the same boring theme that the game a year ago had. Yes they didn't add any overpowered things anymore but thinking at least I had something new like quad crashes. For example quad crashes were not as overpowered as plain but they were a new and welcome type of transportation. For example something like the boat is also not overpowered but is still something new. Since chapter 2 they haven't added any type of transportation. They're still updated of game regularly though. Not like once a week but at least once a month. The biggest problem I have with this however is that they don't have anything new to add. Every new season used to have at least something new like a new location with a different theme. When season 5 was announced it had a desert area. Season 7 is no area. The map have been 90% the same for a whole year. Last year I just tell people we're wanting Totet to come back. At this point who really cares what Fortnite does. They added and removed so much stuff that adding Totet back won't really bring back the old vibes. Think about the last time you actually felt accomplished when getting a victory If it's not in a couple of seasons ago bringing back Totet's towers won't fix the boring state. I will talk more later on why it's getting harder to bring back the old vibes. The only thing Epic does nowadays is just cycle between loot pools. It's really sad how players call bringing back the old pump a good update because the new weapons are so bad. They would do this for so many seasons that I just don't care about the updates or patch notes anymore. Before I talk about the community let's talk about the skins and cosmetics. The battle pass has been the same boring cycle since the beginning of the chapter. There would always be a collab between Marvel, The Mandalorian, and anyone Epic could just get his hands on. It's the only reason kids buy the new battle passes these days. What happened to the originality of the skins? It went out the window. Most skins nowadays are either versions of skins in previous seasons or parts copied and matched with different parts in other skins. The battle pass also never saw a change since this chapter. No new items. Epic used to add something new each battle pass. For example, season 7 with wraps, season 6 with pets, or season 5 with animated skins. Where is that creativity now? This is the biggest part of why Fortnite hasn't seen growth in ages and that's the community. Where are your favorite Fortnite streamers you know used to play Fortnite? They're most likely playing other games now. That's the biggest reason why the battle royale feeling you used to get when winning a game is gone. Where are your friends? Probably playing other games. What's the point if you're just gonna get destroyed by these kids who grind in build 24-7? If I get killed, I don't really care anymore. If I win, it doesn't really matter. It doesn't mean anything because you've been through this process so many times. Even hating on Fortnite has no point because Epic is still getting publicity.  No one plays because it's fun. Anyways, there's my biggest point. At least a year ago, Fortnite could have came back and changed the game but this year is too late. It's still one of the most popular battle royales right behind Apex and Warzone and it's going to keep on dying slowly until new players stop joining altogether.


Today's webinar, Association Between Shift Work Exposure and Frailty, it will be presented by Dr. Dodana Khan. Dr. Khan recently completed her doctoral degree from the Faculty of Health at York University. Originally, she was trained as a medical doctor. She completed a Master's of Public Health and Health Behavior and Health Promotion from Ohio State University. Her career goals have matured out of a long-held interest in the social determinants of health, which are the conditions in which people are born, grow, live, work, and age. Workplace and labour force conditions are important determinants of health, as we know, and they shape health in powerful ways. Dr. Khan's research focused on job factors, specifically working schedules and their long-term consequences on the health of the working population. So now, I will turn it over to Dr. Khan. Thank you so much, Jennifer, for your kind introduction. It was very kind, and I have attended CLSA webinars, and they're always very beneficial, and I'm very delighted to be part of it today. Let me share my screen. And also, I want to welcome all the audience, and I really want to appreciate your presence here today and your interest in our research. So the article that I'm going to present today is actually one of the projects of my PhD thesis that I recently completed under supervision of Dr. Halatameem and my committee members, Dr. Heather Adgil and Michael Rotondi, and specifically for this project, Dr. Chris, who is an expert on frailty. So we investigated the association between shift work exposure and frailty among middle aged and older adults at three years of follow-up. And we recently published this article in the Journal of Occupational and Environmental Medicine, and it was very exciting that our study has been selected as CME module. But more excitingly, we found that this article has attracted a lot of media attention. About 46 stories has been published so far, but more excitingly, we found that people are coming out and they are sharing their personal stories of how they were exposed to shift work and how shift work has affected their life. There was a lot of social media stories on credit, Twitter, Facebook. And I think that that all makes sense because most of us has exposed to shift work in some point in our lifetimes, or we have seen our loved ones or closed ones, how they were exposed to shift work and how shift work has impacted their life. And I think keeping all these in mind, I think at some point we realized that shift work is very important. It is an integral part of our economy, of our society. We are living in a globalized 24-hour society that never shut down. And the reason behind it is because we all need these continuous services and we all enjoy these continuous services in a form of security, emergency, production and supply. But at the same point, we cannot ignore the negative health outcome of shift work, specifically on workers. And also we cannot just eliminate shift work from our society because we know that it's important. So let's dig deep into what shift work is and how we measure shift work in our study. So shift work has been defined as any work outside the regular hours, that's 9am to 5pm. So any work outside this window is regarded as shift work. In literature, there are different definitions that have been used, but this is the standard definition of shift work. In some countries it is used as 8am to 4pm, but pretty much this is the window that is regarded as a normal daytime work. Shift work has been classified in literature and there are a couple of different types of shift work. Regular evening shift work is when you start work after 3pm and the work end before midnight. Regular night shift work, that's after 11pm and ending before 11am. And then there is rotating shift work. So by rotating shift work, we mean that if the working schedule is changing from day to night or day to evening. So these first three types of shift work are very common in literature and they have been studied a lot. There are some other types of shift work as well like on-call or casual shifts. They don't have prearranged schedules and also there are irregular shifts. Shift work is quite prevalent, it's everywhere, we know that. But specifically if we look at Canadian perspective, we found that one in every four Canadian is working in shift other than regular daytime hours. Two-third of protective service workers like police officers, firefighters and security guards, they are exposed to shift work. 45% of health workers, 40% of sales and service workers and 42% of primary industry workers which included farm workers, miners and forestry workers etc. They are exposed to shift work. So if we look at this prevalent, this is quite prevalent. So shift work is everywhere and the same prevalence is also found in other developing countries like Japan and in different countries of Europe. We found the same prevalence rates. With this much prevalence, keeping this prevalence in mind, one might be thinking that okay, what are the effects of shift work on our health? So in literature, shift work has been linked to some short-term effects like sleep disturbances, accidents and work injuries at workplace and mood disorders. In addition to these short-term effects, there are some long-term health effects that have been linked to shift work. In physical health, we found that shift work has been linked to cardiovascular diseases including hypertension and myocardial infarctions, diabetes, paptic ulcers and cancers. And in addition to that, there are a lot of social health issues which has been linked to shift work and mental health issues including depression and mood disorders. I think next I would like to discuss some mechanisms that have been linked and have been discussed in literature that how shift work is impacting these negative health effects on our body. So the first mechanism that's really important to understand is the circadian timing system in our body. So in our brains, there is a biological internal clock that is located in the hypothalamus. On both sides, there are suprachiasmatic nuclei that act as a biological clock in our brain. And this biological clock is responsible to synchronize the internal and external environment. Now what happens in shift workers? Because shift workers, this mechanism is disrupted and due to interference of this normal circadian rhythm, there could be disturbances at metabolic level, hormonal level and also inflammatory responses are disrupted. Another mechanism that happened discussed in literature is light and dark cycles. So what happens during nighttime when there is dark? So the dark has a signal to the pineal gland which secretes melatonin. Now melatonin is a hormone that is required to induce sleep during nighttime. Now what happens during nighttime when there is light exposure to the workers? So this reduces the circulating melatonin and if sometimes this light is so bright that the levels can completely be suppressed and there will be no melatonin in the body. And melatonin has a very significant effects on our body. In the absence or disruptive melatonin can have negative effects on our body. So that's the second important mechanism. In addition to that, now I want to look into what happened. So there is a cortisol secretions as well. So normally cortisol is secreted in the daytime. So there is more secretion of cortisol in our body and at nighttime the cortisol levels are decreased. And melatonin is reversed to that. Melatonin at nighttime, its secretion increases and in daytime, its secretion decreases. Now what happens in shift workers that this circadian rhythm is disrupted due to which the cortisol is increased during nighttime and melatonin is decreased. So that's where the negative impact came into. And this is how shift work can affect our body. Now in addition to these two mechanisms, there are some behavioral factors that has been linked to shift workers. Shift worker has been found to be involved in unhealthy eating behaviors. There is a link between low physical activity and shift work. And also shift workers were found to be higher incidence of smoking. And among them there's higher intake of alcohol as well. So these factors can add into the pathogenesis of shift workers and can cause disease. So there's social isolation. So now we don't know that whether there is one mechanism that is acting or there is a possibility that all these mechanisms are working together to cause the disease in shift workers. So these are the mechanisms. It's really important to understand the pathogenesis of diseases in shift workers. Now for the rationale of our study was based on a recent International Commission on Occupational Health recent report that they published. It's a consensus statement and they claim that there is strong evidence linking shift work to cardiovascular diseases, gastrointestinal and metabolic disorders like type 2 diabetes and metabolic syndrome. And less consistent evidence was found that linked shift work to mental health problems and reproductive health problems. So we based our rationale on to this consensus statement and we did our literature review to find out the relationship between shift work and frailty. We did find although as we already discussed the shift work has been linked to a lot of physical health issues, diabetes, optical cells and cancers that include prostate cancer, breast cancer, colorectal cancers, a lot of social health issues, mental health issues, but there was a huge gap in literature regarding association of shift work and frailty and we could not find a single study that have looked into it. So to fill that gap, we aimed our study and we aimed to investigate the association between shift work exposure and frailty among middle aged and older adults. So let's discuss the methodology of our study. So we utilized a Canadian longitudinal study on aging database. So there are, so let me explain these cohorts a little bit. Most of us are familiar with that. So there are two cohorts of CLSA tracking and comprehensive. So for our study, we pulled these two together. So we combined these two cohorts. The tracking cohort, there are 20,000 participants and they provide all the information through telephonic interviews, while comprehensive cohort included 30,000 participants and they give in-person interviews and also they also visit data collection sites to provide further other information as well. So for our study, we pulled them together and also we utilize the baseline data that was completed in 2015. And when we were designing our study, we only have first follow-up, that's a three years follow-up that was completed in 2018. So we have two databases, two time points. One is baseline 2015 data and the other is first follow-up that is 2018 data. CLSA inclusion criteria included community dwelling adults. They included those who are cognitively healthy and those who are able to speak and understand English or French. CLSA excluded participants, those who are being a resident of Federal First Nation Reserve or other First Nation settlements in the provinces. Also, those participants were excluded who are being a full-time member of Canadian Armed Forces, not the permanent resident or Canadian citizen. And also those individuals were excluded if they are in long-term care institution that is those providing 24-hour nursing care. Next, I want to discuss that what type of variables were included in our study. And I think it's really important to understand how we measure our primary exposure variable. So for primary exposure variable, we utilized CLSA labor force modules. So there are two type of labor force modules in CLSA. The first one is pre-retirement labor force participation module. And this module collected data from retired participants. The other module that we utilized was labor force module. And this module collected data from currently working population. So what they did, they asked them whether they are working. And if they say yes, they are working. So they asked, okay, what type of schedules they were when they were working. So then there are daytime work, night shift work or rotating shift work. So this is how these two modules were utilized. And we derived three primary shift work exposure variables. So our first exposure variable was ever exposed to shift work. So this variable kind of gave us an overview of shift work exposure. And we categorize into two categories. So the first one is daytime work. That is they are not exposed to shift work. And that's the daffodils group. The other one is ever exposed to shift work. So if any participant, whether they are retired or they are currently working, they are exposed to any type of shift work. Night shift work, rotating shift work, they are included in this variable. Just to give an idea, just like any type of exposure. The second variable we derived was shift work exposure in current job. Now, for this variable, we excluded the retired participants. And we just included those who are currently working. Because we want to get an idea that those who are currently exposed to shift work. And the second and third variable was shift work exposure in longest job. So the categories for them were daytime work. That was considered unexposed because they are working daytime. And night shift work and rotating shift work. So these are the categories. And these are the variables that we utilize to assess our primary shift work exposure. Our outcome variable was frailty. Now, how we define frailty? So we utilized a standard definition, which is defined as medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual's vulnerability and developing for developing increased dependency and death. So that's the definition of frailty. Now, the next step is how we assess frailty. So in literature, a couple of methods have been utilized by different researchers. But we selected a standard procedure that is accumulation of deficit model. So our frailty index score is based on that standard model, that is accumulation of deficit model. And this method or this model has been recently utilized by researchers that created normative frailty values for Canadian population and they utilize CLSA database. So we utilize the same set of variables to create a frailty index score. As I already discussed that we used pool data. So by pool data, I mean that we combine tracking and comprehensive cohorts together. And we utilized 52 items. We included 52 items and we tried our best to include all the variables, all those factors that are significantly related to frailty. And they included self-rated health, vision, and hearing. We included 30 variables that are linked to chronic conditions. Five variables were included that were related to activities of daily living. We included cognitive function variables and also three variables that were linked to mental health. So all these variables are significantly related to frailty and we make sure that we include all of them. So in total, we include 52 variables to create frailty index. And what we did, we transformed this score into zero means no deficit to one means deficit. So deficit that's presence of that factor. And for interval or ordinary variables, which are more than two responses, so we use the fraction of complete deficit. And I will explain it in the coming slides that how we use different codeings when we have different options in different questions. For example, osteoarthritis. So here we asked from the participants that whether doctor ever told you that you have osteoarthritis. So there are now two options, yes and no. So yes means that the deficit is present, so that will be coded as one. No means there is no deficit. So that will be coded as zero. So that's simple, right? There is yes, no, one and two. So if we have two options, yes and no. So that's simple. One means deficit is present, zero means no. Now we have questions like doing housework. So we have three options here, unable, with help or able. So if the participants say that's unable to do housework, that definitely means the deficit is present. So that's one. And if the participant is able to do housework, so it means there is no deficit. So one and two. But we have another option that would help. So we kind of use the fraction of deficit for this option. Then we have some questions in which we have five options, like self-rated health. So and the options are poor, fair, good, very good or excellent. So if somebody is saying that their self-rated health is poor, that means there is presence of deficit. That's one. And if somebody is saying that their health is excellent, it means there is no deficit. But then we have different options. So we use the fraction of that deficit to show each option. So that's how we use the coding zero, one. And we do the coding for all our variables. So the next step is to create frailty index. OK, so now to calculate each participant frailty index score, so we sum the deficit, whatever deficits are present, and we divide them by the total number of deficits that were considered. So we use this formula. In numerator, we have the number of deficits that were present in that individual. And in denominator, we have total number of frailty score that we utilize at 52. So we get the continuous frailty scores, but we want to classify frailty. And then we use that. The final step was the classification of frailty index. So those whose frailty index was less than 0.10, that will be considered non-frail. And those whose frailty index score was from 0.10 to 0.20, that will be considered mild frail. And then those who have frailty index score more than 0.2, that will be considered frail. And that's how we use our classification. I want to give you some examples of how we classify. So for individual one, we found that 15 deficits are present out of total 52. So then we divide 15 by 52, and we get 0.29. So the 0.29, according to our classification, the individual one will be classified as frail. For second individual, we have seven deficits were present out of 52, which make the frailty index of 0.13. And according to our classification, the second individual is classified as mild frail. And the third individual, there are four deficits out of 52. So that's frailty index as 0.07, which means that the third individual is non-frail. So that's how we did our classification. Just to give you an overview of all these study objectives, so we have three independent variables, three primary shift work exposures, and we have dependent variable, we use frailty index score, and we then classify into three categories. We included the following covariates, socio-demographic and lifestyle factors were included like sex, age, ethnicity, marital status, education, household income, and major lifestyle factors like smoking, alcohol intake, retirement status, and baseline frailty. In addition to that, we also included health-related factors like BMI. And for female participants, specifically we controlled for reproductive factors as well in our models, that's badity, number of pregnancies, history of hormone therapy, use of oral contraceptives, menopause classification. So these are all variables that we included in our study. Okay, so next I want to show you the flow chart of our study. So we started with 50,000 participants, as I already discussed this, because we pooled the two dataset together. So we excluded participants if they are frailty, if 10 or more frailty items were missing out of 52. So if some participant has 10 scores, at least missing, so that participant was excluded from our study. Also we excluded participants who reported never worked in any job. We excluded participants who reported working in seasonal or on-call or casual or prearranged schedule because we cannot document their exact schedules. So that's why we excluded those individuals. And also we excluded participants who have missing information related to working schedule. So after applying these excluding criteria, we were left with 47,000 final study sample. And this is the study sample that took part in our study analysis. So at baseline, we have 47,000 participants and we followed them for three years. We excluded at baseline, we measured our shift work exposure at baseline and we also measured all the covariates at baseline. After three years, the outcome variable that's frailty index, we measured it updated score at three years of follow-up. So it's kind of a longitudinal study design in which our exposure was measured at baseline and frailty was measured at three years of follow-up. We found that at baseline, the mean age was 59, about 60 years with standard deviation of 10.15. 51% were women, 95% were white and we found that more than 50% participants reported to be living with partners. They have education of high school to some college level. They are former smokers. They drink at least weekly and they are most of them, more than 50% were in high income group that is 50,000 Canadian dollar and above. Also we found that one in five participants were exposed to ever exposed to shift work. And as far as currently working population is concerned, 4% were exposed to night shift work and 12% are doing rotating shift work. As far as their longest job is concerned, 4% reported to exposed to night shift work and about 16% reported to exposed to rotating shift work. For analysis, we did multinomial regression models and we stratified our analysis on sex. We did three separate models and we generated for three separate models for our three primary shift work exposures. We presented odds ratios and 95% confidence intervals and odds ratio greater than one means that there is increased risk of frailty and odds ratio less than one means that there is decreased risk of frailty. At three years of follow up, we found that 66, about 67% were non-frail, 26% were mild frail and about 7.2% were frail at three years of follow up. This is the table that summarized, I took it from my study and this table summarizes adjusted multinomial regression longitudinal models and odds ratios were presented with 95% confidence interval in brackets. So you can see that there are two columns. The first one is for male and then we have females. So we stratified the analysis for male and female and we did find that. And also I want to mention here that male models were controlled for age, ethnicity, marital status, income, education, retirement status, baseline frailty, smoking, alcohol and VMI categories. And you can see that female models were adjusted for additional covariates that are specific for that, including reproductive health factors. And we did found some significant findings. We found that among males ever exposed to shift workers, they have higher odds of being frail at three years of follow up when we compare them with daytime workers. And similarly for females, we found that ever exposed, if females were ever exposed to shift work, they have higher odds for mild frail and frail at three years of follow up. And interestingly, we found that a rotating shift workers among female workers, we found higher odds of being mild frail and frail as compared to daytime workers among female shift workers. So and we couldn't find any significant results for currently working population. So if I have to summarize the main findings, we found that ever exposed to shift work, both male and female, there's increased risk of frailty at three years of follow up. Rotating shift work in longest job, we found that among female shift workers, there's increased risk of frailty at three years of follow up. And for current job, we couldn't find any significant difference for male or female both. Do our findings have some pathophysiological basis? I would say yes. We are not sure about exact mechanisms, what is happening, but as some of the mechanisms, I have been discussed in the start and there have been discussion in literature that shift work and impaired body level of cortisol, which in turn increase pro and anti-inflammatory proteins like plasma tumor necrosis factor alpha, interleukin 10, C-reactive protein, and they have shown to contribute to ongoing disease process. So we can speculate that the Sarcadian misalignment can disrupt all these mechanisms which can act as a preliminary marker of occurrence of frailty. And in addition to that, there are studies that have shown that sleep deprivation, poor sleep quality, and melatonin depression disruption due to light exposure can contribute to development of frailty. So I think there are some pathophysiological basis for our study findings. And I think it's really important that we should discuss the limitation of study here. We were unable to capture some shift work related information like type and direction of rotating shift because there are studies that have looked into different types of rotating shift as well. There are forward rotation, there's backward rotation, but we were unable to capture that information. And number of consecutive night shifts worked. And number of days off between shifts because this information was not documented in CLSA database. So we were unable to capture some more detail of shift work. And we were unable to capture exact timing of occurrence of exposure. So when we were asking about longest job, so we could not find exact like how previous that exposure was. Was this like a few years back or was this like a 10 years back so we cannot get this information. Also we pulled evening and night shift together because this have done previously in literature. So we did the same because we have a small number of events in our database. So we pulled them together. And also a generalizability of our findings. I think they're because the ethnicity is 95% white. So we cannot say that this is generalizable to all the population. But we still believe that our study has some strength to our knowledge. It's the first study to investigate the association between shift work exposure and frailty. We utilize large Canadian population based longitudinal data and it has a detailed information on shift work. We have included 52 factors for frailty. And we included both current and retired labour force. It was me. And also we included both work schedule night and rotating our shifts. Also, I think CLSA has diverse group of Canadian workers included. So our study is included different types of workers and also CLSA questionnaire utilized a standard measuring tool that are compatible with other international surveys as well. I think our findings are quite significant considering specifically our findings have highlighted the rule of gender in addressing frailty. We have shown that female shift workers are more likely, specifically rotating shift workers are more likely to be at risk of getting frail. So I think future studies or interventions can consider gender when addressing their programs and designing their interventions. Modifiable factors of frailty like shift work exposure among working population. I think it's of clinical relevance and this will assist in extending healthy active life expectancy. Also, I think now the focus should be on designing shift work schedule that are less disruptive to Sarcadian rhythm. It's really important to consider. As a future implication, I think now it's the time that we should focus on educating our workers. I think a worker itself should be educated and employers and also at organizational level there should be counseling tools and also there should be health promotion programs. There should be more awareness of what is shift work and how it can affect workers' health. And also I think focus should be on the health surveillance and work fitness evaluation programs both individual levels and at policy levels. I think the shift scheduling should be organized in an appropriate manner, in a manner that should be less disruptive to the worker. And also I think shift work regulations, there are a couple of regulations, federal regulations regarding shift work. So I think that the focus should be that they are properly implemented. And finally, I think more research is needed as I already discussed that there was no study that was done of finding the association between shift work and frailty. So I think we need more research, more in-depth information related to shift work, scheduling a workplace and personal factors. And I think we only could study the three years of follow-up. So I think that's not enough. We need more extended follow-up periods to study longitudinal relationships. And I think I really want to acknowledge here my supervisor, Dr. Halatami, my committee members, Michael Rotondi, Heather Ethkil for their contributions. And also my co-author, Dr. Chris, who has expertise in frailty and he really helped me understand what frailty is and that was very nice of him. And also I want to thank CLSA team for providing such a great database and all required support. There are some references and thank you so much. Great, well, thank you very much, Dr. Khan. There's lots of questions that have come through the chat. Just a reminder, if anybody has any questions for you to put them into the Q&A box at the bottom, the first question, and I'll just start at the top and go through them, regarding the frailty index threshold values, specifically point one and point two, what is the rationale behind these values? So there is no clear cutoff that we want to classify frailty, but we have used these cutoff which have been already used in literature. And also there is clinical relevance as well because the studies that have utilized these cutoff points. Also, I want to explain like if we say that somebody has frailty index of point one, as we said, like point, if frailty index is less than point one, one zero, so it means that individual is non-frail. So what this point is telling us that the 10%, so just imagine that there are 100 bad things. That's how Dr. Grace explains always, that there are 100 bad things and we are looking at how many an individual has accumulated. So if we say point one zero frailty index, it means that there is 10%, so out of 100, that individual has accumulated 10 bad things. So their chances are very less that they they will have, they are frail. But if, according to our classification, if somebody has more than point two zero frailty index, which means like 20%, so they have accumulated 20 deficits out of 100. So that makes them quite frail. So their possibility or probability in future to get frail increases. So that's how we use these points. Great. The next question is about a reference, which maybe we can follow up, you can follow up by email after, unless it was posted into the chat, I don't think so. So we'll, yeah, maybe if you can follow up, we'll follow up with you and get that out to the webinar participants. The next question, perhaps I overlooked it, but how are the two time points for the outcome variables at baseline and three year follow up utilized in the regression models and why is this approach considered a longitudinal model? Yes, thank you. That's a very good question. And that's, we discussed it with our, one of my committee members is biostatician. So we discussed this approach. So what we did is like we measure our exposure at baseline, that is shift work exposure.  So we included that in a model, the latest frailty index score. And we adjusted in our models the baseline frailty. So when we adjust our models for the baseline frailty, so that make it a longitudinal design. And that design has been used previously in literature and it has like a statistical basis. Great. And next question, what were the ages, BMI and other demographics of the categories of frailty spectrum outcomes by sex? I have to go back to like the tables and everything, but if you're asking that, like what the BMI categories are, like going to sex, they were not very difficult on the gender. Like they were not very different. So if they're asking like by sex, yes, we categorize them or yeah, so we BMI categories, demographic, I didn't get like what they want to say here. Okay. Well, maybe they can post a follow up or email you directly. Directly, yeah. It just email me and I will share my detailed table that that's also on the published site. Yeah, so I will. And then the next question, what numbers of individuals were current workers? Yeah, so current workers, if you see, I'll share the flow diagram. So I think they were around 29,000 because we excluded, if I quickly share my presentation slide, there was follow a flow diagram because we excluded here. If you see my screen. So here, so we excluded 29,000, those were retired. So then the currently working were 18,000. Yeah. So moving on to the next question, do you have baseline information on frailty status? So baseline prior to follow up? Yes, we measure frailty index at baseline. Yes, so what we did, because we have baseline and then we have follow up. So for our baseline, we have 52 variables and we included all those variables that are present in both cohorts in tracking and comprehensive. So we make sure that and then we calculated frailty index. Excuse me. We calculated frailty index at baseline, 52 variables.  All right. The next question and which you may or may not know, I may need to answer is, does the CLSA have gender as a variable? Did you use that variable? I know we do have it. So go ahead. Yeah, but we do not use this variable for this study. We just use sex. Yeah. Okay. Moving on, we have a question from Roberta. What should organizations do to mitigate some of the impacts specifically of rotating shift work? Yeah, that's I think is a very good and very important question. So rotating shift work has been in literature it has been regarding more disruptive than the regular shift work. So by regular shift work, that means a person is doing night shift again and again. So body kind of adapt to that work, but rotating shift work, what is happening that a person is continuously changing from day to night and then night to day and then day to evening and then. So the body does not get enough time to adopt those changes. So definitely, yes, we need to focus on rotating shift war. What we can do, there are a couple of recommendations in literature. They're first of all, there are few types of rotating shift workers that were considered, like I can not say healthy, but less disruptive as compared to other rotating shift. Like if you are doing forward rotating shifts. So by forward rotating shift, I mean you start with the day shift, your next shift is evening, and then you do night shift and then you do day again. So that is considered as forward rotating shifts. Forward rotating shift is considered less disruptive towards circadian rhythm as compared to if you start from night, then you do evening and then you do day shift. So these kinds of things have been discussed in literature. And the second things is I think education, the worker should be educated that these are the risks to their health and also in addition to that, I think if the resources are available to, like if there is a healthy options for them and also they should focus on exercises and they should focus on like to rest after their shifts enough to sleep after their shift. So yeah, there are a couple of like individual factors and also I think there should be some, I think there should be some of the implications should be at policy level. Yeah. Great. We have two more and a few minutes left. So did you stratify the analysis based on shift work professions, meaning nurses versus night shift versus nurses versus a night shift security guard? That's a very good question and I wish we could but we cannot. We do not have information regarding the specific like profession of the workers. We had this information but the format of the information was like they are an open-ended question. We cannot utilize that very easily. So we did not but that is something that I think future studies should look at and that's really good question. Yeah, but we cannot stratify in our analysis and no, we didn't stratify. Okay. And what about did you remove people who died during the three-year period from your analysis? No, we did not specifically but we definitely like included those who gave all the information. So automatically those were excluded from our study that died. Yeah. Great. Oh, one more just came in. So from Adeline, are you saying that shift work is sure to add to getting? I think they want to say that shift work like has a risk of arthritis. So like we haven't looked specifically on arthritis but definitely arthritis is included in the frailty index. So what frailty is telling us is that the person is vulnerable to disability and vulnerable to morbidity in future. Definitely, yeah, that's what is telling us and shift workers, those who are doing shift worker they are at higher risk of because they have more frailty, they are frail. So it's telling us that in future they're at higher risk of or they're more vulnerable to disability and morbidity. Yes. And there's one more question I think. Yeah. So have you considered using change in frailty index instead of adjusting for frailty index at baseline we can, the former is a typical longitudinal design. Yes, we understand, but we have like very short follow up period, there are three years but I totally understand that that is that's like an ideal approach. But to adjust again for even the first approach again, in most of the studies, it is considered better to adjust for baseline status as well. And it also happens in a lot of clinical trials as well that they adjust for baseline status to just, yeah. So I think, okay. And I did see a question in the chat which I'll just reiterate, it's not put in the Q&A yet. So you mentioned that you did not exclude those lost to follow up, were you able to avoid the biases of using participants lost to follow up? Yeah, there is, yes, definitely. I think there is lost to follow up at three years of follow up, yes. And were you able to avoid any biases that may have been the result of that? Or for that lost to follow up? Yeah. I think we did like because we adjusted for that. I didn't, I said that's a question. So I guess if you adjusted for it then it would have been, yeah, okay, well that makes sense. But we didn't. Great. Okay, well I think I don't see any other questions. So this is probably a good reminder to everyone to please complete your, for those just starting to leave please complete your survey on the way out. And again, thank you for an excellent presentation. I think we've learned a lot and I know I did about the topic. I'd like to remind everyone that the next deadline for CLSA data access applications is October 4th. So you can visit the CLSA website under data access to review available data as well as additional details about the application process. I'd also like to remind everyone, like I said before to complete their survey upon exiting today. The next CLSA webinar is actually going to be on risk and protective factors for elder abuse in Canada findings from the CLSA. It will be presented by Dr. David Burns from the Factor Inventosh School of Social Work at the University of Toronto. You can find registration details on our website at CLSA dot sorry www.clsa-elcv. And remember the CLSA promotes the webinar using the hashtag CLSA webinar. And we invite you to also follow us on Twitter at atclsa underscore elcv. So thank you very much everyone for attending today and for Dr. Khan for a great webinar.


We got an overwhelming turnout at the show. They sold out of tickets, and we did record sales and talked to a record number of people. And it was really great feedback. We never really interact face-to-face with our consumers in the past, and so being able to see them in person and shake their hand and hear what they thought about us and receiving such wonderful praise is amazing. A number of consumers come up to us and say, hey, I've heard about you guys. I've actually ordered a piece. I'm a huge fan. Everybody was so positive and so enthusiastic that I really do think that it's really reflective of this country and where we're going. And it's really exciting to be a part of it, especially in the capital. We're in an exciting time because we're in an industry where things haven't been established. There is no status quo. And we have the option of kind of setting that. And we have the great luxury of being able to tell that story with our customers. That's our future.