covering introductions. Alice and also Mrs. Longway from Ministry of Health Malawi. Then our first session after that on an overview. Tomorrow we start at the same time. We start at the same time. That's 11 o'clock Oslo time every day. And then I will in the first session tomorrow take us through the brand new WHO standard supply chain data elements. WHO has been working over the past several months to develop a standardized list of key data elements. These are data values that should be captured for various supply chain commodities and reporting. So I have the honor to take us through that. We will take a break and then after the break we have Adam Kosi from HIST West Africa. He's going to take us through some really interesting use cases that they have been developing in Mali and Burkina Faso around supply chain monitoring using DHIS2. Day three, we have probably one of the leading world experts on supply change, George Maguire. He is going to, he works for the International Red Cross. He also consults with us and the WHO. He's going to take us through some of the LMIS indicators and walk us through, and this is again another collaboration with the World Health Organization where they developing standard indicators for supply chain. George has been an integral part of that. He's going to take us through what they've come up with and how some of that can actually be factored into your DHIS2 instances. After George, we have Mongini from HIST Malawi. She's going to take us through what Malawi has been doing to develop, connect their supply chain system to their HMIS, which is DHIS2 of course, and produce integrated analytics. So some really incredible dashboards and insights coming out of Malawi there. Day four is a lot about interoperability, a big topic when it comes to supply chain and be able to get the various supply chain data sources into DHIS2. So we're going to get started on day four. The morning session is going to be with what our interoperability, we're going to get started with Morton. Morton is our lead interoperability engineer here at the University of Oslo working on DHIS2. So he's going to take us through some of the basics of interoperability. Then we have a really interesting use case from John Lewis. He's coming to us from HIST Vietnam, where they've been able to connect DHIS2 with Msupply, a fairly popular LMIS product out there in the market. And he's going to take us through that process of how they're able to connect those two platforms. Then after the break, I think we have Anne-Marie from iPlus Solutions. She's going to take us through the platform Medexus. Medexus is a really excellent LMIS platform that's available. They have been connecting Medexus to DHIS2 in Burundi. And so that's going to be a really interesting case study of how we get these two systems, these LMIS systems and DHIS2, talking together, sharing data. One thing that I forgot to mention on day two after our Adam presents his case study, we actually have Adam staying on the line with us for an expert's lounge. So that's it. Or just around Africa and you want to understand how they've managed to build out these kinds of supply chain systems and DHIS2, the ones that Adam will be presenting on. Adam will be around for a little while longer to answer any and all questions that you have on how you can get something like what Adam and his team have done deployed in your country. So we've extended Adam's time a little bit here to make sure that he's available to answering your questions. And likewise, we also, if you're based in Southeast Asia or you're interested in knowing more about John Lewis's use case and his Vietnam, how they were able to connect with M-supply and get DHIS2 data flowing between those two platforms, John will stay on the line as well on day four from 1.15 to 2.15 Oslo time. Day five, which is Friday, we will have a fairly technical day. I will be presenting on how to configure DHIS2 to be able to calculate key supply chain indicators. It will be if you are not a DHIS2 technician, a lot of this may go over your head. We're going to get kind of deep quite quickly. But for those of you who are more technical in DHIS2, I think you're really going to get a lot out of this day going into the nitty gritty of how we actually configure these kinds of supply chain indicators in DHIS2. Then on day six, November 16th, that's next Monday, we have George McGuire coming back with us. And George is going to be taking us again through how to use some of these supply chain indicators. So how can you actually turn these values, the presentation of this data in these indicators into action, which is going to be really cool. After the break, George is then going to take us through some very much cutting edge applications of DHIS2 to build out stock catalogs using barcode scanning, using tracker, all of that in DHIS2, in a pilot project that they have going on in the Red Cross in Yim and Field hospitals. So that's going to be really interesting use case, very much cutting edge.  She is the new manager of the Stella Project out of the University of Basel. And I'll talk a little bit more about this later today, but this is a partnership that we have with the University of Basel and Swiss TPH to provide support to all of you all who want to implement and use DHIS2 for supply chain. So a lot of resources, a lot of a lot of excitement there. So Aliyah is going to come in and kind of round us out with what that partnership and those organizations, the Stella Project, can provide to all of you if you so choose to use the resources that are available. And then finally, the last session is a course review and a little bit of country planning feedback from any of you all, any questions that you have. So that is it for the program. I am now going to hand it over to the prestigious Alice who is going to who manages all of the academies at the University of Oslo to take us through the various tools and platforms that we're going to be using to communicate with you throughout the week. So Alice, I'll stop sharing and it's over to you. Thank you so much, Scott. Hi, everyone, and welcome to this first edition of the LMIS Academy. So as Scott mentioned, we will be using different tools during the academy. The first one is the LMIS Academy repository. I have sent the link to the to each of you prior to the academy. So I hope you have received it. And if not, please let me know. And I will share again the link. Do you all see my screen? Yeah, we can see it. Yes. Okay, great. So you will see it's basically a Google Drive. And in this drive, you will find a folder for every day. So let's click on the first day, which is actually today. So you will have the recording of the live sessions. So each session, including this one is recorded and will be made available as soon as possible after the academy and let's say within 13 minutes to one hour. So you will find the recording of each session here in this folder. And you have this folder for every day. Same goes for the presentations. Each facilitator will make sure to add the to upload the presentations in this folder as well. So you will be able to have a look after the academy finishes. And then the two forms which are very important to us is the feedback form. So basically, we are very interested in collecting your feedback and comments for every day. So once the academy ends, you will be invited to go in this folder and to complete the form that let me click, you will be able to click here. And then you will have a link and you will be able to give us your feedback, which are, as I said, very important. And then you will have the other form that would like you to fill in every day as well, which is the attendance form. So same process, you will click on the document and you will click on the link to the attendance form. So the thing is that for this academy, what we wanted to do to make sure that you all pay attention to the content, you will be given what we call the words of the day. So every day you will have a different word and we will ask you to include, to add this word into the attendance form. So yes, so that's it for this one. And for this, for today actually, it's only today you will have another form, which is the participant survey, which includes some specific questions we would like to ask you. Scott will develop on that one later on. So yes, so this is basically the repository. Once again, if one of you do not have access to the repository, please let us know and we'll send you the link. Then the second platform that we will heavily use, and I believe most of you are already on the Academy Slack channel that you can see here. So don't hesitate to join if you have not done so yet. On this, on the Slack, you will find different channels here. For instance, the announcements channel that we will be using to inform you about any specific topic you would like us to, would like you to be aware of. If you have specific questions about logistics, then you are invited to ask them on this channel as well. So really don't hesitate. If you want to ask anything, we are here for to reply to your questions to assist you. Scott and the facilitators team as well. So don't hesitate to ask any questions that you would have. Then as Scott mentioned when he was presenting the agenda, we will have two expert lounges. One expert lounge for Africa and another expert lounge for Asia. So depending on the region where you are based, if you have any questions related to logistics in your local context, you will be able to ask these questions during the expert lounge. The expert lounge for Africa is scheduled for Tuesday from 1.15 to 2.15. We will have one facilitator from East West and Central Africa, which will be probably either Edam Kossi or Sakebo Alassane for those of you who know them. So they will be available for one hour and they will be facilitating discussion on the expert lounge for Africa. So it will be tomorrow at 1.15. So any of you interested, don't hesitate to join them on this channel so that you can discuss with them and ask them for tips, advices related to your various projects. Then the same goes for Asia. We will have an expert lounge for Asia scheduled for Thursday, same time from 1.15 to 2.15. So same thing if you are based in Asia and you would like to ask any questions related to logistics in your local context. Don't hesitate to join this channel and to participate in the discussion. It will be facilitated by one of our colleagues from East Vietnam, probably John Lewis, who will be there for one hour to discuss with you. And then you have some overchannels like introduce yourself because we want to know where you are based, what are you doing exactly. So don't hesitate to say hi on this channel. Then if you have any technical issue in regards with, for instance, accessing the different documents, presentations, recordings, etc., don't hesitate to ask some help here. And Martin, who is also a member of the training team at his PIO, will be more than happy to help you. And then finally, the last tool that we will be using is Zoom. So you're all already on Zoom, obviously. I have shared with you some tips on how to use Zoom last week. So I believe you have read them. So it's very straightforward, basically. You are invited to keep to stay unmuted unless you have a questions and one of the facilitator is happy to give you the floor. We will also advise that you do not use your video. So just to make sure that we have enough bandwidth to conduct the academy. On the right side of your screen, at the bottom you have few, you have few buttons that you can use. For instance, you can click on yes or no if required. You can, for instance, raise your hand as well if you want to ask a question live. Even though for this academy for any questions related to the presentations, you are invited to use Slack as main tool to raise your questions. So yes. That's it for me. So once again, welcome all and I hope you will enjoy this academy. Thank you so much. No, thank you so much, Alice and team. Really great jobs organizing these academies, especially given the confines that we work under now with COVID. So we're very appreciative. Okay, so let's keep on chugging ahead. As Alice pointed out, please use Slack to ask any questions. I even see that Arthur Haywood, you raised your hand earlier. Maybe you had a question. Please, Arthur, do post that question in Slack. You're probably not the only one that has that question. And we will use Slack as our main vehicle or tool for you to ask any questions and for us to answer those questions. We have well over 100 people in this academy. We expect up to maybe 170 people. So it will be the largest academy that we have ever, or largest level two academy we've ever done, which is quite exciting. But it also means that we just have to be very careful about how we are communicating and how we keep things organized. So we will be using Slack not only to just keep things organized, but also to allow everyone to share their questions and be able to answer them a little bit more efficiently. Okay. So I think that, oh, and the other thing that I just run under to reiterate from what Alice pointed out was that we, this academy is, we will be giving out certificates of participation, certificates of participation. And in order to get that certificate of participation, you have to answer the attendance every day. And just to stress that the way that we are monitoring attendance is through this word of the day idea. First time we've ever done it, but it hopefully will work out where we will give you a word of the day. I'll give it to you later in the second half of the presentation this morning. And then you will have to go in and type that word of the day in into the attendance form. Today we'll do it together. Tomorrow I'll just give you the word and you'll have to do it on your own, but it just proves to us that you are actually here. You watch, you attended the session, or maybe you've, if you're, if you're, if you're doing this asynchronously, you've watched the video and that you're letting us know that you are actually, you're actually paying attention and engaged with the content for the day. Scott? Scott? Yes. Sorry. I forgot to mention something which is also important related to Zoom and the attendance. As you may have all noticed, you are requested to register before joining the Zoom session. So please, when you register, because we would like to see who is also taking part in these live sessions, it would be great if you could make sure, as most of you actually did, make sure that you, you mentioned your name and surname, basically the same information that you provided when you registered to the Academy. It's also very important to us. Thank you so much. Yeah. And I guess I should say that you're probably going to get tired of typing out your name, surname and email every day multiple times for us. I do apologize for that. We're all still adapting and getting used to the tools that we have to use to be able to provide these kinds of trainings. And right now we do ask that you do provide the same information every day, your name, surname and email address, just so that we can monitor who's joining each day. Okay. So now I have the unique pleasure to invite Kate Longway, again, the the director of policy and planning at the Ministry of Health in Malawi, to kick us off with opening remarks. And just a little bit of backstory. This Academy was originally scheduled to be run in May in the long way. And we were really excited to be able to have a lot of folks, Malawians from the ministries of health and the surrounding countries, to be in one place, to be able to share experiences and to kind of start to build this kind of community of practice around this, around logistics and supply chains and uses for DHS too. Of course, COVID hit all of us and we had to cancel that Academy. But we still held on to the best part, which is hopefully the opening remarks from Kate Longway. So Kate, I will invite you now to, I think I can unmute you and I'll give you, Martin, are you able to enable? Hello. Yeah, there you are. We can hear you fine. Yeah. Thank you, Scorch. And I welcome everyone. Good morning, afternoon to all the participants. And welcome to this very important forum. Representatives from various ministries of health, partners in health systems strengthening facilitators and participants. It gives me pleasure to welcome you all to this DHHIS2 Logistics Data Integration Academy. The Academy was originally scheduled to take place here in Malawi, as Scorch said, but due to COVID-19 pandemic, which is upon us and the travel restrictions, we are now hosting it virtually. With financial and technical support from the University of Oslo and of course other partners. I would like to congratulate the organizers for working hard to put this workshop together, despite the challenging environment brought about by the pandemic. The overall objectives of the Academy are to one, build capacity in DHHIS2 design and customization in various features, logistics information management system. Two, strengthen health information systems, HIS, by developing a network of high level DHHIS2 skilled personnel within the health sector. And three, provide a forum for sharing experiences in the design and customization of DHHIS2 and LMIS with global and regional experts. Ladies and gentlemen, you may wish to note that Malawi started using DHHIS2 in 2012. Since then, we have intensified efforts to ensure that the software is managing all aggregate level data in order to support evidence-based decision making. In particular, we have undertaken a number of important activities aimed at improving the management of routine health data using the DHHIS2 software, which includes extraction of program reporting rates, scorecard programs, to improve reporting rates. The configuration of national and program level indicators for improved visualization of data. See, updated the reporting forms in DHHIS2 and finally working towards incorporating more program reporting in DHHIS2. One of the challenges for the ministry is to ensure that the DHHIS2 is integrated and interoperable with patient-level data systems in order to reduce manual sharing of data between these systems. Considering that there are many systems operating in the health sector, they may provide relevant knowledge and skills for the design, development, and customization of eHealth systems, including routine HIS, hospital information system, and MHealth, not only in Malawi, but also in the participating countries. Distinguished participants, their focus on LMIS is particularly important because it is impossible to talk about achieving SDG3. That's ensure health, our health lives, and promote well-being of all at all ages without talking about the relevance of the chain of the supply chain. Ensuring that everyone has health coverage and access to safe and effective medicines and vaccines requires that key information on availability of commodities is available to facilitate delivery of effective health care services. It is for this reason that some of you may be aware, Malawi has integrated DHHIS2 with the open LMIS system, which is used for the supply chain management. A number of indicators and dashboards have been configured in DHHIS2, trying creating service, data, and commodity consumption. This is a big achievement, not only for Malawi, but the global community working on health systems strengthening. It is an important milestone towards having a single platform for visualization of health data. In this regard, let me take this opportunity to thank our partners for the financial and technical support that facilitated this week. These partners include USAID, Bill and Melinda Gates Foundation, who supported GUNICA Data for Action Project, University of Oslo, and also the Global Fund. Distinguished participants, it is important to understand and utilize what is possible within our health information systems in order to support planning and decision making across various levels of the health system. It is there for my sincere hope that in this academy we will be imparted with new understanding on various strategies for implementing and using LMIS data and of course, HMIS data, including how to configure relevant indicators and dashboards for use across various levels in our health care system. Finally, ladies and gentlemen, let me urge you all to take advantage of the experts we have in our midst to learn as much as we can, as well as share our country experiences. With these remarks, I would like to declare the academy officially open, and I wish you a successful academy. Thank you so much for your attention, over to you, Scott. Great, thank you so much, Mrs. Longway. We really appreciate that opening remark and it is a true shame that we were not able to all be together in Malawi this year. Hopefully, when we do this academy next year, you'll be the first country that we come to to try to see if we can't organize again to be together there in Malawi and have this academy again. Thank you so much and I think that is a wonderful way to get us started. With that, I will start presenting myself again. This will be our first presentation. Martin, you can go ahead and start recording this presentation. Looks like we already are. Great. Again, Scott Russ Patrick. I'm the DHS2 analytics product manager. I've also been largely responsible for coordinating the University of Oslo's response to the various requests and community needs around supply chain. Although, of course, the product manager working on supply chain is not my full-time job, but I'm actually very happy to announce that we will have full-time staff beginning next year working specifically on supply chain. There will be additional resources here at the University of Oslo, as well in our partner organizations. We will talk to you a little bit about how you can utilize those available resources to you in the near future. With that being said, I do have the honor to take us to our first presentation and give us a bit of an overview of how we consider and view DHS2's interaction with the supply chain system, what it can do, what it can't do, what we want it to be able to do, and give you a little bit of a background there. Before we get to that, though, it is time for the Word of the Day. The Word of the Day is welcome. Welcome, all of you. Let me just take you quickly through how you fill this out together. We'll do it together today. Tomorrow, you're on your own to complete the Word of the Day. I'm going to exit out of the presentation. I am going to go to the drive. We all see the Academy repository. I'm going to click on Day 1 today, November 9th. I'm going to go to the attendance form. Then I go into the attendance link document. I see that we have the attendance form here with this link. I see many of you already coming in, people streaming in as I speak. I'm going to click on the link. That's going to take me to attendance Day 1. I'm going to fill out my information, my email. By the way, my email is just scott at dhis2.org. If any of you ever need to email me about something, that's my email. The Word of the Day is welcome. Okay. That's all you have to do. Press submit. There you go. Now, we know that I have attended today. You have to do this. Again, we give out certificates of participation. If you're having issues with that, please post those issues that you're having in the Slack channel. The Slack is where we are getting any questions. You can use the technical support Slack channel. Martin is here working diligently to make sure that you have access to everything that you need access to. Let me jump back into the presentation then. Then moving right along. What is this academy actually about? Okay. We are going to be giving this academy in a seminar style, meaning that we will have presentations, multiple presentations every day. These presentations are being recorded. You can watch them later. You can rewatch them or you can share them amongst your friends, colleagues, other folks that you think it would be useful for them to see. We will not be having many exercises. I don't think we have any exercises or any kind of additional follow-on material or anything like that. It's really just a lecture style, seminar style presentation of the material. The reason that we're doing that, let you understand, is because the DHIS-2 in the supply chain space is still relatively new. Some countries have been doing it for quite a while, but most countries are still just getting started with using DHIS-2 for supply chain. In many respects, there's not necessarily a right way or a wrong way to actually use DHIS-2 for supply chain. Because that has not really been completely established yet. We do have some best practices, but we don't have a right way. We don't have a wrong way. Because there's not as much global guidance around this particular subject matter, we don't feel like we know enough, necessarily, yet to quiz you on or assess your abilities to use DHIS-2 in this way. Because, again, you could really use it for a lot of different ways. We're going to cover and you'll see. We'll cover many different use cases that are very distinct from one another. All of these are perfectly valid. You could use them. You could not use them. You could do something else. The goal of the Academy is just to present you on what DHIS-2 is able to do, not necessarily tell you that there's a right way or a wrong way necessarily. Again, produce, show you what DHIS-2 is able to do. We also want to make sure that you know what DHIS-2 really is not able to do. There are certainly some things in the supply chain space that DHIS-2 is very poorly equipped for. We want to make sure that you at least know that and that's very clear to you. We're going to make sure you again see several use cases and different models of how DHIS-2 has been used in supply chain and monitoring logistics. We are going to introduce you to the WHO supply chain indicators and data elements. These are brand new. I think you're probably the first group of people to actually see them. We're talking about they are maybe just a week old at this point. That's quite exciting that we have those now and that we're going to be able to present those to you. We are point four here going to try to establish a supply chain community of practice. This is already the largest level two academy that we have ever had. We want to channel this momentum that will be generated from this academy into a place where we can continue to grow and share ideas, thoughts, learn together and channel that into our community of practice. If you're not already a member of the DHIS-2 community of practice, which is community.dhis-2.org, I think hopefully by the end of this academy you definitely will have become a member. We want to show you how you can configure DHIS-2 today for some basic supply chain monitoring. That largely comes in on day four, day five. You will start to see how actually if you're a DHIS-2 technician you can use it to configure some basic reporting forms as well as the more advanced indicators. Then the last point is we want to provide you with the contacts for future support. Again, we're building actually quite a large team of technicians, of supply chain experts, of partners that are going to be available to provide you continued support post academy. We want to make sure that you know who these people are and how you're going to be able to interact with them. Martin, I see on the technical support channel a lot of folks saying they do not have access to the attendance form. Are you working on that? Yes, we are Scott. We are working on it. As soon as we get it open for everyone we will be sure to announce it both on the Slack and also in here. We will repeat the code phrase for today, the code word for today. The code word is welcome. Just bear with us. The first day of any of these academies we're always stumbling through a little bit of technical issues. I appreciate your patience. Don't worry. You can go back and fill out the attendance form at any point. It's not going to be taken down. Please make sure that you actually do it. Moving right along here, you've already seen this slide a little bit, but I just wanted to repost it. When we're talking about supply chain, what are we talking about? It's good to have an image in our brains of what is actually going on with supply chain. Here we see some very common issues. You've probably worked in the field. You've probably been to health facilities in rural places, even urban places, and you've seen similar setups for storing and monitoring of supplies, commodities, multiple bins. Here on the left side we see a bunch of vials of vaccines. Then in the middle we see a health facility store room, stock room, and then on the right we see a stock tally card or a stock card. All of these are very common pictures that we see when we go into the field when we visit health facilities and even hospitals. What you see is the systems that are monitoring these are very different. Different kinds of tally cards, bin cards across different districts or certainly between different countries, different processes and methodologies and different styles of storing drugs and keeping drugs and commodities organized. It really is quite a diverse world out there, but I just did want to present to you just a couple of pictures of this is what the world looks like. We have the challenge of building information systems that not only support what is currently happening, but also potentially improves what is happening. I think that's the most important thing to appreciate is that we're not building supply chain systems in DHIS to manage the status quo, to just keep things as they are. We want to build information systems and supply chain systems in DHIS to improve these pictures to make things more organized, to make sure that we have fewer stock outs. That's a unique challenge and hopefully in the course of this week you will appreciate some of the the strategies and the ways in which we can do that. Why do we keep talking about LMIS and DHIS too? This is a slide that I've actually presented probably half a dozen times. The point that I want to make with this slide is that over probably the last 10 years as DHIS too has really expanded into dozens and dozens of countries. Now I think we're at something like almost 100 countries using DHIS too in various forms and capacities. Certainly a lot more countries than that if you include all of the various NGO projects and multilateral projects and that kind of stuff. Many countries are struggling with supply chain and I actually have some slides on this later about what are the things that people are struggling with specifically from some good assessments that have been done recently. Many countries are struggling with supply chain, monitoring stocks, keeping stock amounts updated. Many of those countries already have DHIS too. They're using DHIS too to monitor the routine health service delivery, patient counts, disease surveillance. Maybe they're also using it to monitor other things like agricultural outputs. Education is a big one. They're saying we've got all of this DHIS too expertise. We've got all of these folks sitting in the Ministry of Health, sitting in the Ministry of Planning from various NGOs that are partnered with us that all know how to do DHIS too, build reporting forms and data elements and all this stuff in DHIS too. Why can't we just use DHIS too to monitor supply chains when we're still using Excel spreadsheets or really old systems that don't perform well? For the past five to 10 years, our response to that at the University of Oslo has been, well, yeah, of course, you can use DHIS too for this if you want, but we're not necessarily completely supporting that use case, meaning we're not building in functionality within DHIS too as a technology, as a platform, to support supply chain specifically, and we are not building out, you know, guidance documentations, academies like where you're sitting right now, reference materials, guidelines, you know, we're not doing those kind of things either. But still, the community demand has been there, and I think that's the key point is that there's been a lot of initiatives, grassroots initiatives, locally driven initiatives to use DHIS too for supply chain. And that has really been the driving force behind us kind of at the more global level, DHIS too, higher levels to say, okay, hey, the community is still, they've never stopped asking for this. They would get the questions all the time. The fact that this is the largest level two academy, I think is testament to that. And that we need to respond. The University of Oslo, we need to get ourselves organized, we need to get our acts together, and we need to respond to this community request, this, to be able to have DHIS to support supply chain more properly. And then there's another really key driving point here. And that key driving point is, and this is something that we have seen time and time again, WHO is really pushing on it, UNICEF is very much engaged with this. And that is that in order to have a strong health system, a strong health system, we need to have the HMIS data, which again is your disease case loads, your diagnostic, your treatments, your services being provided, and your supply chain data, your LMIS data in one place. We need to have that data side by side, so that when you build a map, a chart, a dashboard, any kind of report from your HMIS, you're also able to pull in your supply chain data. Why is this important? Because we know that a lot of the issues, people that countries and ministries are having in providing clinical services are because of issues in the supply chain.  Health facilities talk out of malaria medication, people are not treated for malaria, when people are not treated for malaria, malaria, morbidity, mortality spikes. And so if we actually want to use the health information system to improve health service delivery, we have got to get supply chain data in the HMIS, which means that DHIS2, again, serving as the HMIS and dozens and dozens of countries, has to be able to properly support this kind of data. And when I say properly support, I mean build the analytics, produce the indicators, and allow the decision makers to be able to see all of these data next to each other side by side, and be able to say, hey, I've got an issue in my coverage rates, it's because of this supply chain issue, and I'm able to go in and fix that supply chain issue, which then addresses my health issues. We call this root cause analysis or bottleneck analysis. And if you're working with UNICEF, I'm sure many of you are familiar with the concepts of root cause analysis or bottleneck analysis. Okay, so what is the somewhat of the problem statement here? And I've kind of alluded to this a few times already. But what we see is that we around the world have fairly poor quality logistic services in resource poor countries, so low and middle income countries, and even some high income countries have fairly poor logistic services. It's fairly universal. It's something that you kind of see from country to country, different solutions, different initiatives. Universally, a lot of money being spent on this, a lot of money being spent on this from partners, from ministries, from donors. And we still see a lot of the same chronic issues, still high stock out rates, low stock availability rates, issues with seasonal stock resupplying, just a lot of the issues, even despite the huge investments, still popping up. And some, you know, many places are of course getting better, but we still see some very pervasive issues that we are struggling to address, you know, mostly across the board. We still in the supply chain space have a massive reliance on paper records, on spreadsheets, on data being put into spreadsheets and being emailed or manually transferred between health facilities or up to district level, up to warehouse level, very slow and I'll say antiquated methods of recording and communicating and sharing data. And, you know, I often like to say that there is no DHS2 equivalent in the supply chain space, meaning DHS2 is the health information system again in some 90 plus countries. There is not an equivalent technology in the supply chain space. There is no DHS2 equivalent in supply chain, at least not yet. And so in lieu of that, you have a lot of local solutions you have, but still a lot of countries just working on the basics, paper records, spreadsheets. And those countries that do have solutions that have developed their own supply chain information systems, LMIS, or maybe they're using a something that's like an open source supply chain like open LMIS or maybe they're using Medexus or M supply. Those three specifically have just have a handful of countries using each one of them. But for the most part, you see a lot of different types of systems out there. You know, it's really kind of the wild west of logistics management information systems out there. Everyone's doing their own thing. Everyone has a fairly, has slightly different systems. And what does that mean? That actually usually means that when you want to connect it to DHS2 or to other systems, you want to get all of that data into one place. It makes it increasingly difficult because each country has its own unique system. It has its own unique process, which again is not necessarily a bad thing. You know, we're not trying to homogenize the world. We're not trying to say that there needs to be one LMIS to rule them all. But what we are saying is that for those of us who provide technical support to countries when they want to try to connect various systems to DHS2, it makes it nearly impossible for us to help each country because each country is very, very, very different from the others. And when you have, you know, nearly 100 countries asking for support, there's only a very limited amount that you can give to each one of them. And also donors, you know, they don't have the money to support 100 different interoperability layers and unique systems within each country. It makes it very difficult. So we do have a hodgepodge of different LMIS systems out there. We also lack integration between LMISs inside a country. So many countries actually have multiple or parallel supply chain systems within different groups or programs. So the malaria program may have its own supply chain system. The HIV program may have its own supply chain system. Or more complex than that, you may have a supply chain system that goes from facility to district, and then a entirely different one that goes from district to region, right? How do you get all of these to talk to each other? You know, how do you get all of these to share data? How do you, which is necessary for, again, efficiency and bottleneck analysis, root cause analysis? That becomes very difficult. It's nearly, seemingly nearly impossible. And yeah, so the second to last bullet point here was, again, that different programs have their own supply chain systems. And it's natural that somehow this does start to develop because, you know, different donors come in to support different programs. So USAID or PEPFAR will come in and support HIV. So what do they do? They make a supply chain system for HIV commodities because that's what they're supporting. And then maybe Global Fund comes in to support malaria. And so what do they do? They make a supply chain system that supports the malaria commodities. These are solutions. They do usually mean that you have improved service delivery commodities available and flowing down to health facilities for both HIV and malaria and whatever other program. But it does mean it does become difficult, often, for ministries to manage. And again, it doesn't get the data in one place so that we can see all of these various sources of data in, say, the HMIS. And so the long-term sustainability of this approach is something that we need to question. And finally, the last bullet here is there is a complete lack of logistics management at most health care facilities. You do see, I won't say, well, a complete lack is a bit of a strong statement, but they're most health care facilities and especially community health workers who are on the front lines. They are the folks interacting with the patients. They are the folks that are giving out the drugs. We see very poor, most places, information, logistics management, information systems, logistics management in general at those levels. And that's something that should be probably one of the strongest points and one of the biggest things that we need to try to rectify or solve with the development of these kinds of information systems and specifically with DHS2. So a little bit about a landscape analysis. So what are the current state of things? Right now, and we actually have this data because Gavi has published a report. Gavi is the global vaccine and immunization multilateral out there providing support to countries to administer vaccines. They published a guide on country guidance on selecting LMIS that was available last year. And then most recently, the World Health Organization in partnership with Global Fund did a 41-country assessment on the current state of supply chain systems. These are really great resources that I think they're both publicly available so you can go online and find them yourselves. But a quick summary of what they actually found. And that was that there are very there basically no established or accepted global LMIS standards available. What does that mean? That means that countries are making up their own data elements, their own indicators, and very difficult for the multilateral is that they're reporting on different things. They have different ways of defining the indicators. And that means that when the World Health Organization or Global Fund or Gavi, when they ask countries for data to be able to tell the drug manufacturers how many immunizations they need to produce, they're getting very different numbers from different countries because those countries are calculating those indicators in a different way. Which ultimately we have to appreciate that the supply chain doesn't end at the country level. It goes to the global level. Someone is making those drugs and we have to actually give that data to the drug manufacturer so that they know how many drugs they have to produce. There have been situations where the drug manufacturer did not produce enough drugs for the entire world. And then that was the first bottleneck. That was the original root cause. You track it all the way up to global level. And so the WHO now is trying to build out some standards and we're going to take you through those starting tomorrow on what some of those standard data elements and indicators are. Of course, in country context, it can be very unique. And we're not saying necessarily that you have to entirely adopt these standards, but we do want to make sure that you appreciate what is the global community trying to organize themselves around. And this will become kind of, again, the foundational data elements and indicators that folks at the global level are looking at to help make decisions and plan policy and budgets and that kind of thing. The next bullet point is here that we have very little global coordination or guidance, unfortunately. There are many different actors operating in the supply chain space, basically all donors, all multilaterals, many different NGOs. Everyone is coming out with different approaches and guidance, but there is very little coordination amongst them. And I think that that is quite evident when you actually get down to country level and see the many different actors and solutions that have been developed. And again, this makes it difficult for folks like myself who actually provide the technology, because if there are no global coordination and guidance, then we have to again have a very patchwork approach to providing support to countries. And we just go country by country. Sometimes we can help. Sometimes we can't help. And if there was global coordination and guidance, then hopefully maybe we can all be singing the same song. The technology providers like myself can build the technology to support this global guidance, and you yourselves can start to implement and utilize this guidance so that we can kind of be moving a little bit more together. Again, a patchwork of national solutions. We really saw this come out in the 41 country assessment where the vast majority of countries had completely different solutions. Many of them still just paper-based Excel, almost half of them. And then a large variety of applications in use. So the countries that did have technology in place, they were completely different from each other. They were using not only was the user experience very different, but also the software, the kind of the technologies they were built upon was very different. And because of that, it doesn't actually mean that many of these systems would actually even ever be able to talk to each other. For you non-technical folks out there, it's not magic that information systems can talk to each other. It has to be very intentionally developed in that way. And if these systems are not developed to be able to communicate with other systems, then it becomes very, very difficult down the road to get them to do that. It has to be a decision made from the beginning of the development of the technology. And because of the large variety of applications in use, it means that the burden of producing interoperability and sustaining it is largely on country's shoulders. And these interoperability layers and connections become extremely expensive and difficult to maintain over time. Again, yeah, a lot of countries with no real list supply chain information system, some with Excel, many with their own proprietary, more bespoke system, some not for profits, some commercial ERPs in use. And these various tools and solutions cover an extremely wide range level of sophistication where you have, again, some countries that are just recording things on paper records and that paper record eventually gets passed all the way up to the national warehouse. Very, very simple. Up to systems that are extremely advanced ERPs that are, say, like at the warehouse level, scanning every single barcode, updating automatically, doing routing and fleet updates and planning and communicating to DHS2, pushing data, really complex interoperability. There are countries that certainly have that as well. So very broad range of sophistication. Okay, so before I continue on and talk about what we actually do want to do, what are the solutions that we want to be able to provide to you using DHS2, let's now take time, let's take a 15 minute break.


So the sister problem to that last problem we did, so the last problem is that the electron went from n equals 1 was 5 to n equals 2 was 3, or the energy level 5 to energy level 3. In this case we're going from energy level 3 to energy level 5, so this should be going up in energy, right? So we would expect, like last time we got a negative energy. Hopefully this time you guys would expect us to get a positive energy. And if you want to think about it, remember where the energy levels are in relation to each other. So we think about n equals 1 is there, 2 is there, 3 is there, 4 is there, 5 is there, right? So it takes energy, it's like climbing a ladder, to go from 3 to 5, right? So you can fall without having any energy, in fact you're losing energy if you fall off the ladder, if you want to think about it that way. So anyways we again need to remember the Rieberg equation and I have the Rieberg energy constant up here for you guys. So the Rieberg equation is E, the Rieberg energy equation, E equals R E, 1 over n2 squared minus 1 over n1 squared. And we've already identified n1 and n2 over, so n2 in this case is 5. So again I don't have much room on this particular board so I'd really like to just convert this to a 25. Okay so now hopefully you see, right, we have a smaller number subtracting a bigger number from it. Okay so this overall is going to be a negative number, okay? Multiply that by a negative number, we should get an overall positive number. So positive energy means you're climbing the ladder if you want to think about it that way. So 5 times 10 to the negative. Like we should have expected we would have, right, because we went exactly that far down the ladder last month, right? So we have to go that far up the ladder. Okay, again this is the shortcut way of doing it. You could use Planck's equation and the speed of light equation to get the energy, but using the Rieberg energy equation kind of cuts those two steps out. So let's do one the other way.


But I'm pleased to present some new data, some new analyses, in fact, by an excellent student of mine by the name of Obata Alzubi, let me see if I could advance my slides here. So Obata actually came to my laboratory from Syria, and him and his family actually had to flee Syria in the middle of the horrible war there. And he decided to pursue his PhD in electrical and computer engineering at the University of Oklahoma. And when he came to my lab, he had no experience whatsoever doing functional neuroimaging analyses.  He's a really fantastic computer programmer.  And the title of today's presentation is called Taking the Body Off the Mind, Decrease Functional Connectivity in Somatomotor and Default Mode Networks, Falling Flotation Rest. Now, before we begin, I'd like to just take a moment to reflect on what's happening right now on the West Coast. I hope everybody out there is OK. You know, the first seven years of the float conference were all in Portland. And as you could see, it's covered in smoke. The entire West Coast is on fire. And I grew up in California. It's so sad to see this. And I hope everyone's doing OK. I hope we could get some fresh air over to you guys soon. In fact, it's smoggy where I am right now in the middle of the country due to smoke that has actually crossed over to our area. And this is really showing us how interconnected we all are. You know, just this year actually, earlier in January, I was in Oregon in Salem, Oregon. And I presented my first TED Talk. One of these strange situations where you have to stand on a red circle with no notes whatsoever. It drove me nuts. I like reading my notes. But nevertheless, I wanted to speak about something important that I thought was happening in society. In the sense that more and more we're finding this constant connectivity is causing problems for our nervous system. And in this TED Talk, I discussed about how floating could offer an antidote to modern times. And I also discussed and showed some data about how the modern day nervous system craves disconnection. So I encourage you, if you haven't seen that, to go on YouTube and watch the talk. About a week or two before my talk in December of last year, they wanted to put up a blog post to discuss some of my work and they asked me a few questions. And so one of the questions they asked me was what does this year's theme vision mean to you? And I responded, the survival of our species depends on our ability to foresee the future and adapt to the oncoming challenges that face society. Without vision, we are the blind leading the blind. Reactively addressing issues once the fire has already started rather than proactively trying to eliminate such issues before they even begin. And little did I know the sort of fires that were going to appear in 2020 at the time of this. They actually asked me another question. They said, if you could instantly become an expert in something, what would it be? And for some reason back in December, I gave the following response. Immunology, as viruses and bacteria are the greatest threat other than ourselves to humanity. So here we are and all of these are bearing out. I think it's sad that our government couldn't have foreseen this. This was me reading the tea leaves back at the turn of the year. But my hope is that as a society and most importantly as a flow community, we will persevere and we will hopefully take floating to this next step of evolutionary development for our species, which I think it really is. So some good news. Last week, we received notice that a float paper published by the lead author, Dr. Saib Khalsa was accepted for publication in Frontiers in Psychology. This is the first anorexia float study that's ever been published in a peer review journal. And I think the journal title is perfect. It's a special issue on body representation and interoceptive awareness. It was as if this special issue was created with this paper in mind. And so hopefully the next week or two, the PDF will be fully available to anybody who wants that. And I spoke to Dr. Khalsa earlier today. He apologizes. He can't be there for this year's conference, but he's excited to come for next year's. So big congrats to Dr. Khalsa and the whole team for this great accomplishment. Now the study I'm going to be talking about today is a fMRI study. We have 48 healthy subjects who were randomized to either float three sessions in the float pool or three sessions in a zero gravity control condition, which we refer to as chair rest. All float sessions and all brain scans were 90 minutes in length. And really the first two floats were considered acclimation floats to get subjects used to the environment. And then immediately after the third float is when they had their post float brain scan. And right now what I could tell you is the data sets, the 48 data sets have all been through a lengthy quality assurance check. And so these were all the clean data sets in subjects who had both a pre rest MRI and a post rest brain scan. Now the control condition involves the zero gravity chair. It's an active condition obviously. And really what we're trying to control for are the effects of simple relaxation. So in both conditions, participants are laying supine. They're in a comfortable environment. They have minimal pressure on the spinal cord. They're alone in a quiet and dark room for 90 minutes. And we also try to control for expectancy effects. In fact, in both conditions, we read participants the same pre float instructions, and we explain the study in the same way. We say throughout the day, our brain is constantly being bombarded by sensory information from the external world. In this study, we aimed to understand what happens when the brain gets a chance to disconnect from this constant stimulation by floating in an environment with reduced levels of light and sound and reduced pressure on the spinal cord. So in terms of the subject demographics, we had pretty well matched groups. There's 24 subjects and in both in each group, their age and education and sex breakdown was was relatively well matched. There's no differences between them significant differences and all subjects had to pass a very thorough screening process. They were screened to be free of any psychiatric illness past or present and free of taking any drugs or medications. And all procedures were approved by the Western institutional review board. So in terms of this study, what we're focused on is what's known as resting state fMRI. So subjects will go into this giant magnetic donut shaped scanner. They'll see a little screen above their head with a cross on it and they'll be instructed to look at the cross with their eyes open and try to clear your mind and don't think about anything in particular. So this is the standard procedures for any resting state fMRI. The idea is that you're not actively doing any task. This gives you a little bit of idea about the different scanning parameters that we used in our study as well as the analyses. One thing I'd like to point out is we did control for both cardiac and respiratory related artifacts. A lot of resting state studies sometimes fail to control for these things and they could add a lot of noise to the data. We also used a rigorous set of statistical tests and we'll get into that in a little bit that correct for false positives. This whole idea of ACF correction that you see at the bottom means we're only looking for large clusters that would be deemed significant at a pretty conservative threshold. So let's talk about this analysis. This harkens back to what Obata did. It involves something known as multivariant distance matrix regression or what I'll refer to as MDMR. This is a technique that has been around since the turn of the millennium, but it was only recently used actually that study at the top was published in 2014. That was the first neuroimaging study where this particular analysis was applied. And then as you can see at the bottom there, there was a study that Liber actually published in 2018 using this method in resting state data from veterans with post-traumatic stress disorder. So the methods being developed, but I think there's some really beautiful aspects to this particular analysis that I wanted to highlight. So if you recall a couple years ago, a couple conferences ago, I presented some of our first analyses on the resting state fMRI data. And in those analyses, what we ended up doing is placing seeds, small six millimeter spherical seeds in different areas of the brain. And this is typically one of the common analyses for resting state fMRI data. But when you're taking the whole brain and focusing in on just a little tiny six millimeter spherical seed, you're missing out on all the amazing things that could be happening outside of that little seed, that tiny seed. And so I wanted an exploratory analysis that would allow me to inspect the entire brain as it is, rather than trying to pre-specify these little seeds. So this is a much more advanced and updated version of the analyses that I presented on a few years ago and that others in my lab have presented on. And it's a data driven hypothesis free technique that allows you to perform connectome wide association studies. And it provides a comprehensive voxel-wise survey of functional connectivity across the whole brain. And one thing to keep in mind, it is a relatively conservative approach. It uses a permutation test and it does this in order to minimize false positives. So in our case, the approach identifies voxels whose whole brain connectivity patterns vary significantly with a pre-specified variable. And what we specified was what are the hotspots that show a significant difference between the pre-float MRI scan and the post-float MRI resting state scan. And so that's really the analyses that we're going to be focusing on today. And following these permutation tests, which were repeated 10,000 times, what we did is we found those clusters that showed the biggest difference between the pre-float versus post-float scan within the same subject. And we focused on those seeds, which had at least nine voxels in MDMR space or 72 voxels in the original MRI space, fMRI space, which was two millimeters cubed. All right. So I've given you guys the background to get you to this point. Now, what did MDMR reveal about which brain areas are most impacted by the float experience in terms of resting state functional connectivity? So in this table, there's a list of brain regions. And you could actually see those brain regions plotted on the series of images. These are axial scans. But I think the most important point to take home from this is there were nine different clusters. And these clusters mostly were contained within what's known as the default mode network and the somatomotor network. And we'll get into each of those in great detail, so don't feel like you have to know what they are right now. And most of these changes happened, I would say, in the posterior section of the brain. So you could kind of see some of these regions highlighted here. Hopefully you could see my arrow. So what I want to do to sort of just give you a first past summary of what these look like in terms of the connectivity profiles across these nine MDMR seeds. On the left, you see the chair rest condition. And on the right, you see the float rest condition. And each of the points on the figure represent one of the nine MDMR clusters that showed a significant change from pre to post float. And one thing I will point out is this is showing you the correlation. Lines that are in red would signify an increase from pre to post float and connectivity and lines that are in blue would signal a decrease in connectivity from pre to post float. So without being ingrained with all the neuroscience knowledge that would be required to disentangle this figure, one thing I think all of you should be able to recognize is there are no red lines. There's not a single area or set of regions that show an increase in connectivity from pre to post float or pre to post chair. So that's interesting. I think that that's a finding by itself right there. The act of reducing environmental stimulation appears to be reflected by a decrease in functional connectivity within the brain, not an increase. The other thing I want you to take home from this is that the float condition in general shows a much more robust decrease in functional connectivity across these different brain regions. But especially between these three regions sort of highlighted in pink or red, which are part of the default mode. And these three brain regions highlighted in green, which are part of the somatomotor network. So there seems to be a decrease in connectivity, especially between these two different networks from pre to post float, you see it to some extent as well during the chair condition. But not nearly as robust of a response in terms of just the general number of reductions in connectivity. So what I'd like to do now is go into each of these sets of networks individually and show you what changed in the float condition and also what changed in the chair condition. So on the left hand side are the three MDMR seeds within areas of what's known as the default mode network. The default mode for those who have never heard of it are the areas of the brain that are most active when the brain is at rest and not engaged in any active task. It's one of the most well replicated findings in the history of functional neuroimaging in the sense that even after a five minute brain scan it's very easy to see these resting state networks appear and the default mode network typically appear when subjects are doing nothing but resting. So let's start at the top here I've tried to color code this for you guys circles in green are highlighting significant clusters in the somatomotor network and circles in red are highlighting significant clusters in the default mode network. So just to simplify things green circles signify somatomotor and red signify default mode network. And keep in mind these are all seeds in the default mode. So what we did in this analysis is using a t test as we place these seeds that MDMR told us would show a maximal change in connectivity from pre to post float. We actually looked at which clusters showed a significant change. The top row where you see here F signifies the float condition. The bottom row where you see C signifies the chair condition. So I think the first thing that we could see is in these default mode clusters whether it be the right superior temporal gyrus. The right posterior singulate or the left middle temporal gyrus. So this decrease in connectivity both between the somatomotor networks in green. And also within other structures of the default mode network as highlighted here in red. So these are highly significant changes. As you can see it's a broad swath of tissue I mean if you look at the posterior singulate which is really a hub of the posterior default network. You can see these giant changes that begin at the very ventral portions of the somatosensory courtesies going into posterior insula. And then transcend all the way to the most dorsal portions of somatosensory and somatomotor courtesies and this is a wide swath of cortical tissue. In contrast you really don't see much changes in these somatomotor courtesies in the chair condition. Once again you can see these robust changes in the pool condition when you're floating and then in the chair condition we're really not seeing much in terms of significant changes. Just to give you a little preview of what these somatosensory courtesies actually represent. To you what's known as the homunculus. This is one of the most well known discoveries in neuroscience. It goes back to the 1940s 1950s when a neurosurgeon in Canada by the name of Wilder Penfield opened up the brains of various humans who are undergoing different neurosurgical procedures and he started stimulating the areas of the brain that signified motor cortex or premotor cortex and the somatosensory cortex as shown here in blue. And if you cut those areas of the brain and sort of unfold them for you, this is sort of what this larger image shows which is a topographic map of the entire external perimeter of our body. And what Penfield found is that when you would say stimulate this area of tissue, the subject would report feeling a sensation in their lips. And if you go up just a little bit more and stimulate this area of tissue, they would feel something in their nose. And if you go up a little more and stimulate this area of tissue, they might feel something in their thumb. And likewise, if you stimulate the motor cortices in those same regions, instead of feeling the sensations, you'll actually start having those body parts moving reflexively without your control whatsoever. And so this somatosensory homunculus is actually well known. And you could kind of see the different areas of the body that are represented. And this crazy looking dude kind of shows you how much cortical tissue is represented for each of the parts of our body. And as you could see, most of our somatosensory representation in the brain is actually of our fingers and hands, as well as our lips, our mouth and our face. And much less is actually devoted to the body proper, if you will. The other thing to notice is as you get deeper and deeper into the folds of the sylvanes fissure and into the posterior insula here, the sensations are going deeper and deeper within the body itself, becoming more or less what I might refer to as interoceptive. In fact, you could even see here is in the folds, they're already starting to see some abdominal tissue. But as you get deeper, you might actually represent other visceral organs like the heart or the lungs, or even the vestibular system as another example. So when I look at the somatosensory system and when I look at these changes across the somatosensory cortices, it's really a representation of our entire body, both the outer surface of the body but then as you get into the posterior insula, the inner surface of the visceral organs. And so when you place the MDMR seeds in those three somatomotor clusters in the left post-central gyrus, the left posterior insula, and then in the right post-central gyrus. What's fascinating is the biggest changes once again that you see are reductions in connectivity with the default mode network, as well as other somatosensory structures. In the chair condition you do see some changes but quite a bit less. In the posterior insula you see dramatic reductions in the posterior cingulate, the hub of the default mode network, and to some extent you see some of those same reductions in the precuneus, which is also part of the default mode in the chair condition that overlap to some degree with what we're seeing in the pool condition. And then in the right post-central gyrus actually the chair condition shows some of the strongest drops with the default mode. So one final major data slide is the three other MDMR clusters. The top one is really part of the salience network, which I spoke a lot about a few conferences ago. We do see changes in the salience network and its connections with areas of the posterior insula, areas of the prefrontal cortex, which are part of the executive network, as well as areas of the precuneus, which are part of the default mode. So we are still seeing some changes in salience network. In this region of the less superior temporal gyrus the biggest changes are actually happening in executive areas as well as default areas. But let me draw your attention to this bottom area. This region of the left middle frontal gyrus, this is more or less the hub of the central executive network of the brain, the left dorsolateral prefrontal cortex. And what you see are dramatic reductions across the entirety of the default mode, both the medial prefrontal cortex and the posterior cingulate, in addition to other areas of the executive network. Just to sort of show you a different view of this. Most of the prior slides did not see changes in the medial prefrontal cortex, this area is kind of shown in blue here, with the exception of this one seed. The seed of course is in the left dorsolateral prefrontal cortex. And what you see is post float this dramatic decrease in connectivity between the left dorsolateral prefrontal cortex and the default mode network. Here's the interior hub. Here's the posterior hub following the chair condition. You don't see any of that. And I think this is perhaps one of the important findings of this study. And it's actually has some clinical relevance. This area of the left dorsolateral prefrontal cortex just so happens to be the same area of the brain that they're currently using to stimulate in what's known as TMS or transcranial magnetic stimulation. This is in patients who have chronic depression, and they're finding that with repeated sessions of stimulating this area of the brain, you could change the connectivity profiles with the default network. In essence showing something quite similar to what we're finding here. And so I think this is a very interesting sort of aspect of the findings, at least one of the findings. So let's summarize. This was a lot of information to take in. This study represents the first resting state functional nerve imaging investigation of flotation rest, a unique method for systematically reducing stimulation of the human nervous system. The resting state fMRI data was analyzed using MDMR, a statistically stringent whole brain searchlight approach aimed at finding peak clusters of connectivity change between the pre and post float brain scans. The results revealed that a 90 minute session of flotation rest elicit a consistent pattern of decreased resting state functional connectivity within and between posterior hubs of the default mode network, including the posterior cingulate and the precuneus, and its temporal parietal flanks and a large swath of cortical tissue centered around the somatomotor network, including primary and secondary somatosensory cortices extending into the posterior insulin. So that one sentence, I think nicely summarizes the thrust of most of the findings. Minus the slide I just presented earlier with the left dorsal lateral prefrontal cortex. One thing that I think is striking for me is floating reduces so many different sensory systems reduces the visual systems of the brain, the auditory systems of the brain, for example. Yet, the MDMR did not reveal significant changes in those sensory courtesies. We didn't see changes in primary or secondary visual courtesies or auditory courtesies. The areas of the brain that we're seeing changes in are the areas of the brain that represent the body itself. And I think that's really an important part of these findings. Another point that I think we have to acknowledge, and this is, I think, going to be sad for some of you, but the control condition, which was an active form of rest, showed a similar pattern of reduced resting state functional connectivity. And there were no significant group by time interactions. So even though on a lot of the slides and figures, I showed you that the float condition showed significant reductions in these sets of regions, whereas the chair condition did not. What this last statement actually says is even though one is showing a significant change and the other is not the differences between the two conditions were not significant. There could be a number of reasons for this. One is that it was a very active form of rest. So perhaps it's engaging changes in similar circuitry. But I think there's also another more likely reason, which is it turns out you need a lot of data to analyze resting state fMRI. Over the past year or two, there's been a few reviews and meta analyses that suggests that you need to actually study hundreds of people across dozens and dozens of minutes of resting state in order to have any degree of test retest reliability. These were new findings, actually new meta analyses that I didn't even know about when we first started this study. And what it suggests to me is that we were underpowered to detect a significant interaction. I think the changes that we are seeing from pre to post float are legitimate. We were powered to detect within subject changes, but the between subject changes having an end of 24 in each group I just do not think was enough. As you can tell from the figures that I showed you the direction of change is clearly favoring a greater reduction following float than the chair condition. Those changes we have to acknowledge were not significant. I just want to emphasize that. In conclusion, the default mode network resting state functional connectivity, which is reflexively heightened during states of resting weightfulness appears to be significantly reduced after a prolonged period of rest. The post float reduction in resting state functional connectivity observed between posterior hubs of the default mode network and the somatosensory courtesies suggests that flotation rest may reduce self reflective processes directed toward the current state of the body. Since flotation rest can significantly reduce muscle tension, it may be possible that the intervention directly alters the representation of this tension within the brain's body maps. Thus, reduced stimulation of the nervous system appears to be reflected by reduced resting state functional connectivity within the brain networks most responsible for creating and mapping our sense of self. And with that I'd like to close by acknowledging all my great collaborators over these years. Bobada who did a tremendous job with the MDMR analysis. And I'd like to point out, reminta Wilson and McKenna Garland, who are running our NIH funded clinical trial of floating in patients with anxiety and depression, and that should hopefully be completed within the next year.


keep it clean wow I woke up feeling extra good today because I got much better sleep than I normally get I hope y'all did too I hope your Thursday is going really really really good this should be a very fun Thursday very exciting Thursday because today supposed to start at 11 30 we got a presser that features the guy who a lot of us have been wanting to hear from for so long it features a presser where a lot of media people they just been wondering and waiting how he feels about different things what's he gonna say what's his thoughts on this and that's what's been driving them crazy cuz they just don't know that presser features one Lamar Jackson so that will be fun but the Ravens also had a presser yesterday that featured somebody who we love hearing from because we love that he's a part of this team because we've actually already seen his impact on this team and his friends impact on this team too that being T Martin now me I didn't watch a second of the presser yesterday because I got very lazy because I started seeing quotes come out from the presser but then I didn't see it live streaming on YouTube I do have the Baltimore Ravens app but I just didn't even think two and two didn't go together and by the time that they did I was like you know what I just I'll catch it later but two quotes stuck out from me from that presser I know Devon Duvenay spoke T Martin spoke and I know some other people did too but T Martin said some stuff and I was like okay now wait a minute but before we get into it team keeping clean I love y'all thank you thank you I just want to say thank you because you all support to this channel we're still a small channel it's at 55,000 right now but I appreciate y'all supporting a lot of comments I see from people every single day on every single video I appreciate that I know sometimes the videos may come out well yeah work well yeah school are you doing this and doing that whatever it may be I appreciate you watching I appreciate you watching not only watching but I appreciate you watching consistently I appreciate you watching when you can I appreciate you supporting the ways that you do so thank you for that and then one last thing I always hate that like tiktok will have these stupid songs like stuck in your head like sometimes I randomly walk around singing my money don't jiggle jiggle it for anyway so for the quote that really stuck out to me the first one the guys do from T Martin the guys do have a chip on their shoulder and they want to go out and prove that they're ready for their opportunity and when we don't draft the wide receiver what the organization is saying to you is we brought you here for a reason and it's your time now that of course is speaking about the Baltimore Ravens wide receivers and that has been the only position right now that has me hung up I'm like man I just whenever I was just talking to one of my guys yesterday he's like you think Ravens are Super Bowl team and I told him I think they're very close they're very close but the thing that I just that's holding me back is just the unknown at wide receiver I just don't know how it's gonna be I don't know if this is a group that can get them there hopefully they can hopefully they can but it's just so much unknowns with that and y'all know how I feel about it I will love for them to add a significant young guy who's still in his prime to and I feel like that would just help take them over the top will they do that we'll see with this quote it would point to the direction of no but at the same time you know Ravens and their smokescreen so you just never know you never know but you figure they're gonna add somebody somehow some way some veterans some way we'll see though now one my guy Hendo from Ravens online undatekeepers he made a really good point in yesterday's video in the comment section because of course when we talk about the Ravens potentially adding a wide receiver that is obviously a hot topic some people love talking about it some people hate talking about it I see y'all in the comment section people like you talking about this again I just I can't stand this white receiver talk I love it and I'm with it all day y'all know that but anyway he made a really good point because whenever we talk about wide receiver a lot of some a lot of people like hey yeah they should add one a lot of people like no they should roll with the young guys and some people in between they like hey if we do it we cool if we don't cool to but what my guy Hendo said from Ravens online undatekeepers y'all check his YouTube channel out he said that if the receivers if the young receivers that we have if they're like that then that veteran won't even see the field they won't even see the field because the Ravens they always talk about it they like putting their best guys out there with the offensive line they like putting the best five out there sometimes it take a little longer than other times but eventually they like putting the best five out there with cornerbacks safeties linebackers whoever it may be they like putting the best guys out there so say for instance they add a veteran receiver it shouldn't take away from the younger guys if the younger guys are showing like a we like that we got it so that's just something that I did appreciate from my guy Hendo shout out to him and it was a really really good point that I have told him I never thought about now an even more favorite quote from yesterday's presser and shout out to the folks on Twitter that be putting in like Jeff Zribick Jameson Hensley Sarah Ellison we love y'all Kyle Barber we appreciate y'all I know Jonas Schaefer he be putting stuff out to shout out to all those Ravens beat writers because it is man I wish I could do like a long shout-out list of all these people that cover the Ravens because they make our experience so fun and interesting and they keep us informed on so many different things like this to articles to tweets to reports to updates whatever it may be we appreciate all y'all that cover the Baltimore Ravens thank you for that but the other quote was about the deep passing game we examined it during the offseason it was something that coach Hubbaugh wanted us to improve on so it's been an emphasis we've been pushing the ball downfield down the field more hey if you gonna do that no problems with me no problems with because it's a beautiful thing you know Lamar love that too you know Lamar is with that all day every day that do loves throwing the deep ball so Ravens can incorporate some more deep passes and those like for me yeah I'm greedy I'm very greedy like especially when I'm be playing Madden that's all that I be looking for the short stuff I'll be like yeah I thought a little check down every once in a while I thought a little medium but but the D-pad that's that's my bread and butter so with Lamar you that's his to Lamar is always looking downfield and again you may hear the the the the media say otherwise oh man he's always running no he's always looking down feel like a year you know Lamar you know Lamar always looking for that big play always but yeah that's I like what he said and I just hope that it sticks what I mean when I say that um it's just really not even just the emphasis on a deep passing game because the deep passing game if Lamar is there that's gonna be there because that's that's part of his game that's a big part of his game but just really the emphasis on the passing game as a whole that's the direction I hope that excuse me that they're headed in and again y'all remember last year for a period of time while Lamar was obviously still the starter the Ravens were top in the league or at least top two I think there's no they were top in the league they were number one in the league for uh for like a couple of different statistics when it came to the deep ball as far as attempts yards per attempt they wouldn't like number one downfield throws or something like that like they were up there last year for a significant amount of time and then well you know the rest of the story with all the injuries and stuff but so yeah so they they were doing it but now again so based off of what he said what I've been saying that I'm hoping for this upcoming season based off of what he said is they're saying that they're going in that direction that's what they're saying hopefully it happens though and what I mean when I say that is that this we know they're gonna run the ball great we get that shorter running game will be fine but to make sure they incorporate and emphasize the passing game as well we know that you're gonna come up with 50 million different ways to run that ball and that's fine hey well let's come up with 40 at least 49 million different ways to throw the ball to let's make it efficient let's make it effective let's make it to where that is a viable option for when people stop to run because you know people they're gonna look at the team they go they traded away Hollywood they ain't got no deep threats let's load the box let's stop the run okay oh y'all want to load the box guess what we got something for that let's have something for that that's all we asked but it's all I asked and then in a couple of us I know some people like no no just run run against a loaded box that's fine no have some red stay ready so you ain't got to get ready if you go into a game prepared going to each game prepared then you ain't got to prepare during each game it's as simple as that but at the same time it sometimes it just doesn't seem like it's so simple but we gonna see man we are going to see T Martin was brought here for a reason and we again we did see improvement from Raven's receivers last year we certainly did we wish that we could have seen them all together last year it's unfortunate how things ended up going we wish we could have seen both all the receivers together and them with their starting quarterback we just we got robbed of that last year robbed and I know some people oh well we saw more during the Miami game now that Sammy Watkins wasn't in that Miami game he wasn't he was dressed he was on the field but Sammy Watkins was not in that Miami game at all at all he wasn't that was sad anyway team keep it clean I appreciate y'all I love y'all the presser again it's supposed to start at about 1130 so y'all stay on the lookout for that now you know they gonna stream that one on YouTube yesterday they didn't stream it only you know the one with Lamar they streaming that on YouTube so be on the lookout for that we'll of course cover that as well and that because they got some heavy hitters getting ready to speak so I'm sure that video is gonna go on for a while but we'll see y'all then I love y'all y'all have a really really great day again thank you for 55,000 subscribers let's keep pushing let's keep doing it and y'all just keep being great we out


Here we are zooming into the dark nebula LDN 1527. Dark nebula like this one contain dense dust clouds that can collapse into stars. We covered how this works in the How Old Are Stars chapter of the How Old Is It video book. The visible light created by the forming stars cannot penetrate the dust clouds, but infrared light can. Here's the James Webb infrared camera image of protostar L1527 inside this dark cloud nebula. The collapsing cloud triggers high temperatures at the dense center and forms a protoplanetary disk around the core. Here the disk is seen edge on. The protostar itself is hidden from view within the neck of this hourglass shape. Light from the protostar leaks out the right and left of this disk, illuminating cavities within the surrounding gas and dust. The distance from end to end is 17,000 times the distance from the earth to the sun. The region's most prevalent features, the blue and orange clouds, outlined cavities created as material ejected by the protostar collides with the surrounding matter. The blue areas are where the dust is thinnest. In the thicker layers of dust, less blue light is able to escape, creating pockets of orange. This protostar is a relatively young body, about 100,000 years old. Given its age and its brightness in far infrared light, it is considered to be in the earliest stages of star formation. Its mass is somewhere between 20% and 40% of the mass of our sun. It doesn't yet generate its own energy through fusion. Stars like these, which are still cocooned in a dark cloud of dust and gas, have a long way to go before they become fully fledged stars.