Hello, ladies and gentlemen. It is a pleasure to be with you today for the presentation of the ICMJE Guidelines for Writing a Medical Research Paper. My name is Despina Sanadu. I'm a molecular biologist in training. I did my PhD at the University of Cambridge and I worked as an instructor at the Harvard Medical School. It has been now a couple of decades that I have been actively involved in research and scientific writing and publishing. And with these credentials, I would like to share with you my experiences and knowledge on this topic. So I will start by giving you a few words on today's agenda. We will talk about the importance of international guidelines and recommendations. We will talk about a brief introduction to the ICMJE Guidelines and then proceed to the specific recommendations for manuscript preparation, conducting clinical trials, research and publication ethics and then information on the guidelines for submission and peer review. So let's start with the importance of international guidelines and recommendations. What are specifically medical guidelines? They're basically simple structured tools which involve recommendations, checklists, flow charts, et cetera, that have been developed by experts in their respective fields, using explicit methodologies for medical researchers and healthcare professionals in order for them to be able to conduct and report a specific type of research in the best possible way. Now, there's a number of different healthcare and medical editorial associations, each one specializing on a slightly different area and all of them together, offering complementary information and tools for all of you actively involved in healthcare and medical research to be able to utilize to make life easier and to make the quality of your work significantly improved. So we have the, since 2015, the International Society for Medical Publication Professionals which has issued recommendations regarding the ethics that the ethics guidelines, the ethical rules that should be set in place when clinical trials are implemented by the academia and different companies. We have the International Committee of Medical Journal Editors which we will be talking a lot about today since 2017, which has issued a range of different recommendations about conducting, writing, publishing, reviewing medical research. The World Association of Medical Editors in 2017 has issued recommendations about how to avoid predatory and pseudo journals. 2018, we have the Enhancing the Quality and Transparency of Health Research Network or Equator, and we will be touching on that shortly. It contains a broad range of recommendations on how to present structure and present different types of research studies, valuable tools that it is very important for you to be aware of and now know how to use. And then we have the Committee on Publication Ethics or COPE, which has issued a number of ethics-related recommendations. So I will now like to zoom in and elaborate on the ICMJE guidelines and recommendations starting with an introduction on what's available there for you to use. So ICMJE is a small working group of general medical journal editors whose participants meet annually and fund their own work on the recommendations for the conduct, reporting, editing, and publication of scholarly work in medical journals. Why are we emphasizing ICMJE and why are we devoting an entire presentation to that? It's because this organization embraces the world's finest medical journals, including the Lancet, British Journal of Medicine, the New England Journal of Medicine, JAMA, Annals of Internal Medicine, et cetera. The statements, policies, and guidelines that are formulated by ICMJE are widely adopted and recommended by these and many more scientific journals internationally. And this is all in an effort to assist the medical community to assist you in unifying standards for publication of medical manuscripts. The purpose of the ICMJE recommendations includes the following. First of all, they've been developed to ensure the implementation of best practices and ethics standards while conducting reporting, editing, and publishing medical research. These guidelines are aimed at helping the authors as well as the editors and the peer reviewers to distribute accurate, clear, reproducible, and unbiased information. It is strongly recommended that these guidelines are followed along with the individual journals' instructions for authors in order to maximize quality consistency and ensuring uniformity of standards across the board in the medical field. If you're interested in the journals that follow the ICMJE recommendations, you can find this list in the link provided on this slide. Now let's look at some general guidelines. When we go about putting together a manuscript for a journal that we have selected to submit our work to, first of all, we need to consider the specific journals' editorial guidelines, carefully read and familiar with the submission procedures, and be aware and take into consideration the copyright and ethical guidelines. Now the ICMJE recommends that journals should encourage authors to follow specific reporting guidelines for different types of studies. And already there is a number of different recommendations and guidelines on how to implement a research study and present the findings of these studies. Now, as you are well aware, there is a number of different types of medical research. And in this diagram, you can see the presentation of the majority of these different types, the different categories. So medical research can be divided in primary research and secondary research. By primary research, we mean the research that generates primary data. And this can be basic research, clinical research or epidemiological research. Now, each one of these categories, as you can see on your slide, is subdivided in a number of different types or subtypes of medical research. For each one of those, there are different recommendations and guidelines as to how these studies should be structured, specific considerations to be aware of, how the data from these studies should be reported. And then we have the secondary research, which largely involves meta-analysis, reviews and systematic reviews. Again, there are specific recommendations for the secondary research type of studies. Now, ICMGE recommends using the appropriate guidelines, looking into the specific guidelines for the different types of research. And this information can be found, grouped together in a very easy and straightforward for you to use database, the one provided by the Equator Network, the one we mentioned just earlier. So if you log into, if you go to their website, what you will find in the beginning is a search tool, a very useful search tool where you can indicate the type of study that you're interested in, the clinical area or the section of the report, or use free text to search for what recommendations are already available out there to help you in the presentation of your study, in the structure of your study and presentation of your study. So on the right-hand side of this slide, you can see examples of a series of different reporting guidelines that are available. But if you actually try using this tool, you will come to realize that there are many more recommendations out there which very much help all of us in research to do our work even better and in a uniform fashion. Now, if you click on each one of these recommendations, you will find detailed information. For example, if you click on, I picked here the Prisma 2020 statement, which is an updated guideline for reporting systematic reviews. You will find the recommendations for how to report, how to prepare your manuscript, reporting the findings from a systematic review that you have done. Now, another tool that is available to search for international recommendations and guidelines is through the NIH, the National Institute of Health and specifically the National Library of Medicine. So if you go to this website, you can see how you can find by organization or guideline different types of guidelines, again, for the different types of studies. So this is an additional tool that I believe you will find useful. An example, if you click on Moose, these would be recommendations for observational studies in epidemiology. You will find the fine details for how to report such findings. Now, let's move a step ahead and look into the ICMGE recommendations for manuscript preparation. So once you've become familiar with the guidelines and recommendations for your specific type of research, then comes the point where you need to structure your manuscript. So how do we go about doing this? When structuring your research paper, you have the title, the abstract, the introduction methodology results, discussion, conclusion, and bibliography. I'm sure most of you are familiar with these different sections of a manuscript. This is what the final outcome will look like. When it comes, however, to preparing your manuscript, the order of writing the different sections is somewhat different and it is advisable to use the order presented in this slide. So we start with the methodology, then we write the results, the introduction, then the discussion, then the conclusions, and at the very end, it is recommended to write the title and the abstract. Let's look at one of those points in more detail. When it comes to starting with the methodology, what do we put in this section? So the methodology must include details about any animal models that have been used or any biological material or any patients that were included in the study. If we're talking about animal models, we need the specifics of this animal model, how it was generated, how it was bred, under what conditions it was kept, what it was fed, the age of the animals that were used for the study, the gender, and so on and so forth. If we're talking about biological material, we need to specify when, where, and how, how it was absorbed and exactly how it was processed. Also we need to ensure that all ethical approvals were in place for any one of these experiments. If we're talking about studies on patients, then we need to include demographics, we need to include all the clinical characteristics, we need to specify inclusion and exclusion criteria from the study. Again, ensure that we have worked and performed our study in accordance with all the necessary ethics guidelines and regulations in the country where the project is implemented. And then we proceed to describe in as much detail as possible the experimental or sampling design. We need to specifically mention the agents that were used, including the brands, concentrations of the different reagents and compounds that were used, incubation times, temperatures, et cetera. You need to be very detailed to the extent that if someone wanted to reproduce your work at a different time, in a different lab, in a different part of the world, they could follow your instructions as provided in the methodology section and perform the same study and obtain the same result. So this is why it's so important to provide full details. When it comes to equipment, you need to provide details for any advanced equipment that you used, any software, advanced software that you used and the settings that you used for your study. Also, if data analysis were used, you need to specify how it was done, the software, the tools, the algorithms, or if there was statistical analysis, again, all the specifics about what you chose to use, including threshold, et cetera. Once you've completed the methodology section, it's time to write the results. The results must include distinct sections for each subset of experiments, for each subset of findings. So each section should have a clear aim of the subset of experiments. So why did you do this set of experiments? What was the rationale of this strategy? Why you chose to do this? How you applied the methodology for the specific set of experiments to answer the specific question and then a detailed description of your observations. Now, it is extremely important when it comes to presenting your observations that this is done in the most objective and descriptive manner possible. So the results must include figures and tables and diagrams depending on what is best to show your data. It's up to you to choose the best format to demonstrate what your findings were. Very important that you ensure highest quality, highest resolution of any photos and figures, absolutely no manipulation of photos. They need to be exactly as you obtain them, exactly as you saw your results. You need to be careful of the appropriate size and choice of colors. And for that, you need to take into consideration the requirements of the journal you will be submitting your manuscript to. In keeping in mind that diagrams are often a very useful tool if used appropriately. Now, if you have a lot of data and not everything can fit in the main body of the manuscript, you can include it as supplementary material. And each journal has its different guidelines about how to include supplementary material. But it is the location where you pretty much have unlimited space for any additional information data you want to provide to the readers. Another consideration that I would like to touch on is depositing your raw data to publicly available databases. And for some types of data, this is strongly recommended or even required by specific journals. Prime example of that would be omics data, genomics, transcriptomics, proteomics data, where some journals actually require that you submit the raw files to public databases before submitting your manuscript. Some quick tips for authors for the results section include only those results that are relevant to your research question. It is often tempting, especially for younger scientists to include every single experiment and every single piece of data they've generated when preparing their manuscript. Now, this is not always the best for your readers who need to see a concrete story. So ensure that you have a clear structure of your manuscript before you start the question. I'll decide right up front which of all your data are well suited into the story you will be presenting. When it comes to presenting your results, choose the best suited order. You don't necessarily have to present them in the order you generated them. Sometimes you have to consider presenting them in a different order that will make more sense to the readers. Use graphs as an alternative to tables that may have too many records and not be very reader-friendly. Avoid duplicating information in tables, graphs, or figures, and the text. So make sure that the information is presented once in a manuscript, not in multiple places in a manuscript. Choose separate reporting of data by demographic variables such as age and gender. And provide a conclusive statement based on the observations of each section. So once you've presented all your data and your observations, it's very reader-friendly to have a summary or a concluding remark at the end of each results section. Once you're done with the results, it is recommended that you go ahead and write the introduction. The introduction needs to explain why your specific research project matters, to explain why the scientific question you pursued was important and how answering it with the work that you did advances the respective field forward. So the introduction must include the appropriate background of the topic, you must explain what is the bigger problem that you're trying to address with your work and why this is important. You need to summarize the information that's available to date and indicate what are the major open questions in this field. Then you specify the aims and hypothesis of your study and of course include throughout your introduction all appropriate citations. It's a fine balance between having too little which would suggest that you're not well aware of the literature in this field and the other end of the spectrum which is including too many which will overwhelm your reader and will probably go over the limits for citations that different journals have. Something to be aware of when you start writing a manuscript. Once you're done with your introduction, it's time to put together your discussion. This is the section that will encapsulate the study design and main outcomes in an initial paragraph and then it will go on to elaborate on the significance and implications of your findings. So individual paragraphs should detail different major outcomes of your work so you will have multiple paragraphs each one discussing each of your major findings. It's important to include a discussion on related studies, how they compare to yours, how their findings compare to yours, if they're consistent, if they're disagreements, how they complement each other and how altogether they advance the field forward. Remember to discuss any unexpected findings. Try to give explanations for potential discrepancies that may be observed. And some quick tips to bear in mind are summarized in this slide. For the discussion, it's helpful to begin by briefly summarizing the main findings and call plausible explanations for them. Differentiate between and explain results that have clinical and statistical significance. Avoid statements on economic benefits and costs unless the manuscript includes the appropriate economic data and analysis. So try to remain focused on discussing your actual observations, your actual data. Discuss the influence or association of variables such as ethnicity, sex, and or gender on your findings and emphasize the new and important aspects of your study along with the implications of these findings for future research. This is a very important point because this is what will help the reader appreciate the greater implications of your work for their respective field and also provide them with the vision of how this will evolve in the years to come. Avoid claiming priority or alluding to work that has not been completed and avoid exaggerating the significance of your observations. So again, it's a fine balance between saying too little and saying too much about the significance of your findings. You need to be as objective and accurate as possible. At the end, closer to the end of the discussion, we often include a limitation section which is very useful for the reader. Limitations very refer to issues related to the study design, the study population, sample size, study duration, the factors that were evaluated, limitations of the methodology, the number of replicates, the materials and so on and so forth. You know best what the limitations were for your study and it's important to be upfront and discuss these limitations, why they had to be this way, the fact that you are aware of them and how this may interfere with your observations. Now at the end of the discussion, we have the conclusion section that should summarize the key findings and highlight their short, medium and long-term implications in the respective medical and scientific fields. The other section, very important section that one needs to compile is the abstract. The abstract must convince the reader to keep reading. So it's very important that you put together an abstract that's objective, informative, but at the same time exciting. It must include key points from the background rationale methodology, results and conclusions in a way the abstract is a miniature manuscript if you want. Make sure to provide sufficient detail for the reader to be able to pre-create, talks about, but at the same time, make sure that it's lavery differently. Remember that different journals have different limits for abstract size as well as abstract structure and keep these recommendations and guidelines in mind when you prepare your abstract. Then is the right time to consider what the title of your manuscript will be. Remember that title is the reader's first impression of a research paper. It must be concise, accurate, original, captivating and include field-specific keywords. Usually the title is where the most important finding is explicitly stated. Now when preparing the title page, as you're coming closer to your submission, remember that the title page will need to have author information. So the different authors in the agreed order from first to last corresponding author indication, whether there's equal contribution by some of the authors, you must provide the full details of the department institution, contact information, email, et cetera, as well as the author's ORSID ID. Then we have the disclaimers on sources of support. We need to be clearly stated, indicated, mention funding sources or anything else that was provided to you in order to perform your work. Indicate the word count, the number of figures and tables and ICMJE encourages journals to adopt the uniform disclosure form, which is developed for disclosure of relationships and activities. So all this information will be clearly provided to you, requested by you, by each journal. So the journal that you choose to submit to. Make sure you read their instructions and follow them closely. Now we have the references section, where authors need to provide direct references to the original research sources for any information that any data that they're citing. So then we have different kinds of references. If you want, there are references to papers that have been accepted and published. This is the most common form of references used. But there are also cases where we have manuscripts that have been accepted, but not yet published. There may be in press or forthcoming and this is indicated as such because you don't yet have the full details to provide in the bibliography section. There's manuscripts that have been submitted but not accepted yet. And there you can state these manuscripts are in submission. And then there's research that has been performed other individuals that has not yet reached the point of being included in a manuscript, but that has been communicated to you and you have requested and obtained permission to mention it, written permission. So in such cases, which are quite rare, but in such cases, you need to indicate whose observations these were, that you have written permission to mention them and you can indicate that these are unpublished observations courtesy of professor, doctor, so and so. ICMG has a list of dos and don'ts when it comes to putting together the references section. So it recommends that authors, peer reviewers and editors do not use references for promoting self-interests. This means that the references you choose to include in a manuscript must be there because they are an excellent fit to the content of the manuscript and not for any other personal advancement, promotion or any other matter that's of self-interest. Authors should refrain from citing articles published in predatory and pseudo journals. They should avoid citing personal communication unless it is essential information and it is unavailable from a public source. You should be careful to avoid citation errors. So make sure that you verify references using official electronic bibliographic sources such as PubMed and make sure that you go for the original source. Now, some recommendations by ICMGE that go beyond the actual manuscript preparation but are valuable for implementing your studies in an appropriate fashion so that the data can be included in your manuscript and published. So let's look at some recommendations for conducting clinical trials. According to ICMGE, a clinical trial is any research project that prospectively assigns people or a group of people to an intervention with or without comparison or control groups to study the relationship between a health-related intervention and a health outcome. Now, ICMGE has a clinical trial registration policy that's quite specific and very useful. It recommends that all medical journals ensure that clinical trials are registered in a public trial registry at or before the time of first patient enrollment as a mandatory condition for publication. ICMGE accepts publicly accessible registration in any registry that is a primary register of the WHO, the World Health Organization, International Clinical Trials Registry Platform or in clinicaltrials.gov. Secondary data analysis of primary clinical trials should not be registered as a separate clinical trial and authors are encouraged to include a statement indicating that results have not yet been published in a peer-reviewed journal, wherever this is the case. Now, there is a number of different clinical trial registries, the ones that are accepted by ICMGE include the ones shown in your slides, so clinicaltrials.gov, the ISRCTN registry and CTR and so on and so forth. There's a number of different registries one can use depending on their preferences. The links, web links are available here and welcome to use them and surf on their websites to become familiar with how they work and what they require for registering a clinical trial. Now, let's look at the ICMGE recommendations for authorship. Once you have prepared your project, completed your project, prepared your manuscript, ensure that your clinical trial has been registered and everything is in place. Some important considerations and recommendations. Now, authorship is an important matter and close to heart to all those who are involved in research because it's a way to attribute publications to authors. It has direct academic, social and financial implications. It conveys responsibility, endorses ethics and integrity of your work. It's an integral component of an academic, a scientific and often a medical career. Therefore it is very important to be careful how authorship is given under what circumstances to individuals. According to ICMGE, all authors share responsibility and accountability for the published content of a manuscript. Therefore, it is important that all the authors are in agreements to be accountable for all aspects of the work that is being published. It's important that significant contributions to the conception or design of the research idea or acquisition and analysis or interpretation of data for the project is acknowledged in the form of authorship. So anyone who has been part of any of these steps should have the right to be an author on the manuscript. Additionally, individuals who have been involved in drafting the manuscript or revising it critically for crucial intellectual content should also be included as authors. This does not include individuals who have checked for grammar errors or editing errors or the use of English, for example. This would be considered important but minor intellectual contributions. And therefore these individuals would not be entitled by this contribution alone to become authors on a manuscript. And of course, in order to be an author on the manuscript, one needs to provide consent on the final version of the manuscript to be published. So they must have read the final version and confirm that they agree with all the work that has been done, the way it's presented, the way it's interpreted and the way the manuscript is structured. Another section where ICMJE has specific recommendations is about research ethics and publication ethics. Let's look at with more detail some of these points. Now, fundamental principles of research ethics in general include honesty, objectivity, integrity, carefulness, openness, respect for intellectual property, confidentiality, wherever that's due, respect to colleagues, social responsibility, non-discrimination, competence, legality, animal care, human subjects protection, responsible publication and responsible mattering. Each one of those words that were included in the previous slide can be entire chapters and long discussions. However, they're grouped together for your convenience and in the context of this presentation. Now, having seen the main principles of ethical research, there's the other side that should be mentioned and these are some major types of scientific misconduct. So where ethics recommendations have not been abided to. Some major types of research scientific misconduct include author omission or ordinary authorship where authors are included when they shouldn't be there because they haven't made a significant contribution, failure to publish results of clinical trials, so leaving data out, duplicate publications, trying to publish the same work twice, data fabrication, making up data that was never observed. These are major, major types of misconduct that should absolutely never be done by scientists. Data falsification, so modifying your results to better suit the point you're trying to make, absolutely unacceptable, image manipulation to modify what was actually there, plagiarism or sub-plagiarism and bear in mind that whether this is done intentionally or unintentionally, it is still considered plagiarism and you have to be very careful to avoid it and non-disclosure of conflict of interest. Now each one of these points is so important and so major that it can have huge implications not only for your manuscript, but for your career and for the future of your lab and on occasions for the future of your organization. So it's extremely important to be very careful to avoid at any cost these types of scientific misconduct. Now how scientific misconduct dealt with, there's a long list of different approaches that are being taken for different scenarios, but in the case of manuscripts, if there is suspicion of scientific misconduct, the editor will initiate appropriate procedures detailed by committees such as the Committee on Publication Ethics Code. The institution's funders and readers may be informed about this. The expression of concern may be published while the outcome of the code is pending and retraction may have to take place if there is proof of scientific misconduct. Needless to say that it looks extremely bad on someone's CV to have a retracted manuscript. It can have very serious repercussions for their career. Another very important aspect is the protection of research participants where there have been such participants in a study. So planning, conducting and reporting human research should be following the Helsinki Declaration as revised in 2013. The authors must have the approval to conduct research from an independent local, regional, or national review body. And here I must note that different countries have different regulations. So it's very important that you ensure you follow the national recommendations wherever you are based at the time you are performing such a project. Remember the patient's right to privacy and how this should never be violated without informed consent. So you can only go as far as you have permission from the patient as to what information you can include in the study and disclose in a publication. Identifying information such as names, initials, hospital numbers should not be published unless absolutely essential and only if consent for that has been obtained, informed consent. Patients informed consent should be well documented and archived with the journal authors of both as per local regulations or laws. And the journals have the right and should request to view copies of these informed consents to ensure that everything has been implemented as per guidelines. Now, when it comes to working with animal models, one needs to be very careful to protect animal rights. So authors should indicate whether institutional and national standards for the care and use of laboratory animals were followed when performing and reporting these experiments. Authors may follow the International Association of Veterinary Editors Consensus of the Guidelines on Animal Ethics and Welfare for Animal Research Ethics. You can see the link at the bottom of this slide with the full details of how to best protect animal rights and to report what has been done in your manuscript. Another parameter is safe storage of your research data. ICMGE recommends that authors should maintain all the primary data and analytical procedures supporting the published results for a minimum of 10 years. So you must ensure that you have safely stored and have multiple copies, backup copies ideally of your primary raw data and analytical procedures. To ensure long-term availability, the ICMGE encourages the safe storage of the data in a data repository. Furthermore, it is recommended that editors of different journals encourage authors to make the raw data available to public data repositories, such as the ones mentioned earlier. A few words on publication ethics, ICMGE has specific recommendations to avoid duplicate publications. So with that, I would like to specify the different types of duplicate publications that one may encounter. These could be a duplicate submission of the exact same work, unacceptable, a secondary publication, prior and duplicate publication with overlapping sections. Now, overlapping publications result, as you know, in significant distortion of empirical evidence and really lead to waste of reviewers and editors resources on time. They create confusion, they don't serve any scientific purpose, they can be misleading, and unfairly occupy the limited space available in different journals. So this is not an ethical approach to pursue, and now there are guidelines as to how to avoid duplication of the published information. Now, there are some exceptions for overlapping, not duplicate, but overlapping publications, and I'd like to specify these and clarify it in this slide to facilitate you. So exceptions would be a follow-up and significantly updated article on a published preliminary report, an article that reinterprets or re-analyses published data for a different audience in a different perspective. Exception would be the submission of e-prints of original articles in repositories or the translation of an original article with proper attributions and credits. Now, the ICMGE recommendations for overlapping publications include the following. First of all, it is the authors responsibility to inform the journals if the work has been previously posted on a preprint server. Authors must not simultaneously submit the same manuscript in same or different language to more than one journal. Authors must not publish a paper that substantially overlaps with a prior publication, without appropriate attribution and all necessary clarifications and approval. In the submission letter, authors must absolutely clearly state if the submitted manuscript reports work that has already been reported in large parts in a published article. So one needs to be crystal clear as what it is they're submitting. If there are any parts overlapping with previously published work, why this is overlapping, how is this justified and ensure that the editor has a perfectly clear view as to what it is you're submitting. Now, the ICMGE rules for secondary publications, authors should have permission from both journals, primary and secondary publishers. The priority of primary publication should be valued by keeping a publication interval agreed by both editors. The article for secondary publication, which could be an abbreviated version, is intended for a different set of audience. The secondary version accurately reflects authors' data information and the interpretations of the primary version. The secondary version informs its audience that the paper has been published in whole or in part elsewhere and the title should indicate that it is a secondary publication of a primary publication. Now, when you actually follow all these recommendations and reach the point of submission and hopefully peer review, what are the ICMGE recommendations to help you there? In terms of submission requirements, it is recommended that a full statement to the editor about all submissions in previous reports that might be regarded as redundant publication of the same or very similar work are indicated. A statement should be there about the financial or other relationships and activities that might lead to conflict of interest. So be upfront clear about any potential conflict of interest. Make sure there is an authorship statement, the contribution and indication of the contribution of the different authors. Contact information for all authors responsible for communicating about revisions, approvals, proofs, et cetera. And then a letter to the editor that should inform them about the actual content of the manuscript and in addition to the novelty contribution to the field, et cetera, should also indicate if any concerns have been raised regarding the conduct of the specific research or if any corrective action has been recommended previously. Now, some tips for authors here. Avoid publishing in predatory journals. Make sure that you're aware how to spot them, how to identify them and make sure you avoid them. Evaluate the integrity, history, practices and reputation of the journals that you will be sitting. Your precious work. Follow guidance from various organizations such as the World Association of Medical Editors that we mentioned earlier in order to identify the characteristics of reputable journals and choose one of those journals to submit your work. And if needed, seek the assistance of experienced scientists, especially if you're in doubt about either predatory journals or about the journals that would be a good fit for your specific research work. So in summary, as we're coming to the end of this presentation, most leading biomedical journals require compliance with ICMJ recommendations. A detailed understanding of these guidelines can assist you in conducting and publishing credible, detailed and well-documented research. All authors must remember that individual publishers may have individual interpretations and implementations of the ICMJ recommendations. So it is important that first of all, you are aware of the ICMJ recommendations, but also that you carefully read and become familiar with the specific guidelines, instructions to all those of the journal you will be submitting your work to. With this, we're coming close to the end of the presentation. I would like to wish you very good luck with your publications. I would like to provide a coupon here on this website, on this slide, by Enagle to thank you for your attention and to encourage you to use the Q&A button for any questions that you may have. I look forward to answering them. Thank you once again for your attention. I can see we already have some questions, so let me go through them and start answering them for you. Okay, so we have a great question. It says some recent publications, including review articles, include statements supported by old publications. Would you advise to include the recent publication as a supporting reference or the old original publication? It is best if you're talking about data that has been generated to include the original publication where this data was first generated. If you're talking, though, about latest developments in the field and how new recommendations, new guidelines or new interpretations of previous findings are changing, then it is best to cite the most recent work with the latest interpretation recommendation, et cetera. So there's a distinction and you have to choose which one is the most appropriate to cite each time. But if it's data, you will be talking about the original publication of the research data is the best source. Okay, here's another great question. How can I identify the difference between first author, co-author, and corresponding author? Is there a clear line? Okay, so this is a question that many people ask over and over throughout their career, but usually the first author is the one who has performed the majority of the research work, the experimental work, the research work that is included in the manuscript. So it's the one who's actually done if it's a wet lab type of research, the most of the experiments. Co-authors are all the individuals who have contributed intellectually and practically at the scientific level always for the implementation of this project. So depending on the amount of work that they have contributed to a project, that will affect, in a way, determine the order in which they appear in the author list. Now the corresponding author is the one who usually serves as the PI of the lab, is the person who conceptualized the project, who decided the strategy that will be followed, supervise all other members of the team, the one who was responsible for preparing part of or for assessing, evaluating, contributing to the final version of the manuscript. And often the corresponding author, in addition to what I already mentioned, is often the one who had the funding or one of the authors who had the funding to implement this project, to perform this project. But every time you have to weigh how much each individual contributed in order to reach these decisions. Great. We have a technical question. Where can the recording of this webinar be watched? The Enago team will be the right one to answer this question, so I'm sure they will provide you with an answer for that. How to deposit the data on a repository. Are the repositories free? Yes, the repositories are free and each one will have specific instructions on the format that your data should have and the steps you need to take to deposit your data. So for each repository, there are different instructions on how to do it, but it definitely needs to be in a personalized fashion so it will be clear who submitted it, when they submitted it, and it will have specific information on the type of files that you will be depositing and the description of these files that is required. Great question. Another question is how long do I wait before withdrawing my manuscript from a journal? Now, this is a tricky question because we don't usually withdraw a manuscript from a journal unless there is something very wrong. So maybe you want to come back with more specifics about your question so that I can answer it appropriately. We have another question here with increasing availability of published articles online. As an author, what is the best way to handle gray literature and sources references that are not available online? Should the accessibility of those references to readers be a great concern to authors? Again, it would be helpful if you wanted to provide an example as to the sources that you're talking about, sources that are not available online. I'm not sure specifically what you have in mind. Please elaborate and I'll be happy to address. What's important is that any source that we cite is from reputable sources. Publicly or commercially available, but credible sources. That is very important. So you always need to be careful and aware of that when choosing what to base your research on and what to cite. If there are not credible references that you're including, your project and your work loses credibility. Okay, great. So thank you for clarifying your point. In regards to the question, do I wait before withdrawing my manuscript from a journal? Our colleague here clarified that what they mean is, for example, if the manuscript has been with a journal for almost two years due to delays from reviewers. Admittedly, this is an excessive period of time. Two years is a very long time to be with reviewers. And it certainly raises concerns about that journal. It is always entirely up to you to decide where you draw the line and how long you want to wait for a journal to give you a final answer on whether they're requesting revisions or accepting your manuscript. So it's a very personal decision. Often with high impact prestigious journals, one is willing to wait and pursue it for longer. Whereas with lower impact journals, less prestigious journals, if you want, sometimes you want to move on faster. But this is a very personal decision. Okay, here's another great question. Are authors in breach of IP if they upload full text articles of their work in cases where publishers hold the copyright? Yes, this is a very sensitive matter to be careful of. It is advisable that you check very carefully with the publisher and the specific copyrights before you upload your published article. So yes, please check with the publisher on a case by case scenario. Okay, great. So we have a clarification about the question that was raised earlier about gray literature and how to cite it. And our colleague here clarifies that they mean internal documents, reports or old articles that have not yet been digitalized. So if something is published in print or online version or even if it's old and has not been digitized yet, it is fine to cite it as long as it is a credible source that you are citing. However, when it comes to internal documents and reports that have not been officially published have not been peer reviewed, then I would advise against it. Unless it is a credible source that somehow can be referenced, officially referenced. So it's best to stick to literature and sources that are official and other readers can trace and identify. Okay, so I'm very happy with all these exciting questions you have sent in. I very much thank you for your attention. I think we're now coming close to the end of our webinar. I hope it was useful to all of you. I once again wish you very best of luck with your manuscript preparation and submission and look forward to interacting with you in a future webinar. All the best. Take care.


Hi everyone, Joe for jaspyscasebreaks.com. On a Tuesday, happy Tuesday everybody, our first break of the day is a quick little one, 2018, 2019 Chronicles Basketball Hanger Box Edition number 25. Given away a spot in that tiered random team break, we'll just have a couple of mini breaks to do if you're watching live. We just have a couple more to do on jaspyscasebreaks.com and there'll be a breaks field. So go check it out on the website. As always, we're gonna do the break first. Big thanks to all of these people here in break number 25. All 30 teams are in doing the break first. Two and a six, eight times. One, two, three, four, five, six, seven, and eight. Eight times? No, that will not, John. That doesn't come out until tomorrow. It says Wednesday in the title, I believe. If it doesn't, sorry, it's tomorrow. Two and a six, eight times for the teams. Two, three, bowls down to calves. You're new here, John, welcome. Yeah, we usually put in the titles. If it's a pre-order, we'll usually put the date when it's supposed to drop, so always pay attention to titles and item descriptions. A lot of frequently asked questions are usually in the item description itself, so. So be sure to read all of those. All right, and thanks for joining us. This is 2018-19 Chronicles, by the way, folks. So we're looking for who has, I guess there's other solid rookies in here, too, but really we're looking for Lucodonjiches, Mavs, right there, and we're looking for who has Atlanta. Eric has Atlanta, Trey Young, possibilities in here. My expectation level on these little hanger breaks are really pretty low. You're just chasing that tiered random team spot anyway. Let's print, let's rip, let's rock, let's roll. Yeah, that doesn't happen too often, Zach. Like a Donovan Mitchell silver from a salo? Yeah, it doesn't happen often, but I don't wanna overhype a retail box, you know what I mean? That was the official printout. Here is the official break. There's a Mo Bamba, Collin Sexton, Miles Bridges, Kevin Knox, Jalen Brunson, Mo Bamba again, and then we've got an Anfrony, Simon's, and for some Lucas here, Deandre Aitton's not bad, number one overall pick. Jaren Jackson Jr. was a rookie here, and there's a Trey Young for the Atlanta Hawks. That'll be for Eric's and Salah. Nice Trey Young rookie card. Nice, pretty strong stuff right here. All right, now let's see who's gonna win that spot. So let's grab everyone from Eric down to Manny and everybody in between. Let's roll it, let's randomize it. Seven times, lucky seven, name on top after seven. Wins that $1,700 spot. Two, three. Good luck everybody, seven, then final time after seven. First off, a big thanks to everybody from number two down to 30. I appreciate everybody giving this a shot. If you want to, you can try again. I think there's a couple more opportunities to take into that big NT basketball break. And congrats to Ryan S., Ryan Shackleton after seven winner, winner.  So good luck in that break. Thanks everyone else. Joe for JaspysCaseBreaks.com. I'll see you next time for the next one.


Virginia Gautman, a chance for British Royal Marines and US Marines to continue their camaraderie established through years of shared combat. You are not stopping them. I've worked with the USMC in Afghanistan as well as obviously a tour like this. It's fantastic to get some nice things in as well as see some of the bad sides of the USMC. It makes sense for us to be doing this more often. British Royal Marines and the Marine Corps have been together since we went to Iraq, Afghanistan. So that we come back together freaking once the war starts to end down. I'm right boys! We build teamwork, kind of get that competitive adrenaline rush, but yet, you know, the stress of it is, you know, at the end of the day we can go and have a beer together and shake hands. So there's definitely a competitive spirit in both entities. The two Marine Corps competed against one another over several weeks in everything from skeet shooting to boxing. It began during a visit from the Royal Marines Commandant. About a year and a half ago we were, he was back in Washington, we were together and he asked me, he said, hey, would you be interested in that? Would you be interested in putting together a sporting event? And I said absolutely yes. Any time you can get the two Marine Corps together, it's good for both of us. So that's how it began. You know, the Royal Marines always, they have a spirit that is, it brings out I think the best and maybe the most spirited part of our Marines. But I hopefully, like I said, I hope this will become an annual event. We have a little bit more time to prepare. We've kind of worked out the kinks after this year and yeah, looking forward to both the game and the post-party. Both corps hope to make this an annual event. From Washington, I'm Sergeant Andrew Milner.


Hey everybody. Hello from New York and spending a bunch of days here. It's my pleasure to see all your faces again. I'm going to do a quick overview of the dashboard that I've been building that allows us to keep better track of client growth, answer questions like who are our users, where they come from, how are they engaging with our products, where are they blocked, and ultimately where are the those blockers translated into opportunities for new features and products that help us scale the network. So as you might remember the next slide from a previous conversation, the TLDR here is can we actually start answering these questions in a data-driven way? As a growth practitioners, we are held accountable by the metrics we set and we have to really deeply understand the whole user journey coming from product marketing through to data cap provisioning and then ultimately how they're actually using our product. And so my launchpad project was around wearing my data scientist hat yet again. Deep was making a great joke yesterday. He was saying, you don't go to SQL. SQL comes to you.  So the next slide gives you a good sense of like the different places where I'm drawing information from. This has essentially been a really productive collaboration with the Sentinel team that is building an awesome PL data warehouse and figuring out ways in which we can use five-time connectors, for instance, to integrate all these different things into a common place where we can actually build out a suite of really clean databases with easy to use primary keys at a client level, at a deal level and actually understand the full end to end flow of our users across the data onboarding experience. This is the first version of the client dashboard. There's been actually a bunch of changes made under the hood since we last saw each other two weeks ago.  So in this first section, we can answer the question, how are our users finding us and what are they interested in? I'm about to integrate Google Analytics too, so you get a good sense of like the actual places where they're actually on the Internet, where they're finding us. Over here, we get to see some information on data cap provisioning, some crucial metrics like time to data cap, which refers to the time between someone requesting some data that they want to upload through the FieldPlus program and the time where they actually get that data cap. So you see a nice kind of trend here where we are reducing the time necessary to provision the data cap necessary, keeping an eye out on the various requests and what state they're currently in. And then crucially, I call a few different funnel views. One here, I think, is an extremely useful view of how on a weekly basis, our clients are segmented into their different sizes. In other words, how much data have they uploaded so far. And so this is really interesting to see that growth is coming from both people who are just beginning to upload, but also people who have uploaded a significant amount. And this allows us to see where we might put in some of our resources, investing into more of the product marketing early stage, aha moment, versus making it easier to upload data at scale. Because believe me, it's not easy to upload one heavy byte of data. All this culminating with a few things, understanding who our clients are. The National Library is uploading 500 terabytes of data this week. How can we support them down to the people who are actually uploading for the first time? So all in all, this is something that was built with I think a lot of metrics attention. And we are going to, in the next steps, try to integrate things more, document a bunch of things, automate the production of a couple of weekly reports, and hopefully create the space for a data analyst maybe, or in general, create the space for everybody at PL to come in, understand how our growth is actually growing, and really make our, you know, get to a great place where our demand side scales. Thank you so much.


So, welcome to the Dr. Gundry podcast. Today we're sitting down with nightclub owner turned philanthropist, Scott Harrison, who's been a friend of mine for a couple years now. He's got a remarkable story about how he found a way to bring clean water to 8.5 million people. Scott's the founder of the Clean Water Nonprofit Charity Water, and we've actually worked together on a number of projects. So thanks a lot for joining us, Scott. Hey, it's good to be here. Thanks for having me on. It's nice to see you. Good to see you again, and I'm going to see you in a little over a month for the annual fundraiser. Yes. We're so excited. I'm so glad you and Penny are coming up for it. It'll be great. Great. We've been working on it for months. We have a big idea. All right. Great. So here's Scott's book, and it's called Thirst, and it's going to be available. We're actually right about the time you're viewing this podcast. So Scott, I was telling you before we started that I read this on the plane a couple weeks ago, and Penny, my wife read it, and we couldn't put it down. Tell me, in 25 words or less, no, not really, how this came about. And tell me your story, because this is not about just water. This is Scott's history, and take us on the roller coaster. Yeah. Well, okay. So I think kind of three acts to my life. The first act was growing up in a suburban family. I was born into a middle-class family. My dad was a business guy, and my mom was a writer. And when I was four, we moved into this house, a new house in South Jersey. And unbeknownst to us, there was a carbon monoxide gas leak. Now this was almost 40 years ago. They had not yet invented the detector that we go buy in blister packs at the Home Depot. And we just didn't know this. My dad and I start getting some symptoms. My mom on New Year's Day, 1980, walks across the bedroom, and she collapses unconscious. And it took a series of blood tests to identify huge amounts of carboxyhemoglobin, carbon oxide, in her bloodstream. And thankfully, she didn't die, but her immune system was irreparably destroyed, so she was never the same again. And I watched my mom go from this healthy, vibrant, a picture of health to an invalid wearing charcoal masks, walking around with oxygen tanks, living in a containment room covered in tinfoil. So just weird stuff. And her body just became unable to fight off anything chemical, whether it be perfume or carfumes or the ink from books. And some people thought this was in her head, but she knew it wasn't. And family planning stopped, and I just grew up that good kid taking care of mom, doing the cooking, doing the cleaning. I played piano and church every Sunday, and I played by the rules. I didn't smoke. I didn't sleep around. I didn't drink. I didn't cuss. And then I was 18, happened, act two. Moved to New York City, joined a band, grew my hair down past my shoulders, which was a terrible idea, looking back at photos now. And after moving to New York City to be rich and famous and sex, drugs, and rock and roll, really to explore the opposite of my life, I became a nightclub promoter, and I just couldn't believe that there was an actual profession where you could get paid to drink. You could professionally drink and make hundreds of thousands of dollars doing this. And all you had to do was fill up the right nightclubs with the beautiful people and then the people with money, and you could charge $20 for a vodka soda, or you could charge $1,000 for a bottle of champagne that cost $50. So for the next 10 years, I began climbing up the social ladder, trying to become the king of New York nightlife, and I worked at 40 different nightclubs over that time. Work, work, work, work, work. Well, I mean, it didn't feel like work, right? You're partying three nights a week. I'm flying around in Milan and Paris, and it's fashion week, and I'm collecting all of the different things that I thought would make me happy. The BMW, the Rolex watch, the model girlfriend, and the cover of fashion magazines, the grand piano in my New York apartment, the Labrador Retriever. And you can also imagine, I picked up all of the vices that would come with the territory. So at 18, I start smoking Marlboro Reds, and I smoke two to three packs a day for 10 years.  I mean, you name it, I've got it all. The American dream. The American dream, right? And then, OK, you're going to love this. 10 years in, half my body goes numb. Inexplicably. My business partner in the nightlife is like, dude, why don't you chill on the coke, why don't you chill on the cigarettes? You're not exactly a picture of health here. But I start seeing neurologists.  They're attaching wires to my arms and my legs. And I just can't feel anything. I mean, I'll have these episodes where I put my hand under boiling hot water, and I just can't feel it. I could have hit it with a hammer. And this was a real awakening for me. In some ways, I was just faced with mortality. I mean, I was living like I was going to live forever. Nothing could stop us.  And I go to South America around this time, and I have this amazing vacation, and we've rented a compound, and there are servants, and there are horses. We spent 1,000 bucks on fireworks that we just blow up next to the pool. Magnums of Dom Perameal. And it doesn't get any better than this. And I realized that kind of suddenly, but almost in a moment, I had actually become the worst person that I knew. I was morally decrepit. I was morally bankrupt. I was spiritually bankrupt, and I'd come so far from any shred of faith or spirituality that I'd actually been brought up with. And besides the health problems, if I actually continued down this path, if I even lived to the age of 40, which was dubious, the legacy I was leaving was perhaps the most meaningless legacy on Earth. My tombstone might actually read here like Scott Harrison, who's gotten millions wasted. And I knew I needed to make a change. And let me interrupt you with that. All through this, as you write in the book, your devout Christian parents, I don't want to put words in your mouth, but you're kind of mocking them. And at the same time, they've got prayer groups organized for you. Yeah, they're on their knees.  They have those little old ladies wearing the hole in the carpets and just praying for the prodigal to come home. I'm living out the cliche of the prodigal son. I gave my finger to my family. I gave my finger to the church and said, now it's my turn. And I wound up in the proverbial pig pen. It didn't work out well. And I wanted to come home. And that's what happened. So at 28, I asked myself, well, what would it look like to come back to faith? What would it look like to come back to morality, to virtue? And the specific question I asked myself was, what would the exact opposite of my hedonistic, sycophantic, selfish life look like? What would the 180-degree turn? Not the pivot, not the 20-degree turn of the 45. What would it look like to walk so far in the other direction? And the only thing I could think of was to quit nightlife, leave it all behind. And there was an incident I write about in the book that made that pretty easy with guns and drugs and lots of stuff involved, to leave it all behind and to try to give one year back in service to others, to go serve the poor, to see if I had anything to offer. And I wanted to do that in the poorest country in the world, in my mind. And I also realized I would have to quit those vices.  I would have to clean up my life in a dramatic way to even allow a new story to unfold. And that whole thing took about six months, but being a pretty radical guy, there was a moment where I sold all my possessions. I put 2,000 DVDs up on eBay in a single lot. And I began applying to things. Pornodebodies, right? Dude, like all of it.  Yeah, let me stop you again. So I take care of lots of addicted individuals or formerly addicted individuals. And there's usually this epiphany where you hit rock bottom. And it's usually, it's often financially. You're on the street, you've lost everything. When I read your book, you kind of did this. You didn't have that sort of rock bottom epiphany. One of the things that struck me, you had taken a video camera down to South America. And as I recall, I guess we're watching your friends kind of through the lens of the camera. And we're just kind of appalled at actually seeing what you and your friends had become. Was that a big turning point in your life? Yeah, it's almost, it was a moment of clarity. And I think, you know, in some ways, I hit bottom at the top, right? I hit bottom in a compound with the beautiful people. And I remember one guy with us was gambling $10,000 hands of blackjack. And like he just didn't care if he won or lost. Right, so it was almost this veil that was lifted that I realized there would never be enough. Somebody would always have a more beautiful girlfriend. Somebody would always have a better watch, a better car, better status, you know, a private plane. And that this pursuit would lead to, you know, even deeper and deeper unhappiness. And there was something about, you know, having the camera as that shield between me. You know, there was a moment where someone was like, yo, film this, film this. And I'm like, what's this?  Like there's no this, there's no there there. You know, like this is amazing. Like what's amazing? We've been up for, you know, 14 hours. It's 2pm. Other people were like, you know, going to yoga. Like, you know, we should be going to bed. And yet the DJ is pumping and you know, the drugs are pulsing. So yeah, it was this moment of clarity. And then, you know, I had this amazing foundation that my parents had provided for me. I had the backing of 10 years of prayers. And I was able really to turn on a dime and kind of embrace the grace that was there for me. And in a way, turn a clean page and say, I get a do-over. I'm 28, like what is, what would act three look like? And what's been so interesting, and one of the reasons I wrote this book is, you know, I really believe now no one is beyond redemption. You know, no matter how bad your past might be, the mistakes you've made, the shame, you know, or any sort of guilt in that. Chances are you're not as bad as me.  I mean, you know, if this guy could go from, you know, the depths of depravity to lead, you know, a nonprofit that's raised a third of a billion dollars and like is out there teaching about compassion and empathy and radical generosity, like there's a pretty good chance for me. And what's been fun is, you know, so where the story went then, I sold everything I owned, I applied to these famous nonprofit organizations that I'd heard of. And then of course, nobody would take me because how would a nightclub promoter in any way be useful to a serious humanitarian group, right? They'd take you, doctors, we know how they're useful, but guys who sell $20 vodka sodas, you know, not so useful in Darfur, you know, the mission, right, the mission to Sudan. So finally, one organization writes me back and says, hey, if you're willing to pay us $500 a month, okay, and if you're willing to go live in Liberia, West Africa, this is a country I'd never even heard of. Like I didn't know where Liberia was or that it even existed. And they said, look, we're leading a team of doctors and humanitarian surgeons and we need a photojournalist. And I said, well, I actually take good pictures. I have a journalism degree at NYU that I've never used and I'm a pretty good writer. So maybe I could tell the 15,000 people on my mailing list, on my guest list. Maybe I could actually tell them a new story, a story that mattered, a story that helped people and didn't just get them wasted. So I accepted this position. The beauty was I had to pay this group $500 a month to serve. So, I mean, if I was looking for the opposite of my life, I found it, right? Not even volunteer for free. No, pay to volunteer and then go live in a war-torn country, the poorest country in the world with a group of amazing doctors who'd volunteered their time. So you're on a medical boat, right? Yeah, 522-foot hospital ship. Like I imagine an ocean liner that someone decided to gut and turn into a state-of-the-art hospital and bring the best doctors and surgeons in the world to people who just couldn't afford access. So the cruise liner would actually sail up and down the African coast, would pull into port, we would have advertised our coming and thousands of people would be gathered to see our doctors. More people than we could even treat than we could bring on the ship. Yeah, I've done surgical missions to Africa, to Zimbabwe and China and India. And you're right, it's, you know, there's more people than you could possibly serve and the conditions, we would actually operate in hospitals, not on a boat, but even there the conditions are just horrendous.  And so what happened to you doing that, that you said, I've found my calling, but maybe this isn't quite my calling. Yeah, I think, and this might help people that are struggling with addiction, you know, or might have some failed attempts of getting out of that. You know, for me, the environment mattered so much.   So nobody was smoking, nobody was drinking. People went to bed at 10 o'clock at night and got up at five. So the environment changed and this, it felt right to me, it felt healthy, it was wholesome, it was a place of compassion and grace and service. So the cool thing for me was, I immediately just start running around with a camera. I take 50,000 photographs that first year and I'm documenting patients before their surgery and after surgery. I'm living in the leprosy colony. I'm traveling around the country, trying to learn as much as I can about the conditions that we're seeing about the root causes of some of the sickness. And I'm emailing the 15,000 people on my club list, these photos and these stories. And of course, some people are like unsubscribe, right? Didn't sign up for that. Too much information. Yeah, way too much, like where's the Prada party again? Where's that party at the Chanel? But most people said, this is amazing. How do I help? I didn't know that there were doctors out there giving their time. I didn't know that there was this ship and that we could sponsor a surgery and help somebody get their life back. So I was almost instantly able to redeem the decade of relationships, that guest list. Email open rates back then were like 100%. So the feedback loop was coming in. And I wound up doing one year, that stretched into two years. And I saw a lot of stuff and I talk about some of this in the book. But the one thing that just stuck with me was when I saw people drink dirty water. When I went into the villages and saw that children were drinking from swamps and from ponds and from rivers, brown viscous chocolate milk looking sludge. Ponds filled with algae and bugs actually crawling on the surface of the water. But yet this is all that they had. And I learned that this wasn't, these weren't isolated villages. 50% of the country was drinking bad water. So half the people in the country where we were bringing doctors into didn't have the most basic need for health men. And you watched, I think you watched a little girl who was, her clothes were brown because everything was washed in brown water.  Imagine seeing that, imagine seeing a child forced to drink from a river because of the conditions she was born into. By no fault of hers. But yet that's the only available water. And then watch a child drink this and then vomit on her shirt. It was horror what we were seeing. And I learned that 52% of the disease throughout the developing world or what some people might call the third world, half of that disease was directly caused by unsafe water, a lack of sanitation, a lack of hygiene. So if I really cared about health, instead of maybe funding another 50 or $60 million hospital ship, what if I went and just tried to provide people with the basic need? What if I tried to go into that country and help the 50% of people drinking contaminated water get clean water to drink? And to me, this was the question behind the question. It was the root cause that I had stumbled into. And I didn't have to be that smart to put it together.  So I came back to New York at 30 and this was gonna be my mission was gonna be to improve people's lives, to end extreme poverty by helping the world, everyone in the world get clean water to drink. And at the time, there were a billion people living without it. So it was one in six humans alive 12 years ago that didn't have clean water to drink. And I'm like, well, we gotta start somewhere. So let's just start. So how, okay. So now you've had this epiphany, you realize you're gonna help the world and blah, blah, blah. So how does Scott Harrison, knowing nothing about this except how to get a lot of people together to go to a party, translate that into this, I mean, this amazing journey on, okay, how do I save the world, Scott Harrison? Yeah, well, okay, I had the issue. And the circumstances at the time were not ideal for starting a charity. It was not the ideal charity startup climate. So I come back and I find them $30,000 in debt because my business partner never paid our taxes nor dissolved our company. And he's like, bro, all the mail's in the bathroom. I don't know, I don't even open that stuff. So if you wanna deal with it, that'd be great. So I immediately get on a payment plan with the IRS and he lets me sleep on his walk-in closet floor of this loft that he was living in. So I actually had free rent at the time, which was something, thanks. I'm running around showing people the photos that I'd taken on my laptop, trying to get them to care, trying to say, look, there is suffering going on. And we can end it. Like, there's a solution. We could go drill a well or build a water system in this village and we could change everybody's health. We could change everybody's lives. Do you wanna partner with me on this? Do you wanna give? And what I learned, and again, having the unique benefit, on paper, I was uniquely unqualified to ever be successful at this. But in some ways, I was actually uniquely qualified because I came from outside the trappings of the institutional system. I didn't know how big charity was supposed to work. And as I talked to my friends, I realized I didn't trust big charities. They were not giving to the huge charities that we might hear about and people would have problems. They had so many problems. Where does my money go? How much of my money actually gets to people? Oh, I bet the CEO is making millions in dollars and hiring his friends and his cousins and his nephews.  And I would hear expressions like the black hole of giving. And I learned there was data behind this. USA Today came across a poll that said 42% of Americans don't trust charities. And NYU polled Americans and found 70% of Americans said they believe charities wasted money or badly wasted money. So this shocks people. I mean, there's people listening right now but America's the most generous country in the world. Like who is more generous than Americans? But yet 70% of the people in the country think charities are misusing funds. So I thought, boy, this is right for disruption. I mean, if I'm gonna make a significant impact on the global water crisis of a billion people, then I'm gonna need to completely, I'm gonna need to create a new model, a new construct. We're gonna have to reimagine the giving and the experience to get these people back to the table. I wasn't interested in poaching other charities donors. If you were happily giving to another org, that's great. But I wanted to get someone who wasn't giving and say, look, you can trust us. You should be giving, you're depriving yourself by not giving out of your abundance and out of the blessing, the privilege that you've been born into. So I had a couple ideas on how to do that. The first was just to create a model whereby 100% of every donation we would ever take from the public would go directly to projects. And as you've read in the book, I mean, opening up two bank accounts, keeping the overhead separate and trying to find people to actually pay that was incredibly difficult. But we believed that if a child sold lemonade and turned in $6 and we could send all $6 to help people get clean water, it would be incredibly powerful. Whether that was $6 or $600,000. So the 100% model became this pillar where we said we'll raise all of our overhead separately, our office costs, our salaries, even our flights, the toner for the Epson copier. That's gonna come from a very small group of business leaders and entrepreneurs who don't mind paying for that stuff. So the 100% model was powerful. The second thing was just let's just prove what we do with the money. Let's just tell people your money went here. Here is the water project that you built. And at the beginning, we were just putting all these projects up on Google Earth and Google Maps. So we would show people the satellite images of these projects as they were built. And we said, we'll prove your money time and time again. And then the third thing I wanted to build a beautiful brand that was not shame or guilt inspired. I mean, so many charities manipulated people into feeling icky, right? You remember those commercials from the 80s with the flies landing on kids' faces and with sad eyes. They look up at the camera and the 800 number comes and they work. But no one tells their friends about those commercials. No one wears the T-shirt. There is a zero word-of-mouth movement when it comes to a charity that makes people feel like that or manipulates them into giving. And the brands I respected, the Nikes, the Apples of the world, they inspired people. Apple would run campaigns of innovators and challenging people to think creatively. And Nike would say, there's greatness within you. You may not think you could ever run that marathon, but we believe in you. You may not ever think you could climb that mountain if you lost an arm, but we know you can. And these were the brands that were hope-filled, that were imaginative, that were inspiring. I wanted to do the same thing with charity. Invite people to be a part of a party, a party where the world gets clean drinking water and say, hey, just think about fundraising. What are the first three letters? Not downer raising, not shame raising, not guilt raising, fundraising. It should be a blessing to get involved in important causes and to help others. And then the fourth thing was just the fourth pillar would have been, we've got to work through local partners. No guy that looks like me should be anywhere near a drilling rig in Africa or India or Southeast Asia. We could raise awareness, we could get people to care, we could get them to be generous, but the work must be led by the locals in each of these countries for it to be culturally relevant for it to be sustainable. It had to be locally led. So our job would be to find these local partners, grow their capacity, and they would get the credit. They would be the heroes. You know, as I played it forward, success would be spending $100 million and helping millions in a country and going there and them having no idea who we were. But knowing and celebrating the local partners who actually made that possible, who turned our money into clean water. So we put these things together. And I say this now, and it just doesn't sound that innovative. You know, it doesn't sound like we are not landing rockets on platforms in the middle of the ocean, but it just worked. It just really worked. And people started to give. And we would hear time and time again that people were making their first ever gifts, often in their 40s, their first ever gifts to charity because they knew where their money was going and they believed in the cause. You know, listening to your story, it's amazing. So you call it fun, but in fact, as you talk about it in the book, there's really nothing fun about digging wells. And one of the wonderful things in the book is you talk about some of the personal challenges with certain wells that turned out to be nightmares. And some of this, one of the things that, you know, it's fun, but tell me about this. There's a wonderful, it's a horrible story about this young, I think 13-year-old girl who broke a pot of water on the way back to her home. And one of the things that is so empowering about Charity Water is, and I'll let you tell the story, but this is more than anything about empowering women and girls. And that's one of the things that really motivates me with two daughters and a wife and three female dogs. So tell me about this little girl and what effect she had on your life and how you had to find this little girl in the village? Yeah, well, you know, just let me start with water as a women's issue. So I've been to 69 countries. I've been to Ethiopia 30 times now. I just never see men get water. It is culturally the job of the women and the girls to get the water. And often that water is five hours away or eight hours away. Often these women are raped on the way to the water source. They're attacked by wild animals or hyenas. They're often giving birth down by that river or swamp because they need the water. And it's a real, real challenge. One stat that I remember from early on had such a deep impact on me was women just in Africa waste 40 billion hours fetching water. And 40 billion hours, you kind of like, no, I don't know how big that number is. It turns out that it's more than every single human being working in the country of France for an entire year. I do realize the slight irony there, but it's a huge like unrealized economy of just wasted time. You know, imagine the GDP that you could put together if that time was turned into productive work. So, you know, I've learned this that water is hugely empowering to women. It's hugely empowering to girls. And, you know, there was this story, it really came at a time when I needed to reconnect with the urgency of the work. I've been making a lot of speeches. I've been out fundraising and trying to build the organization and dealing with recruiting and just, you know, all the stuff that really wasn't the field work at the time. I was in Ethiopia, I was staying in a really crappy, what we call zero star hotel. Although one of my donors called it a negative one star hotel.  I said, yeah. He said, oh, I'm from a village very far away. It's called Meida, a couple thousand people live there. And he said, growing up, there was this woman in our village and she would walk with the other women eight hours a day. He said, one day at the end of her journey, she, like you said, she slipped, she fell, she stumbled and the clay pot that was attached to her back with a rope breaks, she watches her water spill out. And he said, she didn't go back for water. He said, she took a rope, she tied it around her neck and she hung herself from a tree in our village. He said, the village elders found her body swinging there. And I remember he just let that sit for effect in this little restaurant with fluorescent lights. And he said, the work you're doing is important. And he walked back into the kitchen. I remember not believing it. Oh, it's not true, right?  But it really nagged at me and I asked my wife, really permission to go and live off the grid. This was so far out. You know, there was no coverage of any kind. And I wound up flying back to Ethiopia after confirming with our local partners, this story was true, you know, flying up to the North, driving five hours and then hiking nine hours over the mountains to reach this village. And I spent the next week learning about her story. I met her mom, I saw her grave. I met the priest who gave her funeral. I met her best friend who actually walked with her for water that day. She took me down to the water source. And at the very end of it, I saw the tree. And you know, for me, there was no more visceral representation of the urgency of this work than a frail tree that held a 13 year old's body because she'd slipped. And I asked her friend, I said, you know, why do you think she actually killed herself? And her friend said, well, shame. So she says this to her translator, shame translates well. She said, you know, her carelessness meant that her family would have had to go without water that night. And it was even worse. She also broke the clay pot, which was a valuable asset. So she's spilled the water. She's broken the clay pot. It would have been too much for her to face them. And you know, look, I know every single person that's with us right now believes 13 year old girls should not be hanging themselves from trees because they spilled their water. In fact, 13 year old girls shouldn't be walking for water in the first place, walking to some disgusting swamp. So I came back just fired up, like we got to go faster. We need to help more people. We need more donors, more supporters, more volunteers, more partners.  Yeah, and that's exactly right. And that's a good segue. As you know, Gundry MD has so far donated half a million dollars to do 50 plus wells, 50 plus communities. 50 plus wells. And it's all through the generosity of everyone who buys a Gundry MD product. And I've been so impressed. I don't fly to do missions anymore. But I'm kind of living vicariously, I guess, in the mission field with you. Because again, 13 year old girls should be in school, number one. And one of the things that none of us realize is that these girls, because they're carrying water, sometimes four hours, six hours a day, aren't in school. And they certainly shouldn't be hanging themselves because they broke their pot. And just what you've done with all of this, I mean, it's a remarkable story. And not only that, it's really kind of a fun read. Particularly, if you like despicable characters flow. I deliver there, I deliver. Yeah, he delivers really, you really end up really either wanting to party with this guy or really wanting to bring him down. But it's funny. One of our chief water officers who's in the book was sitting with two kind of older conservative donors in Chicago that had just read an advance copy. And he calls me and he's like, he asked them, what did they think of the book? And they're like, he was so much worse than we ever thought. Wow. But I feel like, you know, transparency's our thing.  And I think that you lead with your failures and your mistakes. And hopefully that actually helps people because you're just honest about it. Yeah, now let me bring a touch on something you mentioned. But I think this is so important that you're right. I am very, very distrustful of charities. Particularly, every few years, a big thing of somebody high up in one of the charities, and I won't mention names, is living this lavish lifestyle, is flying first class, great cars, great clothes, great foods, dining out every night. You're in the back of the bus on the airplane. You're not in business class, even though you're not. Unless someone else is paying for it. Ah, well, there you go. If Google's paying for it, I'll take it. But that's true. Yeah, we've raised over $300 million. We have never bought a business class ticket for myself or anyone else at the org because we take stewardship really. That's a value of ours. And I think that's important. And the other thing that's important is this crazy business model of yours is you literally do have two accounts. There's some of us idiots, including me, that say, I'm going to give you some money to buy pens and staplers and turn the lights on. So that when somebody gives you money for building a well, it's not going to go to keep your lights on or even to buy you an economy class ticket. And I think that's such an interesting way. How'd you ever figure this out? Just a lot of listening. Really a lot of listening to people and what they wanted. And so you're being modest, so I'll brag on you. Steven and Penny have actually joined a year ago or so of the 130 families that keep our 100% model intact. So beyond everything you've done with Country Nd, that's really useful. And it's clear, though. So we owe you and Penny transparency, and we need to win your trust. And I just believe that people are open to a lot of value propositions. If I told people right now that my copy machine was broken and we really needed $450 to fix it, $450 would come in right away. People want to meet needs. It's not knowing. It's the opacity. If I tell you, Steve and Penny, our greatest need right now is to hire the next water engineer, to hire the next accountant, you are willing to give to that. So for us, it was just this perfect clarity. There's 100% of the public's money directly to go to projects, then there's this overhead account, and you always know what you get. And now 131 generous families like you have made it possible for over a million people to donate. And people don't know this, but we actually pay back credit card fees. So if someone went online right now and gave $100 with the American Express, I really wish I got the $100, but I get $97. And you guys, the 130 families, make up that $3. What? And we send the intended $100 to the field. So you actually get a fraction of some water projects every single year. For us, 100% really means 100%. And I think integrity is the core value when you're trying to win trust. And there's stories in the book of how we could have compromised that so many times. We were going to go bankrupt at one moment before we touched one penny of the public's money. We missed payroll at other times. We didn't pay ourselves because we said we can never touch that. That is sacred. Our promise is sacred. Integrity has to be at the core of everything that we do. And I think it always worked out for us. There was always when you were willing to die for your values, it's amazing how someone always comes along and kind of, it just works. One last thing, because I think it's so important. Charities, OK, and you talk about building a well in the water discussion now, and everybody's clapping and cheering, and we're having a party. Not like Club 54 or whatever. But here's what is so interesting. You realize that it's one thing to dig a well, but it's one thing to keep that well working. And so you don't just say, OK, we dug you a well. Goodbye. Have a nice day. You now have this incredible system that you guys designed from the ground up to report to you via satellite, what's happening with a well? Does it need a piece? Is it non-functional? And I think maybe that's, I think you're modest, in that that's probably the biggest differentiator between this charity and others. You're continually committed to what you've produced. I mean, look, for us, if we're going to build gungery MD wells, and then we're going to leave and they break, that's not a win for you or your customers. It's not a win for us. But yet that was actually the status quo in so much of the water sector. We build, we train the community, we hand it over, and then we wipe our hands and we move on to the next. And we said, no, we actually want to know that these things are functioning over time. And we tried to solve that problem with technology. We won a big grant from Google, actually. And we started putting our wells online. So we now have over a billion leaders that we're monitoring just from Ethiopia as wells are talking back to us, saying, here's how much water we're generating every single day. And here's when we're broken. And then when they're broken, a local team of mechanics that we've been training now across many of these countries turn up, respond. So imagine like Geek Squad or AppleCare. Like imagine actually, if your iPhone broke and a few days later someone knocks on your door saying, hi, it's AppleCare, I'm here to fix your iPhone. Yeah, I'm here to fix the broken glass. That's the system we're trying. Oh, good, it's broken. That's the system that we're trying to actually design around the world because we think people should have a high quality of service. And then the repairs are actually paid for by the local community. So we kind of subsidize the setup of AppleCare that turns up at your house. But we think you're willing to pay for that screen. We just want to make sure that we know. And the whole Sensor Project is open source. They're incredibly cheap. So a Charity Water Sensor now costs a hundred bucks that's protecting a $10,000 well. And we're now hoping to roll them out in five countries beyond our projects, beyond our portfolio. So the vision for this is actually much more generous. I mean, it's beyond our impact. And we hope that just this technology can help millions and millions of people. Okay, enough about Charity Water. People who are watching you, people who are going to get the book. What are personal takeaways from your life changing experience? What can people get from all of this? Yeah, well, I wanted to share my kind of, I guess, personal redemption arc because I believe no one's past to find them. I talked to so many people who feel like they're stuck, that purpose has been so bandied about. And they're like, well, I don't know how to find my purpose. I do this job every day that I don't like. Or I would hope that there's some glimpses or some things that people can grab on to in the book and say, oh, wow, this is what that might look like for me. And I really would hope to say to people that you could really redeem anything bad and dark in the past, you can turn that for good. Some of the first wells were built by nightclub owners and by DJs. So the same skill that I'd really developed, I was a promoter. I was just promoting something that was wholly dark and unredemptive.  The last 12 years, I've been saying, care about others. Use your time and your talent and your money to end needless suffering. Reach your hand across an ocean, be a good neighbor. Care about your brothers and sisters suffering around the world and your life will have more purpose and your life will have meaning. So I think that one of my favorite quotes that I kind of talk about at the end of the book is this idea of not being afraid of work that is never ending, this idea of work with no end. And I think that if you can position your life to care about others, to figure out what can I do with the blessings in my life, with the abundance, with the new health, that some people are discovering. How can I use that to help others?  When I was serving myself, I was rotting inside. It was absolutely rotting. And even though I had the car and the watch and the girlfriend, I was rotting inside because it was positionally wrong. It was all about me and it wasn't about others. Yeah, and in the end, it's all about others.  Yeah, one of my favorite expressions is the more you give, the more you give. I actually want to get people addicted to giving. When you give and you get that positive feedback loop and you know that something positive has actually happened, it makes you want to give more. And we need more, we need more giving in the world. We actually need more charity in the world. Even though the word has become tainted for so many. Charity means love. It means to serve your neighbors in need and get nothing in return. And I think at any time, certainly that I have lived, we need more love in the world. We need more generosity. We need more grace. We need more people looking after others. And I think at the end of the day, that's really the message, is to find your own path and a way to do that, to do that authentically. And you will live a very different life. And if you'd come in, if you'd run into me over a plate of cocaine 14 years ago at five in the morning smoking my third pack of cigarettes and someone said, this guy one day is gonna be speaking in front of 20,000 people talking about clean water and generosity and this guy's gonna have raised $330 million for clean water. You'd be like, no, no, not that guy, right? And now I have a beautiful wife and I have beautiful children and I get to do this for a living. I get to advocate for others and I get to invite people to bring the best parts of themselves, their passion, their creativity, their generosity into this life-giving thing. And it ends with a day on earth when all of us have clean water to drink where every single person alive has their most basic need for health met.  And our biggest, you know, look, there's an element of personal faith in it. Charity Water has always been a secular organization. You know, the thought to me that you would have to, you know, pray to the God I pray to or do what I do on a Sunday to either work here or contribute is just crazy to me. The vision is just too big. So I get to live out my personal faith and my personal theology through my work, through serving others, through bringing clean water to people. But, you know, we have Muslims, Muslim school kids during Ramadan send in $60,000. We've had synagogues write us letters and say this is the first non-Jewish organization we've given to in the history of our synagogue but water and the 100% it's too compelling. As you said, like our biggest donor who's given over $15 million, you know, thinks I'm praying to a figment of my imagination but he's been with me to 11 countries now and he's brought his children along and he's one of my closest friends. So yeah, that's been, it's been a very big tent. Everybody can agree to agree on clean water. People shouldn't be thirsty, you know? And I think we should end with that. Folks, get this book, it's a good read. You're gonna, you're gonna get involved in this. It's even got pictures in it if you wanna see pictures. And normally we answer a reader's question but I think in the interest of time I'm gonna save it for our next time. And it's got- And let him know, all the money goes to charity water. So I don't, I turned over the book advance, the all my author proceeds that is all going to actually help people get clean water. So just by buying the book, they're actually helping people.  So- I'm extreme.  You gotta be pretty extreme. You gotta love this guy. So, and I love the book. So get it, it'll be out in your bookstores, Amazon, Barnes & Noble, go for it. And Scott, pleasure, I'll see you next month and keep up- Yeah, wait. Thanks for having me on. This is Dr. Gundry and I'm always looking out for you and charity water.