The times, they are a-changin’ (and bringing new syndromes)

If your doctor told you that she was giving you a placebo and that it would help you, would you believe her? As it turns out, based on new research, maybe you should.

Placebos are often considered “fake” treatments. You may have heard them described as “sugar pills.” They usually take the form of pills, injections, or even entire procedures that are used in clinical trials to test “real” treatments. For example, one group of study participants is given an active drug and another group is given a placebo, which looks exactly like the active medication but is completely inactive. The participants can’t tell whether they’re getting the fake drug or the real drug. The researchers wait to see if the people taking the real one do better (or worse) than those taking the fake one.

To complicate matters, there is a documented “placebo effect,” which means that some people actually respond to a placebo even though it shouldn’t have an effect on the body. This has been thought to be largely due to their beliefs or expectations that they are getting the real treatment and not the fake one. But what if people were told, up-front, that they were getting a placebo and not an active medication? It stands to reason the placebo would have no effect. Right?

Wrong.
What an “open-label placebo” can do for you

Dr. Ted J. Kaptchuk, a professor of medicine at Harvard Medical School and director of the Harvard-wide Program in Placebo Studies and the Therapeutic Encounter (PiPS) at Beth Israel Deaconess Medical Center in Boston, has been studying placebos for more than 20 years. His most recent work on these “open-label placebos,” as they’re called, is fascinating. I had a chance to interview him in person earlier this year.

In one study, Kaptchuk looked at people with irritable bowel syndrome (IBS), a common condition that causes abdominal cramping and diarrhea or constipation that can be debilitating for many. Half of the study volunteers were told they were getting an “open-label” placebo and the others got nothing at all. He found that there was a dramatic and significant improvement in the placebo group’s IBS symptoms, even though they were explicitly told they were getting a “sugar pill” without any active medication.

Kaptchuk says placebos won’t work for every medical situation—for example, they can’t lower cholesterol or cure cancer. But they can work for conditions that are defined by “self-observation” symptoms like pain, nausea, or fatigue.

“People can still get a placebo response, even though they know they are on a placebo,” he adds. “You don’t need deception or concealment for many conditions to get a significant and meaningful placebo effect.”
Are open-label placebos a promising new strategy?

Kaptchuk says more research is needed — and some is currently under way. He has another study at the Dana-Farber Cancer Institute studying cancer-related fatigue. And a recent study overseas looking at open-label placebo for chronic low back pain looks promising. If placebo works for chronic pain, explains Kaptchuk, it could allow patients to reduce their doses of opioid medications and help prevent addiction.

“Our hope is that in conditions where the open-label placebo might be valuable, instead of putting people on drugs immediately — for depression, chronic pain, fatigue — that people would be put on placebo,” says Kaptchuk. “If it works, great. If not, then go on to drugs.” Antibiotic resistance occurs when bacteria mutate to “outsmart” or resist antibiotic medicine, making the bacterial infection more difficult for doctors to treat and cure with standard medications. According to the Centers for Disease Control and Prevention (CDC), more than 2 million people are infected with antibiotic resistant bacteria every year, and more than 23,000 people die from these infections.

While some bacteria become resistant to a particular antibiotic, other, more dangerous strains have grown resistant to almost every treatment option. This means that doctors must use stronger and less common antibiotics to treat these infections. But a recent discovery now has doctors concerned about the success of even these last-resort antibiotics.
The appearance of a serious superbug

In May, a woman in Pennsylvania became infected with a form of E. coli infection resistant to the drug colistin. Colistin is usually reserved for infections that don’t respond to the strongest antibiotics. Scientists from the Multidrug Resistant Organism Repository and Surveillance Network (MSRN) at the Walter Reed Institute of Research (WRAIR) showed that a gene called mcr-1 was responsible for the bacteria’s resistance to colistin.

MCR-1 is found on a plasmid, which is a portable piece of DNA that can replicate on its own. The presence of mcr-1 means that the bacteria can develop a resistance to colistin, weakening its effectiveness as a treatment. “This development is distressing because colistin is a drug that most doctors will never need to use but it’s nice to have in your back pocket, just in case,” says John Ross, MD, an assistant professor of medicine at Harvard Medical School. “If there is a potential that bacteria can become resistance to colistin, it’s kind of like losing your security blanket.”

As more cases of bacteria with mcr-1 are discovered around the globe, many doctors are concerned that this gene could transfer to a type of bacteria known as carbapenem-resistant bacteria, or CRE, that is resistant a group of antibiotics called carbapenems. When an infection doesn’t respond to carbapenem, doctors normally use colistin. But if a plasmid-carrying mcr-1 transfers to CRE bacteria, then these bacteria would be resistant to both carbapenem and colistin, says Ross. If this happens, CRE would become a superbug –– it would be completely resistant to all forms of antibiotics.

Although the creation of a CRE superbug would cause problems in hospitals where bacterial infections are more common, CRE infection is rare, as there are fewer than 600 reported cases each year.
Explaining the rise in antibiotic resistance

There are multiple factors that are speeding up the process of antibiotic resistance:

    Antibiotics in agriculture. Today, the most widespread use of antibiotics occurs on farms. According to the CDC, using antibiotics in food-producing animals has contributed to the rise of antibiotic resistant bacteria in animals, which are then transferred to humans when we eat foods from these animals like meat or milk.
    Evolution of bacteria. Currently, bacteria are evolving to develop resistance to antibiotics faster than we can create new medicines to treat them, leaving doctors with fewer tools in their arsenal to fight against bacteria.
    Overuse of antibiotics. Many people take antibiotics when it isn’t medically necessary. “Most upper respiratory tract infections, whether it’s a sore throat or sinus symptoms, are due to viruses and will get better without the use of antibiotics,” says Ross.

Protecting yourself and your family

The appearance of super bugs doesn’t mean that healthy people will suddenly become infected with different types of untreatable infections. The threat of antibiotic resistance is much larger in hospital settings, especially in people who are recovering from surgery or have weakened immune systems. Falling short of creating brand-new medicines to treat bacterial infections, doctors urge patients to take antibiotics only when absolutely necessary.

“Often times people with an infection will feel better without antibiotics, and antibiotics, in a lot of cases, won’t speed up the process of getting better,” says Ross. “We need to have a conversation about how we can limit antibiotic use as a society as a whole.” The results are in from the 2015 National Youth Risk Behavior Survey (YRBS). There is a lot to celebrate — but there are also some trends that parents, and everyone who spends time with or works with teens, should know about.

The YRBS is a nationwide survey of high school students conducted every two years. More than 15,000 students participated in the 2015 survey. The point of the survey is to monitor behaviors that can put the health and safety of teens at risk. It’s a confidential survey that allows teens to admit to things they might not want to admit to their parents and teachers. The more we know what is going on, the more we can put things in place to keep teens healthier and safer.

Here’s the good news:

    Cigarette smoking among teens has dropped to its lowest level since the survey began in 1991. Back then, 28% smoked; in 2015, that number was 11%.
    Soda consumption is down too; the percentage of teens having one or more sodas a day dropped from 27% in 2013 to 20% in 2015.
    Physical fighting is also the lowest it’s been since 1991; it has dropped from 42% to 23%.
    Fewer teens are having sex. In 1991, 38% of high schoolers reported having had sex; in 2015 that number was 30% (down from 34% in 2013).

This is all good news. But there were also some worrisome trends:

    While they aren’t smoking as much, they are using e-cigarettes more: 24% reported using one in the past month. This could lead to nicotine addiction and other health problems.
    They aren’t getting into fights, but they don’t necessarily feel safer: 6% of students reported missing at least one day of school in the past month because of safety concerns.
    They are having less sex, but they aren’t using condoms: after going up in the late 90s and early 2000s, condom use has dropped from 63% in 2003 to 57% in 2015.
    Not surprisingly, technology is leading to some risky behavior:
        Computer use for more than 3 hours a day (for non-school stuff) has nearly doubled, from 22% in 2003 to 42% in 2015. That’s a lot of sedentary time.
        Among teens that drive, 42% report texting or e-mailing while driving in the past month. That is terrifying.

If you have teens in your life, talk to them about this survey. Find out what they are doing — and talk to them about making choices that keep them safe and healthy, not just now but in the future too. These aren’t easy conversations to have, but they are incredibly important. They could literally save lives.

Even more than conversations, as a society we need to work to put education, laws, services and supports in place to be sure that we are doing everything possible to take care of our youth. They are our responsibility, and our future. When are symptoms due to a medical condition, and when are they just a part of life? That’s the question that came to mind as I read about “computer vision syndrome.”
So, what is a syndrome, anyway?

Before considering the health hazards of working long hours in front of a computer screen, it’s worth asking what a syndrome is. In medicine we often use the word syndrome to describe a group of features, such as symptoms, examination findings or test results, that tend to occur together but without a clear enough understanding of their cause to be considered a specific disease.

Some syndromes are described by the part of the body involved: carpal tunnel syndrome, for example, is caused by the compression of a nerve in a narrow part of the wrist called the carpal tunnel. Other syndromes are named for the person or persons who were among the first to describe them: Down syndrome is a genetic disorder named for the British physician Dr. John Langdon Down, who described it in 1862 — well before its cause (an extra copy of chromosome 21) was recognized. Still others are named for the problems they cause. For example, restless legs syndrome” tells you a lot about the symptoms that people with this condition experience. But in many cases, the difference between calling a condition a “syndrome” and simply describing a cluster of symptoms is more about language than about science or medicine.
Eye strain? Or computer vision syndrome?

My medical dictionary lists more than 600 conditions as “syndromes.” Well, now we can add one more: a recently published report describes a new syndrome: “computer vision syndrome.” This is a condition increasingly recognized among people working long hours on a computer who complain of eye problems including:

    dryness
    blurry vision
    double vision
    a burning sensation in the eyes.

Symptoms may be severe enough to interfere with continued computer work.
Is computer vision syndrome a major public health problem?

The authors of the report suggest that up to 70 million people worldwide are at risk for computer vision syndrome. And this number is likely to grow, considering the large (and increasing) numbers of students and employees who rely on their computers for many hours each day. According to the researchers, up to 90% of people who use a computer for prolonged periods of time will report one or more of these symptoms. And that’s not counting other health problems linked to extensive computer use, including back, neck, and shoulder pain; carpal tunnel syndrome; and headaches. Together, it’s enough to make you view an ordinary computer as a potential health hazard.
Why are vision problems so common with computer use?

The authors of this paper suggest several explanations for computer vision syndrome:

    The text and images on a computer screen are made up of pixels with blurry edges. The eyes have to work harder to focus on them compared with text and images on a printed page. This may lead to eye strain.
    Reduced blinking is another potential issue. People tend to blink less frequently than usual when working on a computer. (Normally, we blink about 17 times a minute, but this often drops to 12-15 times a minute during computer use.) Less blinking can lead to dryness.

What’s to be done?

There are a number of ways to combat computer vision syndrome:

    Don’t sit so close. Ideally, the computer screen should be about two feet away from your face.
    Position the monitor well. Experts recommend that the center of the monitor should be 4 to 8 inches lower than eye level. Looking down a bit while working means the eyes are less exposed and therefore less likely to become dry.
    Optimize contrast. Black text on a bright white screen is best.
    Minimize glare. Dimming overhead lights, lowering window shades, using an anti-glare flat-screen monitor, and wearing special glasses can all be helpful.
    Take breaks. Try the 20-20-20 rule, for example: take a 20-second break every 20 minutes and focus your eyes on something at least 20 feet away. While you’re at it, stretch your neck and shoulders.
    Combat dryness. Blink often and use moisturizing eye drops if necessary. Avoiding air drafts and using moisturizing compresses can also help.
    Change the font size. Use a larger font or magnify the viewing display if that makes it easier to see.
    Get your eyes checked at least yearly. Many people strain their eyes while using their computers because their prescription for glasses or contacts is outdated. Let your eye doctor know of any problems you’re having. Bifocals or progressive lenses can make a big difference, especially if you do a lot of moving back and forth between the computer screen and printed material.

What’s next?

Computer vision syndrome may be the newest technology-related threat to public health, but new syndromes related to changes in how we work and play is nothing new. I recall a form of tendinitis called “Blackberry thumb” being described as a “scourge” in 2005, when texting on the new wireless device was becoming common. It’s a reminder that as our technology changes, some impact on our health is probably inevitable.

And whether we consider it a new disease, a new syndrome, or just a part of working long hours in front of a computer screen, the most important thing is to recognize the problems described by computer vision syndrome and take measures to prevent and treat them. That’s particularly true because computer vision syndrome may be the latest technology-related syndrome to be described, but it probably won’t be the last.

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Your best cycling days may still be ahead

As parents, we think that if there is anything our children have, it’s time. After all, they are still young; there is time for them to succeed, find love, and stay out of trouble. It’s okay if they are a bit overweight, prefer French fries to salad and video games to soccer games; when they are older all that will change, and they will be fine.

They may succeed, find love, and stay out of trouble — but increasingly, research says that if they are overweight with poor eating and exercise habits, they will stay that way.

A study recently released in the journal Pediatrics followed about 500 10th graders for four years and found that less than 9% of them got the recommended 60 minutes of moderate-to-vigorous physical activity every day — and while they got a bit more exercise in 11th grade, the numbers went steadily down afterward, especially those who didn’t go to a four year college or who went to college but lived at home.

Overweight children are simply more likely to turn into overweight adults — that is becoming abundantly clear. Currently two-thirds of U.S. adults are overweight; a third of them are obese. And what is also becoming abundantly clear is that overweight adults are very likely to stay overweight. A study of almost 200,000 obese men and women in the United Kingdom, published in 2015 in the American Journal of Public Health, found that the probability of achieving a normal weight was about 1 in 210 for men and 1 in 124 for women. Even just losing weight was tough: among the most obese, the odds of losing 5% of body weight were 1 in 8 for men and 1 in 7 for women.

A lot has to do with biology; more and more, we are beginning to understand how the actual chemistry of our bodies can be changed by our diets, in good and bad ways. A lot has to do with our lifestyles and what we come to think of as normal. We are remarkably sedentary as a culture, portion sizes have grown, and we eat far too many processed foods. A lot, sadly, has to do with the growing divide between rich and poor; having access to healthy foods and both the opportunity and time for exercise, is clearly tied to income.

And all of this, every last bit of it, starts in childhood — as early as infancy, even before birth. The best and most effective way to fight obesity is to prevent it — or, if we can’t do that, to catch it early.

That’s why we need to stop thinking that our children will have time to slim down and get healthy—and stop thinking that it’s up to them, not us.

We need to take action as a country and create more access to healthy foods and exercise generally. We need to take a much harder look, too, at how our food is produced and sold. But as parents and communities, we need to be much more proactive than we currently are. It should really bother us that less than 9% of youth get enough exercise. We should be alarmed, actually — alarmed enough to turn off the screens and get them moving. It doesn’t have to be an organized sport or going to a gym; just playing outside or going for a walk could make a huge difference.

I think that’s what bothers me the most as a parent and a pediatrician: how little this bothers us. We are growing not just overweight, but complacent; we are accepting a new normal that is setting our children up for heart disease, diabetes, cancer and other health problems. We are accepting that our children may have shorter lives than ours. It was February, and clinic was teeming with respiratory infections of all kinds: mostly the common cold, but also bronchitis, pneumonia, and sinus infections. The patients were coming in usually thinking that they needed antibiotics for their sinus infection, or another respiratory infection.
The first patient on my schedule was a healthcare provider with “sinus infection” written down as her main issue.* She’d had about two weeks of nasal and sinus congestion which she blamed on a viral upper respiratory infection (URI, also known as the common cold). Her two young kids had been sick with colds all winter, so she wasn’t surprised to have these symptoms, along with endless postnasal drip and a cough.

Her congestion had improved a bit at one point, and she thought that she was finally getting better. But then, the day before her appointment, she awoke with throbbing pain between her eyes, completely blocked nasal passages, and, more concerning to her, green pus oozing from her left tear duct. She had body aches, chills, and extreme fatigue. “Do I maybe need antibiotics?” she asked.
Most sinus infections don’t require antibiotics

Ah, sinus infections. The New England Journal of Medicine rpublished a clinical practice review of acute sinus infections in adults, that is, sinus infections of up to four weeks. The need for an updated review was likely spurred by the disconcerting fact that while the vast majority of acute sinus infections will improve or even clear on their own without antibiotics within one to two weeks, most end up being treated with antibiotics.

It is this discrepancy that has clinical researchers and public health folks jumping up and down in alarm, because more unnecessary prescriptions for antibiotics mean more side effects and higher bacterial resistance rates. But on the other hand, while 85% of sinus infections improve or clear on their own, there’s the 15% that do not. Potential complications are rare, but serious, and include brain infections, even abscesses.
But sometimes, antibiotics for sinus infections are needed

So how does one judge when it is appropriate to prescribe antibiotics for a sinus infection? There are several sets of official guidelines, which are all similar. When a patient has thick, colorful nasal discharge and/or facial pressure or pain for at least 10 days, they meet criteria for antibiotic treatment. If a patient has had those symptoms, but the symptoms seemed to start improving and then got worse again, then even if it’s been less than 10 days, they meet criteria for antibiotic treatment. (That’s referred to as a “double-worsening” and is a common scenario in bacterial sinus infections.)

The authors, however, also suggest that doctors discuss “watchful waiting” with patients and explain that most sinus infections clear up on their own in one to two weeks, and it’s a safe option to hold off on antibiotics. The symptoms can then be treated with a cocktail of over-the-counter medications and supportive care, like nasal saline irrigation, nasal steroid sprays, decongestants, and pain medications.

Of course, many patients expect and demand antibiotics for sinus infections, and even those who are open to watchful waiting may hear about the rare but possible complications of things like, oh, brain abscess, and opt to treat.

In the case of my patient above, she met criteria for treatment. She weighed the watchful waiting option against the potential risks of antibiotics for her sinus infection, and chose the prescription. I can tell you from very close follow-up that she improved quickly, though in truth, we will never really know if she would have gotten better anyway.

*This is a real case, details recalled as accurately as possible, based on my own experience as a patient with a sinus infection, originally posted here. Are you reading this while standing at your desk? There’s a good chance that you are — standing desks are all the rage.

These desks allow you to work at your “desk job” while standing rather than sitting in a chair. They can be custom built (for thousands of dollars) or you can convert a regular desk into a standing desk at no cost by elevating your computer — one of my colleagues simply placed his computer on a stack of books. Sales of standing desks have soared in recent years; in many cases their sales have far outpaced those of conventional desks.

Personally, I love the idea — rather than sitting all day staring at a computer screen, surely it would be better to be standing (while staring at a computer screen). But, I also love the idea of studying some of the assumptions surrounding standing desks. A common one is this: certainly it takes more effort — and extra calories — to remain upright rather than sit, and over a course of days or weeks those extra calories would add up to something significant. But is it true that a standing desk can help you avoid weight gain or even lose excess weight?

That’s just what researchers publishing in the Journal of Physical Activity and Health tried to answer. (Yes, there is such a journal.) They fitted 74 healthy people with masks that measured oxygen consumption as a reflection of how many calories they burned while doing computer work, watching TV, standing, or walking on a treadmill. Here’s what they found:

    While sitting, study subjects burned 80 calories/hour — about the same as typing or watching TV
    While standing, the number of calories burned was only slightly higher than while sitting — about 88 calories/hour
    Walking burned 210 calories/hour.

In other words, use of a standing desk for three hours burns an extra 24 calories, about the same number of calories in a carrot. But walking for just a half hour during your lunch break could burn an extra 100 calories each day.

Prior reports of the calories burned by standing versus sitting suggested a much higher calorie burn rate for standing, but this new study actually measured energy expenditure and likely represents a more accurate assessment.
Reasons to stand by your standing desk

While the new study suggests that a standing desk is unlikely to help with weight loss or avoiding weight gain, there may be other reasons to stand while you work. Advocates of standing desks point to studies showing that after a meal, blood sugar levels return to normal faster on days a person spends more time standing. And standing, rather than sitting, may reduce the risk of shoulder and back pain.

Other potential health benefits of a standing desk are assumed based on the finding that long hours of sitting are linked with a higher risk of

    obesity
    diabetes
    cardiovascular disease
    cancer (especially cancers of the colon or breast)
    premature death.

But “not sitting” can mean many different things — walking, pacing, or just standing — and as the new study on energy expenditure shows, the health effects of these may not be the same. For most of these potential benefits, rigorous studies of standing desks have not yet been performed. So, the real health impact of a standing desk is not certain.
If you’re going to stand at your desk…

Keep in mind that using a standing desk is like any other “intervention” — it can come with “side effects.” For example, if you suddenly go from sitting all day to standing all day, you run the risk of developing back, leg, or foot pain; it’s better to ease into it by starting with 30 to 60 minutes a day and gradually increasing it. Setting a timer to remind you when to stand or sit (as many experts recommend) can disrupt your concentration, reduce your focus, and reduce your efficiency or creativity. You may want to experiment with different time intervals to find the one that works best for you.

It’s also true that certain tasks — especially those requiring fine motor skills — are more accurately performed while seated. So, a standing desk may not be a good answer for everyone who sits a lot at work.
What’s next?

We have seen dramatic changes in the work environment in recent years. These include open floor plans and inflatable exercise balls instead of chairs, as well as standing desks. I have colleagues who have installed a “treadmill desk” that allows them to work on a computer or video conference while walking on a treadmill. There are advantages, and perhaps some risk, that come with each of these changes. But, before we accept them as better — or healthy — we should withhold judgment until we have the benefit of more experience and, ideally, well-designed research. I loved riding my bicycle as a kid, and whizzing along wooded roads with friends on crisp autumn days. For me, the images of blurred leaves and sunshine are still fresh, as are the feelings of freedom, joy, and the wind on my skin. Now, only an occasional bike ride with my children reminds me how much I love cycling.

But there are plenty of reasons to go for a ride, no matter what your age. “It’s fun, it’s socially oriented, and it gets you outside and exercising,” says Dr. Clare Safran-Norton, a physical therapist at Harvard-affiliated Brigham and Women’s Hospital. Plus, cycling is an aerobic activity, it’s easy on the joints, and it helps build muscle and bone.
Back in the saddle

Hopping on a bicycle sounds easy enough, but it can be a little more challenging as we get older, with stiff joints that may make it hard to swing a leg over the top tube of a two-wheeler.

Fortunately, bike manufacturers are responding to meet riders’ needs. One option is the step-through bike, a two-wheeler with a low or absent top tube. “I get emails from people who tell me they’re riding for the first time in 20 years,” says Tony Biria of Biria Bicycles, which in 2002 introduced a bicycle to the U.S. with a top tube that’s just six inches off the ground. Beach cruisers and comfort bikes are also popular among older cyclers. All three of these bike types feature high-rise handlebars that enable you to sit upright; wide tires for a smooth ride; shock-absorbing seat posts; and lower top tubes.

Other bike types include tricycles, which are helpful if you are less stable on your feet; and recumbent bikes that allow you to lean back and ride. “If you have spinal stenosis, a recumbent bike puts your spine in a flexed position and gives you pain relief. But if you have a herniated disk, the bike can make the disk bulge more,” says Dr. Safran-Norton.
Gear up

You can make cycling even safer and more comfortable with special equipment.

Cycling clothes have high-tech fibers that wick away moisture. They are usually neon-colored, with reflective material so you’ll be visible to drivers. Bike shorts have a thick pad or chamois to prevent chafing and provide cushioning.

Bicycle seats (called “saddles” in cycling lingo) are available with extra padding, in wide styles that support the pair of bones you sit on. Go even further with a saddle that relieves pressure on the perineum, the area between those bones, behind the genitals. It’s home to nerves and arteries that supply the lower body, and too much pressure here may cause numbness and tingling in the legs. Pressure-relieving saddles may have a “noseless” or horseshoe design.
Prepare before taking to the road

Getting a comfy bike and all the trimmings isn’t enough preparation to hit the road. You’ll want to consult your doctor first, especially if you have heart disease, arthritis, or thinning bones. “If you have osteoporosis, consider riding a tricycle, which is more stable than a two-wheeler, posing less of a fall risk. I’d advise that you don’t ride a bike if you’ve had a recent fracture. Another fall could make it worse,” says Dr. Safran-Norton.

When riding, remember that the seat height should allow a slight bend at your knee. “You don’t want a straight knee at bottom of the pedal stroke, because the bike could be too tall and you could fall off,” says Dr. Safran-Norton.

Other tips:

    wear a helmet
    don’t use clips to keep your feet on the pedals, which can make injuries worse if you fall
    don’t ride alone
    stick to bike paths instead of the street
    stay hydrated before, during, and after your ride
    and use sunscreen and sunglasses.

Minding these safety tips is crucial. Some evidence suggests that bicycle injuries among people over age 45 have risen dramatically since 1998. But as long as you take precautions, cycling is still considered a safe way to exercise, get around, and have fun.

And remember that having fun is really what this is all about. If you enjoy exercising, you’ll be more likely to do it. In the case of cycling, it may even make you feel like a kid again.

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Raise your heart rate and your mood

The 2016 summer Olympics had its share of exciting performances, upsets, and photo finishes. But for days after Michael Phelps’s first appearance at the games, it seemed all anyone could talk about was “cupping.” It’s an ancient therapy that left multiple circular discolorations on his skin. During “dry cupping,” suction is applied to the skin for several minutes; sometimes it is combined with massage, acupuncture, or other alternative therapies. (“Wet cupping” is similar except that blood is removed by making small cuts in the skin.)

Cupping is supposed to draw fluid into the area; the discoloration is due to broken blood vessels just beneath the skin, much like a bruise. Cupping has been popular in Egyptian, Chinese, and Middle Eastern cultures going back thousands of years, but increasing numbers of people worldwide have been adopting it. Celebrities and athletes have popularized it in the U.S. in recent years.
What is cupping supposed to do?

According to its advocates, cupping is supposed to promote healing and has been used extensively for sore muscles. But that’s only the beginning. Cupping has also been used for

    back and neck pain
    skin diseases such as acne and hives
    lowering cholesterol
    migraines
    knee arthritis
    improving immune function.

And there are many others. If cupping does help with these problems, it’s worth asking: how? From a biological perspective, it’s not clear how the application of suction and drawing blood into an area under the skin would provide all these benefits. A recent review of the treatment describes cupping as a treatment that can strengthen the body’s resistance, restore balance between positive and negative forces, remove disease-causing factors, and promote blood circulation. But exactly how is unclear.
Does cupping work?

A number of studies have examined this question, but unfortunately don’t seem to have  convincingly answered it. In fact, a 2015 review of the evidence found that cupping might provide some relief for chronic neck or back pain, but that the quality of the evidence was too limited to draw firm conclusions.

One problem is that it’s tough to perform a high-quality study on cupping. The best studies are “blinded placebo-controlled trials” in which neither the patient nor the researcher knows which treatment (real or placebo) has been given to a study subject. When medications are studied, coming up with a placebo pill is not difficult; it can be much more difficult to create a convincing placebo comparator for cupping. In addition, pain can be a difficult thing to measure and the placebo effect — improvement related to an expectation of benefit — can be quite powerful.

Still, there have been studies comparing actual acupuncture with convincing but fake (or “sham”) acupuncture.  Similar studies of cupping could be possible. And if cupping truly helped, you may not care if it’s due to the placebo effect.
Are there risks involved with cupping?

Most experts agree that cupping is safe. As long as those treated don’t mind the circular discolorations (which fade over a number of days or weeks), side effects tend to be limited to the pinch experienced during skin suction. It’s quite unusual that cupping causes any serious problems (though, rarely, skin infections have been reported).
So, what’s next?

If you want convincing evidence of effectiveness before trying a treatment, you may want to pass on cupping for now. But if you’d like to try something that’s safe and might help with certain aches and pains (and possibly other ailments), the main downsides seem to be the temporary skin discoloration and the cost — I found estimates online of $30 to $80 per treatment. Some people have it only “as needed” but others may have it monthly or even more often. Future research could prove that cupping is as good as the claims say it is — but we’ll have to wait for the results of high-quality studies to know if it’s true.
New research has shaken up a time-honored strategy for treating advanced prostate cancer that’s begun to metastasize, or spread. Doctors ordinarily treat these cases with systemic therapies designed to kill off metastatic tumors appearing throughout the body. But they don’t use local therapy to treat the primary tumor in the prostate. That’s because the primary tumor — unlike the metastases that it spawns — is rarely lethal. So doctors have been reluctant to give local therapy, such as radiation to the prostate or surgery to remove the organ, if it’s not going to improve the odds of survival.

Now investigators are turning that assumption on its head. According to their findings, men who received local therapy while being treated for metastatic prostate cancer lived longer than those who didn’t, “and that makes a case for being more aggressive in how we manage patients who present with metastatic disease,” said Dr. Chad Rusthoven, a radiation oncologist and assistant professor at the University of Colorado School of Medicine in Denver, and the study’s first author.
Looking back

Rusthoven and his colleagues scoured eight years of data collected by a national cancer registry between 2004 and 2014. Their retrospective study identified 6,382 men who had metastatic prostate cancer at initial diagnosis. All the men were treated with systemic androgen deprivation therapy (ADT) for metastatic prostate cancer, but 538 of them were also treated with local radiation to the prostate. At just over five years of follow-up, on average the men who got local therapy had a median overall survival of 55 months compared to 37 months among those who did not. In addition, 49% of the men who were treated with both ADT and local radiation lived for five years compared to 33% of the men who got ADT alone.

Should the findings be confirmed in studies that monitor survival forward in time, “then standard therapy for metastatic prostate cancer will shift to a comprehensive strategy that includes control of the primary tumor,” said Dr. Ana Aparicio, a medical oncologist at the University of Texas MD Anderson Cancer Center in Houston, who was not involved in the study.
Why this approach might work

Aparicio said that treating the primary tumor makes sense for several reasons: First, since men now live with metastatic disease for longer than they used to, they’re more likely to develop symptoms— pain, urinary obstruction, and infections — that can be controlled with local treatment. Furthermore, mounting evidence suggests that tumors in the prostate release chemical and biological substances that promote the cancer’s spread.

Still, Rusthoven and Aparicio both emphasized that local treatments should only be given to men participating in a clinical trial. Local therapy can have significant side effects, “and moreover we need a better understanding of who benefits from the treatment most,” Aparicio said. Her team at MD Anderson is currently enrolling patients for a clinical trial that provides standard systemic therapy for metastatic disease to one group of patients, and ADT combined with either local radiation or surgery to remove the prostate to another.

Rusthoven said he would only give local therapy outside of a clinical trial to a “select group of young patients with limited metastatic burden who are interested in maximally aggressive therapy and who clearly understand the risks and benefits of that approach.”

“This study suggests a different and very novel way of thinking about how to manage men who present with metastatic prostate cancer,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of HarvardProstateKnowledge.org. “There are other cancers where treating the primary cancer in the setting of metastatic disease has been associated with improvements — and this study provides an important impetus to consider this option both in the context of clinical studies and individualized patient selection.” Last month, I took a 7.5-mile hike near Harper’s Ferry National Historical Park in West Virginia. Thanks to a nearly 1,900 foot-elevation gain, my hike definitely gave me a good cardiovascular workout. But there may be some additional health benefits of hiking, as I learned from Dr. Aaron L. Baggish, associate director of the Cardiovascular Performance Program at Harvard-affiliated Massachusetts General Hospital.
“The nice thing about hiking is that it exists along an entire continuum, from a gentle walk on a flat wooded path to mountain climbing,” says Dr. Baggish. Nearly everyone, regardless of age or athletic ability, can find a hike that offers the right level of personal challenge. And hiking may even offer some unique physical and mental benefits, he says.
One benefit of hiking is more for the core

Like brisk walking, hiking is a good way to improve your cardiovascular fitness, particularly if your route includes some hills, which will force your heart to work harder. Taking a hike on the slightly uneven surface of a trail also provides a natural way to engage the core muscles in your torso and to hone your balance skills. “You usually don’t get that type of lateral motion from walking on a treadmill or riding a bike,” says Dr. Baggish.

However, if you have problems with stability or vision, using walking or trekking poles can give you an added level of security on uneven terrain. Use poles with a spiked metal tip when walking on dirt or grass. Plant the pole out in front of you as you walk to take a little pressure off your knee joints.
Going for a hike can offer natural stress relief?

Yet another benefit of hiking may be the restorative and stress-relieving powers of being outside in nature. A number of small studies hint that spending time in green space — nature preserves, woodlands, and even urban parks — may ease people’s stress levels. Giving the growing consensus that stress contributes to high blood pressure and heart disease risk, anything you can do to mitigate stress is likely helpful. In that realm, the benefits of hiking remain anecdotal, but outdoor enthusiasts tend to agree. “There’s a real sense of peace and composure you get from being outside and away from everything,” says Dr. Baggish, whose own passion is not going for hikes but running on trails in the rugged peaks of New Hampshire’s White Mountains.

Here are his tips to take a and enjoyable hike:

    Bring a map and hike with a partner. A companion is good for both company and safety. If you go alone, let someone know when you plan to return.
    Wear hiking boots. Choose well-fitting footwear with good ankle support. Make sure to break them in with shorter walks so you don’t get blisters when you’re miles from a trailhead.
    Stay hydrated. Don’t forget to take plenty of water along on your hike, especially in warm, sunny weather.

Finding trails near you

Looking for hiking venues? Local, state, and national parks are a good place to start. American Trails is a national nonprofit organization that supports local, regional, and long-distance trails for hiking and other uses; check the “Trails” tab to search by state to find hikes in your area.

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Study Habits of Highly Effective Students

Hey guys. So I hope you guys have had a really great 2018 I’m so full of a cold somehow I’m finishing 2018 feeling no great, but I wanted to sit down and talk to you guys about some of the study habits or the study goals that I have set for myself for 2019 to this time of year when everyone starts to, you know, reflect on that 2018 set goals, set resolutions, stuff like that for the new year.

So I have set myself some habits and goals for studying specifically, it’s what I really want to achieve. And it’s what I’ve noticed that I could do better or things that I sometimes do, I don’t do all the time and I want to make them a habit because I feel that when I do do them I work more productively or I feel better about the work they’ve done. So I’m sharing these because I thought that you might want to hear that.

I put it on my Instagram and you guys were interested. And obviously if you think that they might be of use to you guys, then you can obviously employ them and try and make them a habit for you as well. I have written them down, I’ve got five and I’ve written them on a not so sticky, sticky note because these things like don’t stick anywhere. Okay, so the first one is to use timers. I’ve noticed that when I say set a timer for like half an hour, 40 minutes or an hour or something, I find that I work more productively in that time. Because I have a bit of a time pressure I can just work without timers and that’s what I do most of the time. However, I do notice quite big difference when I put a timer on because it means that in the hour or half an hour, I have to learn some notes that I’ve set myself to learn and without a timer. I’m like there’s no stop on this so I can just you know, take my time.

Time and I will set the duration as I see kind of fit. So if I’m trying to learn like a few sides of writing or some notes or something like actually learn it and get it my brain, then I’ll set myself a good amount of time like 40 minutes to an hour, especially if I if I haven’t read those notes quite recently, and they’re going to be quite new.

And then when I’m trying to draw something, I’ll shorten the time and see how long it takes me to get through something on to just see how much I can say, regurgitate if I’m doing it without my notes, and like half an hour, 15 minutes, something like that. So it’s a way to maximize productivity and to just really get your brain and gear it’s kind of more like an exam situation and what you’ll have at the end of the year because yes, everything is time pressured, it just kind of gets you used to that and I can just set one on my watch. I used to use my phone which is just as good or you can just use the clock on your laptop, anything at all just that one and when that timer goes off you either

Move on something else. You take some breaks, get something to eat, get something to drink. And yeah, I just think it’s a really great way to stay on schedule as well. And to just be more productive. I like it. I really do like time. Oh, so you. Second one is to take more brief breaks. And it’s not to do studying. I know. But it can really help you to reset your mind to like calm your mind, and then prepare you for the next bit of work that you’re going to do. So I’m someone who can very easily just get sucked into working, working nonstop and not giving myself any breaks. I’m most rushing to get things done. I put a lot of pressure on myself to be productive and get everything that I’ve wanted to do that day complete.

I do often try and fill my day so it’s crammed full and I don’t give myself any space or time to just breathe. As you guys know, if you watch and keep up to date on my channel, I have used some meditation

apps recently and on my watch as well, which is actually turning out to be really useful in many ways. It pings at me all the time throughout the day telling me to take a one minute brief break. And so far since I’ve had the watch, it’s really bad. I’ve done it once. However, I do notice that when I do take a brief break, it allows me to just calm you know, just like settle down, let my brain and illusion neurons are firing rapidly, just like calm down for a bet. And even if it’s just a minute, I do notice a difference because I’m not so uptight about things.

When people do come in and I’m studying I often will just be like in the zone and I can’t be distracted. However, if I actually take a one minute out one minute, 60 seconds. It’s nothing it’s not going to change anything, but it’s just gonna make a huge difference. And yeah, I need to really appreciate that. If I do meditate or I breathe for a set time, just think

Nothing I’m trying to my mind and make such a huge difference. So I need to do it more often. Number three, yeah, this one, okay, it’s gonna be hot. This one really hard it is to reduce the time spent on the screen. And the reason why I say it’s hot is because everything or the majority of things that I do on a screen and I’m ready don’t like that. So I love working and I love the fact I put myself on my end and the stuff I do online, but everything is on a screen. I’m walking on a screen.

If I’m reading something on the screen, editing a video on a screen posting Instagram picture up on a screen. Everything is just digitalized. And I know that my eyesight has really deteriorated since I’ve been at university and that’s because I’ve just been reading so much stuff I’ve been looking at things that are very close up I slightly short sighted so she was like fine things and the distance and far away especially things on the screen there looking

Blood well okay

yeah I don’t wear them very often because I only really need them in like lectures or if I go to the cinema sometimes I wear them even though the screen is huge it’s because it’s a pixelated and it looks at blood to me and if I’m going to see a show something I read last I’m sorry the like blowing and I can’t see everything but yeah, these are like losses.

So I’m really paranoid about my eyesight by don’t actually try and do anything to help it but then I do if I can, because as I said, everything is on a screen. However, I’m kind of thinking like I need to that for just make sure that I alternate between doing something on a screen and doing something that’s not on a screen as much as possible. So sometimes I will find myself hours or even the whole day just on a screen doing something and last time, especially when I was writing my dissertation and just reading papers online, so I’m not going to print them off because then that’s a waste of ink and paper.

I’ve read everything my destination on a string so much reading last time for my dissertation especially and everything was online I felt that sometimes I would just get up when I’m saying going to dance and going out and stopping my eyes would just be so

I don’t know blood could fall forward couldn’t really focus yes it will give you a headache if you’re on a screen for such a long time and I did get some headaches sometimes especially last time yes I like to stay hydrated but sometimes hydration wasn’t a problem

and that’s when I knew I’ve just been on the screen for too long and I also noticed as well my is extremely hot and read the not necessarily hop I just feel that all the blood inside my body has just been sucked to my ears and they go bright red and then I can feel them burning and like posting like a hobby is I in my is it’s so bad and I wasn’t a strange castle for like a list of my arrows. rad. There’s a line here and the rest of me is just like this beautiful pale color.

And yeah, those are my symptoms. And when I get headaches and I my eyes forward and my ears garage and everything’s posting, I know that I’ve been on the screen for too long. And I experienced that too many times last time, especially reducing time spent on the screen is going to be hard. bought my solution or my goal next year especially, is to just, you know, alternate between doing something on a screen and doing something on the screen. Sorry, I’m reading screams I love them or hate them at the same time. Okay, number four is to Yeah, okay. I’ve written Don’t be scared to dive in.

doesn’t make any sense to you, but it does in my head and I’m going to explain it. Okay. So my problem sometimes is that before I say like I’m writing an essay without any notes, or I practice something as if it were an exam like without any notes or without any guidance and help under a certain time limit. I find I put those things on

off until I feel 100% confident in the stuff that I’ve been learning. I’m really bad at that. I put things off until I feel that I am 100% confident and everything that I know, I know that I have enough to write about in an essay or I can answer questions about that. Or I feel as if I just know enough detail before I then test myself will write an essay and I need to take more of a risk sometimes to just you know, like, dive in, jump in do it straight away, even if I don’t know anything fully because that will then highlight to me what I need to go back over and then what I need to work on. So I’m just very good at putting it off and being like, No, I’m not ready yet. When I have experienced especially a university in an exam What does an essay title which I have to write but I don’t know very much about the topic or it’s very big

and pleasure especially those one question which I think

Didn’t revise for at all and I had to write an essay on it. So it’s gonna mimic those situations if I practice it and that will make it so much easier to deal with. If you’re in an exam and you’re faced with that situation you know go for it you know i don’t know everything I’m but like

on the topic, just do it and see what happened. So the last one is too I’ve just realized all my folders like stacked up there and some random stuff just junk in the corner of my room. Yeah, it’s it’s quite specific one this is to plan essays or your essays because that is everything that get examined on this year. It’s essays as you plan them every single bloody time Holly, I am so good applying my day. Tell me to write to do list I will jump on it very happily. Tell me to plan an essay. I’m like, oh, why don’t just dive straight in and get writing you know, more time to write down more stuff when actually

When I plan that goes so much better. Most of the time I’m planning is just in general a very good thing. However, when I’m writing essays, especially in exams, well like mocks I just forget about the plan and just dive straight in and that is bad. You know God holy No, don’t do that holy and I don’t advise it and I am very good at just not planning essays don’t know why.

Why do you know why? It’s because I’m like, I need more time. I need as much time as possible to write as much done as I can. Sometimes that’s that’s going fine. We’ve come to a conclusion and it’s fine without a plan. However, I have had situations where I’ve just, you know, blood on a play a play on the page written down whatever kind of came to mind next. And that for the structure was not great. You know, I have had that and that was last year in an exam. I remember quite vividly that happening. And I remember just writing and I remember finishing

Like what just happened? Like, I was just sick on a page, you know,

that really didn’t make sense that there was nothing I could do because I had to move on to the next essay. Otherwise I’d run out of time. And that was a bad move. You know, you only learn these things when you make the mistake that was an exam. And I could have told you that I did worse than that exam before I my marks came out, and that was 100% accurate. That was my last exam because I knew just didn’t write the plan that went wrong. Um, so yeah, every time holy from now on plan, and you guys plan essays. If you’re writing essays, or even if you’re writing an extended answer something like that planet, please. I don’t do it enough. I need to do it every single time from now on. plan, plan, plan, plan.

plan every time. Okay, you got that now? Yes, I think it’s drilled. That’s five. That’s five of my study habits goals for 2019.

Was it gonna say oh yes me up coming study videos I’m going to be doing I have planned. You see, I plan these things last is I have thoughts about making them kind of famed or where it’s appropriate. I’m going to theme them and I’m going to be answering a question in one study video. For example, I am definitely going to be doing ones where I talk about whether I listen to music or not, when I’m studying one about how I study when I’m out. If you have any specific questions related to studying, please now’s your chance to leave them in the comments down below. And then if you like something someone has suggested that like that comment on the top ones who get priority, see, I’m going to be answering them and I study video so you get me studying and you will also get me answering a question related to studying that some of you guys might all be thinking because we don’t know if we’re all thinking about these things unless somebody writes it down and you guys like that common and we all find out that it’s a big question in the story.

The world also if you take any pictures of yourself studying on notes you know there’s playing bass notes that we all love definitely tag me and hashtag study with Holly be shows data and I can repost some of them the new yeah How did 2018 go too fast I don’t even know 2018 has been it’s not gone it’s 29

Happy New Year to you guys I’m going to say um yeah I will see you in 2019 a house Gary let’s see what happens Be sure to like this video and yeah for new around here you want to join my YouTube little family down please hit the subscribe Matter what type of circumstances that you have been raised in, or have experienced, you always have the ability to find a way out and create success for yourself. And I had to do that in my own life and see all the college students go towards the campus. And I thought to myself, where are they going, what are they doing, why they look different than the rest of people there in the group and and that always kept in the back of my head.

And our mother said, Whatever you do, in order to change your circumstance, you’re gonna have to get an education and so I kept them in the back of my head. I no matter what, I had to educate myself, I had to get a degree at the people that I saw going to the school down the street, that’s something I could do.

And I had that vision I would go to this school that was like in a predominantly well off area, and everyone had books and and paper and really nice shoes. I remember looking at this thinking, Oh, I don’t have any of that and every time I would come back into My neighborhood I would see the graffiti and I’d see the the trash and I thought to myself, what makes a difference? Why are there people here in this situation versus here in this situation, and every single day I’ll come back and it came down to this.



It was the thinking how we think how we look at situations whether or not we see ourselves doing well and being successful or versus if we see ourselves as a not successful person in an environment are thinking defines our life and when we can take hold of our thought and see it for what it is and change it and transform it and change it to convert it into an energy that Alicia’s a brain power that allows us to change a situation that my friend is how we change our lives. And that’s how we change everyone else.

See: Examples of Ambition in Real life as a Student

What happened was I was failing Algebra I fell down for I failed geometry. I failed calculus and chemistry. And there was this calculus teacher that said, All right, I’m going to offer calculus tutoring for anyone who’s willing to come to the campus during the winter break. And I thought everyone was going to show up. There was only myself and I thought to myself, this is such a blessing. And I sat there and I picked his brain.

I’m like, how do we look? What does an integral mean? What does the the tangent mean? What does the instantaneous rate mean? And these are all words for derivative and calculus, and I got just a sit down with them. And that was the first time ever that I realized I was smart. And when I sat with them, it was amazing because I realized what was stopping me was my own fear. It wasn’t it wasn’t anything with my educational aspect.

It was me thinking I could do well in mathematics. And when I learned to remove that fear and think I’m going to do this, no matter what’s going to happen, I may fail. It may not fail it. I’m going to do well at this. And I’m going to just to see where it goes, I’m going to put my all into it and find out and I put my own to fail. But it is something inside of me shifted. I realized failing wasn’t that bad. If I can, if I can, like spend more with more time that I can actually do really well of this. And that was the shift in thinking I’m like, All right, I’m just going to spend some more time and I’m going to actually get this when I overcome my own fear. It was when I was working with someone else and recognizing that the person next to me was the exact mirror of myself. And if I could help that person right next to me. I was hoping myself at the same time and it became this teamwork.

Every single person on my campus need it mathematics. And so I got chance to know everybody on campus McCain one the most popular people because everyone needed mathematics and that confidence that was built from taking something that I failed that before and shifting my thinking about and bracing it to actually create a new reality for myself.

That’s what empower me and that’s to graduate top of my class, which later on open up the door through a series of events, I learned the power that we have in our brain when I overcame so many challenges. When I was launching rockets, of being a woman in in being a one a person of color in a predominantly area that was different than myself.



I had to I had to think differently. I had to think All right, I’m gonna stand out everything that I do is going to have to be twice as good. That’s just the nature of it.

I had to change the way in which I was thinking in order to do that, how am I going to be such a contributing force to this environment that whenever I leave, I’ve made a difference. And when I realized that, and then when I coupled that with the aspect of mathematics, where the same type of math that we use to launch to Mars, the same type of math that we use to literally reshape our own brain, I realized the power of our thoughts when we are aware of where we are, what we’re doing, and more importantly, the decision that we have in front of us the choice in our thought in a situation whatever decision that we make in that full awareness.

That decision itself is a fractal moment in chaos that literally changes the brain at that very moment to restructure it inside of your head so you can unleash your power.



When you look at how are my thoughts going to align with where I want to go and you decide that moment in time where you decide this is a thought that’s going to get me to being a rocket scientists, this is a thought that’s going to get me to be a doctor.

This is not to get me to be a host of my own show I’m whatever it takes I’m going to have all the type of thoughts that’s going to get me closer to where I want to go in the future. When we realize that we have a choice and how we think about things where we have a choice, are we going to be scared about something? Are we going to go forward no matter what’s going to happen.

That is when we unleash this power to you when you are expected to succeed by your mentors or parents or teachers when there is an experimentation on your life to do well.

At an early age you adopted, you address it, you adhere to it, you create it. But if you are never given that opportunity to know what you are capable of doing, if you are never given that, that word, that encouragement This is to know what you can be good at mathematics.

Even though you failed algebra and geometry and calculus, the chemistry which I did, you can actually do well mathematics at if if there’s not someone showing you your worth, when you can’t see it, you will forever be looking in the mirror thinking that you’re not worth what you are when you see exactly what you don’t want.

If you can take the exact opposite of that. That’s how you find out what you do. For example, when we launched rockets, we knew Okay, we didn’t want there to be an explosion out the jacket which was like the side of the rocket, but we wanted the explosion to go down. So we thought, Okay, what is the worst case scenario?

The worst case scenario is okay there will be a kind of tired flames going out where we don’t want to go something like how can we prevent that? How can we focus on where we do want it to go where’s the ideal part for it to go and the ideal part is for the the all the flames to go down the tubes and go through and create a clue.

So what we had to do in that aspect is literally envision exactly what we didn’t want and figure out the chain of events that could possibly get us there to what we don’t want and then go backwards.

The beauty about working in rocket science is that I had the ability to observe genius brands and realize that any of us can gain a genius brain no matter what age we’re at it doesn’t matter forget it what anyone’s ever told you you can gain a smart brain at any age every decision that you make reshapes your brain More powerful the you are in making decision after decision after decision that will power for your brain. Because that makes you really careful about what decisions you make. Like are you super aware when you’re making decisions I’ve learned to become aware to see, all right, this is where I want to go, how is this decision going to help me get there, it’s always keeping that in the back of their head, like, this is where I’m going to go. And I’d made the decision very early in life that no matter where I was, I was going to change it. I was going to change it. So I would leave my mark to be able to help in a very powerful way. So people after I leave would be able to make their own mark and in building in a way in which was going to be very powerful for their life.



If you’re a person in science, technology, engineering, mathematics, that Lord stem going to do it. There’s such a overwhelming need for you. You have the ability to see the big picture.

You have the ability not only to do the mathematics, but you have the ability to see a big picture and user communication skills in order for people to see how important concepts are. So that is the gift that you bring if you have the opportunity to go into that. Do it.

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How to make awesome grades while studying in school

Let me just say it was a real struggle figuring out I wanted to feel with like the viewers the background but then the lighting was all under my desk was messy so I didn’t want to have that as a background. So here we are, I’ve got my studio lights up to help support me so I’m hoping that this video turns out okay.

Anyways, as you can see for the title today I’m going to be doing a video all about how to do well at university so I’m going to be talking more about the academic side of things. So once I’ve always talking about the social aspects and the partying on my channel, so I thought I’d bring it back a little and actually give some academic advice. I’m going to be discussing study tips, ways to get organized how to keep on top of things.

So if you’re looking forward to the video, make sure the thumbs up button if you are an idea I would like to see more of my videos don’t forget to

the subscribe button down below and click the subscribe button so it will push notifications are that fair review let’s just go ahead and jump straight into the Tips.

So my first tip on how to do what a university is definitely getting organized and remaining organized throughout the year I’m the best way to do this is getting a plan. Our panelists are so important in helping to keep up with things and knowing what your schedule is week two we actually just get mine from TK Maxx.
Let me just say it was a real struggle figuring out I wanted to feel with like the viewers the background but then the lighting was all under my desk was messy so I didn’t want to have that as a background. So here we are, I’ve got my studio lights up to help support me so I’m hoping that this video turns out okay.

Anyways, as you can see for the title today I’m going to be doing a video all about how to do well at university so I’m going to be talking more about the academic side of things. So once I’ve always talking about the social aspects and the partying on my channel, so I thought I’d bring it back a little and actually give some academic advice. I’m going to be discussing study tips, ways to get organized how to keep on top of things.

So if you’re looking forward to the video, make sure the thumbs up button if you are an idea I would like to see more of my videos don’t forget to

the subscribe button down below and click the subscribe button so it will push notifications are that fair review let’s just go ahead and jump straight into the Tips.

So my first tip on how to do what a university is definitely getting organized and remaining organized throughout the year I’m the best way to do this is getting a plan. Our panelists are so important in helping to keep up with things and knowing what your schedule is week two we actually just get mine from TK Maxx.

I believe this whole candles literally free costs 99 amazing we are getting a tonight is definitely an essential when it comes to university. It’s a great way to see when you have your lectures when you have deadlines, assignments, etc. Particularly in the first time of university it’s very hard to keep up with things because on top of going to lectures you’re also doing societies are going out we’re making friends and socializing and so from that when you’re not keeping track of what you’re supposed to be doing it is very very easy to forget things or forget you have that 9am often get that your assignment still friday so to avoid anything like that happening. I definitely

about getting a planner if you don’t like to write down things it doesn’t necessarily have to be a physical one like the one I showed you I mean there’s so many apps we can actually just use the note section on your iPhone I used to do that all the time via regardless of performance we’re doing yeah I definitely recommend having a plan on write down everything keep on top of thing and ensure that you know exactly what you’re meant to demean each week.

The next tip I’m going to be talking about is something I’ve been doing it since like year nine I want to say by any found out the actual time for this morning apparently it’s called the halo so what the halo effect basically is, is that when you first school or university within the first couple of weeks, just how you’re forming an opinion of your class and your teacher. The teacher is also doing the exact same thing with their students at it from day one of your lectures about the front of the class engagement for teacher having the eye contact, paying up your hand to ask a question for teacher it’s going to immediately see as like a good shooter, someone who’s very keen in the subject, someone that really wants to do well.

Essentially someone that they like. Whereas if you’re sitting in the back of the class, which is a bit noisy, oh, like a group of friends than your teacher might just think, okay, I always recommend getting close on time it’s sitting at the front. I’m just kind of engaging with your teacher from the get go find that once you establish a good connection with your lecture are live on his they get so much easier, they’re often more willing to go above and beyond when it comes to answer your questions. I hope out because they know that you’re genuinely interested in the subject.

But personally I love most about this halo effect is that once you spend a few weeks establishing that good bond that get connection for the rest of the year, I find that you can kind of get away with more things that if you miss your lecture, for some reason, I feel like maybe they’re bit more understanding because they know that you wouldn’t miss it for a stupid reason. You know, they’re just a bit more lenient and understanding throughout the year. So definitely recommend being a good student. Usually at the start of time let your team know that you’re really keen on wants to do well.

Tip number three is more of a study tab and something which I strongly recommend it

And that is pre reading before you going to close this is something I did more towards the end of my A Levels and found it so so helpful that I wish I did it before so it’s definitely something which I recommend doing from the very start University is if you’re unaware of what pre reading so it’s basically reading up on the topic that you’re going to be studying in class I find that doing this makes your lectures make it so much more sense because you’re not trying to grasp everything for the first time we’ve actually already had some prior knowledge so it’s more so confirming it reiterating it and just allow yourself to understand the topic so much better so for my personal University which has a lot of you guys know it is University of the Arts London London College of fashion my uni we have this include noodle where our teachers but done exactly what topic we’re going to be doing each week and I often already have like the reading materials out there if I need that I’m going to do in crisis management for example I can go on to the regional is for that topic and just have every little bit before class so that one are actually in class it will make a bit more sense and what’s amazing about pre reading is I honestly doesn’t have to be long at all actually just fine. minutes of skim reading is enough, it’s just something to do that you just have an overview of the topic before you learn a more in depth. So that hopefully makes it more sense.

You can literally do it on your way to lecture as well sure, having breakfast it doesn’t have to be a task that you have to go to the library for, can literally just do it on the go. And if for some reason your university hasn’t published by the reading materials for it, or like resources that you can use your goal is the thing and I you can actually just type in on Google happened over through and hopefully that allow things to make so much more sense to you.

The fourth tip for today’s video is also a study tip and that is to clarify any doubts that you have immediately say when it comes to university, things move pretty quickly. And so if you’re in class and you don’t understand the topic and you know asking questions because you think it will make sense closer towards exam period or whatever the chances are by the time you get to exam here is will also have certainly other topics that you’re unsure about. I was just getting to the point where you physically don’t have time to go over everything again.

So my best piece of advice to all Asked Questions that maybe don’t understand something obviously for teachers just introduce the topic way into she finishes explaining it until you ask a question but at the end of that class you’re like wait a sec I actually don’t understand this concept either asking cause then in that because chances are other students didn’t understand over you asked that question in front of everyone over may be beneficial to the other students that if you’re perhaps shy or the transition classes past, definitely stay back to the end of the class to ask you a lecture about it. Or if you have tutorials or university awesome then in that as well.

But honestly, the Wise we can do is just leave and definitely want to make sure that you just understand things as you go along that by the time you get to your assessments or sound, you already know the content and you can just focus on exactly the thing I’m going to talk about in today’s video lectures. Lecture.

Our lectures is the lecture Do I go to university? I don’t know. But yeah, in terms of lectures, first and foremost, go to a lecture. It’s like maybe it’s because I never had 9am Like all of my lectures, I don’t some people don’t go to lectures, it’s so much easier to just sit in a room for like an hour and a half then to stay at home and cut off your lecture on your laptop and be making notes and not really understanding what’s going on. Even if we’re completely hung over or you just can’t be bothered. Just drop yourself into unique it’s literally about to sit there like arms folded, and just listen and then to be at home and not greater than lecture and then catch up later while you frantically trying to make notes and piece everything together. Like it’s just not worth it. So personally just go to other artists in my opinion, but the second thing and tells the lectures it’s definitely make good to know one thing that took me quite a long time to graph is that you generally don’t need to write down everything that’s on the board. Literally just write down the most important point I know that if you’re like me that it’s quite hard not to do because you want to get down all of the information but learning to make condensed notes from the get go. It is definitely something which is beneficial because it saves you from condensing your classmates later on in the year and it was me so if you’re looking for quick



information of the answers you can easily find a bullet point which has it as opposed to having to like dissect your class know another thing which makes your lecture notes really amazing is using color I know it’s quite long to bring like a whole purpose okay sometimes so I recommend getting those pens that have like the color wheels around it but you can click for like red and then click for blue and then click for black I love phase I’m making and so if that’s something that’s really important I’ll quickly just switch to read and write that impressive it sounds out there again we’ll come back to your notes you know what’s really important and what keywords you either yeah those are my tips which I hope really hope he was at university also have them a quick and simple it’s really good to just reiterate them and have them fresh in your mind before you start going to an active if you did find the city are helpful if you learn something new then I’d love if you could hit the thumbs up button and let me know in the comments down below if you Are any of you enjoyed the video just getting the scroll down below upload new videos every single Wednesday and Sunday. Yeah that is basically the end of today’s tips. Thank you guys so much for reading and I’ll see you in my next one.
I believe this whole candles literally free costs 99 amazing we are getting a tonight is definitely an essential when it comes to university. It’s a great way to see when you have your lectures when you have deadlines, assignments, etc. Particularly in the first time of university it’s very hard to keep up with things because on top of going to lectures you’re also doing societies are going out we’re making friends and socializing and so from that when you’re not keeping track of what you’re supposed to be doing it is very very easy to forget things or forget you have that 9am often get that your assignment still friday so to avoid anything like that happening. I definitely

about getting a planner if you don’t like to write down things it doesn’t necessarily have to be a physical one like the one I showed you I mean there’s so many apps we can actually just use the note section on your iPhone I used to do that all the time via regardless of performance we’re doing yeah I definitely recommend having a plan on write down everything keep on top of thing and ensure that you know exactly what you’re meant to demean each week.

The next tip I’m going to be talking about is something I’ve been doing it since like year nine I want to say by any found out the actual time for this morning apparently it’s called the halo so what the halo effect basically is, is that when you first school or university within the first couple of weeks, just how you’re forming an opinion of your class and your teacher. The teacher is also doing the exact same thing with their students at it from day one of your lectures about the front of the class engagement for teacher having the eye contact, paying up your hand to ask a question for teacher it’s going to immediately see as like a good shooter, someone who’s very keen in the subject, someone that really wants to do well.

Essentially someone that they like. Whereas if you’re sitting in the back of the class, which is a bit noisy, oh, like a group of friends than your teacher might just think, okay, I always recommend getting close on time it’s sitting at the front. I’m just kind of engaging with your teacher from the get go find that once you establish a good connection with your lecture are live on his they get so much easier, they’re often more willing to go above and beyond when it comes to answer your questions. I hope out because they know that you’re genuinely interested in the subject.

But personally I love most about this halo effect is that once you spend a few weeks establishing that good bond that get connection for the rest of the year, I find that you can kind of get away with more things that if you miss your lecture, for some reason, I feel like maybe they’re bit more understanding because they know that you wouldn’t miss it for a stupid reason. You know, they’re just a bit more lenient and understanding throughout the year. So definitely recommend being a good student. Usually at the start of time let your team know that you’re really keen on wants to do well.

Tip number three is more of a study tab and something which I strongly recommend it

And that is pre reading before you going to close this is something I did more towards the end of my A Levels and found it so so helpful that I wish I did it before so it’s definitely something which I recommend doing from the very start University is if you’re unaware of what pre reading so it’s basically reading up on the topic that you’re going to be studying in class I find that doing this makes your lectures make it so much more sense because you’re not trying to grasp everything for the first time we’ve actually already had some prior knowledge so it’s more so confirming it reiterating it and just allow yourself to understand the topic so much better so for my personal University which has a lot of you guys know it is University of the Arts London London College of fashion my uni we have this include noodle where our teachers but done exactly what topic we’re going to be doing each week and I often already have like the reading materials out there if I need that I’m going to do in crisis management for example I can go on to the regional is for that topic and just have every little bit before class so that one are actually in class it will make a bit more sense and what’s amazing about pre reading is I honestly doesn’t have to be long at all actually just fine. minutes of skim reading is enough, it’s just something to do that you just have an overview of the topic before you learn a more in depth. So that hopefully makes it more sense.

You can literally do it on your way to lecture as well sure, having breakfast it doesn’t have to be a task that you have to go to the library for, can literally just do it on the go. And if for some reason your university hasn’t published by the reading materials for it, or like resources that you can use your goal is the thing and I you can actually just type in on Google happened over through and hopefully that allow things to make so much more sense to you.

The fourth tip for today’s video is also a study tip and that is to clarify any doubts that you have immediately say when it comes to university, things move pretty quickly. And so if you’re in class and you don’t understand the topic and you know asking questions because you think it will make sense closer towards exam period or whatever the chances are by the time you get to exam here is will also have certainly other topics that you’re unsure about. I was just getting to the point where you physically don’t have time to go over everything again.

So my best piece of advice to all Asked Questions that maybe don’t understand something obviously for teachers just introduce the topic way into she finishes explaining it until you ask a question but at the end of that class you’re like wait a sec I actually don’t understand this concept either asking cause then in that because chances are other students didn’t understand over you asked that question in front of everyone over may be beneficial to the other students that if you’re perhaps shy or the transition classes past, definitely stay back to the end of the class to ask you a lecture about it. Or if you have tutorials or university awesome then in that as well.

But honestly, the Wise we can do is just leave and definitely want to make sure that you just understand things as you go along that by the time you get to your assessments or sound, you already know the content and you can just focus on exactly the thing I’m going to talk about in today’s video lectures. Lecture.

Our lectures is the lecture Do I go to university? I don’t know. But yeah, in terms of lectures, first and foremost, go to a lecture. It’s like maybe it’s because I never had 9am Like all of my lectures, I don’t some people don’t go to lectures, it’s so much easier to just sit in a room for like an hour and a half then to stay at home and cut off your lecture on your laptop and be making notes and not really understanding what’s going on. Even if we’re completely hung over or you just can’t be bothered. Just drop yourself into unique it’s literally about to sit there like arms folded, and just listen and then to be at home and not greater than lecture and then catch up later while you frantically trying to make notes and piece everything together. Like it’s just not worth it. So personally just go to other artists in my opinion, but the second thing and tells the lectures it’s definitely make good to know one thing that took me quite a long time to graph is that you generally don’t need to write down everything that’s on the board. Literally just write down the most important point I know that if you’re like me that it’s quite hard not to do because you want to get down all of the information but learning to make condensed notes from the get go. It is definitely something which is beneficial because it saves you from condensing your classmates later on in the year and it was me so if you’re looking for quick



information of the answers you can easily find a bullet point which has it as opposed to having to like dissect your class know another thing which makes your lecture notes really amazing is using color I know it’s quite long to bring like a whole purpose okay sometimes so I recommend getting those pens that have like the color wheels around it but you can click for like red and then click for blue and then click for black I love phase I’m making and so if that’s something that’s really important I’ll quickly just switch to read and write that impressive it sounds out there again we’ll come back to your notes you know what’s really important and what keywords you either yeah those are my tips which I hope really hope he was at university also have them a quick and simple it’s really good to just reiterate them and have them fresh in your mind before you start going to an active if you did find the city are helpful if you learn something new then I’d love if you could hit the thumbs up button and let me know in the comments down below if you Are any of you enjoyed the video just getting the scroll down below upload new videos every single Wednesday and Sunday. Yeah that is basically the end of today’s tips. Thank you guys so much for reading and I’ll see you in my next one.

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How To Get 95 Percent In Board Exam, Effective Study Techniques.

Hello, my Socratic of friends. We’re here to help you be a great student. Here’s a personal question do you make new year’s resolutions we do both in January, and at the start of the school year, which feels like another new year, doesn’t it? It’s a great feeling, getting a fresh start and thinking about how to improve. That’s really the whole point of the series, isn’t it. So let’s talk about how to make resolutions and how to keep resolutions. First, let’s think about what makes a good resolution. I’m not going to resolve to become president of NASA that’s just not reasonable. A good resolution is one that is actually achievable with a little focused effort on your part. This should also be something that is personally important to you. Make sure your heart is really in it. I’m not personally excited by marathons so I’m not going to make a resolution to take up running my resolutions always seem to be about learning something big surprise here. Don’t make a resolution that’s vague, like I’m going to get healthy or I’ll be a better student pick something very specific you Want to accomplish? break it down into small, concrete doable actions. As in if I want to get better grades, I will set aside 30 minutes every day after class to review my lecture notes. Or if I want to prove my Japanese reading skills, I will study 10 Japanese characters every day, I’ll be able to take very specific actions. To keep this resolution I’ll put 10 flash cards in my pocket every morning. That makes it easy to pull them out and study a little when I’m taking a coffee break done. Another way to pick a resolution is to think about what’s a good habit you want to adopt. I want to take a 20 minute walk every day. Exercise is good for the brain. It reduces stress and it’s a good way to spend breaks between Pompadour sessions. If I genuinely stick to taking a walk in the fresh air every day. I’m going to be much healthier by the end of the year and I’ll have develop the kind of habit that could last a lifetime. Or maybe there’s a bad habit you want to break if you smoke. You really, really I mean, really, you should stop it sticks. It’s expensive.

Related Post: Study Strategies for High School Students

It causes cancer. What bad habits do you have? I personally don’t have any. Not that I know. Never heard of them. Now don’t go overboard, trying to remake yourself into a completely different person. Pick one thing, okay, maybe two things. But that’s it. It’s much easier to keep track of one resolution than a whole bunch of them. Especially since people who break resolutions often say it’s because they’re just too busy. There’s just too much going on in my life to pay attention to well, don’t let that happen to you. Let’s keep it real simple. Every day. I’m putting 10 flash cards in my pocket. How hard can that be? It helps if you keep track of your progress. Have you heard of this trick from Seinfeld Don’t break the chain. If you mark off every day successfully kept your resolution on a calendar you see a growing chain of accomplishments. It please a nice little trick on your brain. You can see how much good work you’ve done and you don’t want to mess it up. It’s a little added incentive to keep going. Don’t break the chain.

Our friend Simone Gertz you’ve probably seen her work making interesting robots made a beautiful engineered version of the resolution calendar. You can find it on Kickstarter. It’s seriously like a work of art. Every time you do your resolution, you get to light up a day. And she made this beautiful thing to help her keep her resolution to meditate every day for a year to make that a new healthy habit. And it totally worked for her. Okay, that gives us an idea for another video. How do you meditate? That’s a really useful skill to help you be a great student. Okay, stay tuned, coming soon from Socratic.

Oh, but what if you do break the chain? Don’t beat yourself up, get back on the horse. Tomorrow is another day. Anyway, perfectionism is overrated. If you succeed for 350 days of the year. Isn’t that something to be proud of? Compared with last year? Yeah, remember to be kind to yourself, how would you treat a friend who slipped up you’d be understanding and encouraging be that person for yourself. Another thing that can help is to keep a daily

journal entry about your resolution, make a note of the days that were easy. What did you do that made it so easy? Think about the days that were really hard. Can you figure out what made it hard? Did you forget to pack a healthy lunch? And so you got fast food. instead? Did you forget to write down your assignment in your planner so you didn’t write your paper until the last minute. This kind of self reflection can lead the way to real change where it becomes easier and easier to make a resolution. The true habit is something you always do as a regular part of your life. Have you heard the standard wisdom that it takes 21 days to make a new habit? Okay, we’ll talk here that’s pretty made up number we read that this number came from Maxwell mots, a plastic surgeon who studied amputees in the 60s and he found it took about 21 days for them to adjust to their new routine, missing a limb. Therefore it takes 21 days to adjust to a new habit. That’s a pretty big leap right there max. More recently, psychologist Philippa lolly formally studied habit formation and found that it took on average 66 days to form and

habit, there was a huge variance. However, some tasks were easier and took as little as 18 days to become second nature, while others were more challenging and took as long as 245 days. So don’t worry if you don’t find yourself measuring up to some arbitrary standard. It doesn’t sound like there is one. What else can you do to make it more likely for you to succeed and keeping your resolution, let the people around you help you. It can be much easier to make these changes in your life. If everyone around you is on board. Tell your friends and family what your resolution is. That is if they are genuinely supportive. We know there are some people out there who may not want to see you change for the better. That’s the sad truth about human nature. Please don’t let this stop you. If you feel you need to keep your resolution to yourself. That’s okay too. What’s your New Year’s resolution? Is it something we can help you with? Let us know in the comments below. We’re all learning and growing. Here. At Socratic. We make new year’s resolutions because it’s a little stretch toward becoming that person you’re proud to be.

It’s all part of being a great student. One of our new year’s resolutions here at Socratic is to grow a little bigger so we can make more videos for you. Would you like to help us if you find the work we do here valuable, please consider supporting us on Patreon. With your help we’ll be able to grow our team. Thank you. Hello, welcome back. I’m going to share my 2019 study Guide. I thought since everyone is starting a new semester at school with fresh focus, it would be beneficial to define our city goals for this year. And I just kind of want to bring everyone on the right track to have a productive next 12 months. I spoken about the studying amino app before I can’t find my phone currently, or otherwise, I’ll show you here, but can you see it on the screen. But I’ve had gone there to reconnect with these guys and kind of share my studying and school journey and just like share my story and photos because I love doing those as you might have seen on Instagram. If you search my username, Yusuf, you can find my page and a blog post where you can ask me anything. And I’m going to answer the most interesting cues. Oh, and if you haven’t heard about amino before, they’re a diverse network of communities that unites people with friends that share the same passion like productivity and studying so to check out my q&a and follow my goals on setting amino you can click the link in the description.

Related Post: How To Get 95 Percent In Board Exam, Effective Study Techniques.

Check out the painter to common follow the prompts download the app or you could just search an app store or find me on there with my username so now let’s get into my goals for school

This is usually have charm but I wear sweaters when we’re kind of warm. So yep okay so I think the roles help you guys to kind of more see my perspective phones who are now for the last two months I’ve just gotten a whole new mindset about my priorities and how school needs to rewind my priorities to reach my first goal which is passing school and it’s my last year

I have five months ago. It’s just crazy.

And honestly, I’m just not sure if I see myself passing but I have the courage to just go for it and give my best.

And I definitely wanted to say that I gave my best to that’s going to be my pursuit. And that’s my first goal number two gold kind of goes with that. And this is maybe something more people can relate with. And it’s having a good relationship with studying that just seems not to even make sense because it’s like studying you know, but I feel like if we already spent so much time sitting at a desk, you just kind of take away from your life if it isn’t something you can enjoy or at least just be okay with. That’s one of the things I want to talk about more in the future How can you make study more attractive to yourself and how can you spend your time doing it effectively saving time and just feeling better about it so this can be one of your goals feel good about studying and not hated my goal is just all kind of seem a bit more low key but they’re actually you know, a big deal in my book and it’s to pass all my classes before my

final exams. So I have about three or four classes where I don’t have the passing rates a passing grade. So the grades for us is it goes from one to six and four is passing grade. And in three or four subjects I don’t have a for it can seem so hopeless. But it seems hopeless to me right now, like my math grade and my physics grade. But as I said, I’m not giving up and I’m just going to try and I also just want to share that with you guys. Because even though I may have to study content and all this content on being productive, I suck at school and I just want to be grateful for an opportunity and let’s just make the best out of it. Okay, number four, again, goes with this goal, and it is to get help in those subjects. Let’s just all be self aware and know what we need to happen. And one goal for you guys which is be to ask for help. Just be aware of

What don’t you know and know that your teachers that’s their job to help you. And if teachers don’t have that capacity because their personality or because your mindset make sure that you get help. So that’s what I’m going to be doing. Yeah, I just had to make the camera lighter. But my last study goal is to be present during lessons. And I know that everyone kind of has lessons where it’s more chill and it’s kind of their time to catch up with their friends.

But let’s, let’s use our time efficiently. And the more you get into your brain during assessing the less you need to do after being active during classes is one of my goals. But those are the things that motivate me. And those are the things that I want to put in front of my mind and to be reminded off daily desktop. I’ve written them down and I definitely recommend you guys to write down your goals.

Thank you for reading this study tips of a be talking about who goes out Why does my tummy her I think too much but let’s hope I passed his school year and I’m sending you good as energies. I’m coming to you with a tips very soon I’m going to give you guys live updates and just talk about my life and sing that song. See you soon. Peace out.Salaam aleikum RG page to have those special Jojo many viewers a tips up Nepal remarkable the acne inshallah both helpful video is freedom out to the cake toppers castle castle top cars are there or do I am thrilled to top CUNY garbage the garbage good doctors are not toppers top Carnegie Versa but the important reason but I don’t care topper stop there or do it every student I will average also bichara who read at the top or bottom up Component button to bottom batanga team rarely do 333 barely both important to do three view is are they important or two to three oppose the other important bother in team bottom up nigga implement here to inshallah the top ranked school may up Nick last make college may universities birthday can he be a birthday Zulu inshallah subset of belly Bertha many of whom are so many students do their own cubicle top to bottom longer to get some key se como si are teaching jujitsu top quality also average and only a sequence the bottom to top opportunity or Omen Haiti will be up to bottle to inshallah customer who say Pele I get up this channel a new way to please naps a request Kurt Nokia subscribe Carlo clipboard helpful channel hookah medically bright bionic leg and Joe map to bottom but the reality based on the data or YouTube the whole sector Mexico D motivate and encourage like and Joe map to live Kelly up to future and what karma inshallah subscribe car or a video person that likes Galena please 200 likes

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