Good afternoon. The first item of business this afternoon is portfolio questions. The portfolio on this occasion is education in skills. The invite member is wishing to ask a supplementary question to press the request to speak buttons. I'll put the answer in the chat function if they're during the relevant question and I call question number 1, Fulton MacGregor. To ask the Scottish Government what action it is taking to encourage local authorities to provide all primary school children with the opportunity to access swimming lessons. Felly, we have been working with Scottish Swimming, Education Scotland, Sports Scotland and Scottish Water to pilot bespoke interventions and approaches within local areas to provide opportunities for more children to become confident, safer and competent swimmers. I recognise the importance of ensuring that all children can have equal opportunities to access in swimming lessons, regarding their families, social or economic circumstances. Therefore, inclusion is central to our approach, and there will be a specific focus on targeting areas within quintile, one of the Scottish index of multiple deprivation. I thank the cabinet secretary for that answer. In a recent poll of over 1,000 people in Scotland, 93 per cent of respondents agreed that all children should learn to swim, and 90 per cent agreed that learning to swim is an important part of every child's education. What further action does the cabinet secretary think that local authorities, including my own and North Lancer Council, can take to ensure that every primary school pupil goes to secondary school, having had the opportunity to learn to swim? There are a number of local initiatives in place across Scotland that help to promote learning to swim, the Scottish swimming learn to swim framework that seeks to help children to become safe and competent swimmers by developing a consistent structure and set of quality standards for lesson providers is delivered by 37 partners in 162 pools across Scotland. The framework is already delivered by the main community learn to swim provider in 25 out of the 32 local authority areas, and it is also being provided in a further two local authority areas, albeit not by the main community learn to swim provider. Progress is being made within two further local authority areas towards delivering the framework during 2023. Active Schools also plays an important role in supporting local swimming clubs to link to schools. A couple of supplementaries that need to be brief, as well as the responses first, Brian Whittle. Thank you, Presiding Officer. According to Scottish Swimming, more than four in ten children leave primary school in Scotland unable to swim. We all know the impact, the positive impact on health, both physical and mental that swimming would have. We all understand about the inclusion about being able to swim, about learning away from the class and really important life skill. In fact, I would conclude this in the attainment gap. Councils are breaking point and being forced to consider the most extreme budget cuts, including cutting free swimming. Does the cabinet secretary agree with me that it is an investment to ensure that our children can swim? What will the Scottish Government do to make sure that all children get that opportunity? Mr Whittle does raise an important point, not just about the physical benefits of this, but the mental health benefits as well. I pointed to my original answer to Fulton MacGregor about the importance that is being placed on learning to swim programmes to ensure that children from the most deprived communities in Scotland, in particular, have that ability to take swimming lessons. That is something to ensure that promoting equality of access that we are determined to continue to work on. Thank you, Deputy Presiding Officer. My constituents of Spears Valley have been campaigning for better water safety in Scotland for the last seven years following the tragic death of their son, Christopher and the River Clyde, in 2016. Even competent swimmers can be vulnerable to injury or death in the water. Does the Scottish Government therefore agree that more engagement with local authorities is required more broadly to establish easy access to water safety training and education across Scotland? First of all, I thank the member for bringing up this important expansion to some of the original points. Water safety education and drowning prevention is exceptionally important. It is not just about confident swimmers but also, for example, about the dangers of cold water shock and so on. That is certainly something that is also included in the work that Water Safety Scotland and Education Scotland are continuing to do. To ask the Scottish Government what its position is on whether current funding for colleges is fair when compared to the funding received by universities. The Scottish Government values the tertiary education sector with each part making a crucial and unique contribution to Scotland. The 2023-24 budget allocates nearly £2 billion to colleges and universities, which continues the trend in a year-in-year increase of the budget in cash terms. The called sector has been allocated an increased resource and capital budget of over £30 million for 2023-24, at a time when public finances are significantly constrained, which demonstrates our commitment to the sector. The called sector resource budget will be increased by 3.8 per cent compared to this financial year as compared to a 2.5 per cent uplift for universities. I agree that colleges and universities are very important. However, some universities, not all, are sitting on considerable reserves of money, while some colleges are really struggling and are trying to reach the hardest to reach people, both younger and older, in our communities. Does he not think that perhaps we should be rescuing the funding a little bit away from universities towards the colleges? I think that John Mason recognised at this point in his question. Of course, the position across universities is not entirely uniform, so we must make sure that we continue to support our universities to be sustainable. However, in essence, in relation to the core of his question, I would refer back to the figures that I have just given. We have given a £46 million resource uplift to the tertiary sector this year, and we have waith that towards colleges, £26 million for colleges and £20 million for universities. In respect of a direct shift of resource, if you look at the capital allocation, the increase for colleges is a direct result of us taking the decision to shift some of that resource from universities. We are undertaking what we can to make sure that we sustain the sector. A lot of interests and a number of supplementaries want to get them all in, but they will need to be brief as well as the responses first. The minister talks about additional funding for colleges, but he fails to mention that colleges need money to support additional rounds of voluntary severance or to potentially reduce the risk of compulsory severance. The situation is just that bad. Can the minister guarantee that any additional funding will be flexible and for the colleges to use up their discretion? If he cannot do that, will he tell the chamber what his spending priorities are for that funding? Clearly, pangos was referred to the additional resource. We are in a period where we need to look ahead and ensure that a college sector is responding to the priorities of our society and economy. That is what that resource is there to do. We are engaged in a wider discussion about how we can empower and provide more flexibilities more generally to the college sector so that it can continue to do that within the resource that has already been allocated to us. That is my key priority for college resource. College principals are acting on the basis today of a real-terms cut, because the £26 million in funding that the minister talks about is not available to them. They do not know what they are allowed to use it for. It is caught between the Scottish Government and the Scottish Government, and there is no clarity. Can the minister provide today clarity on what that money can be spent on? If what that money will be spent on is exactly as I have just said, to make sure that the college sector is able to continue to be responsive to the needs of their local communities, to the needs of our economy, to the needs of our society. The precise application is a matter of discussion with the SFC, and I expect it to be engaging fully with colleges in that regard. The minister is talking rubbish. That money is not available for colleges. The reality is that the Government, 20 months on, from when the funding council did its review about the future of the sector, still cannot decide what it wants from the sector. When is it going to make his mind up about the colleges? I do not even understand what the basis of that question was. I have set out quite clearly what our priorities are in relation to that resource.  To ask the Scottish Government whether it will provide an update on the continuation of curriculum for excellence. Curriculum for excellence continues to help to equip to pupils with the knowledge, skills and attributes needed for learning, life and work, as demonstrated by the fact that a record high number of young people were in work training or further study after leaving school last year, more over the gap between school leavers from the most and least deprived areas in work training or further study is down to a record low. However, we are not complacent and every curriculum should seek to evolve and improve. That is why we are progressing an ambitious programme of educational reform, including taking forward curriculum-related recommendations made by the OECD, Professor Louise Hayward's work and also the national discussion. Thank you for that answer. New research conducted by the University of Stirling found that under the curriculum for excellence there has been a decrease in the number of national qualification entries in S4. Cabinet Secretary, the curriculum for excellence was meant to broaden the child's education, not narrow it. What has went wrong and are you concerned that a child's educational experiences have significantly narrowed? The curriculum for excellence is about broadening the experience within schools, so we will be giving the findings in the Stirling report very detailed consideration. It is also encouraging to see how many young people, for example, have taken advantage of the breadth of choice now available in the senior phase, such as in qualifications to do with skills for work or foundation apprenticeships. It is not simply just a matter of comparing the data relating to qualifications and the qualifications structures, but also the very widened opportunities that we have outside the SQA exams and, for example, as I say, on foundation apprenticeships. I welcome the update from the cabinet secretary. Just this week, new statistics have shown that attainment numbers for positive destinations are at a record high, with over 95 per cent of school leavers in education, employment or further training three months after leaving school. While that is testament to the hard work of our teachers and young people, does the cabinet secretary agree with me that those figures prove that this Government is delivering in education? As Karen Adam rightly points out, there was exceptionally good news in the statistics that came out around positive destinations earlier on this week, and she points to that in her question. I think that that is a testament to the exceptionally hard work of our teachers and their support staff and our young people, and it very much demonstrates the record and our continued focus on delivering for Scotland's children and young people through education. Question 4. Pauline McNeill, who also joins us remotely. To ask the Scottish Government what steps it is taking to support Glasgow students in student rental accommodation in the light of the report that proposed rent increases by the University of Glasgow. Minister Jamie Hepburn. As a ton of institutions, universities are, of course, responsible for their own operational matters, including rental costs for student accommodation. However, I do expect them to take into account the current cost of living crisis and set rents accordingly. We are supporting students directly by providing £16.8 million in hardship funding for the current academic year to support higher education students experiencing financial hardship in addition to tuition fees and a range of living cost support, where they are currently exploring options to further support students for the 2023-24 academic year. Pauline McNeill. I thank the minister for that answer. He will be aware that a report by NUS Scotland on purpose-built student accommodation has been described as appalling by the president of NUS, Ellie Gormersol. The report found that an average of these rents has increased by 34% since 2018. A quarter of student samples in the report could not pay their full rent on more than one occasion. It has become a real problem and rent increases of 9.5% by the University of Glasgow seems incredibly harsh. I have understood the minister's answer. He is hinting very strongly that he also thinks that that is wrong. In view of that, does the minister believe that it is unfair to students and that private landlords, after all, can only increase up to 6%? That this Scottish Government should legislate to cap high-rents in student accommodation in the private sector and that a modern fair Scotland would do this? One of the things that we are undertaking right now is a review of purpose-built student accommodation to consider a range of questions and that type of area can be considered as part of that activity. Fundamentally, I very much agree that it is incumbent on every institution, whether they are a private provider or an academic institution themselves, to consider the position of students, to consider the affordability of rents, particularly in the context of the current cost of living crisis. In Scotland, 12 per cent of students have experienced homelessness and others have been forced to live in makeshift accommodation. At the beginning of this academic year, the University of Edinburgh converted a common room into makeshift accommodation to house students on a short-term basis. What guarantee will you give the first-year students who are rolling in our Scottish universities that they will be able to access student accommodation? Of course, the Scottish Government is not a direct provider of student accommodation. Again, I would expect that every institution in offering a place to a student to be taking very serious account of the ability of that person to accommodate themselves adequately for the coming year. It is incumbent on institutions to do that. To ask the Scottish Government what impact the Scottish budget 2023-2024 will have on education and skills provision in Glasgow. The Scottish Government's education and skills portfolio will provide over £4.2 billion in 2023-2024 to help to improve the life chances of our children, young people and learners of all ages and to support everyone who reaches their full potential. Through the local government settlement, we will provide Glasgow City Council with £1.4 billion of revenue to fund local services, and that is an important contribution that we can make to their delivery of education. As part of that settlement, Glasgow City Council will receive £16.5 million to at least maintain the number of teachers and support staff at current levels and continue to ensure that there are places available in the teacher induction scheme for probationer teachers who need them. Glasgow City Council is due to also receive over £7.5 million of strategic equity funding to support education recovery and tackle the poverty-delated attainment gap, and schools in Glasgow will receive over £23 million in pupil equity funding and powering Glasgow's headteachers to improve the educational outcomes and wellbeing of children affected by poverty in their schools. James Dornan, I thank the cabinet secretary for that answer as we approach Scottish apprenticeship week. Will she join me in recognising the crucial role these schemes play in providing positive destinations for young people in my constituency of Glasgow and across Glasgow and as we celebrate this year's achievements? Will she say what progress has been made in aligning work-based learning opportunities to support the important transition to net zero for future generations? Supporting Scottish apprenticeship weeks is, of course, very important. This is an annual celebration of the success of the Scottish apprenticeship scheme. Our priority is, of course, to ensure that apprenticeships are of high quality and lead to sustainable employment opportunities. We do, of course, know that the climate emergency will require enormous societal change and we are exploring how we can effectively integrate sustainability and green skills into the apprenticeships programme through climate emergency skills action plans. I will take a supplementary, but I will do so reminding members that this is a question about education and skills in Glasgow. I call Ross McCall. I was looking at it from the Scottish budget proposal because last week in the Education, Children and Young Persons Committee, the cabinet secretary revealed that £123 million would be taken from that education and skills budget for £23.24 to pay the teachers deal. I was just asking what will be cut from the education budget and maybe that might apply to Glasgow. Here we go, Presiding Officer, because day in, day out we get normally from Mr Kerr a point of order demanding that I do more to solve the teaching skills, the teaching pay dispute that we have. When we say that we are making progress, which I have to say to Ross McCall will require funding, then we are criticised for doing that. As the Scottish Conservatives keep demanding that we solve the pay dispute, they have to bear in mind the reality that that will cost money, it will have to come from somewhere within the Scottish education budget. If they start having a serious discussion about that, I will start taking the questions and their proposals on the teachers dispute more seriously. To ask the Scottish Government whether it will provide an update on the number of baby boxes— Excuse me, Mr Kerr, could you resume your seat, please? Mr Kerr, could I please ask you to refrain from shouting across the front benches and cabinet secretary nor to respond to those? To ask the Scottish Government whether it will provide an update on the number of baby boxes that have been distributed since the scheme began. As it is hard, Scotland's baby box strongly signals our determination that every child, regardless of their circumstances, should get the best start in life. Our universal baby box programme, the only one in the UK, opened for registration on 15 June 2017 and delivery of baby boxes nationwide began on 15 August 2017 for all babies born and resident in Scotland. I am delighted to see that, since then, we have distributed a total of 250,560 baby boxes to families across Scotland, providing essential items for the first six months of a newborn's life. I thank the minister for that response and, of course, welcomed the news a few days ago that a quarter of a million baby boxes have now been delivered across Scotland. Can I ask her to outline what she sees as the benefits of ensuring that all expecting parents across Scotland have access to essentials for their newborn, regardless of their circumstances? Preparing for a baby's arrival can be one of the most exciting times for a family, but also one of the most nervous ones. Scotland's baby box supports parents by giving them access to essential items, as well as important practical information on how to support their new arrival. As well as practical support and items designed to have a positive impact on parent and child interaction, our baby box provides a financial saving of over £400 for families through the items provided, which, in the current cost of living crisis, is making a huge difference to families across Scotland. To ask the Scottish Government what its response is to the recent study by the University of Stirling published on 20 February 2023, which showed that the curriculum is narrowing under the curriculum for excellence with a reduction in the choice of school subjects. The Scottish Government welcomes the publication of this report, and the report states that, under curriculum for excellence, a growing proportion of school leavers are arriving at positive destinations within three months of leaving school, which suggests that the implementation of curriculum for excellence is having a positive effect on student outcomes. In terms of curriculum choice, the senior phase is designed as a three-year experience in order to offer greater personalisation and choice for learners. What matters most is the collection of qualifications, awards, skills and experiences that a young person leaves school with, not the subset of qualifications that they achieve in one year of the senior phase. So the record high number of young people who are in work, training or further study after leaving school last year is reflective of the success of curriculum for excellence, which continues to equip young people with the knowledge, skills and attributes needed for learning, life and work. I am very grateful for that answer from the cabinet secretary. I thank her for her previous comment and her continued focus on education. The choice attainment and positive destinations report produced by Mark Priestley and Marinaras Shapira may have had some difficult reading. The research provides ample evidence that a great deal of curriculum making is driven by a need to fulfil external demands for the right kinds of data, particularly relating to attainment. Further on, it is a cause for concern that some curriculum making practices have negative consequences on subsequent attainment and transitions, predominantly affecting young people from less advantaged backgrounds. The social justice issues are particularly ironic and alarming given the Government's policy focus on closing the gap. Does the cabinet secretary agree that, by narrowing the choices available to our young people, we are doing a disservice in trying to close that poverty attainment gap? That is a very welcome report. I met Professor Policeley to discuss it recently and also the pleasure of attending a lecture that he gave on this in Glasgow. He does raise a number of challenging points, not just for the Government but for our agencies, for local authorities and so on, and we are taking that very seriously. One item that I will touch on presenting in some detail if I can is around data. It is important that we collect data, but as I have discussed with Professor Priestley, we are, I think, with him about gathering it for the right reasons. We collect data, for example, on why children are at school or not attending, for example, to ensure that we are providing the support to schools, to provide the support to the young people, to get them back in so that it is not something to hold them to account to but something to support them with. That is a very important point and there is a lot more that we can do in that within the national improvement framework and so on. I give that as an example of the work that we are taking forward very seriously with Professor Priestley, who, of course, sits in our Scottish Education Council for the work that he says. There was a quote that the member gave that there are also a number of positive quotes in the report for the sake of time. I will not go into them in detail, but I am sure that Mr Quickfield is well aware of them. I am very grateful. There is a number of supplementaries. I will try to get all of them in if I can, but they will need to be brief as well as the responses for Stephanie Callaghan. Thank you. I note the absolute data in the study around any impact in neurodivergent pupils. Does the minister agree with me that it is extremely important to collect this data to ensure that we could not understand the experiences of pupils with additional support needs? Absolutely. When we are talking about the collection of data, it is important to ensure that we are genuinely appreciating the needs of pupils with additional support needs. Stephanie Callaghan mentioned neurodivergent pupils. Of course, there are other pupils within that additional support needs category, and that is absolutely something that we are determined to do, for example, through the pupil's senses. First of all, I apologise, Deputy Presiding Officer, for my outburst earlier, but I had never thought that I would hear the day when a minister in any Parliament would say that they were not going to answer a question seriously, but they were not going to give the matter-in-hand serious attention. I think that that is contempt of this place, and so, Deputy Presiding Officer, let me make it clear as well, it is contempt of this place. Mr Kerr, do you have a question? I do have a question, Deputy Presiding Officer, but I want to make it clear that that sort of comment from Mr Kerr clearly is not acceptable. The University of Stirling report is indeed uncomfortable reading, ought to be very uncomfortable reading for this SNP Government, because, in essence, what the report says is that we are letting down pupils by narrowing their subject choice and limiting their opportunities in life. Therefore, I would say to the cabinet secretary, teachers are working hard. Our teachers are working as hard as they can, they cannot work miracles. The cabinet secretary and her predecessors have failed a whole generation of Scots. Shouldn't the cabinet secretary apologise for the SNP's appalling record in education? I think that I am more than happy to check the official record, but what I said was that I was not taking Mr Kerr seriously in some of his retorts on the teachers pay dispute. However, when he comes to discuss the reports that have been produced by Professor Priestley, quite rightly it should be challenging reading. That is the entire point of us having a reform process to ensure that we celebrate the successes that we have, something that Mr Kerr does not do, but also to challenge ourselves to improve something that Mr Kerr can also have a thought about. We know that delivering a robust curriculum is key to providing our young people with opportunities as they move forward in life. With that in mind, can I ask the cabinet secretary how the Scottish Government will continue to live on its commitments to raise attainment and substantially eliminate the poverty-related attainment gap? Well, our commitment to the substantial reduction and elimination of the poverty-related attainment gap stands strong, and that is exactly why we have over £1 billion worth off-expansure going in to the Scottish attainment challenge over this parliamentary term. As the results have shown, that is now showing a real improvement, particularly in our primary years. Thank you, cabinet secretary. Question 8 is not lodged, so that concludes portfolio questions. There will be a brief pause before we move to the next item of business to allow the front benches to change.


Hello everybody! Watch this video to find out how to recover data from RAID 6 array-based Synology NAS DS 2422+. In today's video, we will explore how to configure backup schedule for important data, how to recover accidental remote files from the recycle bin, and how to retrieve files if the RAID is degraded, completely destroyed, or if the NAS device is out of order. We will also have a closer look at fine details of configuration and recovery with the latest firmware version DSM7.1. Synology is a well-known manufacturer of NAS storage systems. Typically, such devices as Synology Disk Station and Rec Station NAS are easy to use and can be found in various RAID configurations, including RAID 0, RAID 1, RAID 5, RAID 6, and RAID 10. They also support their own storage configurations, SHR, and SHR2. In the work of any network attached storage, there are maybe certain issues that could result in loss of data. Quite often, users may accidentally remove important files, or there can be various problems that block access to data or cause data loss. Possible scenarios also include underwear breakdowns, run configuration, firmware issues, and so on. If you lose access to files, the first rule is to stay calm and not to panic. Any wrong action at this stage often leads to losing all the information. As in the case with any NAS, recovering data is never easy. To restore accidentally removed information or retrieve files from any not-operable NAS, you need a specialized software tool. For starters, let's explore how to create a RAID and how to change its level on this specific network storage device. The process of building it will help you understand the working principle behind RAID, and it will make the recovery process easier. When new hard disks are connected to NAS, you should install the operating system and run initial configuration. For installation and startup, the operating system will suggest configuring the settings for a new storage pool. You should choose the RAID level, select the disks to include into the new array, the capacity of the new storage, and the file system. Check all the settings and click Apply to confirm them. After that, the process of building and optimizing the array begins. When it's over, you will get a new volume with the size you have set. To change the RAID level, you need to remove the existing volume. As a result, all data will be erased from the disks, because a disk array cannot be rebuilt without formatting its hard disks. To do it, open the menu, Storage Manager, Storage Pool. On the right, click on the three dots button and choose Remove, and then confirm the action. This will delete both the pool and the storage volume, as well as all files from the hard disks. After that, click Create and Start to create a new array. Now choose the RAID level. Click Next, select the hard disks, the volume size, and the file system. Then click Next and Apply. As a result, you'll get a new volume. Now you can create a shared folder, configure access permissions, and add your data. If you accidentally deleted important data from the shared folder, you can recover it from the Recycle Bin. By default, the Recycle Bin option is activated when you create a new shared folder. It will help you restore accidentally deleted files without using any additional software. To see if this option is enabled, open Control Panel, Shared Folder, select the folder from which the files were deleted, and click on the Add button. Make sure that the box next to Enable Recycle Bin option is checked. To restore your files from the folder, open File Station and browse to the folder from which important files were removed. After that, open the Recycle subfolder, find the items that were deleted, right-click on a specific file or folder and choose Restore and Overwrite. And all the files will be restored to their previous locations. If the Recycle Bin option is disabled for this shared folder, try recovering the deleted data from a backup. By default, the Backup tool is not installed. If you have already installed and configured the backup utility, you can use it for recovery. In the Package Center, you can find lots of backup apps. I'll show you how to configure backup and restore deleted files with the tool called HyperBackup. This utility lets you backup various types of data on Synology NAS, such as System Configurations, Apps, Packages and Shared Folders, and do it either on Skiddle or Manually. The backups are stored in their own database, which can be easily viewed, restored or downloaded. With HyperBackup, you can recover package settings and data as of some previous date. If you have already configured backup, you can restore the required data from a backup file. To do it, go to the DSM menu and run HyperBackup. In the Programs window, click Restore, select Data from the list, then select the backup and where you want to restore the data. When the process is over, the folder status will change to the status it had on the date of the backup. If the Recycle Bin option is inactive on your device, if the backup Skiddle is not configured, if there is no access to the hard disk within the array, or if the array is damaged because your NAS is down, you can still have your files back as long as you use a data recovery tool. Instead, download, install and run Hetman RAID Recovery. Het will rebuild the damaged RAID with the available hard disks so that you'll be able to retrieve the remaining data. To start the recovery process, take the drives out of the storage device and connect them directly to the motherboard of a Windows computer. If your motherboard lacks setup ports to connect all the disks or if you have a similar problem with power connectors, you can solve it by using special expansion cards and adapters, and you can see a few examples on the screen. When taking the hard disks out of the NAS, don't forget to mark the width numbers so that you will put them back into your NAS in the same order they used to have. Also, you will need some space to save the data, and it should be of the same capacity as the data you are trying to recover. This program supports all popular file systems and RAID types. It doesn't matter if your Synology NAS uses a conventional RAID or a Synology Hybrid RAID configuration, the recovery tool supports both types. The operating system may suggest initializing or formatting the hard disks for further use while they are connected to the computer. Never agree to that. Because if you do, there is a high risk of losing any remaining information, and it can make the recovery process much more complicated either. To have your files back, start this scan analysis. Right-click on the volume and choose Auto. After that, choose the scan type, Fast Scan or Full Analysis. If the NAS is down, but the program manages to rebuild the RAID correctly, a Fast Scan is enough. When the scan is over, open the folder where the lost files were stored. Previously deleted files are marked with the right cross. You can use the preview window to see the contents of all files, including videos and documents. Select all the items you want to recover, and click the Recovery button. Choose the directory where you want to save the files, the disk and the folder, and click Recovery again. When the recovery process is complete, you'll see all the files in the specified folder. To ensure more safety for working with damaged drives, this program has a feature to scan the scan images instead of actual HDDs. This will reduce the disk load and extend the lifespan. Summing up If you have a backup at hand, you can easily recover accidentally deleted files. But if your storage device is down, there is Hetman RAID Recovery to help you. And that is all for now. Hopefully, this video was useful. Remember to click the Like button and subscribe to our channel. Leave comments under this video to ask questions. Thank you for watching and good luck.


This paper proposes a novel approach to building extraction from very high resolution, VHR, remote sensing images. It combines the advantages of deep learning and guided filtering to achieve better results than existing methods. The authors use a deep residual network to train their model on VHR remote sensing data, then employ a guided filter to further refine the output of the deep learning model. This produces a more accurate segmentation map of buildings in the urban area. Experiments show that the proposed method achieved significantly improved results over other state-of-the-art methods. This article was authored by Yongyang Su, Liangwu, Zhongxia, and others.


What is up you guys welcome back to another one if you are new to the channel I'm Goldpony I do Card Chuck SUV reviews on YouTube and today we are in the new 2020 Mazda CX3 courtesy of Jack G Mbalvo Mazda in York PA for more information on their inventory please feel free to check out the link in the description box below and so you guys probably already know I've already done the CX30 the all-new SUV from Mazda for 2020 but I still gotta check out the CX3 I feel like I've done this one the past few years I always like to see if there's anything new and there are plenty of changes actually for the 2020 model year of course I will be going over them all in all Mazda is known for its legendary handling elegant looks and incredible value so I'm quite excited to get started on this one so what do you say as always let's go ahead and start with pricing so when it comes to pricing let me start with the first major change for the 2020 CX3 being that the touring and grand touring trim levels are eliminated for the 2020 model year so essentially you have one trim level option being this sport comes in front wheel drive for twenty thousand six hundred forty dollars or an all-wheel drive configuration for twenty two thousand forty dollars and so powering this little beast is going to be a two-liter direct injected inline four cylinder putting out 148 horsepower at 6000 rpm 146 pound feet of torque available at 2800 rpm power against at the front wheels or all wheels through a six-speed automatic giving you mpg numbers coming in at 29 in the city 34 highway for the front wheel drive 27 in the city 32 on the highway for the all-wheel drive configuration and so before we do any kind of acceleration test in the Mazda CX3 I did want to mention there is a sport mode button is located just to the left of the shifter so let's press it you guys probably heard that it did immediately downshift for me so it is going to hold the rpms at a much higher level still hanging on to that gear but anyways by holding the rpms at that higher level it is going to give you a little more acceleration on demand there it's also going to adjust the shift points as well and it did what I actually also mentioned although there's no paddle shifters on this cx3 you can still manually shift through the gears in this one if you wanted to to do that simply slide the shifter all the way to the back and to the left and although 99 percent of the time there is going to be no need whatsoever to manually shift through the gears but we are in pennsylvania so if it were to happen to snow and you wanted to do some engine braking that option is going to be there for you so that's kind of nice and so but now having mentioned all of that and since we are yet still in that sport driving mode what do you guys say let's go ahead and do a quick little acceleration test in our 2020 cx3 and let's see how quickly we can get this one here up to speed all right you guys coming up to my straightaway now let's come to a complete stop here in five four three two one here we go not the gorgas thing of the world but it's okay it's all good this is more of a commuter car anyways it should definitely be enough to get you up to speed when you're merging on to the highway or something like that and hey there's another mazda cx3 what's up obviously it's a pretty popular vehicle if that guy had one but i will say when merging on to the highway that sport mode beside the shifter there is definitely going to be your friend that's going to help you accelerate just a little bit quicker there but having said that it's not the quickest thing in the world but then again that is sometimes the sacrifice you have to make for the amazing reliability that mazda is known for so this is an SUV that is going to last you quite a while so that is kind of the trade-off when it comes to reliability they're not always the quickest cars and this may fall into that category but nonetheless to go along with that acceleration as always braking is equally important so i did want to mention to you guys braking setup is actually going to differ whether you go with the front wheel drive or the all-wheel drive configuration for example front wheel drive setup is going to be 11.02 inch ventilated front disc however with the all-wheel drive setup that is bumped up to 11.6 inch ventilated front disc in the back it's going to be the same regardless that comes in the 11.06 inch solid rear disc back there as far as the braking feel goes that has been 100 on point in my short little test drive today so certainly no issues with any brake pedal delay or anything like that definitely brings the mazda cx3 to quite a quick stop so that is a good thing but touching on suspension and handling up front you're going to get a McPherson strut front suspension with the stabilizer bar in the back torsion beam rear suspension and as far as ride quality goes it's been pretty good so far today i will say i'm going over some rocky terrain right now and actually it's it's really good over these rocks i've had a lot of other vehicles not handle it as well as the cx3 handled that right there so actually ride quality is definitely very nice in this one as far as steering feel goes it's something that mazda is definitely known for they do have a little weightier of a steering feel comparatively speaking to other manufacturers out there so steering feel definitely feels good in the 2020 mazda cx3 nothing too heavy nothing like a Mustang or something like that but still quite a nice feel to it compared to the other suv's and x segment i should say as far as cabin noise goes it's been relatively quiet in my test drive so far today so that's nice too and touching on visibility i could definitely see perfectly fine out the back absolutely no issues there whatsoever so visibility is 100 on point in addition to that mazda went above and beyond when it comes to visibility because they added rain sensing windshield wipers coming standard on the 2020 mazda cx3 so essentially what that means is when the cx3 detects any kind of mist or rainfall it will automatically turn on those windshield wipers for you kind of like automatic headlights so it's one less thing you have to worry about better helps you focus more of your attention on enjoying the drive in the mazda so that is definitely a big old plus as well but that about rounds out the performance segment of this review you guys let's now go ahead and take a look at the exterior of this brand new 2020 mazda cx3 all right you guys so here she is the new 2020 mazda cx3 actually looking very good still to this day in my opinion so let's go ahead and start up front on this one now to the side's led headlights with auto leveling will come standard of course on this one that auto leveling feature that's something you usually find in upper trim levels of other manufacturers so I do love that mazda just put it on their one and only trim level being the sport here on the cx3 automatic feature of course coming with those headlights meaning when it starts to get dark out they're going to turn on automatically for you there adaptive front lighting system once again mazda killing it with the headlights adaptive front lighting essentially is when you turn the steering wheel going around the bend at night those headlights will swivel better help illuminating what is around that bend so you're less likely to hit a deer or a squirrel or a possum or whatever and again that is yet another feature that is typically found on either luxury vehicles or very top trim levels of other manufacturers and sometimes it's not even found so once again well done mazda for that as well led daytime running lights coming standard up there as well and of course taking a look at the center front grill you will find that chrome molding surrounding the bottom portion of the front grill there so definitely looks good up front but let's now go ahead and make our way to the side here so let me first start by mentioning the most obvious way to tell the difference between the cx3 and the cx30 being the cx3's floating roofline what that is is that gloss pillar all the way towards the back it's going to kind of distinguish itself from the mazda cx30 so floating roofline on the cx3 black window surrounds coming standard when it comes to their side mirrors they are body colored power adjustable side mirrors with integrated turn signals you can actually get silver roof rails if you wanted them for an additional 300 that is an option on the cx3 when it comes to the side skirts always like to mention it they do come with a matte black finish on both the side skirts and the fenders some suvs do body colored but the cx3 is going to be finished in a matte black then take a look down at the wheel setup 16 by 6 inch aluminum alloy wheels are the one and only option and they certainly look good at least they're a double five spoke design so they definitely look good there but now let's go ahead and make our way to the back starting up top there you do have a body colored shark fin antenna which is nice because some other suvs in its class actually make that a matte black shark fin antenna kind of looks awkward up there so do you like this body colored rear spoiler with an integrated brake light coming standard of course just below that rear window wiper and just below all of it dual exhaust outlets actually I love that with bright tips and they are exposed a lot of suvs these days are tucking them underneath and putting fake exhaust outlets so I absolutely love that mazda left them exposed and their dual exhaust outlets in a four cylinder you hardly ever see that either so what do you say I think you guys know what we have to do next as always here is that exhaust clip it's so pronounced since we are around back when it comes to opening that rear liftgate it is a manual liftgate as expected so essentially just lift up underneath that rear liftgate and that is how you're going to go ahead and open this one up once opened up cargo capacity is going to come in at 17.8 cubic feet if that was not enough space there of course is a 60-40 split meaning the rear seats do fold down bumping that up to 42.7 cubic feet which in typical mazda fashion is below average for its class typically mazda does make suvs with slightly less cargo space but slightly more driving enjoyment I don't know why that's the trade-off but still a little below average for its class but 42.7 with the second roof folded there and you will also find a cargo area light back there as well but then making our way up to the rear legroom that is going to come in at 35 inches even for reference I mean even six feet tall this is how much space I have back there of course the rear passengers can also find a rear center armrest with cup holders that's always a plus as well but then making our way to the front seats they are manually adjustable cloth seats there's no heat available there's no leatherette no power adjustable seats it's a pretty basic setup but then again it's a very affordable price point so that's what I'm gonna back that up with but any who seats are definitely comfortable no issues with finding my perfect driving position still so it's definitely a good thing take a look at the steering wheel it is tilt and telescoping it is wrapped in urethane no leather steering wheel available on this one then make your way to the startup let me first start by showing you guys the key here you do have your mazda logo at the very top then lock unlock it is a pretty basic key setup but good news is here's a big plus for this price point it is a push button start so if you wanted to simply leave the key in your pocket simply just put your foot on the brake and press that engine start button which is located just kind of to the bottom right hand corner of the gauges there and so this is where it gets a little better when it comes to the gauge setup you will have the odometer and the gear that you're in found all the way to the left on the right side you're gonna have how many miles you'll have left until you hit empty in your outside temperature front and center of course you have your tachometer there is a digital speed readout within that tachometer that's a pretty cool setup and a lot of mazdas use that quite honestly but the best part is even with this cx3 you kind of have a heads up display and i say kind of because it's not actually displayed upon your windshield because that's usually the better type of head up display because you are looking directly forward but it's slightly below that you have this little plastic thing that pops up when you start the vehicle and it actually displays the head up display right there so i did find myself actually looking at that quite often it is much more convenient than looking all the way down at the gauges i will say that so it is actually very functional head up display it's not as good of course as the one that's displayed on the windshield but it's pretty darn close to be quite honest you can still very easily keep your eyes on the road and watch that at the same time so honestly for this price point having a head up display at all is pretty darn cool but so anyways making our way to overall interior quality now again at this price point it is a pretty standard setup however i will say there are some optional features that you may want to go with there is a frameless auto dimming rear view mirror with home link controls for up to three different garage doors that's a three hundred and twenty five dollar option if you wanted that there are aluminum cx3 door cells that is a one hundred dollar option if you wanted to go that route but as far as the standard setup goes again it's pretty basic you do have some leather with some contrast stitching found just above the climate control settings there and there's climate control settings definitely a very easy setup to use you're going to instantly know how to work that i do like the design found on the doors of the cx3 right around the power window buttons is kind of an imitation carbon fiber look it's not authentic of course but this price point it really shouldn't be just in front of the shifter you have dual usb charging ports you also have an sd card slot and a 12 volt power outlet a little bit of rubberized storage in there so things don't slide around as much just behind the shifter you have an electro mechanical parking brake with an auto hold button actually as well just to the side of that you have your circular dial and buttons to control the infotainment screen although the infotainment screen is touch screen as well and i'll get more into that in a second but just behind that even more storage and of course you do have a center armrest and if you're wondering where in the world is the cup holder that is found kind of just below the center armrest here so i don't know i guess if it's a tall drink you might have to leave that center armrest tilted up you have space to actually put your drink but if it's a smaller like mountain dew can or something like that you could probably leave the armrest down just put your hand in there and get it but as i alluded to let's now go ahead and take a look at the tech display front and center you will find a seven inch color touchscreen display and again you can control it using the circular dial and buttons just behind the shifter it's probably going to be the easier route while driving or when stopped it is a touchscreen display as well like i was saying but this is actually pretty cool it does come with bluetooth and audio streaming it's still at this price point comes with android auto and apple carplan that's the big win because that means all you need to do is hook your smartphone up through one of those usb charging ports i was mentioning and therefore you have free navigation displayed up on that tech display as well as the ability to liken this like your pandora songs there's youtube music a bunch of different compatible apps you can choose to display up there so that is a huge win right there especially at this price point can of course check out your radio settings up there as well and by the way you will find a six speaker sound system coming standard for the cx3 so do believe you guys know what we have to do next let me go ahead and turn the radio let's see what we got playing today and let's test out the clarity of this one i mislisted the bush it's been so freaking long but anyways sound system is pretty much as expected it's six speakers it's not going to absolutely blow you away but it'll get the job done for the size of the cx3 i will say that but last thing i wanted to mention to you guys on that tech display of course is when you do put the cx3 in reverse you will of course find a rear view camera letting you know who or what is behind you which is always is going to lead us into safety so let me first start by mentioning the very most important part about safety the 2020 miles to cx3 is an iihs top safety pick plus which is the very highest designation given by iihs that's a huge bonus there front side side current airbags will come standard in the back you're going to have latch aka lower anchors until they're still chill for the rear car seats also rear child door locks back there there's a tire pressure monitoring system that comes standard but also standard this is where it really gets good there are a lot of advanced safety features that come standard including a blind spot monitor with rear cross traffic alert that's awesome smart city brake support with pedestrian detection forward collision warning adaptive cruise control with stop and go a lot of times that's more of a luxury feature or a feature at least found on upper trim levels of other manufacturers that's huge and a lane departure warning system as well and so but anyways you guys that is about it for this one as far as my final thoughts go a ton absolute ton of value still to this day in the miles to cx3 so definitely a huge plus there if you look at a consumer reports magazine is going to show you excellent reliability or well above average i believe is what they call it so the very best reliability rating i should say by consumer reports still looks absolutely wonderful has amazing steering feel that is another huge bonus really the only trade off to the cx3 in my mind is the cargo space you can get some of its competitors do have a little more cargo space but still at the same time still a super solid pick here with the reliability the standard safety features ihs top safety pick plus a really definitely something you probably want to consider and test drive but that is about it for this one you guys thank you so much for watching feel free to follow me on social media at the bottom of the screen there if you like be sure to hit the subscribe and the bell notification button if you're in a new car reviews that is what we do here on this channel after all do appreciate you guys watching more than you know and i will see you guys all in the next video stay gold


Hello everyone. My name is Massimiliano Maineri, the co-chair of the Leipzig Health Centre in Leipzig, Germany. And I worked at Toronto General Hospital as a fellow and as a staff for many years. And I'm always extremely pleased to be invited to this conference that's been grown through the years and has actually made it through very difficult time that we could have never foreseen when this whole adventure started many years ago with the hard work of Annette Vegas. What I was asked to talk about was today the use of echocardiography for intraoperative assessment of mitral valve repair, specifically for minimally invasive surgery. I have a few disclosures. I've received honorarium from ABBA to talk about mitra clip, which is not a topic in my talk today. In Leipzig, we are a Philips reference centre. So all of the images we have, they come from Philips machines. Unfortunately, we don't get any money for it, but we get equipment and software from the company. And I'm also part of the writing committee of the National Board of Echocardiography for the TXM. I wanted to guide you through a systematic approach for the evaluation of mitral valve regurgitation for surgery, and I'll be using the guidelines that were actually published two years ago. And we'll talk about some of the measurements that are important or that our surgeon thinks they are important, and we use for communication with our surgeon, and then we'll talk about assessment of the results. These are the guidelines I mentioned. This is a very interesting paper that came out two years ago. It's hard work of a big group of people from North America, including Annette, who was involved in these guidelines. And what these guidelines are, they're basically a roadmap for intraoperative echocardiographers to tell them what it's expected from them to do for specific procedures. And this is what it's written about mitral valve repair. And the guidelines propose a systematic approach that starts from evaluation of mitral valve anatomy. When we talk about anatomy, it's always nice to go back to the actual anatomy of the heart. And we're now talking about the mitral valve, which is this valve that I've highlighted in this animation between the atrial left atrium and left ventricle. It's called mitral because it resembles this head that's still wore by bishops in many churches. And if we turn it around, it looks like the leaflet of the mitral valve. The mitral valve is composed by two leaflets. And what helps us orient ourselves is that usually between 11 and 12 o'clock is the aortic valve, which is anterior, and the left atrial appendage, which is at about 11 o'clock. And as I said, next to the aortic valve is the anterior leaflet and away from the aortic valve, so opposite to it is the posterior leaflet. The mitral valve is not just a valve, but in order to have a functioning, a well functioning valve, all components of this mitral valve complex need to work in synchronous. And these components are the atrium, the annulus, the leaflet, the corded tendine, the papillary muscle, and the left ventricular biocardium. If any of these elements is pathologic or changes itself, then that affects the functioning of the mitral valve and the valve may become incompetent. What it's important to understand is the mechanisms of mitral regurgitation. How many reasons can there be for the mitral valve to leak? And Carpentier many years ago, this is from 1983, described these possible mechanisms into three types. And they are divided into primary and secondary mitral valve regurgitation. And they talk about and they're focused on the motion of the leaflet. So we can have normal leaflet motion, where we have a dilatation of the ring or a leaflet perforation or a cleft or an indentation. We may have excessive leaflet motion, which is what we commonly see or most commonly see that presents with leaflet prolapse or flail. And then we have restrictive leaflet motion. Restrictive leaflet motion can occur in systole and diastole. And that's a degenerative mitral valve or a rheumatic mitral valve. Or the restricted motion is only in systole due to tethering of the leaflet, which means that there's forces that pull down on the cords and prevents the leaflet to close. But the leaflets themselves, they're actually normal. And this is type three A for systole and diastolic restriction and type three B for only systolic restriction. It is always, it's very important that we understand where the problem is in the mitral valve. And as you can see here, we all know we use this carpantienome enclature, where we have divided the posterior mitral valve leaflet into three portions. They are usually identifiable due to a small indentation between them. And more laterally, we have P1. In the middle, we have P2. And medially, we have P3. Opposite to it, opposite to them, we have also divided and we divide the anterior mitral valve leaflet into one, more lateral, two in the middle, and then three medial. This was, for me, one of the biggest challenges as I started learning transasophageal echocardiography in Toronto. And I just couldn't understand how my staff would tell the surgeon it's a P2 problem. It's a A1 problem. It's a P3 problem. And actually, for each of these, so in order to see and to visualize all six of these scallops, we need four or five views. And these are the views that we normally have, and we need to visualize all of them. There's a four-chamber view, mitral commissure view, two-chamber view, and long-axis view. Now the challenge is always to remember which one is which. What's also not always so clear is that it's not even so, we're not even 100% sure that what we see is what we think we're seeing. So when we have a four-chamber view, the four-chamber view cutting right in the middle of the valve, which is a perfect four-chamber view, then we see the two portions. But actually, if we take this probe and we pull it up and we start to see the aortic valve, then we are no longer seeing the A2 portion of the valve, but the two portions of the valve, but we're moving laterally. And then actually, if we push the probe in, we start to see the coronary sinus, and now we're going to see the more medial aspect of the valve. So with a four-chamber view, we can use this view to scan through the valve in and out. Something similar we can do with the long-axis view, where now instead of pushing the probe in and out, we can turn the probe right and left. And if we turn left, we're scanning through the more lateral aspect of the valve in the one segment. And if we rotate to the right, we scan into the more medial aspect of the valve, that's the three segments. Now, we don't have to think too much about it anymore, because we have multiple planes that can be displayed at the same time. And this is what we normally do. We display the mitra valve in the mitra commissural view, where you can see here in the middle that's highlighted in yellow. And that's you see the yellow line on this model where it's cutting through. It's cutting through P1, which is actually to the right side, where the left lateral appendage is P2 in the middle, sorry, A2 in the middle, and P3 to the left side, which is the most medial aspect of the valve. Now, if we place the secondary plane right in the middle, what we see on the right side in the long axis, now we know for sure these are the two segments. What we can do is now stay in there, just move our secondary plane more medial or more lateral. And now if we move more medial, we're going to see the three, which is what we see to the right. Or if we move more lateral, then we're going to see the ones, that's what we see to the left. Obviously, now we have 3D imaging, and you know, I'm a big 3D fan. And the 3D imaging really allowed us to fully appreciate the complex anatomy of the mitra valve. We can obtain a block of the mitra valve. We look at it from the left atrium down into the ventricle. We can see the valve just like the surgeon sees it. We can actually flip it and look at the valve from the bottom. So from the ventricle to the atrium. And just looking at the 3D, the unfast view, which is the surgical view, which is the orientation of the valve, the same way the surgeon would see it with the anterior leaflet at the top, the aortic valve at 12 degrees, 12 o'clock, and the posterior leaflet at the bottom. Just looking at these blocks, you can probably tell right away what type of problem we have here, and how it correlates to what type of disease or what type of, what is the cause of that agitation. With 3D now and newer technology, we can make this block looking more realistic using with the philip system, so-called true view or glass view. And what really, I think 3D big difference for the mitral valve is to be able to identify clefts and indentation. And I never understood how can we see a cleft in 2D. It's extremely difficult. Now after many years of experience, I could probably make a diagnosis, but we don't need to do it anymore because if you look at the valve on the left, you can clearly see that there's a cleft between P1 and P2. And if you look at the right, there's an indentation, which is sort of an incomplete cleft that goes through the leaflet. Then this is very important to tell the surgeon, so the surgeon can appreciate little details that sometimes when they look at the valve, the heart is empty in diastole, and the valve is not loaded, and these details may, they may not be able to appreciate it. Once we have a 3D block, we can still cut this block into perpendicular planes. And we can use this multiplier reconstruction that we did it live here that's using so-called multi-view with the philip system. And we orient the blue plane to cut through the mitral valve manual. So now at the bottom left in the blue panel, we have the mitral valve in the long axis, in the short axis, and we have at the bottom the aortic valve. And now we can position our red plane right in the middle. And as we position it right in the middle, when we look at the red panel, now we're looking at the P2 segments and the A2 segments. We take this red plane, we move it now more medially, and this is what we did on the left. And now we're seeing the three segments. You take this red panel and you move it to the left. Now we see the one panel. You can do it as we did it live, or we can do it offline with multiplier reconstruction. This is an example from another data set where we see in the bottom left, the A1 segments in the middle of the two segments and on the right is the three segments. And we still have our eye can still much better appreciate a leaflet pathology and leaflet morphology in 2D, better than in 3D. But 3D gives us like an over look at the whole valve in just one blink, one shot. We can take these 3D models with 3D block and then build a 3D model of the mitral valve. We do it and we've done it many times for research purposes. We in Leipzig don't do it on a regular base, although these models we did studies when I was still in Toronto with Tyron David and we demonstrated that they're reliable and they correlate with direct measurements of the valve. And you get a whole set of automatic measurements. But this is a matter of communicating with the surgeon and making a decision together how we can use these measures to guide their repairs. Now that we've looked at the anatomy of the valve, we need to evaluate the severity and confirm the severity. And how we do this, we do it with color Doppler. So with color Doppler, color Doppler will help us to further confirm the cause of mitral regurgitation because the color normally goes away from the prolapse and towards the restriction. So whenever we see something in 2D, we put color on, then it needs to make sense. Yeah, if it doesn't make sense, then we've done something wrong. Most likely with our 2D assessment or 3D assessment without color because the color is always displayed where it is. Therefore, we need to find the reason for a jet that's going in a certain direction. With multiple planes or X-plane or D-plane or multiple planes, at the same time, we can use the mitral commissural view just like I showed you for the 2D image. And we're going to also use this technique with the case that we present in later. And we can then use the position, the secondary plane on the primary plane on the first plane, so on this mitral commissural view, and then scan through the valve and go look for the jet and see exactly where the jet is coming from. We can use 3D color. 3D color gives us a nice depiction of where the colors come from. Now with the newer probes, we can have a good enough temporal resolution so that in one beat we can display the color. And what is never to forget is that we are now evaluating a patient who's intubated, with mechanically ventilated, and who's asleep. And this patient was evaluated before in the echo lab, but he was awake, and he may have had a TEE, and the TEE was extremely uncomfortable, and the blood pressure was very high. So it's important that we try to recreate in the operating room the same physiologic condition as we had in the echo lab when they did the preoperative assessment. Or what we think, or what we know that the preoperative condition for these patients are, and before the patient was put to sleep and before the patient was breathing spontaneously. This is an example of a case of an ischemic mitral regurgitation, where you can see the same patient on the left with 100 over 60 blood pressure and on the right with 170 over 90 blood pressure. So what looked like a minimal mitral regurgitation was actually severe mitral regurgitation, and this patient was actually treated for that. What we also have learned from a 3D color Doppler is that this jet that we thought that the jet is actually around comes from around orifice. When we actually cut through it, we realized that this orifice for ischemic mitral regurgitation specifically is actually not round, but it's oval. So that sort of speaks, so adds more information in one direction. This would be for ischemic mitral regurgitation and also it highlights the limitation of measuring the vena contracta in 2D and in one play alone. So we've seen now the reason for the mitral regurgitation we've looked at the jet. Now we need to see whether there are elements that are speaking against the repair of this valve or things that may make this valve difficult to repair. What do we provide our surgeons so then they can sort of make a decision? We usually provide them the annular diameter, which is the anterior posterior diameter, the length of the leaflet, C-sub distance diameter and length of the ventricle, tenting height and tenting area for ischemic regurgitation, and then we look at the distance of the circumflex from the mitral valve annulus. If you want to actually have a roadmap that's sort of very helpful in decision making in the OR, this is what our colleagues in Boston proposed and in this paper there's one of the ex fellows from Toronto General Hospital that's Aidan Sharkey that's become extremely productive in Boston as they move there. And you can see that what they suggest is that when we see mitral regurgitation then we need to establish the pathophysiology of this function and then understand whether this is ischemic or non-ischemic and then exclude predictors of repair failures. What are the predictors of repair failures that were identified by this group in this paper? These are the tenting height and tenting area, so more than one and more than 2.5, the angle of the P3 segment of the posterior leaflet, a very dilated ventricle in diastole and in systole. And these are actually all the parameters that have been proposed and described in the literature to speak against a repair in case of ischemic mitral regurgitation. These are basically proportional to the extent of tethering of the leaflet and to the dilation of the ventricle. When the leaflet are extremely pulled down, when the ventricle is extremely dilated, then the chances of successful repair are much less. What happened though with ischemic mitral regurgitation is that ischemic mitral regurgitation presents itself with two very different phenotypes. One phenotype, which you see at the top, you have all portion of the leaflets anterior and posterior are pulled down into the ventricle and you have a central mitral regurgitation jet. So you see the jet is central, comes from the middle of the valve. Or when you have involvement of the posterior papillary muscle and the inferior wall of the left ventricle, then you have tethering of the P3 segment, then you have an eccentric mitral regurgitation jet. This is the case where the repair of this valve is not going to work. It's going to eventually very, very soon fail. Here is another paper that showed that the most significant measure against predictive of failure for mitral valve repair was a P3 tethering angle of more than 30, which basically means that the P3 segment was pulled down way more than the other segments of the valve. And this is an example of how this with multi-primary construction can be measured. We are talking about the mitral valve. In a good portion of patients with mitral valve disease, we have concomitant tracaspid valve disease. Why is it important to look at the tracaspid valve? Because if we operate the tracaspid valve at the same time as the mitral valve, there is no increase in risk of death and in morbidity for this patient. So it's basically the same. And it's not that difficult for our surgeon. What's important for us when we do minimally invasive mitral valve surgery is that if we need to repair the tracaspid valve, then we need to put a neckline. And we in livestock do it in the induction room. Before we go to the OR, it happens sometimes that we identify tracaspid regurgitation when we were already in the OR and we had to put it in the OR. That wasn't really very, was an idea because the surgeon had to wait and we have to work with much more stress. But when should the tracaspid valve be addressed at the same time as mitral valve repair? The guidelines from 2007 are very clear. All the time when the tracaspid valve regurgitation is severe, it's class one indication. When the tracaspid valve regurgitation is mild or moderate, then if the annulus is dilated, which means tracaspid valve annulus measured in the four chamber view in diastole more than four centimeters, or when there is no tracaspid annular dilatation, but there is evidence of pulmonary hypertension. Now, tracaspid valve repair includes the use of a ring in the great majority of cases. So we pretty much always use a ring, whether there's so many different types of ring, complete rings, partial rings. How do we choose the ring? So at our center, what we do is we basically want to choose a ring that's pretty much as big as the anterior mitral valve leaflet. And that's why the surgeons want to know the length of the anterior mitral valve leaflet to have an idea of how big of a ring they're going to put in. Other measures that's been used is the inter-trigonal distance, which is basically the distance between the two commissures of the valve. We in Leipzig don't really use it. How important is it to pick the right ring? It's very important, but the surgeons will still use a sizer. So our measurements, they're not going to be the final decision on what type of ring we're going to use. It's more to give them an idea of how big of a ring and how much they can play with the ring in this specific patient. SEM is a phenomenon that can occur after mitral valve repair, and there have been many studies describing the risk factors for SEM. These are what's been described from Andy Maslow and many years ago, and that's actually included in the guidelines that I mentioned before from 2020. And these are the measurements we're also using in Leipzig. It's the ratio between anterior and posterior leaflet less than 1.3, angle between mitral and aortic valve less than 120 degrees, septum more than 1.5 centimeters, and a c-sep less than 25. Zirconflex artery runs just next to the mitral valve annulus, and there's a high chance or there's always a risk that when we put stitches on the annulus, we take the Zirconflex within. And in Leipzig, we've described, my colleague described in my boss a few years ago in this paper, and the video is from the paper, a technique to actually look and follow the left main into the Zirconflex and to see how the Zirconflex runs within, so next to the mitral valve annulus. We can do it with 2D, we can do it with color, and I'm going to show you in the case later how we actually do this. With 3D, with a 3D block and multi-primary construction, we can actually identify the Zirconflex and measure the distance between the Zirconflex and the annulus at different points, and here you can see we've done these measurements and we not only know the distance, but we actually know what is the distance at which and which specific points. There is an information that our surgeon actually like to have in order to sort of know how much relaxed they can be or more nervous need to be when they put the stitches in the annulus. This technique has been compared to CT and actually demonstrated great correlation with CT in this paper. That's the work from one of my colleagues, Carmen and Bevilacqua and many of my current colleagues that work together to put together this very nice study. With minimally invasive approach, as you all know, and Elmeri has certainly already talked about it, we need to place lines in the groin, so a venous line and an arterial line. When it comes to the venous line, the first step is to identify the wire in the superior vena cava, and then we advance the catheter, the cannula in the superior vena cava. What is very important is that you need to see the wire in the superior vena cava, and I'm not going to say it, I'm never going to say it enough. What's happening very often is that especially after the wire has been placed in the right position, the surgeons dilate, and after the second or the third we use three different dilators, then the wire comes off of the superior vena cava, now they want to advance the catheter. That's extremely dangerous because if the wire is not in the superior vena cava, it can be in the right ventricle, it can be in the right atrapendage, and if we now advance the cannula with the dilator of the cannula, then there is extremely high chance that we're going to perforate the right ventricle or the right atrium. The surgeon must wait, if you don't see the wire in the superior vena cava, please scream, you are allowed to scream, you need to scream and tell him to stop, wait until I don't see the wire, you don't advance the cannula. We've seen already, unfortunately, in my short time in life enough complications because the surgeons just didn't want to listen and didn't want to wait. For the arterial cannula, we identify the wire in the descending thoracic aorta, we don't see the cannula, and as we go on pump, unfortunately, this is what can happen, this is a case of very unfortunate case of pelvic dissection after cannulation of the femoral artery. After repair, what do we need to look for? The guidelines are suggesting that we look for residual MR, we need to exclude mitral stenosis, exclude SAM, and look at left ventricular systolic function, and then also have a look at the other valves. What we do in Leipzig is, as soon as the clamp comes off, and you can see here, now with color flow, we follow and look at the circumflex and we look at flowing the circumflex. When you're still on pump, this is the time where you have the best chance and the best look at the flow in the circumflex, and what you can see here, we usually drop down the max limit to 15 or 20 in order to sort of be able to appreciate lower velocity flows in the coronary arteries. We look at co-optation lens. In Leipzig, we never reject, we respect the leaflets, so we put new cords and it's always nice to see that there's a co-optation that's more than five millimeters. We look for residual MR and anything really that's more than trace or mile, we don't accept it. So we go back on pump, we try to repair and if it doesn't work, then we go and replace the valve. Mitral stenosis has to be taken into consideration, doesn't happen very often. Ideal way is to have a gradient no more than four millimeters of mercury. If you have elevated gradients across the valve, you need to look at the hemodynamic conditions and you also have to look at, you can also use 3D to planimetry the valve and actually see what the effective orifices of the valve after repair. I warned you about coronary circumflex occlusion, it does happen. When it does happen, it presents itself with lack of flaw in the coronary artery, but also a very obvious whole motion abnormality in the lateral wall. As you can see here, this was a patient that from Johara went directly to the cut lab and this is an old echo, which I've taken from an older presentation, but this is not something that hasn't happened in the last couple of years. Still once twice a year in a high volume center is something that still happens. SEM is a problem. You can see here just a case of SEM after mitral valve repair. What is the solution volume? Yeah, we can give volume, volume and beta blocker and just ignore it. That's probably not the right solution. There shouldn't be any SEM. We've had a case where after we had a significant SEM, then the surgeon was and was Michael Barger, went back on pump and he took the ring down and put a bigger ring. The valve was still competent and the SEM was gone. This is something to keep in mind if you use the smaller ring and you have SEM, then you need to think of if the valve would be able to tolerate a bigger ring. After mitral valve repair, we also need to look at the other valves. This is a case where you can see that the aortic valve and the aortic valve is basically in continuity with the mitral valve annulus. Here is a case of a patient who as soon as we came off pump and we checked the mitral valve, then present itself with this aortic valve regurgitation that wasn't there and you see it before. You can see that the jet is not actually coming from the center of the valve from where we normally see a jet, but it's coming from the leaflet itself that actually was perforated by the surgeon as he put the stitches of the mitral valve ring. This case, it's actually one of these cases from the experience of our surgeons in Leipzig is that the mitral, iatrogenic mitral insufficiency, aortic valve insufficiency as a result of damaged leaflet is not going to get better over time. It's not something that you can say, oh, it's mild, we just leave it alone. Putting it all together, you can follow what we do in Leipzig, but there's guidelines and guidelines now are pretty clear. The mitral valve regurgitation has been extensively studied and our work as a co-cardiographer in DOR has been always a key component of treatment of the patients. It is important to understand the anatomy and the mechanism of mitral regurgitation. You need to assess the severity in physiologic condition. You need to talk to the surgeon and create this bonding with the surgeon and this is also the advantage of working often with the same surgeon and actually have a strong team and you need to be familiar with possible complications and I don't have to tell you, I think it's quite self-explanatory that the advent of 3D made a big difference, especially in the assessment of mitral regurgitation and planning for surgery. I'd like to thank you very much for inviting me and for your attention and this is my email if anyone wants to ask me questions that you didn't dare asking or we didn't have time to answer and you're welcome to visit us in Leipzig for our master class next year in June or anytime whenever you want to come and see our center and have a trip to Europe and Germany. Thank you very much and we'll have a chance to interact a bit more in the Q&A session.