Hello everyone. In this lecture we shall discuss armamentarium of local anesthesia. Main equipment necessary for the administration of local anesthetic include the syringe, the needle and the local anesthetic cartridge. In addition, you may also need topical antiseptic, topical anesthetic, applicator sticks, cotton gauze and a hemostat. The first equipment is the syringe. The syringe is the vehicle whereby the contents of the anesthetic cartridge are delivered through the needle to the patient. The syringe types available in the industry can be classified into non-disposable syringes, disposable syringes, safety syringes and computer controlled local anesthetic delivery systems. In the non-disposable category, you have bridge loading, metallic cartridge type aspirating syringes. Pressure syringes and eject injectors. American Dental Association criteria for acceptance of local anesthetic syringes are given here. The syringes must be durable and able to withstand repeated sterilization without any damage. They should be capable of accepting a wide range of cartridges and needles. It should be permittable for repeated use. They should be inexpensive, self-contained, lightweight and simple to use with one hand. It should also provide effective aspiration and it should be built in such a way that any blood in the cartridge can be easily observed. Now let's have a look at the different components of bridge loading, metallic cartridge type syringe. Here is the assembled syringe and here is the disassembled one. As you can see in the figures, there is a syringe barrel which is metallic. This is the piston with the harpoon at its end, a pointed harpoon at its end. Then you have the finger, a grip, a thumb ring and a needle adapter. So the term bridge loading implies that the cartridges inserted into the syringe from one side of the barrel. Here is the syringe barrel and the cartridges inserted through the side. So there is a hinge mechanism which is operated to insert the cartridge into the syringe barrel. The needle is attached to the barrel of the syringe at this point which is the needle adapter. The needle, from the needle adapter it passes into the barrel so that it penetrates the diaphragm of the local anesthetic cartridge which is inserted into the barrel prior to insertion of the needle. The cartridge also has two ends. So the one end of the cartridge will be penetrated by the needle and the other end which has a silicone rubber stopper is penetrated by the harpoon which forms the tip of the piston. How does this syringe become an aspirating type of syringe? When a negative pressure is exerted on the thumb ring by the administrator the blood will enter into the needle and it will be visible in the cartridge. If the needle tip is within the lumen of a blood vessel that is called negative pressure that is if the administrator pulls the piston with the harpoon behind then it creates a negative pressure which will take the blood within the cartridge if it is within the blood vessel. And if the administrator applies a positive pressure that means if he pushes the piston forward towards the needle side it is then called positive pressure. By this way the local anesthetic solution can be deposited at the desired target site. With commonly used bridge loading metallic cartridge type syringes an aspiration test must be carried out purposefully by the administrator before or during drug deposition. However the studies have shown that many dentists don't purposefully perform an aspiration test before injection of an anesthetic drug therefore to increase the ease of aspiration self-aspirating syringes were developed. As mentioned earlier the cartridge which is inserted into the syringe battle has two diaphragm ends one of which is penetrated by the needle and the other which rests on the tip of the piston. So self-aspirating syringes use the elasticity of the rubber diaphragm in the anesthetic cartridge to obtain the necessary negative pressure for aspiration. Unlike in the aspirating syringes the piston itself aspirating syringes don't have a sharp harpoon but the metallic plunger here is blunt and flat and the cartridge diaphragm rests on this metal projection inside the syringe that directs the needle into the cartridge. So any pressure acting directly on the cartridge through the thumb disc or indirectly through the plunger shaft which is the metal projection over here at the piston. So this pressure acting on the cartridge distorts the rubber diaphragm at the piston end of the cartridge which produces a positive pressure within the anesthetic cartridge. That means any pressure given through from the thumb ring over here will push this plunger towards the rubber diaphragm on the cartridge so that a positive pressure is created within the cartridge and when this positive pressure which is given is released it then produces a negative pressure within the cartridge which permits aspiration. The point to be understood here is that the positive pressure created within the cartridge which then gets converted into negative pressure in order to aspirate is produced by this metallic plunger alone or it is produced by the pressure given from the thumb ring. It is found that the thumb ring produces twice as much negative pressure as the plunger shaft which is this metal projection. So the use of self self aspirating dental syringe permits easy performance of multiple aspirations throughout the period of local anesthetic deposition. This is a plastic disposable syringe. So this syringe contains a lure lock screw on needle attachment mechanism and it has no aspirating tip. Aspiration can be done by pulling the plunger of the syringe before or during injection because there is no thumb ring. Aspiration with a plastic disposable syringe needs the use of both the hands. In addition these syringes don't accept dental cartridges therefore the needle attached to the syringe must be inserted into a vial or a cartridge of local anesthetic drug and an appropriate volume of solution should be removed. The next component in the armamentarium is the needle. The needle permits local anesthetic solution to move from the cartridge into the tissues surrounding the needle tip. Most needles used in dentistry are stainless steel and are disposable. All needles have these components in common the bevel, the shaft or the shank, the hub and syringe penetrating end. The bevel defines the point or the tip of the needle. It is manufactured as long medium or short bevel. It is found that the greater the angle of bevel with the long axis of the needle, the greater will be the degree of deflection as the needle passes through the soft tissues of the mouth. The shaft or the shank of the needle is a long piece of tubular metal which runs from the tip of the needle through the hub and continuing to the piece that penetrates the syringe or the cartridge. The two factors that needs to be considered with the shank are the lumen or diameter of the needle and also the length of the shaft from point to the hub. The hub is a plastic or a metal piece through which the needle attaches to the syringe. The syringe penetrating end of the needle extends through the needle adapter and it perforates the diaphragm of the local anesthetic cartridge. So these are the parts which form a needle. As mentioned earlier when needles are selected for use in various injection technique there are two factors which must be considered. They are the gauge and length of the needle. Gauge refers to the diameter of the lumen of the needle. The smaller the number the greater the diameter of the lumen. For example a 30 gauge needle has a smaller internal diameter when compared to a 25 gauge needle. The smaller diameter needles are less traumatic to the patient than needles with larger diameter. The most commonly used needles in dentistry are 25, 27 and 30 gauge needles. Coming to the length. Dental needles are available in two lengths mainly long which is approximately 40 millimeters and short needles which are approximately 25 mm. The needles should not be inserted into the tissues till their hub unless it is absolutely necessary. The weakest portion of the needle is at the hub so that the needle breakage occurs. Long needles are preferred for all injection techniques requiring penetration of significant thickness of soft tissue. There are several clinical problems pertaining to needle insertion. Pain on insertion is mainly due to use of dull needle. Therefore this can be avoided by using sharp new disposable needles and application of topical anesthetic at the site. Bending of needle can make them weak and lead to needle breakage. So never attempt to force a needle against resistance. Smaller gauge needles are more likely to break than larger gauge needles. Pain on withdrawal of the needle is more likely that they occur when the needle tip forcefully contacts a hard surface like bone. So here also needle should never be forced against resistance. Injury to the patient or administrator. It happens mainly due to carelessness or inattention by the administrator. Even sudden unexpected movement of the patient can also cause injury. Therefore the needle should remain capped until it is to be used and it should be made safe immediately after withdrawal from the mouth. A new approach to reducing needle deflection has been described as bi-rotational insertion technique or BRIT technique. In this technique the operator rotates the needle in a back and forth rotational movement while advancing the needle through soft tissue. So this technique is similar to that of entrodontic instrumentation. It has been demonstrated that deflectional bending of a needle can be minimized or even eliminated regardless of the length or gauge of the needle as long as the insertion was performed using BRIT technique. Dental cartridge is a glass cylinder containing the Luchelin esthetic drug along with other ingredients. A pre-filled 1.8 ml dental cartridge consists of four parts. Cylindrical glass tube, stopper, aluminum cap and a diaphragm. Stopper is located at the end of the cartridge that receives the harpoon of the aspirating syringe. Stopper was initially mixed with paraffin wax in order to produce an air tight seal around the against the glass walls of the cartridge. Glycerin was also added to act as a lubricant. Today silicone stoppers are used hence eliminating the need for paraffin and glycerin. Aluminium cap is located at the opposite end of the cartridge from the rubber plunger. It fits around the neck of the glass cartridge thereby holding the diaphragm in position. Diaphragm is a semi-permeable membrane usually made up of latex rubber through which the cartridge end of the needle penetrates. The perforation of the needle is synchrically located and round thus forming a tight seal around the glass chamber. Contents of a dental cartridge include local anaesthetic agent which aids in conduction blockade, vasopressor, sterile water which acts as a solvent, sodium chloride to maintain the isotonicity of solution, sodium metabysulfite which is an antioxidant to vasopressor, methylparaben, a preservative which is no longer used due to its allergic nature. Some of the clinical problems related to dental cartridge includes bubble in the cartridge. A small bubble of approximately 1 to 2 mm in diameter is formed in the dental cartridge. This bubble is composed of nitrogen gas which was bubbled into the local anaesthetic solution during its manufacture. This was to prevent oxygen from being trapped inside the cartridge. The stopper can become extruded if a cartridge is frozen and the liquid inside expands. In this case the solution is considered unfit for use. Burning sensation on injection. Burning sensation can be caused as a normal response to the pH of the blood. Also cartridge containing sterilizing solution, an overheated cartridge or a cartridge containing a vasopressor has lower pH which results in burning sensation. Corroded cap or a rusted cap. Aluminium cap on a local anaesthetic cartridge can be corroded if it is immersed in disinfecting disinfecting solutions which contain quaternary ammonium salts like benzalconium chloride. In this case the cartridges shouldn't be used and discarded. The leakage of local anaesthetic solution into the patient's mouth during injection occurs if the cartridge and the needle are prepared improperly or the needle puncture of the diaphragm is not centric. If it is a void or eccentric it can cause leakage of solution during injection. Broken cartridge is another clinical problem related to cartridge and the most common cause is mishandling of cartridge during shipping. How will you carefully handle local anaesthetic armamentarium? After each use thoroughly wash and rinse the syringe free of any local anaesthetic solution, saliva or any other foreign matter. You may autoclave the syringe in the same manner as other surgical instruments. After every five autoclavings dismantle the syringe and lightly lubricate all the threaded joints especially where the piston contacts the thumb ring. You may clean the harpoon with a brush after every use. The needles must never be used on more than one patient. Needles should be changed after three or four tissue penetration in the same patient. It should be covered with a protective sheet when not being used and it must be properly disposed after every use. Some of the things you need to keep in mind while handling syringe, needle and a cartridge. That's all for this lecture. Thank you.


Hi everyone, as professor said I'm working at the faculty of civil engineering in Zagreb and I'll present our case study which is partly has been presented on some of the previous meetings because it all started with STSM back in 2016 and it continue to a new STSM which I've been in February. So just have a short introduction for you who haven't seen it already. So my presentation is named application of bridge weight motion measurements in assessment of existing bridges. I divided the presentation as most fathers did so here I will just give a short introduction about the bridge and decision scenario based on assessment strategy then short introduction about monitoring method applied and then data and results which we obtain and in the fourth chapter the value of information and associated costs. So for start this is the bridge the bridge is located in Slovenia it's a highway bridge small one only one single span of 20 almost 25 meters cross section of the bridge is classic pre-stressed high type girder connected with monolithic depth. We had all the original designs and drawings and we did a visual inspection back in 2016 and we built a 3D model in Sophistic software for assessment of the bridge. Bridge is 26 years old so it's not all the bridge but we use this one because we had all the data and monitoring data. So main objective of this case study is to prove that initial investment in monitoring in this case weight in motion will result in extended bridge service life reduction of overall maintenance costs and overall optimization of bridge management process. So back in 2015 I think we started working on multi-level assessment method for existing bridges in Croatia because a lot of them smaller bridges are built in the 60s and 70s and they are very bad state and we started using for the first time weight in motion measurements so we developed like three-level assessment method where we have first one without monitoring data then with short-term monitoring and with low-term monitoring. So the point is if bridge passes the assessment on the first level then you don't have to do the next levels because every each level is much more complicated and of course it costs more. So in the first step just basic numerical model based on visual inspection and with traffic loads based on design code for new bridges as there are no assessment codes or criteria in Croatia or also in Europe. Bridge rating is based on deterministic or probabilistic approach it's based on the detail of the analysis and if the bridge doesn't pass assessment on this level then we can use the strategy with short-term monitoring which is done with bridge weight in motion for a short period of time and if it doesn't pass then we can take a long-term monitoring data but it takes a lot longer time to be collected. So about the bridge weight in motion for those of you who are not familiar it's a method that measures every vehicle that passes the bridge. It uses bridges as weighing scales so it has advantages over stationary systems because stationary web systems are built in the pavement so you need to close the bridge you need to dig in the pavement and they are permanent this one is fully portable so you can apply it on the bridge measure it then move it to another bridge and it plays under the bridge so there is no interruption in traffic which is very important especially if you are talking about highway bridges and also it has higher accuracy and it besides traffic data it provides structural information. Information about how the bridge is responding to traffic laws which we use you will see in this first step. Disadvantages is that it requires a certain level of knowledge about the bridges so you need an experienced bridge designer to decide where to put sensors when to measure and how long to measure etc. The bridge weight in motion we used is developed in Slovenia since the early 90s and it's called Sibym and its sensors look like this they are placed under the bridge here we can see a girder bridge so we have sensors on each girder on the middle of the bridge and on the beginning and the end of the bridge here is one small slab bridge also its sensors so it's now used in more than 25 countries and the data is used in some countries for assessment but in some countries it is used only for some statistical statistics about traffic and here we will show what you can use the data for so traffic data acquired with this system is speed number of axles weight and spacing of each axle for each vehicle that passes the bridge but it also gives what is important the structural response of the bridge which gives the influence lines the realistic ones not the theoretical ones distribution of load over if we have a multi girder bridge and also dynamic characteristics of the bridge which can be important parameter and especially based on pavement condition etc so the application of the data is the most important thing because a lot of countries has the measurements but they are using it only in traffic analysis but we can use it for pavement and bridge design or assessment and also in some countries it is used for selection of overloaded vehicles so the assessment strategies which are including weight and motion measurements are one with the short term measurement and with the long term in short term we can only get the structural data the influence lines and the load distribution but it takes only a few hours for a few hundred vehicles so you can do monitoring on an existing bridge in practically one day or a couple of days if we need a longer calibration for traffic data and dynamic characteristics we need a lot longer period at least two months or 100,000 vehicles but I'm talking only about heavy vehicles so everything which is which weight is below four tons is neglected so you need some time to collect 100,000 vehicles especially it's not very frequent road so for structural data as we said we have realistic influence line which usually shows reduction over the theoretical influence line here we can see the reduction and as all of your engineers you know that this reduction leads to the reduction of bending moment in the middle of the span which already attributes to the bridge load to resistance ratio and it also gives us distribution of loads over girders so you can define or indicate a critical section of the bridge because not every girder is in the same condition not every girder is loaded the same and on these bridges almost every girder as they are prefabricated they have the same reinforcement and tendons so you can indicate which one is in critical condition it also reveals non-visible cracks and changes in the stiffness so here are the just quick ratio of resistance and loading on each girder this dark blue this is done without any monitoring and this is done with only one day of monitoring and applying the influence line and distribution factor so already here we can see that it attributes to overall ratio then the next step if bridge doesn't pass its assessment on this level is to use traffic data which takes a longer time so at least 100 vehicles but with enough data you can build a site specific traffic load model and with that you can apply it on your numerical model instead of your design traffic model here is the ratio also resistance load so this is without any monitoring this is with shorter monitoring and with longer monitoring so you can see it's almost double the ratio of resistance against load and also you get dynamic characteristics which can reveal the real state of the pavement which is also important for brief design and this is all deterministic approach and of course all this can be done and it should be done on probabilistic level with a calculation of probability of failure and values of ability in this so this year analysis was done using forum method I'm now working with professor tons on a big metal model to do this all with Monte Carlo simulations to get even better results I think it will be done in coming months and now the most important part is the part about how much this costs and how much the bridge owners can save using this monitoring method this is also not finished yet as this is posterior decision tree we need to relate the cost of bridge with cost of measurements which is a bit hard because not every bridge of course cause the same consequences of bridge closing or failure are different depending on the bridge type etc so we build a this is a simple visualization of decision tree where we can we have assessment without any monitoring with shorter monitoring and longer monitoring so the related costs which we defined or we are in process of defining is cost of bridge failure cost of bridge repair and cost of short and long-term monitoring but the important thing is that these two costs come this are direct cost but you also have indirect cost of course if bridge is closed then you need to take into account the other natural alternate routes the traffic jams the reputation loss etc and in case of bridge failure you can also have extensive damage not only material there can also be human lives in danger so it's a bit hard to to define them in the model for bridge in general we can we can speak in some ratios and we decided to do it like to take a bridge value as one and then indirect costs are one portion of bridge value cost of bridge barriers other portion of bridge value and we are in the process of finishing that model and then we will have exact number in value of information analysis but what we know from previous experience mostly in Slovenia where they are using bridge weight in motion for over 20 years they are using it for decision making and they in general they came to the conclusion that overall costs are minimal comparing to the fact that the bridge does not have to be strengthened or replaced or closed for at least 5 to 10 or even 10 to 20 years and if you take into account the cost of the bridge repair and all the indirect costs then costs of these measurements and analysis are really minimal here are some of the costs but they are really general and they also depend on which country are looking for but for example installation of bridge weight in motion for a short bridge is 75,000 euros which when we think about the prices of bridge design and bridge repair is really not much for short term data post processing is really not much because we only have a couple of hours of measurements and the bridge analysis is also not so much but of course it depends on the bridge size bridge type etc. for longer term the installation costs the same but maintenance and post processing are more expensive and we need to take into account the time that we lost doing measurements and of course the analysis is also a bit more expensive due to size specific load models etc. but when we compare this to the bridge value and to the direct and indirect costs of bridge failure or bridge repair bridge closing they are really minimal when we know what and the first presentations the amounts that colleague from Brisa was speaking about how much they spend how much are they spending every year on maintenance then this is really neglectable cost and I think that's it so we have prepared a couple of questions for decision makers so first one is do you perform any type of weighted motion measurements if you do the most important thing is what you use the data for a lot of countries are using the data only for statistics and you can use it for much more but you need to have some rich engineer who knows how to use it of course is this example enough for you to invest if you're not using already and do you use any other measurements monitoring technique for assessment and of course are you interested in a pilot project because if you are they are willing to do a measurement to do an assessment if you will if you are ready to finance so that's it presentation and of course the questions for the audience and especially for the bridge engineers and we would like to start probably with the first one are you using it here in Portugal do you use it more than for statistical purposes is anybody who would like to answer this question is it the reason the question yes so we're not using you are not using okay simple answer not using yeah so very first so that's right have you heard for it no no yes I knew that so this is something you so a study of last question is valid yes this is the most important for you is there any is there any other here who would like to show the previous previous slide right because with all the last one with the cost yes exactly that one you argue that your cost of monitoring are small which of course they are but the only thinking with that is that you least cost of bridge failure cost of bridge repair right as they are not accounting really for probability for that happens right the probability of that bridge actually fail or meeting repair are what tend to power by s3 that's kind of typical for a typical bridge right so I'm afraid that you are overestimating here by a factor of perhaps a thousand of cost consequences of failure of repair versus the cost of this bridge so this bridge if we could use if we have all the data for some bridge from the 60s or 70s we would use it but unfortunately we use this one because this was the only one we had we had over one year of measurement yeah but I agree but the reality is that even if you take the bridge from the 60s its probability of failure is not one right as would assume because it's still there and probably carry quite a lot of traffic so we have to be careful and I think the gains from monitoring are not that huge those are good example by Daniel Zonta a couple of years ago with Barcelona where it was I left with sort of feeling that it's more or less equal what you pay and what you get of course case specifically thank you for this I'm sure you have thought about the expected cost in terms also the probability that it happened multiply with the cost given that it happens it is a very clear statement are there any other questions are you dealing or maybe we can have the next presentation in the perspective of this that it is not already applied in article or seldomly applied rich rate emotion I think it's important to know that the note models for bridges have derived based on rich rate emotion so the duration of the load models can simply be read up with I think very reasonable costs and I think there's great potential in the knowledge of the actual loading on a specific bridge for a moment and in the perspective of the traffic prognosis for the next year so one addition yes thank you my opinion is still work to be done and I think this is a very good approach but as the exam we heard the previous example the value of this is connected to the to the study of the behavior comparing this data with the with the behavior forecast in the model so in order to understand this kind of measures should trigger alerts or trigger actions again the value of this isolated could be nothing because in fact you should measure you should compare and that should trigger actions and the value because the risk of failure and the need to repair is always the same the difference is between the means you are using to collect information interpretation and should be interpreted of course if you do nothing if you don't put sensors and you just inspect analyze the behavior of the bridge and you reach the conclusion that an intervention should be done in fact in the end you should pay the cost of instrumentation of course instrumentation if as more comfort in the safety point of view you can control better and also you can but you must interpret the results against the behavior models and that should be in this in my opinion if you create a framework this this work should be done in a more and not an effort more effectively we should not only focus on measuring and in fact a lot of technology is arising we are becoming more and more strong collecting data from the bridges the second is to put these in the models because all these information should be interpreted and then should lead to a framework of actions and that framework in fact the safe postings are in that framework of actions yeah I mean I agree that all this data was used to calibrate the existing models because first model was theoretical and then more and more data you build a more precise one and about the costs and how effective this is there's really good example in Slovenia they are using it for over 20 years and they are using it with their own department to do for decision-making and they they have a list table it was on one of the conferences I can't remember they show how much in millions of euros they managed to save I mean of course you can always do the repair and it would be better but the point is in priority direction because you don't have the money to repair all the bridges in country but in order to direct them which one should be repaired first and which one in wait for five years I think in that case this this is important because the best of it to repair or replace all the bridges in the country but you cannot do that so when you have a lot of them then you should rank them and for ranking I think this for sure but I believe that I don't know if you understand well about what I said I believe every owner in the world would like very much to have all the bridges with this kind of intervention have a dashboard with all the states and all the states of all every bridge every single bridge but for that they should have also the trash orders design and to interpret whether the behavior of the bridges more close to the to the limit state or not in order to provide prototypes and then and then in fact repair framework of action thank you so what is actually saying is we need the thresholds the warning the performance indicator and the associated warning and this is an important issue which we have to discuss also in tomorrow again oh my last session I will show you my life thank you very much for this comment this is very much appreciated and goes exactly along the lines we have been setting up this cost action and our decision like this yes the information must trigger actions and yes the information only provided if we can modify the actions actually just need to work through this we have it in our tools yeah maybe I should stop thank you very much that was also the reason that the simple example with no not you have a clear threshold depending and then you can do two simple actions so that that is what what it is important to have actions and so on so thank you very much for the presentation again


Many of your businesses rely on our place within the European Union. I understand that you'll have concern about the debate that's taken place in Britain over the last couple of years and the drift of this debate. I share your concern. There's one other reason which I think argues against exit from the EU. And that is to do with the character and nature of our country and how we have succeeded in the past. I believe we have succeeded as a country that looks outwards not inwards. That trades with others doesn't put up barriers. That engages with others doesn't stand away from them. That opens itself to new influences and doesn't shrink from them. An ambitious Britain has always been an outward looking Britain. An inward looking Britain cannot be an ambitious Britain. And of course reforming the EU is hard, it's frustrating, it has difficulties. Winning allies is hard, but it's the right thing to do and it is far better than leaving.  I will fight your corner for Britain to remain within the European Union. I will fight your corner to reform the European Union so it works for our economy. I will do it because it's in our national interest to do so. It will help us to build the outward looking one nation Britain I believe in. And it's what I commit to today. Thank you very much.


The next item of business is consideration of business motion 10034, in the name of Delford's Patrick, on behalf of the parliamentary bureau, setting it a revision to the business programme for today. Any member wishes to speak against the motion should press a request to speak but now, and I call on Delford's Patrick to move motion number 10034. Moved. Thank you. No member has asked to speak against the motion, therefore I now put the question to the chamber. The question is that motion number 10034, in the name of Delford's Patrick, be agreed to. Are we all agreed? The motion is therefore agreed to. I take it dead to preside enough so that you are not meaning to press your button here. Thank you. The next item of business is consideration of business motion 10024, in the name of Delford's Patrick, on behalf of the parliamentary bureau, setting it a time double for the stage three consideration of the procurement reform Scotland bill. Any member wishes to speak against the motion should press a request to speak but now, and I call on Delford's Patrick to move motion number 10024. Moved. No member has asked to speak against the motion, therefore I now put the question to the chamber. The question is that motion number 10024, in the name of Delford's Patrick, be agreed to. Are we all agreed? The motion is therefore agreed to. The next item of business is topical questions. Question number 1, Neil Findlay. To ask the Scottish Government, in light of the recent reclassification of mesh implants as high risk in the United States, when mesh implants will be banned in the NHS in Scotland. Minister Michael Matheson. The Cabinet Secretary for Health and Well-being has written to both the Medicines and Healthcare Products Regulatory Agency and to the European Commission asking that they urgently consider the US Food and Drug Administration's proposed reclassification of surgical mesh for treatment of pelvic organ prolapse. The European Commission is seeking further research and expert opinion. The cabinet secretary has asked for assurance that it will act quickly once the research is available to reclassify these devices if the evidence points to that requirement. The implications for many after the implant of a mesh device are devastating leaving women disabled and chronic pain and facing a life of multiple operations and uncertainty. We see in the US understrel your mass class actions against the manufacturers and these are pending. The Scottish Government originally told me in an answer to a parliamentary question that only six women in Scotland has suffered an adverse impact of a mesh implant. That figure then rose to 101 but an FOI I submitted to health boards reveals that over 330 women have had to have mesh fully or partially removed and over 10,000 have had an implant. That despite a parliamentary answer suggesting that the number was 2,000— Yes, but can we have a question? Can the cabinet secretary or the minister confirm if he now has definitive numbers of those implanted and those who have suffered complications? I can say to the member that we have a range of figures for the number of procedures that were undertaken where they used transvaginal mesh implants. They go back to 2007, 2008 and up to 2012 and 2013. I am more than happy to make sure that those figures are provided to the member on the annual breakdown that we have. In terms of the actual figures relating to particular problems with a specific product, we do not have specific data on that for the reasons that the information relating to a specific product is not recorded in a patient's medical notes. What we are doing as a Government is taking forward a programme of work to look at how we can make sure that where there are medical implants used in a procedure is a way in which that can then be recorded into the patient's electronic records in order to make sure that we have a much clearer picture of a number of patients who may be affected should problems develop with a particular medical implant. What are obviously large numbers? The Scottish Government has been reluctant to suspend the use of mesh devices. It is apparently out of concern that the manufacturers will instigate legal action against the Scottish Government. Can the minister confirm if he is still concerned that the Scottish Government could face legal action from manufacturers? If he has changed his mind and is now ready to put the women of Scotland first over any legal concerns that he may have, does he have the same concern about the legal action being pursued by those who have been horribly injured by those products? Of course, as a Government, our sympathy is with any woman who has had a complication as a result of treatment that has been received through the use of this particular type of medical product. However, he will understand that those products are regulated by the Medicines and Healthcare Regulatory Agency and also by the European Commission. We have to be led by their guidance on this matter. Like other regulatory bodies across the world, MHRA and the UK are not recommending that it should not be used at this present time. However, we have asked for an urgent meeting with them to ask them about what specific action they now intend to take as a result of the FDA's actions in the United States. Equally, we have also asked for the European Commission to be very clear about the two pieces of research that they are undertaking as well, to make sure that once the findings of those research projects are carried out, action is taken quickly. If that leads to the need for a reclassification of those products, we will act on that. We have to work within the regulatory function that we have at the present time so that the member can be reassured that, if there is any change to the guidance and recommendation that is made by the MHRA or the European Commission, this Government will act swiftly on that matter. Thank you, Presiding Officer. Given the emerging worldwide concerns about mesh implants and the difficulties and costs associated with removing them, can the minister assure our Parliament and our constituents that the Scottish Government will be issuing fresh guidance to NHS boards on the use of mesh implants and will be taking a more open approach to dealing with legitimate concerns and be prepared to play their part in a worldwide collaborative approach to resolving this emerging problem? One of the actions that the cabinet secretary has taken forward is the establishment of a working group who is looking at the very issue. One of the early actions that that working group is taking forward is the information and the consent that is provided by women who are undergoing this procedure or potentially undergoing this procedure. My understanding is that the working group intend to issue that very shortly and we will make sure that that is rolled out right across the whole of the NHS so that women are fully informed about this procedure and some of the issues that are associated with it. The member also made reference to the impact that it has on those women who have complications. Another piece of work that the expert group is taking forward is the patient pathway for those women who have complications to make sure that that is robust and that it is very clear and that they receive the early treatment that they require in this matter. Of course, if there is a need to engage with other authorities across the rest of the world, we will be more than happy to do so. However, I hope that the member is reassured by the actions that the cabinet secretary has taken. We intend to make sure that, where there is a change in any recommendations around this particular procedure and using this particular type of device, we act quickly within NHS Scotland. Presiding Officer, can I ask the minister whether he is aware of any potential risks identified that relate to the use of other mesh devices such as a hernia mesh and how those devices have been affected by the decision in the United States? I am afraid that I can only refer to the proposal from the FDA. My understanding is that that is in relation to the use of pelvic organ prolapse mesh, so I am not able to refer to mesh that is used for other procedures. However, it is worth pointing out that today the evidence does not point to a particular product produced by a particular manufacturer. It is important that we make sure that this procedure is one that the public can have confidence in. There is an area of work that has been taken forward by York University to look at the procedure using mesh and using natural tissue to see whether the outcomes for patients are better. Once we have the findings of that from the MHRA, we will then be in a position to consider how that can be rolled out to clinicians in NHS Scotland. A constituent of mine was one to first have this mesh implant in February 2007. Within weeks she knew something was very far on. Constantly she had it removed in 2008 and January 2014. Can the cabinet minister confirm what advice was given to those who took part in the pilot programme for the mesh implants? To quote my constituent, the Scottish Government it was her understanding made funding available in 2008 to have these implants removed, but because there were so many cases the Government had a change of heart when it realised the severity of the situation and the funding was removed. Can he confirm that that was the case? On the final point that the member made reference to, I do not have any recollection of that whatsoever. If there are patients who require an intervention or medical intervention on the basis of complications relating to a particular product, medical device that is being used in a previous procedure, then we would expect clinicians to take that further in an appropriate way. That is a matter for clinical decision making, rather than ministerial decision making. In relation to the specific points that she made about her constituent, if she wishes to write to me with the specific details, I would be more than happy to make sure that that is looked into and that she gets a full and detailed response to it. To ask the Scottish Government what its response is to the report in the Sunday Herald, suggesting that the Labour Administration in the 1970s ignored advice about setting up a North Sea oil wealth fund. The two reports written by Professor Gavin McCrown and highlighted this weekend provide further evidence of the mismanagement of Scotland's oil and gas resources by successive UK Governments. The costs of ignoring this advice are now clear. Norway discovered oil at the same time as Scotland and now has an oil savings fund worth £500 billion, equivalent to £100,000 for every man, woman and child in Norway. There can be no clearer demonstration of the need for Scotland to make our own decisions on the issues that matter to Scotland than those revelations, which show that, in spite of the evidence presented by the then Scottish Office and the arguments of distinguished individuals like John Smith, the Treasury failed to put Scotland's interests first. However, with up to 24 billion barrels of oil still to be recovered from the North Sea, it is clear that the sector will be an important source of tax revenue for decades to come. With independence, we will have the tools to ensure that the wealth generated by those resources can be used for the long-term benefit of the people of Scotland. I note the figures that the cabinet secretary mentioned in relation to Norway, and I wonder if he can give any idea as to how much money we might have had in our oil fund had the Callaghan Labour Government at the time actually heeded the advice of Government advisers. Analysis on this point was undertaken by the Fiscal Commission working group, who concluded that, if Scotland had established an oil fund in 1980, it could have eliminated its share of UK public sector debt by 1982-83 and accumulated substantial financial assets of between £82 billion and £116 billion by 2011-12. The evidence that the Fiscal Commission has put into this debate is significant evidence that indicates the strength of the missed economic opportunity for Scotland as a consequence of not having those resources stewarded in the most effective way for the long-term interests of the people of Scotland. I thank the cabinet secretary for that response. Sometimes we are told that bigger is better, and yet can the cabinet secretary explain how a small country like Norway has repeatedly made very wise decisions, and a larger country like the UK has repeatedly made very unwise decisions. The information that became available at the weekend demonstrated the fact that there was a very active and deliberate choice made in the 1970s, which was to essentially use the resources from Nosea oil and gas not to provide long-term economic security for the people of Scotland, but instead to utilise that resource to prop up the failing United Kingdom economy. Of course, the issues that Scotland faces today about determining our own political future are issues that are very similar to the issues that were considered in the 1970s. The great advantage that we have is the opportunity in September to take a democratic decision to put the people of Scotland in the driving seat of determining their own future in this question. The advice that Gavin McRone gave to the UK Government last century is very interesting, but perhaps more important and more topical is the advice that he gave to the finance committee of this Parliament last week, when he said that if Scotland's public expenditure was similar to the UK average, Nosea oil would be a kind of bonus, which would be all right. However, Scotland's public expenditure is about 10 per cent higher than the UK average. In other words, in 2014, diverting oil revenues to an oil wealth fund would require swinging cuts in public expenditure. Is that the cabinet secretary's plan? No, it's not, because what that question ignores, as it always ignores from Mr Gray, is the stronger financial position of Scotland that we are in. If Mr Gray happens to look at the last five years of the GERS information, for example, it shows Scotland to be in a stronger financial position to the tune of £8.3 billion compared to the rest of the United Kingdom. That opens up choices. It opens up choices as to whether we reduce debt faster or whether we invest more in public expenditure and public services, or whether we invest in the long-term orphanage. However, the crucial thing is that none of those choices are available to us because the UK parties persistently squander the natural wealth and the financial advantage of Scotland. The sooner that we have the opportunity to take the decisions that are in the interests of the people of Scotland, the more we can take decisions about the long-term future of our country. Based on the cabinet secretary's updated oil figures, which he has yet to publish, how much does he think that an independent Scotland could put into an oil fund in year 1, and how much could it put in in year 2? The first thing in answering that point is to put on the record once again that, given the advice and given the opportunity to invest in a long-term oil fund over the last 40 years, the United Kingdom Government decided not to embark on that proposition. The Government has set out, with the assistance of the Fiscal Commission, the arguments about how we could construct a long-term savings fund for Scotland, and I have just answered Ian Gray demonstrating that, based on the last five years, Scotland was in a stronger financial position than the rest of the UK, equipping us to invest in an oil fund if we choose to do so. The key point is whether we decide to take our future in our own hands, or whether we will leave it to the United Kingdom Governments who have made such a mess of the public finances of the United Kingdom and wasted Scotland's oil revenues in the process. I apologise to Malcolm Chisholm and Chick Brody. I simply do not have enough time to let you ask a question, but I think that we have had a wide range of views on it. The next item of business is stage 3, proceedings on the procurement reform, Scotland Bill, in dealing with the amendments.


The study found that the incidence of surgical site infection, SSI, among patients undergoing elective surgery of the colon and rectum was 12.3 percent. Risk factors associated with SSI included non-administration of preoperative enteral nutrition, diabetes mellitus, heart disease, symptomatic state at the diagnosis of colorectal cancer, and greater than or equal to two altered nutritional biochemical parameters at diagnosis. Patients who did not receive preoperative enteral nutrition had a lower chance of developing SSI compared to those who did. Additionally, patients with heart disease, diabetes mellitus, and symptoms at the time of diagnosis of colorectal cancer were more likely to develop SSI. Furthermore, patients who underwent laparoscopy had a lower chance of developing SSI than those who underwent open surgery. Finally, the average length of hospital stay was longer in patients with SSI compared to those without it. This article was authored by Javier Pia with Tilda Ramozan Zanegui, Marco Solanzogarca, Diego Rodriguez-Viller, and others. We are article.tv, links in the description below.


the native file system API is now available and stable. There are new origin trials for WebHID and the multi-screen window placement API. There's some new stuff in CSS and plenty more. I'm Pete LaPage. Let's dive in and see what's new for developers in Chrome 86. Today, you can use the file input element to read a file from disk. To save changes, add download to an anchor tag and it'll show the file picker and then save the file. But there's no way to write back to that same file you opened. That workflow is annoying.  But with the native file system API, you can call show open file picker, which shows a file picker then returns a file handle that you can use to read the file. To save a file to disk, you can either use that same file handle that you got earlier or call show save file picker to get a new file handle. Before writing, Chrome will check if the user has granted write permission. If write permission hasn't been granted, Chrome will prompt the user first. Calling show directory picker will open a directory allowing you to get a list of files or create new files in that directory. Perfect for things like IDEs, media players, and things that interact with a lot of files. Of course, before you can write anything, the user must grant write permission. There's a lot more to the API, so check out the article on web.dev. There are two origin trials that I want to call out. Human interface devices, commonly referred to as HID, take input from or provides output to humans. There's a long tail of human interface devices that are just too new, too old, or uncommon to be accessible by the system's device drivers. The web HID API, now available as an origin trial, solves this by providing a way to access these devices in JavaScript. With web HID, web-based games can take full advantage of gamepads, including all the buttons, the joysticks, sensors, triggers, LEDs, rumble packs, and more. Web-based video chat apps can use the telephony buttons on specialized speakers to start or end calls, mute the audio, and more. Of course, powerful APIs like this can only interact with devices when the user explicitly chooses to allow it. Check the description for more details, examples, and how you can get started. Today, you can get the properties of the screen that the browser window is on by calling window.screen. But what if you have a multi-monitor setup? Sorry, the browser will only tell you about the screen that it's currently on. The multi-screen window placement API starts an origin trial in Chrome 86. It allows you to enumerate the screens connected to your machine and place windows on specific screens. Being able to place windows on specific screens is critical for things like presentation apps, financial service apps, and more. Before you can use the API, you'll need to request permission. If you don't, the browser will prompt the user when you first try to use it. Once the user has granted permission, calling window.getScreens returns a promise that resolves with an array of screen objects. I can then use that information when calling request fullscreen or placing new windows. Tom has all the details in an article on web.dev. The new CSS selector, FocusVisible, lets you opt into the same heuristics that the browser uses when deciding whether to display the default focus indicator. You can customize the color, size, or type of number or bullets for lists with the CSS marker pseudo element. And Chrome Dev Summit will be coming to a screen near you, so stay tuned to this channel for more information. All the details including links, docs, and specs are in the updates post linked in the description. Check out the latest Chrome DevTools video, and don't forget to subscribe. I'm Pete LePage, and as soon as Chrome 87 is released, you're right here to tell you what's new in Chrome.


Good morning, everyone and welcome to another edition of high Z update on this Friday May the 6th Mr. Claus You look like you look like a jack-o-lan you know What's going on Well, I'm only one-third of my way through my coffee this morning It's an early start for us on the West Coast, but for this show it's worth having an early start because I love this show I love doing it, but on top of all that I swear I was on patch and switch because you're wearing my shirt What do you do man? That's that's later. That's at nine o'clock. It's Friday. It's Friday. It's a fortnight I gotta I gotta pay homage There you go. Well taught me everything I know about podcasting. There you go. Well, I hope you hope you find them Whoever that mysterious man is because I was trying to work all the strange Ghosts and goblins and junk out of my setup because I'm in my new office and the new house right now I'm not set up. I just rapidly got set up yesterday in time for the show for yet for today and I Like literally I'm using my backup camera here as opposed over here My lights are focused as if I'm using it over here. It's it's all discombobulated So I think today's show is gonna be a lot of fun You think this one not not patch and switch. I mean this one this one. Okay. Okay. Yeah, I think it is gonna be a lot of fun actually though the PG's or product groups, I guess we love our acronyms have gone really tight lipped FLA is my friend Then again TLA's and FLA's three letter FLA or letter acronyms Yeah, yeah, so so in case you don't know this is the ramp up to build season. So we're in the month of May The build environment is currently being built And they generally tend to hold off a lot of the news Until after build launches because then they use the announcements inside of build environment So I'm assuming that the pickings were pretty slim today The pickings were extremely slim this week in terms of how many Actual announcements and and I typically try to stay away from preview because I want to make sure that's the announcements or something You can actually use in production unless it's really really kind of like Really cool then I then I say okay. It's in preview but start looking at it so yeah fairly slim slim pickings but there are some people on tech communities that have released some put some articles this week that are very very interesting and Open the door for Fixing some actual issues. So I picked a couple of those. Okay. Well, I'm looking forward to it I know what I saw something that we're supposed to be talking about and did my reading and my research on them So looking forward to them as shall we get started and share some of these?  No, I would say I'm assuming you have shared desktops You're ready to go off and show the article because I know I didn't set that up. There we go. There we go So the first one from tech community is from the core identity and security blog area and community It's out there and specifically talking about password list RDP with Windows. Hello for business So I'm a huge fan of Windows. Hello for business the device I'm using supports it right here with this funky little camera And it's absolutely awesome to be able to go off and to use and can be part of your password list strategy Nice and easy to deploy out on your environment But this particular one is basically a very nice setup on a walkthrough of how to establish Using Windows. Hello for business using an RDP connection to get into different places It can be a bit complicated with regards to the setup involved for it with the official documentation Or they link off to what that all happens to be but the idea behind this is Um, this gives you the best way to do it with the RDP environment as well as with remote administrative console experience as well Pretty cool, man. So Betty's basically any time there's a pop-up that says Hey, put in your credentials. Right. You can use hello and I'm looking at my own environment here in this house because I've got a few machines under the desk there that I've Pillaged and duct taped together from missing the Misfit parts Where it's just my lab because I have to simulate on-prem When I do a lot of my stuff And I have to remote into it and I always I'd love to be able to just look at the camera because I got my brio that's right next to my actual camera For microsoft hello, right So why don't if I could just like rdp and then And I'm in that would be so wonderful Right, but like the you know, I'm scrolling through the document there I just want to call it obviously prerequisite prerequisites You got to worry about is you have to have a hybrid joined Windows 10 slash windows 11 machine that you're going to be using for this particular setup You have to go ahead and have pki involved with a modified certificate template And you also have to have GPO configured for dual enrollment And then finally also have both a standard level user and a high a high privilege user that has been synchronized with azure ad That you'll be using for this particular environment for that setup. And then again, we don't have time to go through everything in here, but paul does a really good Good job of basically breaking down each of the individual steps the power shell You got to run the configuration with certificates and sort of stuff good screenshots that happens to be in there And then an example of how that all works But you basically are able to go off as I'll as I'll quote from his conclusion using this method We have achieved passwordless multifactor authentication for rdp and remote administrative tools The mfa is something that we have in the device where the certificates are stored And the something that we know which is the pin used to unlock those keys So it meets the requirements for what password is like A couple of good comments in there people asking some questions about it too Go check out that article now. You already did the blog post for this, right? Where you I did them all off and links and stuff like that So go check out the blog post associated with this episode and take a look at that If it's something that you want to go off and set up Yeah, and if you're it's either on itopstalk.com, which takes you right to the blog or aka dot ms slash az update We'll take you to the latest episode right All right, who's up man? What's next? What's next? Uh What's next is that we can now automatically rotate keys in and generated in key vault Now, I would say this is probably The second most common issue that comes up amongst it pros and operations folks and even everybody that works in it The first one being it's always dns The second one Is being that there's been some kind of a key that expires Either a key that expires or a key that was leaked Yes, one or the other and you need to repeal it. So like if you're if you're using for example storage accounts Uh, and you've got the key The secondary key because I never give the for the primary key to anyone but the the primary the secondary key for example if you've Put it into a configuration of a script somewhere to connect and dump some data into it and that gets leaked um, now you have to manually Rotate it Well, if it was in key vault your script would have to go and get it every time it runs And if it rotates on its own What happens if it gets leaked it'll get rotated. So Uh, this is now generally available. Uh, it was in preview for a while So you have to set up a policy for uh, how the automated key rotation actually works The information is all in docs, uh Fond configure auto rotation key. It also comes with a policy for expiry, which I have not mentioned in the article But now you can expire a keys. Um, that are linked to your environment Plus if you have for example like uh, encryption or and stuff like that You have to pay particular attention to when you rotate your keys so that you don't end up locking files that are already encrypted with the old key Got it Not bad at all My my puppy just walked past. She was not impressed with the auto key rotation feature Uh, so she's decided to leave the studio and she's now Going back to her bed in the hallway. Well, it's also early. So she's we're probably kind of she's like, why is this guy talking? Why the lights on in this office? That's right. You got it. Uh, yeah, so we've got actually, uh comments from facebook We're now uh streaming on facebook as well the books of face the metaverse the metaverse Speaking of which maybe we should uh Do a test and run the next az update in in a metaverse somehow We I got my I got my new uh VR headset right on man. We can try something like that at some time All right, so uh next article that we have is this next one is so easy. I can do this You can do that one. I can do this one. All right, I'll let you do that one. However, it is in public preview Yes, but it's so cool. You said we don't do public preview But sometimes when there's not enough to talk about we do it in public preview because we need to have articles, right? Yeah, but this one, uh considering I was at the p uh Power shelf summit last week. Okay. Okay. Okay. You take it. You take it. You were just no no No, no, go ahead. Go ahead. I insist. I insist. Okay. You were just at the summit You were talking with a bunch of folks Talking about the bunch of folks we uh, we had a discussion with the even the product group on um Maybe some of the issues that we have with power shell code fragmentation And when I mean code fragmentation, I mean you have uh, because mostly Everybody on this list. So I'm talking about uh, paul and andrew and our facebook user Which for some reason in our interface just comes up as facebook user Uh and jared and everybody else and anthony We all have these like usb keys with a whole bunch of scripts. Do people really still have those? Well, I've migrated to a github repo, but I'm sure some people say it's it's an analogy. Okay. Okay. I'll I'll let you know with it. I'll let you run with it but we all have like our repos of key of uh scripts and some are written for uh windows power shell 5.1 some are written for Power shell six and some seven and now seven point two And if you're running it locally you're running it with this version if you're running it in azure You're using azure power shell if you're running it in a function it's like we're getting to the point where there's they're starting to get fragmentation in the the the Versions of power shell that we use in those scripts and some Will behave differently. So you have to be really careful as to where you want to run your stuff in which version you run in it and actually Jared says he does Anthony says I still use a 3.5 floppy. Actually, I use a zip drive I'm a five and a quarter man five and a quarter with the plastic notch you cut yourself the whole that's right Yeah, we've been around I got key cards somewhere Anyway back to the article back to the article. So now, um The power shell functions team is working really really hard to keep up with the releases of power Shell because power shell now be an open source the releases are coming more frequently uh and So the the the functions team is working to keep up with that pace So that we can avoid at least having that fragmentation where If you are using power shell core or power shell Seven because we don't call it core anymore. Um We can always try to be at the very at the latest stable Release which is currently 7.2 So that's that's really cool. Especially since I'm got a whole bunch of uh demos for a couple presentations that I'm building on using um Azure function and power shell. So that makes my life easier. Yep Not bad Not bad at all my friend We have the passwords next We are talking about password again now I will freely admit I am a huge fan of password managers Uh, I've been getting password managers up and running with my family for the most part Almost everybody's using them. My my wife still prefers to have A limited number of passwords. She has not fully embraced the ecosystem But at least if I'm setting the passwords for the different accounts inside our password manager that we use Um, she knows how to be able to pull it up and do it And be able to get that strong password um, and I would I would add to that that Having gone through a death in the family in the last year When we tried to as executors tried to get over some of the accounts that they were using because they were The person that passed was the person that paid the bills for like embridge for gas Electricity and stuff like that With password manager in some cases you can have shared vaults, right? And have those passwords. So we've set that up at home as well. But yeah, so that's What what we're talking about in this particular space is an is an additional functionality added to Microsoft authenticator again, also As corporate users at microsoft we have authenticator on a crap ton of stuff as a way that we implement multi-factor authentication And be able to go off and have you know proof that you're logging into different resources online Is it like that so i'm very very familiar with microsoft authenticator even through party websites They need to have like tokens generated and stuff like that. I'll use microsoft authenticator as well And it's all it's been extending its functionality more and more but This particular one we've got an mvp that's off and written up an article about how to use Microsoft authenticator to generate strong random passwords For you and they go through Actually, no, sorry. It's not mvp. It's a product manager on the authenticator team It's kind of strange if they would have someone introduce a product manager. Hello, let me get you over to To rajat, uh, who's going to talk about this but either way, um, you can use time-based passwords You can use push authentication all that sort of stuff that's all part of the authenticator But they basically added the funx now you've now having a random password generated so on your mobile device pull up the website you're working with um, and go ahead and Fill out the details when you have to go off and build an individual Password through a user ID or password prompt And then they walk you through how to go and do a auto fill or synchronization Of those passwords from your microsoft account. So obviously, um, it only works with microsoft accounts Which is the consumer versions of the accounts. It does not work with enterprise level or your work accounts if you will And allows you to go off and store those random generated passwords It recognizes the website is being asked for just like another password manager would And allows you to auto fill those and obviously you have to select and have auto fill enabled for Your particular device in question be it ios or android to be able to go off and make it work It's great. It's there. It's free And it is individual for a single user It's not shareable amongst the family that you and I were talking about before that's more functionality for an advanced capability um I'm not going to bother plugging one or the other but just you just start using password managers, please This is a great step if you don't have one if you are looking for one with more functionality There's a bunch out there in the market that's transcend different things and as you mentioned It's definitely worthwhile getting everybody involved and using them early like the best part is My son as an example, he swears by his password generator Like he does he doesn't know what any of his passwords are anymore. He doesn't care He just new website goes in makes a new user id random password gets generated That's super strong and long and then gets stored in his uh in his environment. So it's good It's good to get the statement. I have the same issue I can't I if you asked me to log in to our corp my corp account right now with my password I wouldn't know what it is. Yeah It's like 24 characters like really complicated Uh, I generated once I logged in once. I turned on power power less powerless Passwordless I was not powerless. I was passwordless. Oh And and I did something I normally don't do I read the comments And someone actually asked I think Neil Palooza asked any plans for shared passwords for a small business or family situation And rajat doing the good thing that p.m. Should be doing is following up those comments And he says the team is working on shared passwords for family scenarios. Look at that Not bad my friend pretty cool bad and there's a there's an extension for chrome I couldn't find one in the edge native Store But you can use the chrome extension on edge Because it's true chrome. Yeah, it's chromium as the engine so you can do that So you could have it on your machine synced up to your phone Using your microsoft account to store all your passwords nice Pretty cool. How many are we gonna save in the year by not having to uh Buy a third party product. Well, I don't know the uh The big thing for me is gonna be that It's eventually this is one step closer towards our original story at the very beginning going password less And so that's ultimately where I want to get I want to get to the point where it's like look It's something I've got something I know and it's not a password and it's just Follows me around wherever that happens to be Oh jaren says that it's built into edge nice cool I'm gonna have to look into that. Oh, yeah profiles. So, um Um What else is coming up in the community because we're done our news articles because they're pretty light this week The next section is talking about community type events and what's going on. Hmm. I bet you you have something About microsoft build, right? Uh, I don't but I should well pull up the registration page because I'll talk about microsoft build as you get there Um, some goodness from the build side of things. First of all, congratulations. I know you made the preview reel With your outtakes of doing welcome to microsoft build get ready for it for that little video that's right there So that's kind of cool. Go to my build at microsoft.com Uh, and I'm not letting the cat out of the bag. I don't think but let's just say that Um, next week some very important information that everyone likes to look at will be available online I can't say what it is, but generally it helps you plan out your couple of days of build Is all I'm going to say that sort of stuff comes up next week In order for you to participate you are going to want to go off and register at my build at microsoft.com We're doing a whole bunch of new stuff this year I can also share that we have been working hard to try to get more technical content into microsoft build in a variety of ways and As with anything we iterate and try to make better take feedback iterate and try to make better So give bill a shot see where it's at. I know it's still primarily for the developer audience But there is stuff in there for infrastructure and operations folks as well Uh, personally, I love watching the announcements coming out of the satya level the first day keynotes That's where I get a lot of stuff as far as value is concerned for things But there's a large amount of things going on There's some learn live sessions that are going to be in there, which are kind of cool I know our team is signed up to be able to do one of those at least if not two of those And there's always a whole bunch of opportunities for the connection zone to go off and to have ask the experts with different product teams and stuff like that So, um, there's definitely a lot of stuff that's going on the question I always get asked is when are we going to be in person again? And the answer I always give I have no clue I had my first in person last week. Oh, yeah, that's right. It was the power shell summit, right? Power shell summit it was so wonderful and I'm not going to be as heavily involved in build this year because I am um Not preoccupied but pre-engaged somewhere else If we have any french-canadian speaking Right now that are listening to us May 24th to 26th, I will be in kebec city La Villereine dans notre belle province de kebec Cette site de web c'était construit dans les mille les mille neuf cent Seuf cent quinze quelque chose comme ça No, it's it's their it's their their schtick is there the they wanted what they wanted to look vintage this year But it's a web at kebec or web in kebec It's an All it's missing is that is the under construction with the guy going like this with the pickaxe I really like the little hamburger here for for the menu. Ah the hamburger menu. Oh nice Because typically we have the three lines and we call that the hamburger. So you're presenting in kebec. That's cool, man I'm gonna be presenting in kebec. I guess they they were looking for a french-canadian presenter for represent microsoft and nice all the other ones were involved with world so They uh, they went to the bottom of the barrel and got me Nice Nice. Yeah builds 24 26 um and the kebec web at kebec 22 it's taking place as well Um, are they going to be recorded? Are they going to be streamed online? Uh unknown at this point We're still uh kind of i'm still discussing with the organizers exactly How this thing is going to go but uh apparently they're looking at like They're looking at uh 800 people In person So and there might be some of some of the breakouts. I believe are hybrid. Oh, yeah, uh, but it's more on the react view type script javascript part of the equation Which is really weird to see me there. Yeah, no, I I believe that the coming year is going to be very much a test With a variety of different types of uh engagement being hybrid and or in person and that sort of stuff We can never go back to the In-person only kind of stuff because everyone's looking for the on online type of access to things in some way shape or form Uh and likewise as well the in person stuff. We try to accommodate that sort of thing So I think 2022 slash 2023 is going to start to open up a bunch of different possibilities as we Start to wrangle with how to handle in person stuff like I had an in person meeting last week That was like a three-day workshop in leadership team meeting with a bunch of people We literally spent the first like hour of the meeting figuring out how to present in the same room with people like How do you ask questions? How do you make sure you're including the people that are online and remote?   You like it literally took us a first hour just kind of worked out the semantics What we're supposed to do so you mean at the board room table You can't hit that a little button to raise your virtual hand Well, so what we came up with what we came up with was the conference room camera Was the main camera that we used so that we could see everything Each of us had to join teams because there's teams obviously And then we muted our speaker or muted our microphones But we turned cameras on so you would at least see the persons in the people in the room And yes, you could use your raise hand stuff And then we designated a different person every chunk of time To be the chat moderator to make sure that people were respecting the hands up And we're respecting the chat on the side to be able to pull stuff up But it was we we managed to work it out worked out well They're very inclusive that I like trying to be like this is the it's like why do you need to go in person this stuff? We we spent the first half hour at the summit Just trying to figure out how we shake hands in the world Was it awkward the awkward? It was the big elbow, the bump, the hand Did you do a foot tap? I haven't done the foot tap Yeah, I I I actually just try to break the ice when I'm meeting people in person for the first time in a long time I'm like, okay. I like are you a hugger a handshaker or a bumper? Ah, that's good. They they choose it's on them. That's how I work And we have one more community event coming out very very very shortly. Okay. What's that? Oh That's that's a hilarious graphic that does not render well Yes, the patch and switch show is back after a couple of fort nights actually because of scheduling other things going on Um, we managed to get both joey and myself and jared Uh all coordinated in our internal chat to be able to say we're going to do a show So we're going to have a show coming up in about an hour and a half or so I might nap in between the shows so don't tell anyone Uh, so we'll see what's going on So join us on a on twitch.tv slash patch and switch coming up, but we still have The learn module of the week and i'm going to put you on the spot because I didn't see which one it was Do you have one? I do Okay, okay, and I actually pump the learn modules because this is also not just about news It's about learning something new that you can take with you on your Journey of learning with microsoft learn. Which one did you pull up? Accuracy I actually went a little bit of a different route this week because I didn't pick a learn module I picked the whole learning path which has a bunch of modules on how microsoft is using Multifactor authentication as part of cyber security Nice, so this is a two hour and 17 minute if you read every single word and did every single piece of the lab Uh, it looks like it's uh, what summary and other ones one two three four five six Like the first one is a securing active directory with mfa. Right second one is understanding mfa identity management on microsoft 365 and the third one is to implement and manage that hybrid identity So so we have the ability as microsoft even other people can make them as well If you have a learn profile You can make your own learning paths to be able to save them and share them with friends and families stuff like that I just want to pull this one out I mean this one here is quite cool because it's obviously tied to a multifactor story We talked about at the very very beginning But an example of pulling them together from interesting resources across the board are good other bald friend In the team or in thomas Created a desktop support Learning path that doesn't exist. He literally made one as a collection And pulled in modules just as if you were doing an exam for Managing and working with windows 10 and windows 11 in an enterprise environment Um, I don't know if you can pull that one up easy enough pull up on twitter his tweets and I will continue to uh Let's continue the ramble. I don't find it Just to kind of just to kind of see that it exists if you just look for or in thomas nothing fancy You you weed out and look in between the different posts about his sci-fi Models and pictures that he shares But it was created a little while ago and it actually was a blog post also on Itops doc.com if that's easier for you to find Is that the one on oh, yeah, that's the one. Yes came out the earlier in the week But on itops training for windows client desktop support Just pull up that url people can see it online on the screen share as we sign out the show Free training for windows client desktop installation support and troubleshooting So he literally went through The different content on microsoft learn to create this equivalent learning path Thank you very much for copying that url and we'll be putting that inside the blog post You can take a look at it later as an optional one Because people need to go off and remember how to use and work and manage desktops And no one's no l2 We do we still do that? Yeah, it's pretty cool Let's wrap it up my friend. We're at time We are at time and I know that you have to go and have another coffee and so do I have a nap And then have a nap have a nap. I'm gonna go for a coffee and try to find some contacts in the house Thank you very much. Mr. Claus for joining me this morning Pleasure as always and well be sure to watch you in an hour and a half And for all of you at home watching this, uh Can you see that? The breweries are calling Yes, well, maybe it's a little early for us. Yeah later later. Maybe anyway for all of you at home Thank you very much for joining us. We'll see you next week. Cheers. Cheers


And so what happened from that is that it's set off a chain event of defensive behavior and caused me to be depressed. So I want to make clear that I'm not using depression as an excuse for acting. It's actually the opposite. Oh so now Ethan Klein opened up about his depression and all is supposed to be forgiven. What is up everybody? This is Chris from the Rewired Soul where we talk about the problem but focus on the solution and if you're new to my channel, my channel is all about mental health and what I like to do is pull different topics from the YouTube community to try to teach you how to improve your mental and emotional well-being. So if you're into that kind of stuff make sure you subscribe and ring that notification bell because I make a ton of videos. I'm not even in my normal setup right now. This is my second video today because that's how I roll. I make so many videos that Tristan's actually sitting right here off camera. You don't even realize she's there but anyways anyways. So yeah I want to talk about A3A3 productions, Ethan Klein, his depression and first I want to give some shout outs to some people who helped me out on Twitter. So the first one is Karen, Karen Terry. She tweeted at me and told me that Ethan talked about this on his podcast and she's thought that I'd be interested in. I'm like oh cool.  So Alex from the channel Carson Geek, she actually did a guest video not long ago about autism spectrum disorder. I'm gonna link her channel down below. Go check out her channel. She's amazing. But she actually got me the timestamps of when Ethan talked about it like Carson Geek, you amazing girl. So anyways I was on my way to pick up my son. We moved across town so it was a long drive so I listened to it on the way there and yeah like there's some excellent things to kind of unpack from Ethan opening up about his depression and there's so much, there's so much that all of us can learn from this okay. And like again if you're new to my channel this isn't about Ethan. Ethan's never gonna see my video. You're watching my video. This video's for you. All right like I will say this. I was talking to Tristan a little bit earlier about this. Like I enjoy Ethan sometimes but I'm like a huge A3A3 fan boy or anything like that. But I will say this like it's just interesting to me because it's one of the reasons why I make my videos the way I do. Like I see so many people attacking Ethan or just people online and I'm like you're probably doing most of this stuff in your own life. You know what I mean? It's just these other people obviously YouTubers it's on camera but that's why I try to take these things and try to teach you. So if you're going through some of this stuff but anyways let's get started. What have people been saying about me recently okay. That I'm a hypocrite, that I prioritize money over everything else, that I've thrown friends under the bus, that I'm ignorant and poorly informed and spread misinformation, that I'm arrogant, that I cannot handle criticism and that I've used people just to name a couple of the reoccurring themes. I'm sure there's so much more you could say about me. Um and let me just say this okay for the record that I am guilty of all of those things. So the first thing I want to say and I was I was telling Tristan this I'm like oh my god so for those of you who don't know I have an entire playlist called How to Apologize because with all the controversies that just happened and everything like nobody knows how to apologize.  Ethan in this podcast like I was like oh my god like Ethan's like apology and outing himself was like better than a PR team has done for some of these multi-millionaire beauty gurus. Like Ethan just goes down a list of things he's being accused of and he's like yep that that's what it was. I did those things you're absolutely right. Like he just he just like what like that it's not that hard everybody so if you're wondering how to apologize just like save that clip and just replay it like a million times over again. Like one thing I was telling Tristan too I was like I feel like he even apologized for like some parts of that where I don't even think he needed to but he just took all of it and like he goes on to share his uh his story of his battle with depression and everything and he done he did what I talked to you guys a lot about right? Like he gives you a reason but it's not an excuse.  He knows very well so he's not trying to give it as an excuse. And I'm pretty sure you know looking back that I started to become more arrogant and overconfident and on some probably deep unconscious level a feeling of almost infallibility that I could take anything on. For for the most part like in the beginning he explains how his ego kind of took over and this is what kind of led to a lot of the initial depression and I can definitely relate to that. Um so those of you who don't know and you haven't been around for a while like or you haven't been around this channel for a while I made a video a long time ago. I actually used to be in the professional e-sports industry. I used to travel all over the world and all these things but I just destroyed it because my ego got out of control. So I could definitely relate to what Ethan was saying like he was just on this high right and he could do no wrong and then when he started getting criticism like his ego was like no no I'm right you're wrong and he talks about how it almost felt like physical pain. Even people that like respectfully would disagree with me would turn me like bitterly against them.  This is what I've been telling you okay I literally just talked about this in my video about the film theorist and Shane Dawson. This is the science of beliefs this is the neuroscience of beliefs. So when Ethan's talking about how it triggered his fight or flight response this is what I've been telling you. It challenged his beliefs in his medial prefrontal cortex okay. His belief was that he is infallible that he makes the best content. Everybody should love his content so when people criticize him he would get defensive and what it took him was therapy to realize how defensive he actually gets and this is something like it's funny because I was only halfway through this podcast when I picked up my son. My son's nine and a half he's about to be ten on New Year's Eve. We were driving back and I paused the podcast and I was explaining it to my son you know because my son is like oh well what if those people just don't like him because he has a lot of subscribers. I'm like yeah right I'm like what if I'm like but if that's what you think everybody's doing then how are you ever gonna grow or how are you gonna learn and that's kind of what Ethan admits to. Ethan says like he wasn't even taking like constructive criticism well. So what that snowballed into was his lack of confidence, his depression, his irritability and he talks about how he starts taking it out on Eli right and like that's one of the reasons why I'm so grateful for for Tristan. Like you guys you need to understand like like if I get like moody or a little if you will um like Tristan'll be there to call me out on it you know what I mean and and that's important like that's that's why that's why I keep her around you know but no this is why one of those things where I tell you that you need to keep people around to tell you what you need to hear not what you want to hear especially those of us who struggle with mental health issues like we need people around who know when we're not acting like ourselves like Tristan knows me right if I started acting different she would know hopefully she would catch it early on so we can nip it in the butt before it got out of control. It was so I was just so miserable that I was so tired of being myself that I was willing to do anything to be anything I want I didn't no longer want it to be myself. So the last thing I want to talk about the last thing I want to talk about is something that so many of you can relate to it's something that I can relate to like Ethan talks about how he was suffering for two years for two years this is why one of my favorite sayings is pain is inevitable but suffering is optional he talks about how for two years he was sitting in his depression he refused to take antidepressants like he was like oh well I shouldn't have to take antidepressants I should just be able to eat better and exercise like I've talked about it in other videos about him in the past like yeah that all sounds good and well but if you don't even have the the go to get out of bed and do those things or the motivation or the drive then what good is that so he's sat in that for two years how long have you sat in your own misery just not getting help like Ethan is just now seeking therapy Ethan is just now taking medications I'll say this the antidepressant is not at all what I thought it would be that right there that right there what he just said is what we call contempt prior to investigation right so Ethan's talked about it in the past about how why he doesn't take antidepressants what he thinks they're gonna do what right and then he goes on he says yeah and it didn't do any of those things so for two years he sat in his own misery finally takes the antidepressants he's like oh this is what they are right like think about that for a second like I say this because I can relate I can relate to so much of what Ethan said like I had such terrible mental health I had my drug addiction my alcoholism my depression my anxiety and I refuse to get help but this contempt prior to investigation like what I teach my clients is this and I'll shorten the story a little bit but I imagine when my son was a baby right and like you would try to get him like you know like uh I don't know mush peas and he loves the mush peas and he's just eating them all day long right then all of a sudden you get like mush carrots and he doesn't even smell it he doesn't taste it but he refuses to eat it and you're just like eat the food kid like right like why wouldn't he eat the food he hasn't even tried it but he's saying he doesn't like it you right but think about how many times we do that oh uh therapy's not gonna work for me oh what are these medications gonna do we're judging these things that we haven't even tried before like do you know how irked I get when I ask I'm like hey have you tried meditation no that wouldn't work for me and I'm just like have you tried it no like what what like this is why I say on my channel we talk about the problem but focus on the solution like this like your mental health takes action you have to take action steps that's why if you are a hashtag rewired soldier you are taking action steps I don't care what it is but I really want you guys to learn from what Ethan um you know took for granted which was like how help was available but he waited he sat in that for so long so if you're watching this video right now and you're in the middle of it if you're in the middle of this depressive storm or anxiety or whatever it is ask yourself like why are you sitting in your own misery why haven't you reached out for help in my description of every single video I've been making there is a link to our free mental health support group on facebook you can at least do that all right so like join the facebook group come in there talk to us let us know what's going on give us problems give us solutions provide support for one another like come on join us we're a great group of people but anyways I want to hear down in the comments below like let me know in the comments below like have you have you been somebody who sat in your misery way too long like did you have all these like misconceptions or ideas about like therapy or even medications or anything like that and then you didn't you're like oh that wasn't so bad like let's have a conversation down in the comments below all right but anyways that's all I got for you with this video if you liked this video please give it a thumbs up if you're new make sure you subscribe and ring that notification bell because I'll make a ton of videos and a huge thank you to everybody supporting the channel over on patreon you're all amazing and if you would like to sign up for patreon you can click or tap right there there is exclusive never before seen content for all the patrons five dollars and up all right so go ahead sign up it's fun time all right thanks so much for watching get into the solution and I'll see you next time