So, the topic of my presentation is type 3 mitre regurgitation. I have no conflicts regarding to this topic. And in the next half an hour or so, 25 minutes or so, I would like to describe the classification and mechanism of type 3 mitre regurgitation, discuss a systematic approach for the interoperative assessment of mitre regurgitation, also discuss a little bit of some morphological changes related to chronic mitre regurgitation, and also discuss and apply the last ASC 2017 guidelines in order to quantify the mitre regurgitation, type 3 mitre regurgitation. Okay, so our first case is a 66-years-old male with a past medical history of severe art crystallosis and also an art dilatation, who presented to the hospital with severe heart failure, had a normal angiogram done last year, and also at the same time he had a TEE done that showed a severely dilated left ventricle with an EF of approximately 20% in a low-flow, low-grade art crystallosis. So the proposed surgery for this patient was a tissue AVR, plus or minus ascending art and NMR replacement. So our interoperative TEE assessment showed indeed that the patient had a really bad art crystallosis, as you can see here using the X-plane or the biplane view, we can see the art revolve is pretty calcified, really poor opening. Doing all the measurements, we got an art valve error of 0.6 square centimeters and also a mean gradient of 29 millimeters, probably because of the low ejection fraction. So when we start doing our left ventricle assessment, so we also saw the right ventricles pretty normal in size and normally in function as well, but the left ventricles dilated actually with a really poor ejection fraction. Here we can see in the four chamber view and also in the transgastric view, the medipap transgastric view, how dilated the LVE is and how poor the LV function also is. When you keep moving our assessment and you keep moving the multplane angle, we can rotate the angle to evaluate all the walls, we go to the two chamber view and also to the long axis view where you get the same diagnosis. And also when you look the mitral valve in the long axis view, we can see the mitral valve although looks normal, the leaflets look normal. The function of the mitral valve doesn't look normal. So we can see the mitral valve looks a little bit restricted. The leaflets look a little bit better with poor leaflets co-optation line. In order to improve our assessment, we put some color on, color flow up and on and we can see now is that the patient has some sort of central mitral regurgitation. Probably this mitral regurgitation is related to the poor leaflet co-optation due to the leaflet restriction. So according to Carpegne classification of mitral regurgitation, we have three different types of mitral regurgitation. We have type one with the normal leaflet motion, type two, sorry, with the excessive leaflet motion and type three with restricted leaflet motion. Type three, you can divide in type three A and type three B. Type three A is the one that we have that the valve itself is diseased, which is going to be the second case that I'm presenting today. And type three B is the one that we have the normal leaflets itself, but something else is going on with the ventricle probably some sort of remodeling when we have all the subvalvular apparatus being pulled into the ventricle and the leaflet co-optation gets a little bit better and that's the reason why the patient starts to have mitral regurgitation. This is the case that I'm presenting now. The patient has a really big ventricle, dilated ventricle and that's the reason why the patient is presenting with mitral regurgitation. Following the 2017 ASC guidelines, we should do an integrative approach with all the different parameters in order to get a good assessment of the mitral regurgitation. We should use a morphological assessment. We should look at the valve, see how the leaflets are working. If there is some pathologies in the leaflets itself or it's something related to the mitral valve apparatus, which in this case was the reason why, so we can see here the leaflets are really restricted in motion, especially the posterior leaflet. The leaflet co-optation line is, we have a really poor leaflet co-optation line, especially due to the poor posterior leaflet mobility. We can also look at the, we can also evaluate the LV size and also the LS size, which are indirect signs of mitral regurgitation. Moving forward to the semi-quantitative, qualitative and quantitative assessment of the mitral valve, we can use the color flow in order to identify the mitral regurgitant jet and also with the color flow, we can also, if possible, we can, if we can align the whole jet, we can also measure the vena contracta width and also we can evaluate the flow regurgitant area of the mitral valve, of the mitral regurgitation. We can also use the, like I said, the vena contracta width, which is pretty much the true orifice of the mitral regurgitant lesion. And also we should also, we can also measure the, we can also measure the pulse wave doppel in the pulmonic vein in order to get a good sense of how the receiving chamber is coping, is dealing with the excessive volume that is like, is being pushed forward to the left atron. So when you have a systolic flow reversal in the pulmonic vein, it's really specific for severe mitral regurgitation in about 85% of the cases. So when you move to the quantitative approach, you can use the PISA method to measure the EROA and also measure the regurgitant volume and regurgitant fraction in order to get a better sense of how bad or how bad is the severity of the mitral regurgitation. For our patient using the PISA assessment, we are able to measure an EROA of 0.3 centimeter square and also a regurgitant volume of 35 ccs, which puts the patient in using all the integrative approach that the 2017 guidelines present, put the patient in the moderate range of mitral regurgitation more towards the grade two mitral regurgitation value than the grade three. So if we put all the parameters that I just said, we can like I'm showing you that the patient had a dilated LV size, dilated L8 size. He had a vena contracta width of 0.4. He had systolic rebounding of the pulmonic vein flow. He had an EROA of 0.3 and a regurgitant volume of 34 ccs. So the patient ended up getting a bio bento. He had also ascending and ascending ME-R to reconstruction. And what they found was that the Arctic valve was by Cosped with left and right fusion. So here is the patient coming off bypass on a lot of ionotropic support. You can see, you see now the new valve in place. You can see the mitral valve leaflets are opening and closing a little bit better. The patient is hyperdynamic at this point coming off bypass on 10 mics of dog with still a little bit of mitral regurgitation. And the follow-up echo on this patient two weeks after the surgery showed a marginal improvement in the LV function. It was 10 or 15% before. Now it was 25% with no paravolvular regurgitation and tracing mitral regurgitation and normal RV function. So this was to illustrate a type three B, Carpentier classification of mitral regurgitation, type three B is related to the valve itself is normal. What is happening is the LV for some reason is dilated, there is some remodeling that is like pulling back all the subvolvular apparatus making the cause for the mitral regurgitation. Moving forward to our second case. Our second case is a 65 years old female with a 148 centimeters height and 92 kilos. With a really complex history. She has a history of a chronic AFib with a normal LV function, some sort of a diastolic dysfunction. She also has a history of rheumatical mitral stenosis. The mitral stenosis was assessed a few years before but because of the patient's severe chorobesity they declined the surgery on this lady. Also a history of a saccigian hypothyroidism. At this time she presented to the hospital with an exacerbation of heart failure, rapid AFib that needs some assessment, that needs some sort of treatment now. So the trans thoracic examination showed a severely dilated LF atrium, moderately dilated atrium, normal RV and RV size and function. And she also had a severe mitral stenosis due to rheumatic disease with a mean grade of 20 millimeters of mercury with a mitral valve area estimated in 1.3 square centimeters and also some moderate mitral agrogitation. So the patient had proposed a mitral valve replacement, also Maze procedure and also isolation of LF atrial appendage due to chronic AFib atrial fibrillation. So we start doing our intraop T assessment. We can see in the four chamber view the biventricular function is normal. We can appreciate the size of the left ventricle which was really big. We can also see the right atrium was also enlarged and we cannot appreciate in the four chamber view at least in this picture the mitral valve like the way you should assess it. We also can see the transgastric and the mitral transgastric view. We can see the normal biventricular function. When we start moving with our multiplying assessment we start moving and change all the walls and all the mitral valve assessment. We can appreciate the size of the left atrium and especially on the long access view we can see some features related to the mitral stenosis due to rheumatic mitral valve disease due to rheumatic disease. We can see both leaflets are really thickened. The mobility of both leaflets are really restricted but especially the posterior leaflets not moving. The anterior leaflet has some sort of appearance of a hockey stick appearance in the diastolic frame. So this is pretty specific for rheumatic mitral valve disease. When you go to the 3G assessment of the mitral valve using the zoom module looking from the atrial perspective we can see the mitral valve in the center of the screen. We can see the arctic valve on the top of the screen at 12 hours and you can see the poor opening of both leaflets due to rheumatic disease. Talking a little bit about zoom mode that we are using to get this picture is a really good modality for real-time 3G and also multi-beta position. It enables us to focus on a specific 3G image and a specific volume. It's really good for evaluating valve and specific areas of the heart especially valve and inter-intel septum procedures. It allows us to have a really good understanding and live understanding of what's really happening in procedures in real-time. But also in order to get a really good picture of the 3G zoom mode we should like having in mind some tips in order to maximize and optimize those frames and those pictures. So in order to maximize the frame rate in order to maximize the temporal resolution we should also like focus in our assessment in one specific structure. Before that we should have a really good assessment of the 2G picture. You should get a really good 2G picture of the structure that we are trying to image. We don't have... There is no way you can have a really good 3G picture without a good 2G picture and assessment. After we get the 2G picture and we do the assessment we should change the focus to the structure of interested and also trying to get the region of interest of region of the area that we are trying to imagine the smaller as possible in order to get the best frame rate. And also in order to make the temporal resolution better and sometimes the spatial resolution better we can change from the live 3G mode to the multi-beta position. So this is going to improve also our temporal and spatial resolution. So going... And also we can use the NPR, the Multi-planar Reformating which we can like cross all the three different axes the X, the Y and the Z axis in order to slice the valve exactly the point that we are trying to see and it can show us exactly where the disease of the valve is. In this example, I took this example because using the Multi-planar Reconstruction we can have a really good assessment of the disease the P3 disease on this valve. Going back to our patient continue with the micro valve assessment put some color on the micro valve you can see that is a really, really good like a really sederity mitre stenosis on this patient we can see the flow acceleration in diastole but also when you get a good frame we can see also that is some sort of mitre regurgitation. This patient has a mixed valve lesion she has some sort of... She has a really bad actually mitre stenosis and also some sort of mitre regurgitation. In order to quantify this mitre regurgitation first before that this patient because of the mitre stenosis the mitre valve is restricted due to like taken in due to the rheumatic calcification this patient is a type 3A carpentry classification the first example that I gave was a type 3B classification which was related to LV dilatation to do some remodeling and this patient has a type 3A mitre regurgitation due to restricted mobility of the leaflets due to the thickening caused by the rheumatic disease. Using the 2017 severity assessment guidelines we should like try to integrate all the informations that we get with the G assessment. So for this patient we have a really thick anemobial mitre valve leaflets we also have a really big, really dilated left atrium using the quantitative, semi-quantitative and qualitative assessment of the mitre valve we can see we are able to get a vena contract on this patient of 0.5 centimeters calculating the EROA and the bi-pizza method we had a really good assessment of the pizza radio we are able to get a regurgitant volume of 34 cc 34 millimeters which would put this patient in the same range as the patient before in the modern range of mitre regurgitation she had like a pretty bad disease in the mitre leaflets pretty restricted leaflet mobility she had a really, really big left atrium she had a variable color jet area and she also had a 0.4, 0.5 vena contracta width with an EROA of 0.3 and a regurgitant volume of 34 cc so this patient ended up getting a tissue valve she also had a maze procedure and also pulmonary vein isolation she came off by pass on some support so this is the long gaxes view of the mitre valve post replacement she had a tissue mitre valve the mitre valve, the prosthesis looks fine both leaflets are opening and closing well we don't see any degree of mitre regurgitation anymore when you calculate the gradient across this valve was below five millimeters of mercury and when he did the 3D assessment of the mitre valve looking from the left atron side we could see the mitre valve on false view opening and closing wells the leaflets opening and closing wells and I would like to end this presentation with a few key points first of all, we should integrate approach of all the different parameters in order to have a more accurate assess of mitre regurgitation severity there is no single Doppler or single 2G modality that is precise enough to quantify the severity of mitre regurgitation in individual patients so we should always try to get some quantitative assessment of mitre regurgitation severity especially when the dagginals of mild or severe mitre regurgitation is not that clear and we also should have in mind that when we are using colorful Doppler we are going to discuss this in the afternoon on the questions we should always have in mind that using colorful Doppler for mitre valve assessment can be very misleading because sometimes although the patient has a really like a small jet error for example a sanctuary jet that goes and hugs the wall area the wall atrium area this patient may have some sort of moderate or severe mitre regurgitation when you use colorful Doppler to assess mitre regurgitation colorful is really important to identify the jet but we should then emphasize the importance of colorful Doppler only we should pay attention to vena contracta width which is much more specific for mitre regurgitation and we all should have a good understanding of the regurgitant flow and the convergence area in order to have a really good assessment of the mitre regurgitation I'm going to stop it there if you have any questions and thank you very much thank you Fabio for the amazing presentation back-to-back-to-back great presentations does anybody have any questions for Fabio well I'll ask you a question with in that first case if you have a patient with severe aortic stenosis and a functional MR when do you decide when do you decide to actually do something to the mitre well I'll actually replace it sorry sorry because could you repeat severe AS and concomitant functional MR and you're going to move from and you're going to and it gets more difficult to deal with the MR after the aortic valve replacements when do you decide to intervene on the mitre valve well that's a that's a good question so it's hard to tell and we should like have a like a patient we should like do a really photo assessment on the patient so for our patient so we didn't we are not expecting to have this this sort of mitre regurgitation beforehand because the transoracic echo didn't show that so when he put the trans the transophageal echo and they saw the echo and we saw the picture so we did a an assessment because the surgeon was asking us should we change this mitre valve should we do something this mitre valve or not so the patient she had a he had sorry he had a my like a more towards the mild regurgitation mild to moderate regurgitation so the patient and end up not doing anything on this valve because he said oh we are going to change them the aortic valve so probably this this is going to allow the latrine to go to remodeling and to get better hopefully the mitre mitre regurgitation is going to go away in a few weeks and that was exactly what happened but for patients we thought like some sort of more than moderate mitre regurgitation is is a hard assessment so we should like have like a see patient by patient see what they they do normally here at the hospital they they try not to touch the mitre valve unless the valve the valve has some sort of organic disease if it's functional and it's caused by probably severe aortic stenosis they they tend to just touch the aortic valve and let the mitre valve alone and in hoping that the mitre the latrine is going to remodel and it's going to get better and the degree of mitre regurgitation is going to improve.


And this is times where I've had a lucid dream and I've been, you know, really engaged with what I was doing. And for whatever reason I died, something killed me in the dream. So, number one, okay, I was walking down this sort of forest path, okay, and there were all these weird flowers sort of growing like around the sides of this path. And for some reason I thought, or I expected, I was lucid at this point, right, but for some reason I expected the flowers would become alive. They would come alive and start attacking me. No idea why I thought this would happen, but for some reason this is what I expected to happen. So these flowers and they were blue and white, okay, these blue and white flowers started to creep up around me. They entangled around my body and then they basically suffocated me. And yeah, this was a pretty scary death in a lucid dream. This was a pretty scary lucid dream story, I guess. And yeah, so they suffocated me and I woke up instantly and I was kind of freaked out. And then from that point on I never dreamed about flowers again. I thought, let's just not risk it. So number two, I was walking down, it always starts with me walking usually, right, except the last one, which is kind of different. Number two, I'm walking down this mountain path and for some reason I try and jump up in the air. I try and jump to start flying, okay.  I've done a couple of reality checks, but I'm not like 100% lucid. I'm one of the lower layers of lucid dreaming in this situation. And so I jump up, I try and fly and I don't quite do it. I don't quite get into the air and start actually flying. And so what happens is I roll down the hill or the mountain and just roll until I wake up basically. I guess I died. It's kind of hard to tell really, but I just kept on tumbling down this hill. I couldn't stop myself and there were rocks falling behind me, you know, it was making a load of noise. I'm not entirely sure why it happened. I think because I didn't really go for it. When I tried to fly, I kind of doubted it. I was just like thinking, yeah, I should be able to fly now. I'm lucid enough. I rushed the reality check, I didn't pay attention really to it. And so I died. So number three, I'm actually climbing a tree now. I'm climbing this kind of palm tree. And I don't know how I'm climbing it because it has no branches, but I'm sort of like my hands are sticking to it like a chameleon. And I don't have any hooks or anything, but I'm just climbing this tree. I'm lucid. And when I get to the top of the tree, the tree starts to rock back and forward. It starts to sway. And eventually it gets to the point where it's swaying so much that I'm touching the ground on either side of this tree and then out of nowhere, out of literally nowhere, the ground starts growing these kind of spiky things like giant spiky, whatever you would call them, bits of metal coming out of the ground, like giant pins. And the tree is still swaying at this point. And I'm desperately trying to control the sway of this tree.  This shouldn't be, I should be in control here and I'm trying to stabilize the tree. I'm thinking like, should I jump out and start flying? Should I try and climb down? But I don't have enough time. And so the tree sways from one side to the other. And then eventually it sways so close to the spike that I get kind of impaled by the spike. And yeah, I wake up and I'm not very happy about it because the night before I basically planned to do this crazy adventure in that lucid dream. I planned to like try and ask my subconscious specific things and try and understand more about this decision I've been contemplating before. And that's what happened. I ended up on this tree getting impaled by this giant spike. Number four. Now, before I tell this story, I don't know if you've seen the film Get Out. But in the film Get Out, it's this guy who goes to meet his girlfriend's parents. And I don't want to tell you the twist at the end, but basically the mother is a hypnotherapist. And she tries to hypnotize this guy to get him to stop smoking. And part of that process is he's sitting in this like armchair like this one, I guess. And he gets hypnotized by this woman. And at some point she says, okay, now you will now sink into the chair. And of course he sinks into the chair. But the visual on the film is you actually see him like fall into the chair and below underground into this dark kind of in between space. This kind of limbo area where he's floating around. He can see like really far in the distance. He can see a TV screen with what is, you know, what his body can actually see. But his awareness, his consciousness has been sunken down into what the mother calls the sunken place. And so yeah. So with that being said, here's the dream story. I guess this is death number four. I can't remember which number I'm on. I'm sitting on an armchair and I'm watching the film from the armchair. Okay, so this is like, I guess a couple of days after I saw the film, I'm watching the film from an armchair. And I'm thinking, oh yeah, it would be crazy if that happened. Imagine being sunken down into your chair. And of course what happens is the scene comes on the film where the chair sinking happens. I then sink into the chair and I freak out and I'm thinking, no, but this can't, this is a dream. I'm meant to be watching this film in my dream. And sometimes, by the way, I do random things in my lucid dreams like I will watch films. Okay, in a lucid dream. I'll be lucid and I'll decide to watch a film. I know it's crazy. It's kind of weird. You might be thinking I'm wasting the dream doing that. I sort of view it as extra time. So sometimes I will do things that I just feel like doing in the moment. Sometimes it's meditating. Sometimes I go for a peaceful walk in the dream. I don't do anything crazy. Sometimes I literally just walk down the forest or walk on the beach and just enjoy that experience of knowing that it's a dream. Anyway, so yeah, I was watching this film. I sink into the chair and I actually get stuck there for about what feels like five minutes or so. But of course, in the dream, that's more like a few seconds. But it feels like a few minutes that I'm stuck there and I can't move and I'm just trying to get out of this sunken place. I'm just floating around wondering when I will wake up. But of course, yeah, if you're watching this and you're thinking like, oh, I don't want to lose a dream now because that sounds scary. It's not like that for most people. And in fact, even if you have that experience, like it feels like five minutes, it's more like a few seconds in real life. So it's really nothing to worry about. And it's kind of fun. Like when you wake up from that experience, it's kind of a scary yet exciting thing to remember. It's like, oh, it felt like I was trapped in a dream, but now I'm awake and everything's fine. Anyway, so number five, the last lucid dreaming death that I've had is a different one. So I'm not walking. I'm not climbing anything in this dream. In this dream, I'm actually underwater. And so the dream begins when I'm, if you've ever watched scuba diving videos or even better, if you've had a scuba diving experience, then you'll know that you sometimes forget which way is up. Okay, if you're underwater, if you're deep underwater, you sometimes forget which way is up and which way is down. And especially if it's a dark or cloudy day and the sun doesn't make it obvious where the surface of the water is, you can kind of lose track of which direction you're going in. And this is kind of scary even in real life, okay? But now imagine you're in a lucid dream. So I'm lucid. I'm diving. It's a cloudy day. I can't really work out where the surface is. And I feel like I'm quite deep underwater. Okay, this feels like I'm really, really deep. I don't know how far and I'm floating around. I'm looking at these fish and suddenly this giant snake starts coming towards me.   And it starts sort of slithering towards me in the water. And I know I need to escape. I need to get up to the surface, but I can't work out which direction it's in. So I end up actually going deeper underwater. I go towards the ocean floor. And I realize my mistake when I actually see the ocean floor. And I think, hold on a second. I'm going the wrong way here. The snake is kind of circling me like a weird shark type thing. And I'm thinking this is bad. This is going to end badly. Although I'm lucid, I can't seem to work out how to escape this. So I try talking to the snake. It doesn't really respond. And time runs out. Okay, if you've been in a lucid dream where it turns into a bad lucid dream like a lucid nightmare, you'll know how this feels. Time feels like it's running out. You know it's going to end badly. And so you just kind of have to watch yourself getting eaten by the snake. In this case, the snake actually doesn't touch me. But what happens is I start drowning. I start gasping for air. I feel like I just can't get that fresh breath of air that you need.  I can't seem to get it. And I drown. I then watch the snake sort of wrap around me and then it eats me. But the actual death was caused by the drowning. So I woke up pretty annoyed and pretty scared. Yeah, so I just wanted to say if you've been hearing these stories and you're kind of scared about lucid dreaming, I want to make it very clear that these are not common experiences unless you already have lots of nightmares. Most of the time I lucid dream about really cool things and it's exciting and fun and life-changing and profound and all that stuff. But yeah, sometimes it doesn't go well. It doesn't go according to plan. And it's just kind of a scary or bad experience. But yeah, please don't let this put you off. And if you do want to learn how to lucid dream or if you've never had a lucid dream but you kind of want the experience, then I do have a video course called the lucid breakthrough course which is linked in the description. It basically shows you how to lucid dream even if you've tried and nothing's worked. It's specifically for people who have already tried. So if you haven't tried yet, don't get this course because you can probably just land for free on YouTube or something like that. But if you have tried and it's not worked, then the course is in the description. And leave a comment letting me know you're scariest or what you would imagine to be your scariest lucid dreaming experience. Like what would you really not want to have happened? And yeah, hopefully you've enjoyed this video and I'll see you next time.


always someone saying what you're saying, better than you're saying. What makes you memorable, isn't that you said it better, what makes you memorable and sticky in our experience with you, is that you have a unique reason why this matters to you.


I'm Tony Long. I'm from the Pew Charitable Trust and I direct the Ending Legal Fishing Project. We've been partners with Interpol, Project Scale and the Environmental Crime Programme from the very beginning. We think this project is vital to bring together 190 different states in the world, members of Interpol in order to fight this international crime that's costing the world $23 billion or more each year.


and welcome to Love Where You Live, a monthly production of the Sheboygan County Chamber of Commerce. I'm Betsy Alice and I'm the Executive Director of the Chamber. Today we have three segments and in our first segment I've invited two very important people to join us, Paul Kuplik who is Vice President of Wisconsin Bank and Trust and Lindsay Harrison Irick who owns Engaged Social Media and the reason I say that these are really important people is that they are at the top of our core of volunteers called the Ambassadors. Historically Chambers of Commerce have always had this troop of people who are their face in the community who do some of the really hard work and the fun work and who make it valuable for our members to be part of the Chamber. So I've invited them here so they can talk about this a little bit this morning. Lindsay is what we call the Royal which means she is the top of the top, the creme de la creme of the Ambassadors for 2017 and Paul is next on deck or successor to the throne. He will be the Royal in 2018 so we've got the top folks here will take good advantage of their time. I think probably the Ambassadors are the busiest group. I know that they meet monthly. I know that they attend countless events and activities and they also commandeer some of those and make them into really special times for our members. So Lindsay I want to start with you and we can kind of chime in too because obviously we all know about the Ambassadors but what do you say about the role of an ambassador if you're recruiting a new person will you tell them? Our goal as Ambassadors are to welcome new members to the Chamber so when a new member joins between our core group of about 30 people that represent different businesses we go in and we attend ribbon cuttings and welcome them through emails and phone calls and just make sure that they have all the necessary tools in order to be successful as a Chamber member. Anything to add to that Paul? We're also very active in the community you've talked about ribbon cuttings a little bit and after our social events for helping the business community just connect with each other. Yeah it's a pretty it's a it's a big commitment that has a lot of tentacles. I can recall one event where the group got on the trolley and they're oh they always wear blue coats. They didn't have them today but they usually wear blue coats at the official events and we went around to businesses to drop off visitors guides and say hello and it was fun. We went to every community in well almost every community in Sheboygan County and I saw that as a pretty big part of the tradition is that core of blue coat people who are out there with a good smile on their face and a welcome. So yeah I think it's valuable and the other thing that I know that you do is when a new member joins you invite them to things such as a business after hours just because people don't feel comfortable immediately it takes a little bit of coaxing and cajoling and then they can become part of the group. So so how does one become an ambassador? Well this year we've become very streamlined in our process so we like to see someone involved in the chamber prior to either having them reach out to us or us reaching out to them to become an ambassador. So like I said we've got about 30 right now. You think the goal is always to increase that so that the more you have in your own network the more people that we know and hopefully gain more and more value for being a chamber member because it's always good to walk in the room and know people. It is. So right now that process has become kind of more of an interview where Paul myself and a few other members of the chamber staff will go in and make sure that they're the proper fit. From there if we feel like it's a proper fit they'll be invited to our upcoming ambassador meeting so they'll get to meet the whole group kind of see how a meeting is run and how everything functions and how all of us kind of communicate as a group. Everyone seems to get along really well. It's just a really natural fit. It's a fun group. Then we excuse them from the meeting and we vote on them as a group. Yeah it's very complicated stuff but yes. Has anyone ever said no? No I don't think so. You know when you're a volunteer I think it's always good that you just find the right fit for the group and a lot of people already know walking the door if they feel like they have the time and the resources to be able to to be part of this. And by then both parties kind of know the group knows and they know whether they really want each other to be part of this. Right. It helps to have either you know in Lindsay's case to be your own business owner or in my case to have a flexible employer that's willing to allow me to go out to these events. I mean because I'm taking time out of you know my daily routine and going to the ribbon cuttings or whatever events we have scheduled that day. So that's always helpful. Lots of them. How many ribbon cuttings? I think we thought 8 to 10 per month of things that we ideally like to be at. So that would be a ribbon cutting which happens for basically when a business expands or adds on or does something of that nature or a business after hours which one business hosts every month for two hours where everyone's welcome to attend. Open houses, groundbreaking, different things of that. So there's a lot of good things happening in Sheboygan County. So that keeps us busy which is great because you get to meet a lot of people and really get to be the face of welcoming people into our community. So why would someone want to be an ambassador? We get to wear really cool blue jackets. Is that it? I knew it. That's a good answer. Yeah, they're very professional looking. Yeah, they're fantastic. I mean honestly from from my personal perspective and and perhaps for Paul as well as you really get to meet new people that you may not have been able to meet if it were just in your day to day experiences. So that's been really interesting and fun is you get to connect with a lot of people and a lot of times they become your friends and you call them to to go out for cocktails after work or nice to go to lunch or to introduce them to another business. I mean it's it's truly all about the networking component of it and building relationships. So in our one minute that we have left I just want to put in a quick plug for the golf outing because I know that it's all hands on deck right now. It's September 13th is the golf outing at Kwikwiak. Well I think we have one for some left so if anybody out there in the listening audience or the viewing audience would well I guess it would probably be too late by then. But in any case always a success almost always a sellout and a lot of companies pitch in to make it a successful event. Tell me how much work it takes. It is definitely all hands on deck between donations and coordinating everything but the most special thing to me is that we are able to present $4,000 a year in scholarships. So I mean to be able to give back to the community and see everyone come together is fantastic. The work component of it I think is minor compared to what you see when these kids light up and they receive $2,000 in scholarships. Right. Well worth the time. And I do have to add too that there are other funds that go into other chamber programs for workforce development and Coastal and all of those kinds of things as well. So it's a big part of the chamber. I mean it's a big fundraiser for us so I thank you very much on behalf of our members and our board because that work is is spectacular. I'm watching it right now at our office every single day. So you'll be there tonight. Yeah, great. Hopefully there'll be pizza. I think so. There you go. Sounds like it. So I want to thank you both for coming in today and helping just educate people a little bit about what the ambassadors are, what they do, and I will tell you how valuable they are. Thank you Betsy. Thank you so much. I'm going to talk about an interesting program that the chamber offers a little brag time for us. It was about five years ago a couple of our volunteers came to me and asked if it would be possible for us to set up some kind of a referral networking kind of event that members could take advantage of. And I basically challenged them back. I said if you design something and bring it to me, we will try to make it happen. So five years later and five deep dive 1.5 opportunities. And now we have today. So I think we started with one. It went quickly to three. Then it became five. And and you know today I've invited a special guest, Lindsay Harris and Iric from Engaged Social Media is here. And Lindsay was probably one of the founding members of this group and some of the first groups that we established. So we're going to just talk a little bit about how it works. If it interests you, all you need to do is call the chamber and see how you can get involved. Our members pay nothing extra for this opportunity. So I find that to be probably one of its biggest selling points. But I think what goes on in these meetings is important. So Lindsay, welcome to the show. Thank you Betsy. Yeah. Lindsay is also a leader of our ambassador group at the Chamber. I I just want to talk a little bit about deep dive groups. I think the name came about because it was a way to establish relationships with other business people. A lot of them either running a business or being a sales representative for that business and kind of going deep with them. So why did you join initially? What pulled you and how did you find it at first? Yep. So I started my business about that same time that deep dive had come out. So I had been in business since 2013. And the Chamber was one of the first organizations that I knew that I had to join in order to network and meet people. So this had come up as an opportunity that was already included with my membership. And it was an hour and a half, two times a month for me to really get involved into network with other people. And the time that I joined, people weren't exactly sure on what social media was. So there was a lot of different, right? How far we've come. So that was an opportunity for me to go out and do my sales pitch and for people to go out into the community and really tell others about what engage tests to offer. And I felt like it was my mini sales force. So that was very nice. Yeah, that's exactly what I say to people when I promote it myself. Is it seems like you have kind of a built in sales force once you have created trust and knowledge about your company, then you have these other how many are in your group? It varies. I think there could be anywhere between 12 and 20 at any given time. So to be able to tell people about new and not becoming things and for them to expand their network. I mean, that's how all this goes, right? Is somebody knows somebody who knows somebody. So yeah, I think that it's doing exactly what it set out to do. Very nice. So I know I'd like you to just take us inside for a minute and pretend that we're all at a deep dive group sitting in the chamber conference room all around a big table. What happened? So deep dive and then it's called 1.5. So the 1.5 represents the hour and a half meeting that it is. So typically how it's structured is we would go in introduce ourselves, introduce our company, say something new that was happening since the last time that we met. Everyone in the room gets an opportunity to do so. And then we have a 10 minute presenter who is allowed to really dive into what they would like others to know about them. So they could do a personal type of presentation. They could do a company driven presentation. So it's really their time to shine. And after that, you've got an opportunity to go around the table again. And to say something new about perhaps an organization that you're part of that they have an upcoming event or they're fundraising for a particular thing. So it really is just truly trying to get the word out about things that are either happening in your life or in your company or in the community or in the community. That's a nice addition to it to I guess so that that group becomes you know, gathers around those kinds of events as well. Yes, I agree. Well, that's a really interesting. So you've been private five years. That means and it meets every other month. No, every other week. Yeah, excuse me. Yep. My particular group right now meets the second and fourth Thursday of the month during lunch. There's other groups that will meet before work. So a 730 until nine. And then there's also a group that meets after work from 430 until six. So the Chamber has really done a nice job trying to vary the time so that it fits into people's schedules where they feel like they're able to attend. As with anything, the more times that you attend, the more people get to know you, the more times that you really get to have your showcase in front of people. And it just goes from there. So that's the incentive to keep attending. Because the group becomes a little interdependent right at some point. I know when we started it, we talked about making it the 1.5 would also point to you'll stay in this group for about a year and a half. And then you can choose another group. Most people don't. Right. Most people want to stay with their original group. Right. And also one more point, the groups are made up of people in particular services or sectors. And we try not to duplicate that unless the group says it's okay. So in other words, if you have two real estate agents, and one is commercial and one is more residential, they may be able to work that out and it would be okay with the group to do that. But in some cases, if they're direct competitors, we'd find another group for them to be part of. Yeah, that's really nice thing is when you walk into the room, you typically don't have a competitor in there. And people are. But the nice thing about how it's all structured is that people really take pride in getting to know you and building a relationship so that they can refer you out and that they feel comfortable doing so because it's their name that's also on that referral. So the more times that you can attend and the better that you get to know people, just the more your relationship starts to build. I've always also said there's a member of the chamber. It's the glass coffee shop. And whenever I stop in there, I always notice that there are people after their deep dive groups who then convene there and meet one on one, just so that they can get to know each other better. And I think they also visit each other's businesses from time to time. Absolutely. Tours and visiting businesses and meeting other members of their company. I mean, like I said before, this is relationship building. So the more people you know, the more that you'll get out of it. Well, I can I can speak for Lindsay and saying that if if networking is the key, then that's the reason for her huge success with engaged social networking because it is I've watched this business grow and change and add services. And and every time you do that, you get to talk about that at one of the deep dive groups. Right. But also it's a matter to I think of plugging into the chamber, being part of the business after hours being part of the ambassadors as you have been being part of deep dive and then also now being on our board of directors. Yes. So thank you. Yeah. Lindsay's made quite a quite an effort at plugging into the community so that she can better her business and its reach. So thank you, Lindsay, for being with us this morning. Thank you. And I know we're going to be meeting with Sean Jackson from the chamber and talking a little more today about benefits. And that's one of them. So thanks a lot. Thank you. To love where you live. We now have in the studio Sean Jackson, who is the Community Relations Director for the Sheboygan County Chamber. I'm Betsy Alice. I am also with the chamber. Today we're going to just talk a little bit about we realized that a lot of times people don't know what the Chamber of Commerce does. What we do for your business, for example. So we're going to talk a little bit about that. And even if you're a member of the chamber, this might be enlightening for you as well, because there's just a lot of stuff to remember when you first joined. So Sean, welcome. Thank you. And Sean joined the chamber. Sean became an employee of the chamber in June on June 1st. Right about there. Yeah. This year. So he's definitely gotten up to speed very quickly and is building those relationships with our members. So he's the best person to talk to about joining the chamber. But today we're going to talk a little about what happens when you've already signed that dotted line. Exactly. So somebody joins the chamber and there's there's a lot that we go through and the chamber has so many events and benefits and ways that people can get engaged. Realistically, the first thing that's going to happen is we're going to give you access to our chamber website. And you're going to go in there and you're going to list the people that work for you. You're going to be able to link your Facebook page and your website and your Twitter account and whatever else you have on the social media side directly to our business directory on our shabuigan.org page. You know, so and then there's a new member meet and greet that comes up where we go in depth with with things. I mean, and the nice thing is that the staff at the chamber is very, very helpful if a member ever has any questions, concerns, needs help with anything very reactive, whether it's somewhat up front or me or whomever. Yeah, let's go back to the website just for a minute because I love one aspect of it too. And that is that they all have what we call the upgraded option for their website page within our website. And they can put videos there and photos there and we strongly encourage it because people click on that people go to find certain types of businesses and they will find you that way. Right. Well shabuigan.org. I mean, first of all, think about it. I mean, that is the number one website of somebody is looking to do something in Shabuigan County. Visit here.  I was looking at a business the other day where in a six month period, they had 158 views just to their directory page. So someone come to shabuigan.org. There's a business directory. They'll look up, say restaurants. That's what this category was at the time. And so there's 158 times in six months that people came to shabuigan.org went to their business directory. And the neat thing is because they had their website link to it, there were 90 people of those 158 that click through directly to their website. So that is a huge benefit from a referral standpoint. That's one example. Exactly. And you know, and the interesting thing is I talked to a lot of our members. They don't know those behind-the-scenes things that we do, you know. So referrals. Yes. I mean really that's, especially if you're a, you know, a small medium business that does a lot of retail, referrals are really one of the biggest reasons that someone is going to join the chamber. Constant phone calls. People walking in. Yeah, you know, I mean, so lots of different types of referrals like I already mentioned the website, but our staff. So you have people coming in the chamber office every single day, especially visitors asking for this or that. Inside the office we have all of the brochures and materials that any of our members want to put in there for their services. A lot of phone calls. We field so many phone calls every single day of people asking where can they go for this or what's a good restaurant or where can I buy this. You know, so we probably have several hundred a month of phone calls just for that. And quite honestly, you know, another benefit of someone joining the chamber that people don't think about is how joining a chamber of commerce boosts, boosts their credibility and boosts their reputation. I know you have some statistics.  Okay, they get a 55% increase in consumer awareness, obviously because we put a lot of, you know, information out there, and then a 53% increase in local reputation. Those are tremendous boosts. I mean, you know, because when you look at buying something or utilizing a service, you really want to be able to buy or use the service of someone you trust. And I think what the chamber does is it gives them that credibility and that built-in trust factor, because if we have a member that joins and we refer people to it, we kind of help each other, hold each other accountable to be a good, you know, retailer. And the other part is the awareness and trust building that goes on at networking events, like business after hours. Yeah, the business after hours is pretty neat. Once a month we have that. One of our business members will host it and it's a really nice social networking aspect. And we have anywhere from 50 to 200 people, depending on the time here in the venue, it's free to our members, you know, so you can come in and usually there's orders. And that's a big deal. By the way, because I don't even have to eat dinner that way. I know. I mean. We had the last one we had was out at Amore in Plymouth. It's connected to Antonio's and Antoinette's, and they have a big catering hall, which is Amore, and they put out, you know, their famous fried chicken and mac and cheese, and it was awesome. Yeah. And then they usually have a free beer and wine. So, you know, it's the social networking is something I really, really enjoy, because that's when you get to know people. You build those connections.  And one other point I want to make that I think business is in this as well, especially those who have employees, is that their employees can attend these events as well. Correct. So if you can't come, fine, but you can also send other people along the way. So I think that's really an important factor. Exactly. And it's just really just, you know, I want our members to engage, call me, Sean at shabuigan.org. It's my email or call the chamber office. And talk to me, because I really want to help them succeed. And we have so many ways for them to to get engaged and succeed in their business. Yeah, I agree. I think, you know, they may be tentative at first. And I also noticed that at our business after hours, we try to take care of the new folks who come in, you know, try to make some introductions for them, get them out on the floor a little more. You know, I tend to be somewhat introverted. I know that's hard to believe. But I remember when I initially joined a chamber back in, I won't say the year when I had a business and it was a little intimidating to attend those events. But I think the ambassadors do a really nice job. The ambassadors are making those introductions. Yeah, the ambassadors do an awesome job. And again, all the chamber staff, myself included, I think we're very we're vested in wanting to see our members succeed and getting them connected with one another is a huge way to do that. I mean, the referrals, me personally, my family and friends already know if we're going to go out and do something, they pretty much know I'm not going to a place that's not a chamber member. Right. And I'm the same way. I have operated the same way. And they actually do it on their own now. It's like, hey, Sean, are these guys chamber members? Well, yes. Oh, and you bring to me to another point, chamber cash. Oh, that's as a final. That's a really important one to talk about. That is true. I am amazed. Like I said, I've been here a little over five months and we sell over $300,000 worth of chamber cash chamber cash that you can purchase in our office or even at festival foods. And it's a check and they can take it to any retailer and use it just like cash. They hand the check in if it's twenty five dollar chamber cash and it's twenty dollars, they'll get five dollars back because the member gets that. But the neat thing is of that three hundred thousand dollars, we have about two hundred and ten, two hundred fifteen chamber members that that money has to be spent at. Right. So it definitely promotes local purchasing. Exactly. Right. Exactly. A nice benefit. Very nice. Yep. Exactly. Well, thanks. I know we left some things out. And we also can talk about sometime in the future about members in other sectors and the benefits that they receive. But this is a great start for those small businesses who are looking to make connections. Yep, it is. Thank you very much for being with us today.


Welcome to JSA TV and JSA Podcasts, the newsroom for telecom and data center professionals. I'm Jean-Marc Slim and joining me today is Michael Holm, data center lead for Telia Finland. Michael, welcome to JSA. I hope everything is well with you. Let's talk about data centers in Finland. What is the current state of the markets around data centers in your country? First, thank you for having me here. Yeah, if we take it shortly, of course, you know, from the history, there are lots of smaller data centers in Finland, but if we are talking about players that could provide capacity in megawatts or over 10 megawatts, then I think we have two other players here in the Helsinki region and one player up in North in Finland. That's really the situation when you're talking about real data centers. I mean, but one thing that we've seen over the last few years, I'd say probably five years, was sort of a new wave of investments coming in in expansions and projects. We've recently had a whole new data center brand launching in Finland, a multi-billion-dollar brand. Why is Finland such an attractive investment landscape at the moment in 2021? Yeah, if you look at Finland, you know, Finland is a politically very stable country. You know, there's really no matter who is in charge, it doesn't change so much. We don't have, we have no corruptions in Finland. We don't have any agitations. We don't have any earthquakes. We don't have any tsunamis. We don't have any major disasters that you have seen in maybe in the middle of Europe this summer. The electrical grid is very, very stable. It's probably the most stable in the whole world. And, you know, as you can see from the weather of side today, we have a very moderate climate here. In fact, you know, 95-96% of the time we can run on free cooling in the data centers. And maybe when you're looking from the money-wise, electricity is cheap in Finland, in the Nordics, comparing to the German market, for example. I think those are the most. And of course, the geographical situation, the proposition, you know, we are very close to Asia and also to Eastern countries here. I think those are the main reasons. So you're building a bridge between Asia and Europe as well. Just to give some context on the energy prices between Finland and the Nordics and the rest of Europe, do you know more or less the difference? Just to give our audience a bit of context, Of course, what is the final end user price that usually depends on how much capacity you buy? But easily, we are half of the price comparing to the normal price in Germany. We have a, at this moment, we have a talking of between 0.15 to 0.18 eurocent per kilowatt when easily in some German market, there could be 0.3 eurocent per kilowatt hour. And this includes everything. So I think that's a major thing. But of course, it depends from country to country. Yeah, and actually, I mean, the Nordics have been famous for the cheap energy prices for a huge abundance of energy as well, and green energy, which is so important. Yes. But I mean, so picking up on the market and how the market is behaving and growing and all that, how is Tellia, what's Tellia role in the marketplace today in Finland and beyond? What are you doing? What are you working on? Tellia is our home market, is the Nordics and the Baltic countries. That is where Tellia is operating at this moment. And in the data center environment, we have one real big data center at 24 megawatt data center in the Helsinki area. That's a modern data center. It was open in June 2018 and built for data center purpose. So it's a new building. When you look at our position, where Finland and Helsinki is, we can serve 400 million people within 50 milliseconds. And I think 50 milliseconds is enough for 95%, 99% of all applications. So it doesn't need to be maybe in the so-called flap area. We have a direct sea cable to Germany, for example, that makes Frankfurt within 20 milliseconds. And then one thing, when you look at Tellia and this data center, we also own the local networks in all of these countries. We have a, I don't know how many thousand local breakouts do we really have. So it's not only the data center, it's also the network behind it and the connectivity between all of these countries. Of course, since this is a new and modern data center, this is very energy effective. We are aiming at this moment close to 1.35, I think. And when we get a little more load, we will be 1.2 in the PUE values. And this data center has been green from day one. We are the only seed and lead certified data centers in the Nordic. It's one thing to say that you're green, but it's one other thing to really prove with a certificate that we have. And from the next summer, all our waste heat, we will be putting back to the Helsinki district heating system. So I think in that sense, we are a very, very modern and green data center. In fact, today I have us in a meeting where we were talking about this European Union, what this is called, Act for 55, Act for EU commissions fit for 55. And I think most of those regulations and these kind of things that European Union is putting on data center business and also another business, we already have them in place. So I think it's a safe selection for the next 10 years, because usually if you come into a data center, you are easily there 7 to 10 years. No, absolutely. I mean, as you know better than anyone as well, the green energy discussion is huge in the industry, but there is a big gap between those who are green and those who say they are, but you don't really know what they actually mean by green. But actually picking up on your heat reviews activities, so sending the heat back out to help heat other places. What are you doing? Where is your extra heat going to? Is it going to schools, hospitals? It's going back to the Helsinki district heating system and the Helsinki for Helene, they are changing to be more greener and so on. So they are using it to warm up houses, they are using it to warm up schools, they are using it to warm up hospitals and so on. It's a one big district heating system that I don't know how many customers they have. But to give an example, when we will be on a fully load someday with 24 megawatt, then with the waste heat we could warm up 25,000 normal households. So that will produce the same amount of energy that you're needing to warm up 25,000 normal finishes. So it's a huge amount. I think that's the thing that is the real green stuff, not the certificate. This is the real green stuff and this will be live from next summer. It sets an example as well, try to place in the industry that we're using. So if you power your data center using green sources of energy and then still use what you produce within the data center to help save even more energy elsewhere, that's when you start becoming the greener of the greener. All of energy is either hydro or wind that we are using for our data center at this moment. But of course, Telia is not just a data center business as well. There's a lot of other verticals within the company. Talk us through what else you're working on, what kind of things we can expect you guys to announce in the coming two years. We are still going through COVID. So I'm sure there's a lot of R&D that's happening behind doors and it's been speeded up by the huge demand for connectivity services and cloud services and all digital services. So give us a glimpse of everything else that you guys are working on and will be doing in the future. Yeah, there probably will be a good talk for many hours, but if we take it down to a few things, Telia has a new strategy to reinvent that connected living and of course 5G is the major thing now for Telia all over the Nordics and the Baltics to be on that level that we should be. In addition to that, we are also doing quite much in how to leverage that network in data and analytics providing services to see various traffic jams and things like that. And also probably one area where we are very active is in the broadcasting. Telia is also a media company these days. We own the television channels. So I think those are the main three things that maybe we are working on over the next year in the bigger picture. We'll see Telia at the Eurovision at some point. Maybe the employees will have an own band there. That sounds good to me. And Michael, so if people want to learn more about Telia, where could our viewers go to to find out more? Of course, if you google Telia, you will find the company web page and so on. Telia.fi slash data center is where you find most about this data center that we have and the other ones. So those are the two things to remember. Telia is not so difficult and a name to remember. No, not at all compared to some others in the industry. But Michael Holm, thank you so much for your time and thank you our viewers for tuning into JSA TV and JSA podcasts and don't forget to check out our social channels for more content. Until next time, happy networking.