Welcome back, everyone, to SuperCloud 6, AI Innovators. I'm John Furrier here in Palo Alto, along with Dave Vellante all day, bringing all the top players in the AI, generative AI industry from infrastructure, software, application development, all building out the next gen AI at large scale. Our Ancona CEO, co-founder of Chara is here, CUBE alumni, great to see you. Welcome back to our AI Innovators and congratulations. You guys are doing a lot of innovative things. In particular, the world spun directly as we had predicted in the last time you were in the CUBE. So thanks for coming on. Well, thanks so much for having me. It's great to see you again, John. So excited to be here and talk a little bit more about what we're seeing in the generative AI space. You know, I love the term luck. I believe that luck is playing, it plays out big factor. Luck is preparation meets opportunity. You guys really at the right place at the right time with the right team. Obviously, the last time you chatted on the CUBE, we're talking about cost optimization and all that good stuff. Now everything's generative AI and now that is the number one conversation right now on how much am I going to spend? Is the juice worth the squeeze? That's the question. Everyone knows they want generative AI but the question is how do they get that? So what are you guys thinking? How are you seeing this spending challenge or opportunity with generative AI? How are you guys seeing this play out? Of course, it's probably impacting your business but what do you see happening? No, absolutely. Well, one of the key things that we're seeing in the space right now is that folks are starting to realize the benefits of generative AI really from a cost perspective and from a revenue perspective and just things like what we've seen with Klarna replacing a good chunk of their customer success costs with something that's much lower cost in a production generative AI model is I think the tip of the iceberg but what customers are starting to realize is that the science, the best practices they're only about a year old and the hardware space is constantly changing. Look, you've got the H100, H200, V100 all coming out in the span of the next few months. Who knows what the next generation state of the art model is going to require and who knows what the actual cost to serve these models once they get product market fit and reach production is going to look like. And I think that that uncertainty is something that's universal across the customers that we talk to when they're looking to do their one year, three year plus commitments to their cloud provider and figure out how much of this capacity from a GPU standpoint or from a high end, you know, ASIC standpoint like in Ferentia or TPU should I plan to actually be spending on as we experiment, go through POCs and ideally get to a place where we can scale something up that's making real production top line or bottom line impact. I want to get into your business. I know you guys are doing extremely well. Not sure you can talk about revenue numbers but I know you've got a series B financing going on right now. You guys are again, right on the growth curve. What are some of the business metrics that's impacting your revenue in terms of customer adoption? What are people looking to spend on? I'll see how they procure compute and GPUs are changing and the platforms are changing. Jensen says it says software world now. I mean, Kamata is going over almost zero cost for compute and GPUs in the future. That's the premise where software now is the value. So what's driving your business? Give us a feel for some of the revenue. What's in your pitch deck? I should ask you. Absolutely. Well, look, I think we've been really fortunate to come out with the right product at the right time. As you said, so what our chair does is we're completely free cost optimization platform. We have customers who saved millions of dollars a year with us on AWS and now Azure. I don't pay us a single penny and we love that. That's customer obsession. And where we make our money is in providing a first of its kind new insurance offering for cloud commitments, which is as simple as saying is if you commit to three years to run this GPU machine with AWS and you only end up using two of it, we'll pay for the one. We're on the hook there. And so what we've seen in our space as we've gone to market and really in our first year going to market, we basically 10X our revenue is that customers are hungry for something like this because of the risk inherent in committing to anything in a space that moves as quickly as generative AI. The chips move quickly, the services you're committing to and software stacks as you mentioned, move quickly and customers want to move fast at a great cost, but not lock themselves into something that might not be the right solution for them one year, let alone one month down the line. What's your vision for as the first of all, by the way, that's absolutely accurate. You're seeing two things happen that's coming out of this super cloud event. One is the organic growth of developer appetite for building on top of infrastructure for GenAI. And two, enterprises bringing their corporate data to the table, which by the way, it's not that easy to just integrate that into a bottoms up. You need to get them both together. You're seeing enterprises trying to go as fast as they can while the infrastructure is changing so fast. In other words, it's evolving which means it's changing constantly. So there's a lot of risk on making a decision that could foreclose the future. Absolutely, and I think that it's a multi-tiered problem because the generative AI, the fancy stuff with the GPUs, to really make that useful in the context of your business, you've got to get your data strategy right. Heck, in some cases you've got to even get your data to the cloud in the first place. So you can use those platforms like Amazon EMR or Databricks or Snowflake to start extracting value out of those data sets that are proprietary to your business and really are the moat to the generative AI that you build that powers your business on a top line or bottom line basis. So I think there's risks at every piece of the stack that needs to be built to support gen AI and CIOs are starting to really realize this as are their counterparts on the finance side, which is where a product like ours that's really blending that insurance aspect with deep technical and cost optimization knowledge can really make an impact in the customers we work with. It's an interesting dilemma because if you don't move fast enough with AI, you could be left behind. If you move too fast, you could make a suboptimal decision on infrastructure. So timing is everything on this wave. I mean, it literally is. If you miss, miss fire, you can be driftwood. On the other side, if you're too late, you missed the wave. So interesting dynamic. How do you guys see this playing out from a use case perspective? Because obviously your success is based on the fact that this demand for gen AI infrastructure and two, they don't want to pave something they're not going to share they're going to use. So what are they doing? What are your customers doing with Gen AI? How are they approaching it? Are they more on the app dev side? Are they looking for a hedge against costs on infrastructure? What do you see there? What's the power dynamics for your success? Absolutely. Well, now we're tracking billions of dollars of annualized cloud spend against hundreds and hundreds of customers that work with us ranging from some of the largest enterprises to fast moving generative AI startups and everyone in between. And I'd say that the kind of most common thing I've seen is then people are experimenting with generative AI but the very earliest minority are really putting it out into product or into internal processes and getting really large ROI from it. We're kind of in that earliest of adopters phase where folks are going from, hey, this new technology exists. Where can I apply it to a POC has been run? We've seen a really great ROI and now we're scaling it across our customer base or across our internal teams in a very specific way. Obviously we saw the reporting from Klarna which was kind of an example down on the internal side but look at folks like- Explain that example real quick. Explain that example real quick. Absolutely. So Klarna reported in their earnings that they were able to replace a significant fraction of the volume going to their human-based support team with responses from a generative AI based model. And I think across the customers that we're looking at particularly large enterprises that's been a really great beach head along with software development and code generation for this generative AI to make real dollars and cents ROI impact. Now compared to the organizations that we work with who actually do generative AI to drive top line revenue as part of a growth driver for their business the usage that we're seeing from the internal example is actually much smaller. And the customers who are really leading the pack here from a spend perspective are the ones who've gone through the training figured out what model works for them think of like an Adobe with a firefly. Hey, this thing really works makes the workflows better or Microsoft with a co-pilot. And now they're starting to contract real revenue against it. And with that revenue and usage growth their inference spend starts to scale with the number of customers they have. And what I'm looking at in our customer base as an indicator for if someone has really made that kind of product market fit transition with generative AI is are they really projecting forward that their inference spend is going to surpass their training spend and there aren't these spend on these models. And I'd say a very small proportion of our customers are there today but over the course of 2024 I think a larger number of customers will probably get into that early majority of customers starting to really get to that point from a spend perspective. So you're seeing in your customer base both cost optimization and revenue growth. Correct, the cost optimization is obviously coming from different places where the revenue is growing but the broad strokes is that budgets are growing not as much as they did say in 2021 or 2022 but a lot of that is going towards these generative AI initiatives and the dollars that are coming back from cost saving on your traditional kind of web serving workloads or database workloads those are getting reinvested back into these gen AI efforts. So I think that's been the common thread of the last quarter, quarter and a half. Okay, so let me play the role of a customer then I'm going to play the role of a VC because I know you're doing a funding round so I'll ask you a few questions on that with a funding side but first I'm a customer pretending I'm a customer love what you're saying I'm in my number one concern is I want to make sure that the money I'm saving and or the money I'm gaining which is net benefit has to be more than my cost. So do I come to you and lock that in? How do you help me?  I mean, cause I want to make, I want to make sure I'm not overspending to get that savings. Take me through that use case. So it's one of the really unique things that we as our chair provide as part of our free platform is a full scenario modeling tool where you can go in, pick any stack of services from AWS from any of their marketplace vendors and figure out in, you know, some scenarios what the cost of that including things like your commitments like our eyes and savings plans or things like our insured versions of our eyes and savings plans what things like an enterprise discount or credits layered on top figures into as a total cost of ownership. And you can do this before you even run the Terraform template or click through the console and spin up that instance and customers love that because they're able to understand and go to their management with some of these very expensive, first box of the project type skews to spin up that might have 24 GPUs attached and really get that clarity in terms of what's going to hit the AWS bill at the end of the day who's going to own it and then what can we do to reduce the cost and the risk of running this workload be it buying a three year commitment if you're sure you're going to use the H100 for the next three years or buying an insured version from us that gives you the flexibility in case the technology changes. And so I think that's been one of the key things that we've seen with our customers as a huge requirement now that the barrier to entry of any new project is 10 X what it was before this generated AI boom. What's great about your company is you're actually on the growth curve doing a series B financing. You're on the upslope. Good funding round for companies like yourself. So I'm sure you're got a lot of action going on. So I'm the VC, what's in it for me? What's the investment thesis? What are you promising? What are you looking at? That's going to be the key driver revenue growth customer acquisition. What are the key metrics? What's the key highlights of your fundraising deck? Well, all of the above, I think one of the key things that we're seeing is that as this model has been validated within the customers that we've worked with in North America, internationally customers are knocking on the door as our partners. Beyond that, larger and larger customers are starting to knock on the door including some large Fortune 500s who are starting to understand, hey, if I'm insuring my biggest line item which is my employees health insurance, my second biggest line item is cloud. Shouldn't I be insuring that as well? And obviously we're looking to add more products both from what we insure as well as new SaaS products and new products for our partners to go to market with them more effectively. And we're already working with some of the largest and most important MSPs and global partners of AWS. And I think we want to do more of that over time. So all of that is in the service of growing the business and taking this vision of commitments for cloud insurance really to the broadest market possible. And that's really everyone using the cloud today. Well, last minute we have left. I'll give you the floor, share, quick plug for what you're looking to hire. So you're doing the fundraising rounds. So good luck with that. Thanks for that sharing that pitch there. What are you looking to hire? What's the stats? Put a plug in for your vision. You know, absolutely. Well, we're hiring for amazing engineers who know the cloud well. We're hiring for great sales people who've come from the cloud or the broader channel ecosystem. And we're also going to be hiring for executives on the finance side as we grow that side of our operations. So, you know, we're looking for amazing people wherever we can find them. And I think one of the key things that I'd love to talk to customers about as we get into this year is figuring out how to budget for generative value. We're looking for more customers who are interested in this idea of insurance for GPUs for their cloud commitments. And we're very excited to have more conversations as the space develops. And as we see kind of the technologies and the trend shift. It's its own financial economy right now, this GPUs is, you know, you definitely got to be in some good action going on. Thanks for coming on. I appreciate it. And thanks for the, the contributions part of our SuperCloud 6 and participating in our AI innovators. Absolutely. Thanks for having me, John. It's good to see you again. Take care. Okay, that's SuperCloud 6. We'll be right back with more all day here in Palo Alto. I'm John Furrier, your host of theCUBE with Dave Vellante and our team. We'll be back with more coverage after this short break.


As part of efforts to improve the quality of health sector, to murder and international standards across the country, Barau Dico Teaching Hospital, Carduna, has called on Nigerians to always consult doctors for proper treatments. The medics call are the deployment of new digital telemedicine machine to provide easy access to medical care centres in the 23 local government areas and across the country at large. Plus TV news correspondent Habila Dorofai filed on this report. There are a high number of people lacking access to good and quality health care facilities that must be addressed urgently and save the lives and patients in local communities. The new telemedicine acquired will help address the challenges patients are facing, which will give them 24-hours access. The Carduna State Commissioner for Health, Hajiya Amina Mohamed Baloney made the disclosure during the launching of telemedicine equipment at Barau Dico Teaching Hospital, Carduna. Experts from here using this machine can consult any patient anywhere in Carduna or even beyond where they link up with the hospital. They can be able to prescribe, they can be able to see what is wrong, they can support the doctors on ground where they are. Very important because as you know we don't have a lot of specialists and so it allows them to consult everywhere. To connect all the wards in the LG and you know our general hospitals are in the LG heads. Most all of them have internet connection but it's something we can advocate to the telecom companies and get them to. But this is very timely because we need, you know people in the rural services, rural areas also need services. Also the Chief Medical Director Barau Dico Teaching Hospital, Carduna Professor Abdul Qadar Musa Tabari says a use of machine will ease some difficulties and hardship faced by the people before coming to hospital for treatment. We felt we must strive to get that telemedicine services.  So that's the beauty of the machine. It's not like other virtual meetings after we have like Zoom, Teams and the rest. No, this one you can see even the minute test detail, if you are a dermatologist you want to see the minute test detail on the patient and then again if the patient, in case the patient is having his doctor somewhere, the doctor needs further consultation. The patient, the doctor can put his stethoscope on the chest of the patient and we have in the machine an electronic stethoscope that can pick that heart sound and so many other things in the chest as if the patient is there alive. However, on high remarks, Dr. Halima Sadia Gumi who represented the Consent Medic Foundation promised to bring such machine into the country to help support and improve the country's emergency care as well as trying to get all the diaspora doctors from Nigeria to participate and come back to help the country. One of the things is you know the telemedicine is how can we bring a machine you know with virtual health now. We can actually support them from the UK, from the US. So it's all about how do we support healthcare in Nigeria with all the ongoing brain drain. We have already started a project actually in Borodiko with the emergency department so I was here last year and we were supporting them to improve their care for emergency care. It says that endurance must frequently go and check themselves and avoid using medication without doctors prescription.


Fair Nigel and Libor Congress President Joe Agery says his organized Libor has been summoned for a contempt of court following a nationwide protest on Wednesday. The NLC president stated that the organized Libor received summons, purporting to charge it with contempt of court over the protest, and directed all workers to resume at the court, wherever they may be across the nation on the days of the court sittings, to hear the contempt proceedings against the leaders of the trade unions. He commanded the leadership of the National Assembly for their timely intervention and pledged to resolve the issues raised by Nigerians. Then NLC leaders also lauded them for their deep understanding of the need for government to provide quick wins as so-called with short timelines to ameliorate the adverse effects of the hike in petrol prices on the citizens. He disclosed these in a statement jointly signed with Festus of Seaforth, the president of the Trade Union Congress. Meanwhile, the union said they had resumed dialogue with President Bola Tinibu's regime to allow full implementation of its pledge and commitment to the petrol subsidy removal. The National Assembly said and we're taking it back to the office with our colleagues there to review it and release a document on our next line of action. We have gone deeper into them. You know, the brokers are broader issues, but they are one or two things that need immediate attention. No one person can call it off. That's why I say we have to go back to the office so that the school looks at it before they come up. And by tomorrow, Dennis will have a colleague at next meeting, you know, to look at a bigger petrol. The president is a pro-democratic activist, so he understands protests. you


All right, then let's take a look at the leadership newspaper this morning.  It talks about the 2023 campaign. Atikut Tunubu Kwankwaso offers a solution to ailing economy. That's how the leadership caption said this morning. There are several riders, APC flag bearer targets, 10% GDP growth. The question should be how? In U.S., to attract investment to Nigeria, ex-Vice President. And you remember there was a saga about him not being able to get to the United States because he had some issues, he had diplomatic concerns. Well, maybe he was trying to prove a point there. Job creation plan will reposition the economy. Kwankwaso, that's the NMPP quoted to say. Now depreciates further to 800 at parallel markets. And yesterday we asked why was the essence of having multiple exchange rates? Ignore G5 at your own parallel or Tom1's PDP. Oh, really? So we have G5. We talk about G5 now in Nigeria. Redesign, Naira won't check the rising inflation. That's what analysts quoted to say. I mean, despite the fact that this is one of the reasons for redesigning the Naira, but economic or financial experts are saying contrary to this. I can't wait to share GD's thoughts. PMB Saludo, others mourn as Mba Zulikei dies at 93. A nationalist and a legend of that. Presidential candidate orders console and condo with David O. trauma over his sons or over their son's death. I mean, that has actually thrown Nigerians into serious mourning. And just before we move away from the leadership, we'll just take this one quickly. Terror lets devastating to economy, federal government. You have to see prop $6 billion power projects. That's the much we can take at this point. Let's go to the nation with these headlines. Al-Unbondal transmission to provide power says Tidwu Al-Unbondal transmission to provide power. He's met the organized private sector in Lagos State yesterday to interact with them. Interesting one there. He made some statements about his economic and business agenda. Rather to that restates commitment to double-digit GDP, promises consumer credit, revolution, renewed anti-terror war. More from the nation. First Republic Minister Meiji dies at 93. One killed many injured in Lagos fire. IU can't lead PDP to victory. We can't insist. And Faso Ranti, a fairly fair has endorsed Tidwu. Write us for those who say, you know, the mind denied it. Well, there you have it. Passengers stranded as unions picket MMA2. Investors lose. 2.8 trillion error. Sell-off worsens. Please probe. David, it was domestic workers over son's death. US UK terror warnings will hurt Nigeria's economy. Says FG. Some stories on the front page of the nation. Well, let's quickly move away from the nation newspaper and just quickly check out the next paper for us is the punch. And on the punch, you find ESCC plans massive raid on Forex dealers. That's the dollar crisis. Narrow's freefall worsens now 857 error. So we talked, we're talking about 800 narrow.  Kogi politician arrested with 326 million narrow BDC operators back commission. The riders you find underneath the board caption on the punch. Now, moving away from that, David Oothopsy, likely as police, three, six workers and detained to, you know, the entire country has been thrown into mourning. And of course, our condolences with the family. Still looking at the front page of the punch. Commuters lament whence Legos drivers bark. Drugs wanted Legos hoteliers, six houses, 217 million narrow seized. Kwankeesotri recruit 1.5 million soldiers and policemen. We're looking at the campaign of 2023. Why I am better than Atiku or be on economy. And Tinibu, that's what Tinibu is going to say. I'd like to take this again. Why I'm better than Atiku or be on economy. Former Legos state governor, I schooled her to say. I'm sure that that should, you know, mean a lot. But Jida Johnson will be telling us more. That's it on the punch this morning. I don't take a final paper of the Guardian very quickly. 2023 rift widens in Southwest over a fairly ferris endorsement style. Medical trip, clock chides Buhari over failure to transmit power to Vice President That's a very important one. Airlines count losses relocate operations as union shots. MMA to some of the, uh, the, the stories on the front page of the Guardian. One is the urges FG to honor May she's memory. Release Kano, uh, some of those, uh, those, uh, stories on the front page. We won't take too much time there. Bring in Jida Johnson's, you know, lecture on hydration of journalism at this point. Jida Johnson, let's start with, uh, a fairly fair day. Taking the headlines again today after, uh, denial. Now the, uh, the first round T camp won't call it that. It's now coming out with a full chest, a full chest to say, um, uh, the endorsing the ABC presidential candidate. What are your thoughts on this? This, what this thing, this developing story and, uh, the lack of unity shown in the Southwest politics as far as a very fair is concerned. There's, there's no difference in the pattern of the various endorsement presidential candidate of the DCR machine. We have the cases of the Bishop, um, the Bishop that came to Abuja. And you also have controversy training. It's, um, it's endorsement or non-endorsement. But Jida Johnson, can you please, uh, turn down the volume of your television set? We seem to be having a haul back. You know, uh, can you please turn down the volume or turn off the volume? Uh, so while we're waiting for Jida Johnson. Thank you. This, uh, very matter has been one that, uh, has, um, uh, snowballed. It has, it's in danger of snowballing to something that may, uh, may, may be far from far worse than what we're seeing it to be right now. I'm sure Jida Johnson knows that very well. Politics of the Southwest as far as the national politics is concerned can, can get, can go to extremes. Uh, remember the day of the Wild, Wild West, you know, uh, in Nigerian politics. So I'd like to take his thoughts, uh, get to hear what he has to say about this. But, um, you know, it started with the now. In fact, I was discussing this at some point yesterday, not day before yesterday. And someone said, Oh, the man has denied it. He said he'd never endorse anyone, uh, that he only blessed, and if that's who comes or becomes here. But I mean, from what the people are saying this morning, we can see, um, that, uh, uh, the, the, uh, the thing is widening. Though the writers on the Guardian give a little bit of a different twist to what other people like the nation, uh, are saying. For instance, uh, what the Guardian sent a writer to that headline, uh, 2023, rift widens in Southwest of our fenniferous endorsement style. Um, it says, conscience of Yoruba nation and those tillable, not a fennifer. Um, I remain a fenniferous leader. We're backing tillable, first of all, to insist. Southwest students ask a day by day to set aside grudges, uh, adopt tillable. Tillable woos press. So that's okay. We have a guest back down. Gina Johnson, uh, welcome back. So you can continue in the, with the point you were making. As far as I'm concerned, if we see that, um, there's a discordant to respect to his endorsement or not endorsement, we had, we had the position of chief fire at the banjo. Now we're hiring the position of chief fire personality. Um, Controversy has trade the, uh, the candidate of the APC with respect to, to, to his, to his endorsement by Bishop or Bishop or by different groups across the length and breadth of the country. Controversy has treat his, his education and the rest of it. I think, uh, moving forward, the candidate needs to step away from, from controversy. And there is usually this misconception that, um, the Southwest will vote in the same manner or I, for example, will be influenced by the endorsement or non-endorsement of a very, very, um, as far as the election is concerned, Nigeria is a bit sophisticated than what used to be in 1999 or what used to be in the 1970s or 1960s. People are looking beyond the prism of the ethnic group or the interest, particularly in the South to vote for whoever they want to vote for. But I think that the candidate of the APC needs to move away from, from, from crisis and from controversy of endorsement or non-endorsement, faith Bishop or no faith Bishop. It will help the candidate to, to ensure that he moves away from, from controversy. And if you check the result of 1979 election, I would have already now been over a million in the Southwest. You be shocked with the number of votes that, that Shagari polled, that MPM polled in the Southwest concerning the presidential election. The results are there that, um, the margin of the votes that they were able to poll, even in the Southwest, where you have how low of a dominant presence, not to talk of a situation where there's no dominant presence compared to how low or when you compare as you are due to. So, I think they, they need to address issues and leave the, the mundane issues of endorsement or no, or non-endorsement. This particularly works better in America, but in Nigeria. It works for them in 20, in 1990. I can't understand the desperation because without the endorsement of Afaniferitunian would have become the governor of Ligusti in 1999. It will have a full show lips. It will have a full show lips. In our choices, four local government elections were cancelled in 1999. Fortinue to win the nomination of action, allowance for democracy in 1999. The result of, if I call Jai local government, Ikorodu local government, Mushin local government, and Ligusti island local government, were added to the result of the powers of the allowance for democracy. Function will have become the, the, the gubernatorial candidate of the DAD. So, I will see the desperation for those that understand the politics of, of Ligusti and the politics of, of the Southwest. GD Les, quickly look at the issue, the dollar crisis and, you know, the solutions or the actions from government and her agencies. The EFCC plans massive raid on Forex dealers. What do you make of this? It's only in Nigeria that you have an informal sector engaging in narrow exchange. Where do you go to, anywhere in the world that you see people selling the, their currency on the road? There's none, there's none. Where you see people trading in the currency?  Also, it's only in Nigeria that you see that governors and government officials will be spending foreign currency. We have preference for, for, for, for, as the good tender, as, as, as the currency of exchange. It's only in Nigeria you see this. It's only in Nigeria that you see that governors will openly be spending dollars. Ministers will only be spending dollars. And then, so the, the, the tests and the demand for dollar, we always be on the increase. We have it on record that there are states in Nigeria where the governors will, the governor, the governor then, we collect the allocation. Once the allocation of youth government is released, you ask the youth government chairman to convert the allocations to, to, to, to dollars. You give them their wish here and then they will, they will use it. So until we have respect for Nigeria, until we have uniform exchange mechanism, not parallel mechanism. Whereby you have the official rate and then you have the parallel, parallel rate. There's no way in what it is done. And there's no way Nigeria will be fashionable. You know the joke someone shared. He said he would have loved America to come out with the idea that they want to change the color or the design of the dollar. And that people should submit or should deposit or should load the, the, the dollars they have in the bank at a particular date. That after that date, then the dollar becomes irreplaceable. He said that's when you see the panic among the Nigerian, the Nigerian elites. And the Nigerians, the, the Nigerian political class. So he said this Naira, the one for Naira is nothing. So what, what is, what is, what is, what is even to, to, to people, you will see when we are, we are out cases of governors giving dollars. It's at the people that here since your arrest, as far as I'm concerned, why, why would you make dollar to be the, the good tender, the currency of exchange in Nigeria and you really get your whole. So what value do you think over time?  That's how bad the perceptual value of our currency is. And then we are talking of the currency improving in value, improving in value. People made money from exchanging, from, from engaging in parallel market. They will buy the dollar at official rate and they will go and sell at the parallel market. So the, the, the, it's something that we have a situation. I mean, can you be compared to, you know, what the city is actually facing, you know, in Ghana? You know, while you were in secondary school, while I was in secondary school, we had a lot of, we had a lot of Ghaninians until there was a policy of DMG. We had a lot of Ghaninians. Cities was regarded as toilet, toilet, toilet paper in the 80s. What has happened to the, to the value of cities over time? It improved considerably until, until the recent economic meltdown necessitated by the lockdown and the COVID, the COVID measure which brought about a halt in business activities. It has affected almost every currency all over the world. It's only the Naira that has engaged the freefall and this freefall will continue. This freefall will continue until we make Naira to be the lead contender. The currency of exchange in Nigeria, even for government, for central bank governors, for officials of central bank and the ministries, and it is a government. The dollar is more fashionable to them than Naira. All right, Djulijans, let's go back to, let's go back to leadership this morning with this look at the terror leds by the foreign missions in some foreign missions in Nigeria, foreign embassies and the federal government through the minister of information and cultural haji, live Mohammed, pointing out that the terror leds having a devastating impact on Nigeria's economy. Maybe they shouldn't make even these leds if that is the case. What's your take on this? What was the initial reaction when the terror leds were released? Releasing terror leds is not something new or something which is done in civilized society all the time. You have level one, level two, level three, level four, level five. So they released this leds for you to be conscious. But we know you are in a society whereby government officials are well protected by the various security agencies they have. So they care less about the citizens. But in other climes, the citizens are the masters. So we need to research the people. So they raise terror a lot. In London, they raise terror a lot from different types of levels and different terms with different measures. I recall the initial reaction of the minister saying that in this country they have terror issues. So why are they raising, now he's talking about two other, why would you not, our economy, they have their own intelligence. They have their own intelligence in dealing with terror, in dealing with terrorism and other security issues. It's about the level of your intelligence. And intelligence is interpretation of information. What are the information you have gathered? What sense are you making of it?  Before they released the, before they released it publicly, they must have shared this with agencies of government in India. These are the stuffs, these are the things, these are the intelligence you have gathered. What are the steps you are taking? And you didn't do anything about it and you expect them to continue with it. And you think it will not hold. You see, it is very, very clear that there's no doubt that it will hold the economy. Because one, let's say for example, the embassies of United Kingdom and United States were closed in our border. People that want to go for a visa or people that wants to come to Nigeria to do business and they come to Nigeria. So I just think that the minister needs to be more cautious and more proactive in releasing a statement and in reacting to whatever information or whatever intelligence that is shared by other countries with respect to the security situation in Nigeria. There's no doubt, you don't need rocket science or issues here to tell you that. Once the terror alert is raised, it will definitely affect businesses because it will affect movement of people and goods across the land and bread of the country and the nation. So it's just a basic understanding of international economies. All right, GD Johnson, thank you so much. We have to go. We look forward to sharing your thoughts on Friday or things being called. That's the much that we can take and we do appreciate your time. Thank you Masiya and thank you people for it. Have a wonderful week. You too. And I call the last piece to the video and chairman. Very sad one indeed. Thank you very much, GD. So we'll take a break. We'll look at what happened today in history today of course being the second day in the month of November and yesterday was the anniversary of the Ikui building collapse. When we return, we'll continue more conversations of course.


Welcome to ThinkTech. We're raising public awareness about technology, energy, diversity, and globalism. This show is center stage. I'm your host, Donna Blanchard, proud managing director of Kumakuhua Theater. And we are coming to you from downtown Honolulu in the Pioneer Plaza, very near Kumakuhua Theater. I'm excited to introduce you to my guests today. They are both participants in the Oahu Fringe Festival, which opens in just a couple of weeks here. We have Peiling Gau and Gwen Arbaugh. And Eli is joining us. And I want to let everyone know right away, this is my first baby on the set. I'm very excited for Eli. And he is integral to the piece that you are presenting with Fringe Festival. So it just makes sense that he is here with us. But we want to make sure that he is as comfortable as possible and you are. So if we need to take a break a little earlier than usual, we'll just cut away and come back as soon as possible. But he just looks like a happy camper right now. So we're good. So thank you both very much for being here. And I'm really anxious to learn about both of your acts. First of all, the Fringe Festival itself, the entire idea of a Fringe Festival I love bringing, creating a space for acts that are not, they're out of the ordinary. They're experimental. They're pushing new and fresh. Yeah, push the boundaries. Is this the first Fringe Festival, the two of you have been involved in? No. I was involved in Fringe on the Mainlands. And I've been involved in every single Fringe for Oahu Fringe. So since 2011, when Mesa debuted the Fringe here, both as an artist and in committee, when Mesa had a committee. Oh, okay, wonderful. Mesa Tupo, who is the organizer of the festival here. Okay, is this your first? No, I was participated in Fringe Festival in Santa Cruz in California, where I dance for another company. Yeah, and this is my second time here in Fringe Oahu Fringe. Oh, okay. And when, before I go any further, I think Eli undressed you just a little bit right before we started. So the pieces that you both have for the festival this year, are they new? Yes, mine is. Yeah, it's a new piece. Okay, good. So let's start with, Gwen, let's start with you and Eli just in case we need to cut for a moment here while he's happy. Tell us about your piece, please. So our piece was inspired by all the performing artists in Chinatown area in the downtown area and in Honolulu who have had babies within almost a year of each other. So we have about a dozen performers who have all had babies. We keep saying there's something in the water. We're all getting pregnant at the same time, but we were worried that we can do Fringe or other productions for that matter. And this was an opportunity for us to get together and have the same concerns as performing artists going in with not very flexible schedule with the baby in tow sometimes. But we could all be understanding of each other and create a dance work. So it's kind of a composition, a compilation rather of different dance pieces because all of all about motherhood, but all of these dancers and other performers come from various genres. So we'll have some ballroom, some burlesque, some modern dance. It's kind of a mix, some lyrical. Are the babies on board for all of it? They're present for some of the pieces, but that's not always practical. We were concerned with them not being good with an audience. So we haven't put them in every piece. They're just on sometimes, but all the pieces are about motherhood and the various issues. Pregnancy, birth, nursing, family life, that kind of thing. Thank you. It is amazing. I know so many artists, actors, dancers, poets who all have babies the same age right now. They're going to be amazing. Things are going to happen when they all become adults. This generation of kids who all came up together. I find that absolutely fascinating and I'm really anxious to see the work. Do you feel that this has been beneficial to you as a mother going through the experience of creating the piece? Yeah, I feel like we've kind of made our own little performing arts baby hooey. Yeah, let's get the end. Yeah, because I think everybody, it's very different than another baby hooey. A lot of baby hooies I couldn't possibly join because I have a different schedule. Performing artists are not available in weekends, they're not available in the evenings, that kind of thing. We all struggle with daycare. Some of us have a day job, some of us don't. But we're trying to perform at the same time as to be new mothers. So it's a very empathetic sort of group circle of women who are going through this together. Yeah. There you go. And when are you actually performing in the festival? We're performing, we're the first show, we're performing Thursday at 6 p.m. That's January 12. January 12? Yeah. And are you at Mark's Garage? We're at Mark's Garage, yeah. Okay. I think you're doing really well Eli. You're doing really well. And I just want to hold him, but that probably wouldn't be good, right, he might break out. Okay, so let's hear about your piece. You're fairly new to the island yourself. Yeah, I just relocated here from Oakland, California at the end of July last year. Yeah, now it's 2017. So I'm really new and I'm very excited to connect to the community here and to share work and to know people here and to share my voice as an artist and then creating a space to improvisation to the community. So I'm really excited about this French festival. This is a good way to jump in. We're going to take a quick break. So we'll be right back. We're going to continue that conversation and we're going to check in and see how Eli is doing. So we'll be right back. Please stick with us. You're watching Center Stage on the Think Tech Hawaii Digital Network. So how are you doing? Welcome to Eibachi Talk. I'm here at Gardo the Tech Star on Think Tech Hawaii. I'm here with my good old buddy, Andrew the security guy. Hey, everybody, how you doing? Hello. Thanks for watching. Good to have Andrew here in the house. Please join us every Friday from one to one thirty and follow us up on YouTube. And remember, as we say at the end of every show, how are you doing? You're watching Think Tech Hawaii, Hawaii's leading digital media platform for civic engagement, raising public awareness on tech, energy, diversification and globalism. Great content for Hawaii from Think Tech. Hi, we're back and we are ever so live on Center Stage here on the Think Tech Hawaii Digital Network. We're talking with Pei Lengau. So you came to the island to you teach at the University of Hawaii. Yeah, I am very lucky. I'm the new faculty of theater and dance department at UH Manoa. Yeah, and my research is about improvisation and discipline and interdisciplinary collaboration and also teaching dance and dance lineage. So my work is reflecting my teaching and research. So I'm really excited about this opportunity to teach in Oahu and then also show work here. Yeah. Yeah. So the tell us about the piece that you're presenting. Yeah, so me and my lifetime partner Gretchen Du, we just initiated this dual improvisational duo between sound and movement called Electro Violet. And this is our debut here and then world premiere here. And our practice is to try to explore the collaboration between sound and movement in equal footing. Because often time when we say collaboration between sound and music, we as a movement artist, we choose music or we ask musician to compose something for us that is already existed. But we are trying to do is to find the equal footing of collaboration. We make decision and make composition at the present moment.  And then you have to improvise as a as your alternate route to go to work in order to not to be late. So we are actually we are dealing everybody's dealing with this improvisation practice every day in our daily life. So we are putting this idea and this device into the art making. So we are not dictating. We are not telling story. We are just being present and reflecting what we see what we hear what we sense at the present moment at the show. So we are having two shows on on Friday and Saturday. And both show will be different. It's Yeah, it sounds like they will be. You're not putting anything any plan. Yeah. You have to trust yourself an awful lot to do that. It is Yeah, trust and of course, to be vulnerable, vulnerable and inviting to be seen.  Yeah. Yeah. Yeah, because well, and both of your pieces being devised from your present state. Yeah, right, makes me so much more meaningful. And I swear when you watch a piece, if you if you watch an improvisation piece, whether it's dance or, you know, Saturday Night Live, you you can tell the moment someone slips into something that scripted or well rehearsed. You know, you know, when people are really present in the moment and creating along with the atmosphere at the moment. Yeah, and then also I, I think it's also a practice of practicing. Like how do we what is difference between practicing and performance? How do you feel different when you are practicing at the studio when nobody's watching or when you're performing when there's everybody's watching you. So that is also part of my research is to bring the practice into a state of performance. So there's, there's no differences between practice, rehearsing and performance. So we are not aiming to end product. We are practicing as our daily life. And then the show is part of the practice. So it's not a production is not the end product is the show is our continuing is one of our continuous practice. Oh, that's a very interesting philosophical way to look at it. Then then for whom are you practicing? You know, if it's not a performance, then yeah, yeah, so see, yeah, like you just met. Yeah, I'm thinking about how do I put things together. So I'm improvising my brain, my mind now. Yeah, because we are is a contemporary dance is a contemporary error. And we are showing what we have and who we are. But we are not putting a mask or tell you my story. The story is ongoing and is still existing just right like right now I'm talking here. But this isn't I didn't prepare anything and I didn't even know what you were going to add. Neither did I. Yeah, it's okay. So this is not a production. This is not an end product. This is a practice towards as a human being as a practice as a universe as a how do I say it as an artist we we just keep practicing as a who we are and then try to find what we are. I don't mean to put you on the spot you're going there very nicely. That's a question that I continually ask myself and my guests because as an artist myself I'm an actor. I am and a director as a director. The first time I directed a show where everything's moving on nicely and we get to the night before opening night or final dress and I realized I had a panicky moment because anyone with 20 bucks could come into this theater and watch this precious, precious thing we had created and I realized that I actually as a director enjoyed the rehearsal. I wanted to stay in that rehearsal. I really didn't feel like I needed that audience. But of course theater exists for the audience. Yeah, yeah, but it benefits the artists so much. Yeah, yeah. Yeah, it's like there's no perfect show right for you to like you practice for so long and then it might happen like some accident or you just slip in your mind you just got a space out and then yeah it's like oh I should have done that or I wish it could be like that but the show is just like at that one moment. So how do you see what is how do you define a perfect show? Right. Production, right? Right and and I think the best that comes out of any performance is what happens after it's finished and you know the artists digest the work and the audience you know it brings out conversations and questions and maybe you can get together and talk about it and also the idea about sharing. Yeah, I'm not telling you or to provide evidence or this is what we believe but it's it's the community of sharing. So I share something and then you give me some feedback and then you share your thought with me and then we continuing of this exchange. I think it's very healthy and it's really good, beneficial in the community for the artists to do this exchanging and sharing voices. Yeah, I do too and like with with your group to have to have a group of young mothers all with the same age children kind of miraculously as it happened. I'm sure that was really healthy for all of you to get together. Yeah, it's a very healthy sharing. I think as far as sharing with the audience though our rehearsal process will in no way look like our performance process is our rehearsal oftentimes we're rehearsing with the babies and we won't be performing many pieces with the babies so there will be a whole different level of immediacy in that that we will have rehearsed with the babies and then we'll be performing with a swaddle or with with nothing like rolling around on the floor and being able to and so it'll be in many ways the performance will be the first time that we've done these pieces without having to hold the babies and so it will be very it'll be the first time it'll be the first time that we've done it without the babies for many of us. So that that will be a whole different that'll be a whole different experience and a whole different level of of reality. Oh yeah, that will be there will be a lot of immediacy to that for you. But yeah a lot of the pieces are built on on our our stories and our sharing between us as performing arts new mothers. Yeah, well and then you're going to be sharing with the audience your experience you know I'm sure a lot of people will be able to see that and remember or look forward to or just people like myself who never had children be able to experience it along with you. Yeah, that's the intended. That's really cool because that's what we're all all about is sharing stuff. But here's what I continually grapple with as Eli shows off the contents of my purse. I always grapple with why do we feel the need why do we feel that need as humans we want to share we want to connect. I connect with people in the elevator you know that I'll never see again but for some reason I feel that need too. Any ideas? Well I think as artists sometimes you're having an experience and you just don't know that anybody else can empathize with it and you have to get it out there and you have to air it you have to air like the issues that we've been having as mothers like you you go to pump at work and people think you're you're on a break and you're playing Tetris in the bathroom. When the reality is you're in there topless with suction cups and your boobs and it's freezing cold and you have no hands to play anything that's that's the reality so so just being able to show people there there are things that are I told Carlin Wolf there are things that are that are mother required but are father optional so we dealt with that too and so like even your spouse doesn't really know quite what you're going through and so it was good to explore these issues and I think it's really important to air those because like you said not everyone knows yet or they may remember or they and or not remember or they may have not experienced it and so it's good to get it out there. Yeah for everyone involved and he is a born performer he's taking to these cameras really really well. I think a lot of kids would probably freak out in this atmosphere here no he's doing really well. So about your piece what do you feel because I'm I assume you've been involved in plenty of pieces that are well rehearsed and designed yeah yeah what do you feel about the the difference between the two doing something that is completely in the moment all performances are in the moment to some extent and and I have noticed in very well rehearsed performances sometimes the best performances come out of a mistake you know or a broken zipper or a dropped line and then everything galvanizes and the show just shines brighter than ever before so there's always a level of immediacy but what do you feel that you as a performer gain differently from creating something organically on the spot. Yeah don't get me wrong I mean as a even though we're we're in proposition group but I can also say we'll we'll rehearse because we've been practicing many times and then still continue can still keep practicing in the studio. So the main difference is for me between performing a set work and improvisation is a state of mind sometimes I feel a slightly different when I improvise because I can track of my my and then I track of the time and space and I see the space from outside of myself and I can I feel more free to respond to what I sense what I what I see and what I hear. At the same time when I perform for the set work I track my my too and then I also include the environment audience with me but through the practicing I execute the movement that is set. So I I think it's somehow I can say it's different and then also it's the same practice for me it's just that the state of mind is very different.  Yeah and then also tracking the time it doesn't just mean the set time but something that just pops up in your mind when you are doing this movement like oh I sensed the time two years ago I did this. It's like you are tracking the time in the past or present moment or anything that is coming out at the present moment. So the space in time is not only it's not only limited to the time and space at that moment but also it expands to a micro moment and universal and larger context of the time and space and it also deals with the memories. Yeah I bet a lot comes up during that. Are you okay we can take a short break if you need to know he looks like he's doing real well just wanted to check in. So for both of you do you feel you just I was kind of surprised that you just met as we were coming over for this I had imagined people getting together for the fringe festival and there being more communication between you but you know it makes sense that there wouldn't really be. At some point during the process do you have that opportunity to mix and mingle and go. At a walk they have an opening event and then they have some closing events and I think Misa and Emily Patton are working on making some sort of events throughout the weekends or meet-ups at bars in Chinatown and that sort of thing. So it happens the weekend of but before that weekend we may not meet anybody that we know. Do you have an opportunity to see most of the acts I know you said you had two shows but if something's running during yours. Yeah we get artist passes so we can go see the show. But you may or may not have time to see the shows like you said there may be overlap between your show and another show. Yeah I would think that one of the it's awesome for an audience to be able to come and see these boundary pushing works but also for the artists who like to push boundaries to be able to get together and see where you might go next and glean ideas for you know where we what we could do together and I'm glad you two got a chance to meet here. That's great um what do you uh so outside of the Fringe Festival you you are now teaching at the University of Manoa. Yeah are you involved in productions there? Yeah yeah I will be choreographing pieces and producing shows for students at the department dance department theater and dance department yeah and I also teach improvisation composition and modern dance technique class and dance production. So yeah I'm hoping that by teaching the courses I can meet more people here and then the artists here. Yeah well you come over to my theater anytime and and Gwen do you have a day job along with Eli? I currently am mostly a stay-at-home mom although I'm very involved in the Philippine dance community here on Oahu and the Japanese dance community the Japanese classical dance community so I'm still doing quite a bit of that and I run special sculptors which is the um contact improv jam on Oahu and I do that in coordination with Laura Reichart and Mareva Minervi so we do that together so that's another another side project. That's another project that you have and the so the festival takes place January 12th 13 14 yeah just Thursday Friday Saturday um and the website do you guys know the website of you? Oahu french.com yes you're correct yeah I had to check um and there's information about all of the other acts as well on the website and there are there's a there's a lot of dance yeah dance theater or um improv comedy improv sort of work yeah there's um an amazing amount of talent right and the venues are all around Chinatown what other what venues other than Mark's Garage yeah we are doing at onking onking and next door is also participating on Chinatown yeah I'll Chinatown that's good to know and yeah we would love to participate at Kumu but just didn't work out this year thank you both very much for being here thank you all three of you for being here thank you it was so nice to have you thank you thank you so much for having us yeah absolutely I look forward to seeing oh he just waved at me did we catch that story nice to have you here okay thank you for being here I would also like to thank our producer Zuri Bender who is in my ear and Jay Flidell who somehow manages to put all of this together we'll see you next week we're gonna have some other acts from the Fringe Festival here um no babies I'm sorry but we'll see you then


I travel around the world full time for wine, but I spend most of the year in Europe. And one thing I miss about living in Asia is access to high quality Australian wines. I don't think people understand the kind of quality that small producers are doing in Australia. This is the far side by far, Pinot Noir from Geelong. This area is in Victoria, Australia, and this wine is awesome. This winemaker was actually named winemaker of the year a couple years ago, I believe. I think of this as almost like a young guy that's made it, that likes to wear a sport coat, likes to wear a jacket, likes to smoke cigars, real old school. You have all those classic notes of leather, earthy tones, a little bit of white pepper you're going to get from burgundy style wines, but you do have enough ripeness, enough fruit from some of those New World Pinot Noirs. Tell me, have you tried this wine before? Do you have any other Australian or New World Pinot Noir favorites for that matter?


Hello everyone, I am Dr. Guru Prasad Vasurkar, senior consultant and neurologist at Manipal Hospital, Ashwantpur. 29th of October every year is celebrated as World Stroke Day. On the eve of World Stroke Day, today we have my colleagues from Department of Neurology and Neurosurgery to have a health awareness talk. Hello everyone, I am Dr. Mahadevappa, consultant neurologist at Manipal Hospital, Ashwantpur. Hi, I am Dr. Raghuraam, consultant neurosurgeon and spine surgeon at Manipal Hospital, Ashwantpur. Hello, I am Dr. Avinash, I am consultant neurosurgeon and neuroendovascular surgeon working at Manipal Hospital, Ashwantpur. Stroke is an emergency. Stroke is a leading cause of disability all across the globe, including our country, India. It's a second leading cause of mortality after coronary disease. So on this day of World Stroke Day, all the organizations related to stroke care organize events to increase the awareness of stroke among the public. So as a part of this, we are having the health awareness talk among our colleagues. So at the onset, I would like to ask my colleague Dr. Mahadev to tell us about what is stroke and what are the types of stroke. Hello everyone, stroke is a neurological emergency. In Kannada language, what we say as a Pashvavayu or in some regional Kannada languages we say as a Lakwa, is basically a sudden disruption in the blood flow to the neuronal tissue. So it can occur either due to a clot in the blood flow or due to sudden rupture of the blood vessels. So coming to the types of stroke, basically we divide broadly into two categories, ischemic stroke or hemorrhagic stroke. Basically the ischemic stroke is due to the blockage of the blood vessels. In common terms, we call as a clot in the blood vessels, which causes decrease in the blood flow, which can lead to neuronal cell death. Similarly, hemorrhagic stroke is sudden rupture of the blood vessels, which causes a blood to accumulate in the neuronal tissue and causes decreased blood flow to the neuronal tissue. So basically, the ischemic stroke is the most common one, occurs in 80 to 85% of the cases and remaining 15 to 20% of cases is a hemorrhagic stroke. Adding to what Dr. Mahadev has mentioned now, there is also a type of stroke called venous stroke, where you can have blocked venous system carrying blood from brain, also leading to stroke. So this happens in specific categories of people like pregnant women or young males or females. There is also an entity called transient ischemic attack, where there can be a transient symptoms of what we call it stroke symptoms and that can improve on its own. Now I would like to request my neurosurgical colleague Dr. Avinash to tell us more about the incidence and prevalence of stroke in our country and the world and what is the impact of stroke on the society as such. So as far as the incidence and the prevalence of stroke is concerned, no country is immune to stroke.  But as a overall world when we consider, the incidence is roughly divided into two categories. Like, you know, one is Southeast Asian and African countries, which have a different prevalence and incidences. Whereas the Western European and American countries have a different set of incidence and prevalence. But overall, in general what happens is the incidence in Southeast Asian and African countries is quite high as compared to the Western countries and also is the fact that the occurrence of stroke in Engage is more prevalent in our subcontinent as compared to the Western subcontinents. As far as the incidence in India is concerned, roughly about 100 to 150 people per lakh. In the sense, if you have a geography of 1 lakh people, about 100 to 150 people in a year can develop a stroke and prevalence, when we talk about prevalence, prevalence is a number of stroke patients present in that geography at that particular moment. When you count them, that is the number of stroke patients which are present in that geography. So, prevalence of a stroke in India is anywhere between, you know, 40 to 700 per 1 lakh population. Again, it varies from one state to another state and, you know, most of the Eastern parts of India as well as the Northeast states have more prevalence as compared to the Western part of India. As you can understand, the burden of stroke in the society is quite huge, which includes our country. And then as Dr. Avinash mentioned, there is a difference in our country as well. That also, because as we understand, hypertension is the single most common risk factor for stroke in the population. And the use of salt varies from areas to areas. So, our coastal belt in the East side and Northeast consume a lot of salt, you know, excess salt in their diet. That also could be a reason why we see much more, you know, stroke prevalence in such areas. So, coming to the next part of our talk. So, I would now request Dr. Raghuram, my neurosurgical colleague to tell us about what are the symptoms patients present when you say stroke and what are the risk factors for stroke? Hi. So, like I think we have already been elucidating the same fact that it is very, very important for us to identify these strokes early. So, obviously, when we have to identify them early, we need to know what are the symptoms so that the person or the common public can reach out to the nearest doctors so that they can be treated in the right time. So, to make it easier, the stroke society has come out with the mnemonic. It's called FAST, F-A-S-T. So, the easiest thing so that any of these four symptoms, if you see, you should immediately rush them to the nearest hospital, if not, at least to a physician so that they can quickly analyze and then appropriately take treatment options. F stands for facial asymmetry. So, if you notice any member of your family having a change in the shape of the face, like one side of the face is not moving, they're not able to close their eyes properly or the mouth is pulled to one side when they're trying to talk and open their mouth. So, these are very, very important and subtle signs. And if you notice any of them, they're important to be immediately shown to a physician. The second one is A, which is arm, which can be either upper limb or lower limb. That means the leg's arms or the hand arm. So, if there is any weakness, that means you are unable to move any of the hands or the legs. Usually, it happens on one side of the body. That's how the stroke presents. So, if it happens on any particular side or some patients may not even have weakness, they may even just complain of numbness and some kind of an imbalance while walking, which also is very, very important because some part of the brain, which is called as the cerebellum or the back part of the brain, controls our balance. So, if there may not be a gross weakness but if this patient is trying to walk and he has imbalance, then that is also a very important sign for us or a symptom for us to pick up and then rush him to the doctor. S is speech. So, if you notice the patient's speech is not as it was before, he's become very slow or the speech is not clear. He's not able to pronounce the words properly. That is another important symptom. And the last and the most important thing is the time. So, why are we included time as a symptom or in the part of the mnemonic is to make everyone understand that time is very, very important when it comes to a brain stroke because the more we delay, more the number of neurons that die in the brain. So, to prevent that from happening as soon as we notice any of these symptoms, which I just elucidated like facial asymmetry, weakness or imbalance and speech problem or sudden collapse. Some patients like Dr. Mahadev told you all before can have what is called as a hemorrhagic stroke and these patients suddenly collapse. So, if any of these things happen without losing any time, please rush them to a physician. The physician will evaluate if it is possible for you or you stay close to a bigger hospital, better you rush them to a bigger hospital so that an immediate action can be taken and we can try to reverse whatever things that we can and reduce the morbidity of the patient. Speaking about the risk factors, I already mentioned hypertension is the single most commonest risk factor for stroke, either ischemic stroke or hemorrhagic stroke, more so in hemorrhagic stroke. What are the other risk factors? Diabetes, as we all know, India is the diabetes capital of the world. We are seeing much more people with diabetes these days. Dislipidemia, smoking, excess alcohol intake and there are less common risk factors and sedentary lifestyle, off-late stress, sedentary lifestyle also becomes significant risk factors for having stroke. When you speak about stroke, it's mostly we talk about middle age, about age of 40 years, you know, elderly. But we also see strokes in extremes of ages. We also see strokes in young people in adolescence and even childhood. Now you would like to ask Dr. Mahadev about a childhood stroke. Yes, so whether the stroke occurs in children or young individuals, definitely. It occurs at any age group of people. It can start from just after birth to the elder most people. So the thing is, like previously known that strokes are very uncommon in young individuals, children and just born people, but that has gone now. Stroke is becoming more and more common in the young children, late children and adolescents also. The only thing is, like the etiology, I mean, what are the causes of the stroke, how the stroke presents and what are the risk factors for these age groups, it just differs. Even though the incidence of the stroke occurring in the children is increasing and increasing, but the early diagnosis is still lagging and also sometimes there is a misdiagnosis also because the clinical profile of children is different from the adults. So speaking about that, the young children or early neonates, the presentation of stroke will be just like decrease in the responsiveness, excessive crying, low intake. Sometimes decreased movement of one side of the body and sometimes the restlessness, lethargic behavior. So these kinds of episodes, we usually neglect. So these kinds of symptoms hint us to evaluate in the line of stroke and also the etiology, what are the causes of stroke and how different they are compared to the elderly people. So elderly people, as Dr. Guru Prasasar said, the causes are like diabetes, hypertension, dyslipidemia. So these are smoking, age, these are the risk factors. But in Engage, the most common risk factors are infections, especially in the neonates and early children. Then comes the congenital heart diseases, then comes the developmental malformations, then structural hemoglobinopathies like sickle cell anemias, then vascular malformations, autoimmune disorders like vasculitis. So these are the things we have to keep in mind and try to evaluate in this line to find the cause for stroke in the young individuals. And also the treatment, most of the treatment it is taken from the adults, but we have to treat the cause in the young children and adolescents. So as Dr. Raghuram has mentioned, it's very easy to recognize a stroke patient. So you can follow the mnemonic B fast. B is loss of balance, E is sudden loss of vision, F is facial asymmetry, A is arm drift, S is change in speech and T is sudden onset. Now question is, how do we assess once the patient comes to the emergency? How do we assess? But as we mentioned earlier, stroke is an emergency. We don't have a luxury of time where we can spend time for assessing these patients. We need to be very fast, very quick in assessing the definitive assets and also severity of the disease. So assessment also has to be quick. We are all trained for looking at the deficits and we use scales like NH, SS, stroke scale or modified rank and scale to functionally assess them and document what is the amount of deficits and the functional deficit. Going on to the next aspect of thing. So while we are assessing the patients in the emergency, we also need to plan investigations because we need to make sure what is the type of stroke. So this imaging, brain imaging is the most important aspect of stroke diagnosis apart from clinical assessments. So now I would like to request Dr. Raghuram to throw more light on the diagnostic we use in initial assessment of the patient and then working up the patient later. So like all of us have been repeatedly insisting on the importance of time. So the moment you reach to any kind of a center, it depends on what kind of a facility that particular hospital or center has to treat these stroke patients. So if you reach a center where there is a CT scan only and not an MRI, I don't think it is wrong that we should waste any more time in trying to move this patient out. So first obviously you can do what is called as a plane CT with a CT perfusion, which would adequately give us adequate information to make out whether it is a hemorrhagic stroke or whether it is a non-hemorrhagic stroke. So once we know that our treatment plan accordingly changes which my colleagues will be discussing further. So if you find out that it is a non-hemorrhagic stroke based on a CT scan and if you have the facility to do further tests, we can do what is an MRI brain which is actually a very very sensitive study for picking up any change in the oxygenation of the brain or decreased blood supply which can lead to decreased oxygenation in the brain. So there are specific sequences in the MRI brain which will also tell us how much of the remaining brain tissue or the brain tissue which is viable which is called as a penumbra. And when we are doing this MRI study like all of us have been discussing what happens in stroke, primarily there is a block of blood vessel in the brain. We can do what is called as a quick MR angiogram like how you do angiogram for the heart. The MR imaging can also give us an information about the blood vessels in the brain and then we have an idea what to do further depending on where the blockage in the blood vessel is. So when we investigate a stroke we look at ABC that is we look at the arteries like Dr. Raghuram said we look at the vessels we look at the and if you're suspecting a venous stroke we also do a venogram. We're looking at arterial stroke we look at the vessels either it can be MR angiogram or CT angiogram or if required we also do a cerebral angiogram via 4 vessel DSA. We also have advanced imaging in the form of perfusion scan where if the patient has come later in the course of the stroke onset like 4 hours or 6 hours later or a patient has a wake up stroke then you require advanced imaging to say that we have some tissue to be saved whether we need to go and do thrombectomy for such patients and B is looking at the blood. So we look at the risk factors like I said dyslipidemia so we look at you know lipid profile we look at certain sometimes you look at homocysteine levels and in younger people we also look at other auto antibodies to know whether they are having a risk of recurrent stroke and the circulation so these are the way we investigate we also look at heart we look at the neck vessels is there any blockages there we need to also work up for the stroke mechanism. So all these investigations help us to know what is the type of stroke what is the risk of another stroke so investments are very important aspect of the stroke work up. Next part is what is the stroke ready hospital and the stroke unit. So to have all these investigation modalities to have the stroke team which consists of a neurologist neurosurgeon intervention neurologist good rehabilitation team stroke nurse we need to have a full setup to give very good quality care and good outcome because we work as a team no one person can handle this such a complicated clinical situation like a stroke. So stroke ready hospital have this an under one roof and all these times all this procedure have to be done in a time-bound manner. So stroke ready hospitals are the places to go when a person is diagnosed to have a stroke. So there is always a question when patient has symptoms of stroke we need they need they need to go whether to a clinic or a nursing home. This will have only partial care they may be a visiting consultant or they will only have CT scan they will not have facility for a cath lab or an MRI. So we need to patient needs to be educated public need to know that stroke ready hospitals are the ones patients need to reach quickly. Later the rehab care and that can happen later in other type of hospitals but important is to understand that comprehensive stroke care happens in stroke ready hospitals or stroke units. So going to the part of the discussion on stroke Dr. Avinash about what is the type of treatments available for acute stroke patients. So as far as treatment of stroke is concerned again it depends on lot of factors like what is the age of the patient what is the duration of onset of stroke. What is the picture which is seen in the scan. Like broadly other colleagues have mentioned depending on whether it is an hemorrhagic stroke or an ischemic stroke the treatment differs. In case of hemorrhagic strokes like Dr. Raghuram mentioned some of the cases may have to be taken up immediately for surgeries. Whereas in ischemic stroke which is the major bulk of stroke which is about 85% of the strokes. Overall what happens when these patients come to emergency is that once we detect that there is a stroke and a major vessel is occluded there is something called a golden period of arrival to the hospital. If the patient falls in that category of golden period then there is facility for giving intravenous injections within certain period of time. If a patient reaches hospital beyond that certain period of time which our colleagues will going to discuss. If they reach beyond that period golden period then there are certain other mode of treatments available in these patients like between 4 to 8 hours of onset of stroke.  So by this technique we will be able to reestablish the circulation and prevent or reduce the amount of damage to the brain cells. And in some specific type of strokes we can go beyond this 8 hours of window period and like Dr. Gurprasad mentioned with different type of imaging techniques we will be able to detect very small specific group of patients who can even be treated beyond 8 hours even upto 24 and 48 hours. But they are very very limited number of patients so the goal of treatment or the plan of treatment for the patient is to reach the hospital as quickly as possible and all modalities of treatment which are available are basically upto 8 hours beyond which is only a rehabilitation and other modes of treatment. So as Dr. Avinash said the facility for giving this type of advanced treatments whether it is IV thrombolysis or mechanical thromectomy is available only for the set duration that is called window period. So that is only available for first four and a half hours for IV and little extended period for the mechanical thromectomy. So the importance is to reach the hospital as early as possible not to waste time taking references going to multiple doctors and the vital time is wasted and patients may not get the benefit of opening up the vessel by these techniques and the outcome is not eventually good. Having said that there are certain patients who come late or also started on medications in the form of blood thinners what we call anti platelets. Some patients require anti-coagulation if they have a diagnosis of dissection of a vessel or there is a cardiabolic stroke we start on anti-coagulation and these medications have to be continued for life. And we also start on risk modification drugs like statins if they are diabetic hypertensive we start them on medications and there are certain neuroparticle drugs we start them on. So at this stage I want to ask Dr. Mahadev about golden period, window period and door to needle time. These are there are certain quality indicators for you know stroke care. So what do these terms mean in stroke care? Yes, so the punchline for all the neurologists and the neuro interventionist is time is brain and brain is a time. So that is the one important thing and so keeping this in the mind we have to know that as we said before itself there are certain signs where we will get to know that the patient is having a stroke. So if the patient or patient family members they are aware of these signs so there are stroke ready hospitals as our colleagues were telling. So these hospitals have a trained doctors, trained nurses, trained paramedicals, therapists and even trained ambulance staff. So if you call them immediately they will come and assess on spot what is the patient situation, how severe is the condition.  By the time the patient is transferred from the home to the hospital door emergency door the conditions can be pre analyzed. As I said what is a golden hour? Golden hour is a time or a golden period what we say it is a time from the onset of symptom till we intervene till we start the treatment. So as we know every minute there is a chance of losing 1.9 million neurons. So this tells the severity of the effect of the stroke. So as soon as the patient has the symptoms of stroke once all this channelized once the patient reaches to the hospital. So in the emergency ward itself the stroke managing doctor will assess the situation with certain parameters they will assess the severity how much the degree of deficits are there. Then simultaneously on the chair itself they will take the patient to the radiology center they will do the imaging they will reduce the time as much as possible. Because as I said each minute counts each second counts so in that period like how much time you reduce from onset of the symptom till giving the reperfusion therapy that constitutes the golden period or golden hour. Coming to the window period there is certain time limit which are set by a stroke association that in a ischemic stroke a time of 4.5 hours ideally 3 hours but can be extended to 4.5 hours is a time period which is allowed for doing the IV thrombolysis. In general term what we say clot busters. There are some drugs which are given as intravenous line to burst the clot which has formed in the brain. These are called as tissue plasminogen activators. The usual drug which we use in our institute are tenectoplasm and alteplase. So the window period for IV thrombolysis it is there from 3 hours to 4.5 hours. In some situations where we call as a wake up strokes sometimes we do not know the patient gets up he already has some deficits. In that situation we can use a help of imaging in that we will know we will get to know that whether the stroke is crossed the 4.5 hours or still within the 4.5 hours. Accordingly we plan for IV thrombolysis and in special situations where the centers permits we even advise for a bridging therapy. Basically initially we do the IV thrombolysis where the clot busters in the form of injection is given and if there is a large vessel occlusion what we say LVO. If that is detected in some modalities of investigation as my colleague said MR angiography or CT angiography. If there is a large clot is present in the brain that patient if the clinical parameters or vitals are stable if it is permittable they can be taken for endovascular intervention what we call as mechanical thrombectomy. So with this kind of early intervention and proper treatment the complete deficit can be reversed. Coming to the needle to I mean the door to needle time that technical term means at what time the patient comes to the emergency department from there to how much time it is taken for giving the intravascular thrombolysis. So that decides the door to needle time. So as much as we try to shorten this period that much of neurons we can save in the brain and there is much chances of reversing the deficits is possible. Thanks Mahadev for explaining this in detail. So one of the important quality indicator for any stroke unit or stroke ready hospital is to minimize the door to needle time. So nowadays we look at less than an hour and some of the centers have achieved less than 30 minutes and I think we should strive the responsibility of the treating team to minimize that door to needle time as much as possible. So all this now I have evidence there is significant of a clinical evidence for IV thrombolysis and mechanical thrombectomy these days. We had a lot of trials results coming in the way of last few years where they have shown that opening the vessel is the most important treatment for any patient coming with a stroke and it has to be done in a quick time. Now I want to ask Dr. Avinash who is our intervention neurosurgeon about how effective are these procedures. So like whatever colleagues mentioned about the treatment options. Once the period of IV thrombolysis is over then the patient will have an option of going for neuroendovascular procedures. These are newer advances which are present in the management of stroke patients. This was earlier before 2000 these techniques were not available. This was first started in 2006 and from then onwards there are multiple different techniques available to take out this. In broad terms these are called as mechanical thrombectomies. The effectiveness of mechanical thrombectomies is like if you consider IV thrombolytics gives about 40 to 50% of reopening chances. Then mechanical thrombectomy has almost like 70 to 80% chance of opening the block vessels thereby by improving the outcome of the patients. So we have been discussing about ischemic strokes all this while. As Dr. Avinash mentioned in his opening remark there are two types of strokes. One is ischemic strokes another is hemorrhagic stroke. When you do imaging and you have a brain clot that means there is a rupture of a vessel and there is a bleed inside the brain. Some of these patients require emergency surgery. So now I request Dr. Raghuram to talk about the role of surgery in acute strokes both ischemic as well as hemorrhagic stroke. That's a very important point I think the key message is what Dr. Avinash was saying. So that is something that is really revolutionized treatment and the kind of results and the recovery of the weaknesses that we see are amazing. So it's kind of a life-changing thing for the patient. So if you could reach the hospital in time that's the best. So then there is this other patients who have ischemic stroke but reach late. So when they are reaching late we really don't have any other acute intervention that we can do except starting the blood thinners which Dr. Guruprasad already mentioned. So some of these patients tend to have what is called as progression of a stroke. So this blood clot which is already formed and blocked the blood vessel continues to extend further and block the major vessels of the brain. One of the major vessels of the brain is what is called as the middle cerebral artery which supplies almost half of the brain on each side of the brain. So if that gets blocked and the patients have a large stroke which means almost one half of the brain is having a stroke and that also causes what is called as edema or swelling of the brain. Unfortunately when there is a swelling of the brain the swelling cannot come out because the skull is a very rigid bone unlike a swelling in the abdomen or the hand which tends to push the skin up and come out. So when this swelling does not come out it causes compression and other important structure of the brain which is called as the brain stem. So when that happens these patients become more and more drowsy or become unconscious and then we have some signs which we pick up in terms of checking the size of the pupil or the eyeball and then we know that these patients are progressing and the swelling is too much. So we have a surgery called as decompressive cranictomy. What do we do in this surgery is basically to provide space for the swelling of the brain. So in this surgery what we do we tend to remove at least a 6 to 10 centimeter half of the skull on the affected side of the stroke so that the swelling can come out and not press on the important brain structures. So this thing does not reverse the stroke that has happened. So unlike what Dr. Avinash treatment what he was saying kind of goes ahead and reverses the stroke these are just more to prevent mortality or death threat when it happens. So basically this is to save the patient and subsequently the patients has to go through intense rehab to improve the quality of life that he has. Other important stroke that all of us have been talking from the beginning is when you have a bleeding or a blood clot in the stroke. So when somebody comes to the hospital and we do a scan and we see that he has a bleed and if it is small we still continue what is called as the medical treatment that is to reduce swelling, prevent further worsening and all that. In case when he comes to the hospital in an acute setting and has a very big clot then we again do what is called as the same kind of a surgery that is remove the bone, provide space. In addition to that we try and go into this clot in the brain and try to take out the clot so that the swelling in the brain can come down. So this is called as an evacuation of a hematoma or a clot. So this is an acute kind of a surgical intervention that we do in both ischemic and non-ischemic strokes. Stroke no doubt the first 24 to 45 is the most important part of the stroke management. We do all kinds of interventions, manage these patients. Most of these patients get admitted in ICU.  So we need to clean them under close observation. We have a team of doctors called Intensivist who manage these patients minute to minute. They are closely monitored in the ICU and we also sometimes require repeat imaging to see how much is the swelling of the brain, what is the any other complication like for example we give TPA that is the clot lysing agent, sometimes these patients can have bleeding complications. So we need to closely monitor these patients. Having said that, once we have the acute phase over, these patients require intense rehabilitation. Once we started on blood thinners, they have been investigated, the risk factors have been assessed and they will go on to the next phase of rehabilitation. So any stroke-ready hospital need to have a good rehabilitation team and then they start working on initially, be it speech, be it swallowing, be it limb physio and all. So now I want to request Dr. Mahadev to tell us about the role of rehabilitation in stroke care. Yes, what if once the patient comes after the window paid, so what is the options of treatment at that time? Say for example patient is coming after 24 hours of onset of his symptoms or staying in a remote area where it took a lot of time to reach stroke care hospitals. So what if the patient is not a candidate for thrombolysis? What if the patient is coming with the major deficits? In that case the rehabilitation part plays an important role. Obviously we give the secondary preventive drugs like and clot stabilizing agents in the form of blood thinners and in the form of neuro-suiticals, neurocorrective agents. Along with that the rehabilitation, a good rehabilitation so that at least the patient can reach to a near normal functioning level is very, very important. So considering this as our colleague said a stroke is a leading disability condition worldwide, not only in India and it is the second most common cause of death next to the cardiac causes. So basically the rehabilitation starts from the day one of admission if the patient is getting admitted with the major deficits. So we form objectives like what are the objectives we look into the patient and treating. So basically the objectives of stroke rehabilitation is to restore the functional capability of the patient, the strength, the speech, the swallow, the cognitive part, the psychological issues. These are the things we will concentrate. Second thing we will categorize the patient and we try to make the patient functionally independent. So how quickly the patient becomes functionally independent. Third thing we try to prevent the complications out of the strokes. The patient is getting admitted into the hospital will be exposed to the hospital-related infections, the bed sores, the nutritional deficiencies. So these are the things we have to take care and we have to more important is we have to prevent the recurrence of the stroke. Then we have to give a good mental support and psychological support to the patients. So the key things is regaining the strength, regaining the balance, regaining the swallow and speech functions and avoiding all the hospital-related infections giving good psychological support to the patients. So as I said, the rehabilitation involves the multidisciplinary action. It is not just a work of neurologist. It involves multiple sub-specialties to take care of the patient. It involves neurologists, neuro-interventionists, speech therapists, occupational therapists, physiotherapists, psychologists, respiratory therapists. So all of these specialties are collectively they have to work for regaining the functional ability and other aspects of the patient's recovery. So how we do that? So once the patient gets admitted, we have to have a common conversation with all these therapists and we have to involve the family. What we have to do? We have to find the risks involved in the patients. One thing is a deficit and another things are comorbidities like the patient is having diabetes, hypertension or other comorbidities. Then we have to set a goal. We have to involve the family members and we have to involve all the other therapists to start the rehabilitation process. And we have to set a goal by the time the patient gets discharged. We have to be in a situation that at least some deficits are coming back. Then we have to reevaluate day by day. We have to assess the patient. We have to do the improvement in the deficits. Then ultimately we have to create the motivation in the patient and family members. So with this kind of intervention, this kind of therapies, the patient can regain some sort of at least near normal functioning. And coming to the newer advances in rehabilitation, there are some artificial intelligence and robotic therapies are going on. Basically what they'll do in this treatment is they will create the robots which help the patient to move their, which train or help the patient to move their limbs, their arms, their legs. Indirectly using the artificial intelligence, they give the signals to the part of the brain which controls these kind of movements. So over the period of time, the brain starts giving signals and patient can get the functional improvement. So these are not available everywhere, but still the research is still going on and we hope soon we can get it in every centers. So the most important question asked by most of the patient or the patient families is the stroke preventable. Or once the patient is admitted with a stroke, they will have this question that can the stroke come back? So definitely there is a risk of recurrence of stroke in all patients. So that's the reason why compliance with the medications, that is the secondary prophylaxis, beat blood thinners, beat anti-diabetic medications, anti-hypertensives, statins have to be continued for life. And that goes on most of the patients and the doctors can decide what extent and what is the doses to be given. So having said that, lifestyle changes, even primary prevention, that stroke can be prevented. So when we see patients at 30s and 40s coming with headaches, very bad lifestyle, we sometimes start doing primary prevention lifestyle modifications. Like for example, you need to have good amount of exercises, at least half an hour to 45 minutes daily cardio exercises, at least five days a week will definitely help them in preventing this type of vascular events. Medical checkups, hypertension and diabetes will not be coming with symptoms always. It has to be picked up early on in 30s, 40s. When the blood pressure is consistently found to be high, they need to be initiated on medications. Diabetes also. By the time they have osmotic symptoms like polyuria or polydipsia, it will be too late. So we need to be picked up during medical checkups. So these are the ways you need to get the vascular risk factors picked up early and then that has to be treated. Along with that, a person has to be abstained from smoking. Smoking is one addiction which can have a direct impact on prevalence and incidence of stroke. Excess alcohol intake also can lead to hemorrhagic strokes. So that also has to be moderated. So all these interventions in terms of lifestyle modifications, management of vascular risk factors will help in prevention of stroke. So at the end, we want to convey this message. I now request all my colleagues to give a final message to the public and the physicians about acute stroke. Starting from Dr. Mahadev. The bottom line, what I want to say is stroke is treatable if it came on the right time, but it can recur if not adhered to the medications. So complying to the medications and strictly strict follow-up and controlling all the comorbidities can prevent the further episodes of stroke. Dr. Rabram. The same thing what Dr. Guru Prasad just illustrated, the most important thing is in addition to all these medications is to do what is called as primary prevention. That is climbing a very good lifestyle habits. Definitely no smoking, no alcohol or alcohol in moderation is very, very important. Smoking especially has a very high risk factor, not only for brain stroke also for heart attack and also doing good quality exercises every day is very, very important. I know most of the youngsters now would say they're very busy, but please make time for yourself. Make sure at least you do an hour of exercise every day so that you can prevent these devastating medical issues. My side is time is brain, do not delay, rush to the hospital if you find any of the symptoms that we have mentioned, get treated fast. The earlier we treat you, better we can save number of cells. One in four has a risk of having a stroke in the population. The burden of stroke is huge. So as public, as treating physicians, we need to be aware that it can hit anyone in the family, in your community. So be aware of stroke and reach the hospital as early as possible. Thank you.