bout for a long time we would probably use our elected members eventually you know if we don't get the ply people don't come back to us we would keep going back to them again and if we didn't get that accountability we would then use the elected members but community groups that haven't been out there for a long time don't know what the platforms are and what stages have got to go through and I think that has to be made clearer you know of a at a community level basically. Thank you Mr Morgan please. I think I just grew the minute but I can just turn to you. Okay thank you very much. Mark Macdonald please. Thank you convener I spoke earlier to both the panels about the ability of some communities to essentially work out who they need to speak to and also having the ability to go through for example grant applications and things like that and other communities who maybe need a bit of support to do that. What are your experiences around the need for support to get maybe grant applications or to go through transfer of assets and where did you look to for that support and was it readily available from public bodies? Ms Boval having gone through some of the process of establishing something new do you want to go first? Well first and foremost if we're talking just about the grant funding first and foremost we thought we would try the lottery the need for a community facility in St Mary's was identified through community plans and before that they'd been offered flats and houses it wasn't sufficient for an area as big as St Mary's and we as I say went to the lottery board but it was because we were getting help from the council it was too close to them and eventually we got actually to the judging table and we were expecting a yes after that and we got a phone call back saying we've refused the application. We actually invited them up to Dundee and said why did you refuse the application and we got a lot of gobbledygookas as Yvonne says but we pulled them up on it and said it's all right we're going to build the centre anyway whether we get funding from you will look elsewhere and we did we got European funding regeneration funding and I think that that's the funding part of it I think from the very start you've got to get volunteers on board you've got to speak to the local community you've got to speak to the young right up to the old and ask what they would see this the shape this community facility would be in before you can apply for funding because you don't know what size they would want what's affordable you know the things you would like the hours you would like to open and so get your community on board immediately on something they want to get their teeth into keep the momentum going with your community don't just sit back and expect the community to ride along with you because my knowledge of communities is whether they're poor communities or not they're very interested in things that are going on in their area and they're very community-based people okay I wonder in terms of the funding aspect did you get a lot of help from the local authority in terms of trying to access that European funding yes because that's not particularly easy no we did that was that was done actually in conjunction with the lottery funding the lottery funding um a lot of that funding was to be to employ admin workers and advisors and when we didn't get that obviously now it's a community run led by communities worked on by communities and opened by communities basically we do everything they're cleaning the lot and but that was mainly the lottery funding some part of building so we'd actually worked in tandem with European funding at that time we were also fortunate I think it could be or it could be one of the only people places in done in Scotland we've got the territorial army on board as well so they have given us a donation of money and they have the whole top section of the community facility which is theirs we can gain access to it but we don't because that's their personal property unless there's a problem with any any power strikes or anything like that going on so it was a loss at the time Dundee City Council were very supportive and I'll always remember and I'll quote it with a certain person in the council the very first meeting I went into with her said to me I don't agree with the community centre and I don't want any more community centres in Dundee to manage but I'll support you and I'll give you all the help you need to get it so we did have the support right from day one with them so I can't complain about the support we've had from Dundee City Council. Thank you. Does Mdae also want to pick up on Mr McDonald's question? Yes, we're the opposite to Alice. Alice has already went through all the process we're on the very beginnings so funding has been quite hard for us because we keep getting told that we fit the criteria and then when we put it in it's too official. It's worse and then it came back and then we wrote it in our language and it came back because we don't fit the criteria. What's that about? That doesn't make sense but no funding is quite hard but as soon as you get charitable status then it's a the say it's meant to be easier but no I think it's still a fight to get funding. Do you think the bill itself may help get you the help that's required to get through the bureaucracy of oh that's too official or you know that's not enough? Possible because we do have workers from the council that do help us with funding and they're brilliant. I mean we just we just keep getting all these funding applications fill them out and send them back and keep sending them on but that's only that's one of the grumbles but apart from the funding as Alice said about getting the community on board if you don't have the support of the community you'll never get it moving okay thank you Teresa please I'll speak about the support first we've been involved in trying to gain a community asset for over seven years now and started off with the being asked by the local council to take over the local community centre which we were quite keen to do we're based in a small building which is two old police cottages with no space basically it's just the cottages and we were quite happy to do that we went get a feasibility study looked at it went back to the council and discovered that we didn't have it there wasn't enough parking space so it's blown out of the water so then we then identified a piece of land in our area that we could take over went to the lottery and got substantial funding from the lottery to carry out site investigations carried out site investigations to find that we needed a quarter million pound worth of remediation on the site before we could build on it we've went from fitting the criteria for the vacant and derelict land fund to not fitting the criteria to the council having spent their money for this year but we'll put you forward for next year when the next year comes they've already spent their money basically and also the cost of the land was prohibitive and we had to reduce the size of the the scale of the building that we were building so we had to go back to the council and say well we we need the whole scale to get the car park in basically and they decided they would lease as a part and sell as a part which the big lottery wouldn't have been interested in so we've been we've been having this fight for years and we've found that you know we're up against officers and when we take up to the top of the council we get sent back down to the same officer again so we just felt as if we were up against a brick wall and the elected members couldn't seem to get through either and I'll be there a second because do you think participation requests and the community themselves being able to ask the reasoning why and influencing the decisions about for example the derelict land fund would be helpful in that regard yeah I do I think the participation is going to give us a stronger voice and it's going to enable us to ask questions that we can't ask just now I think it's going to make a make people accountable instead of getting put the pillar to post and then back to the original person I think it will thank you that's only part of my story I'll let somebody else speak dowry please yes and we have got a much experience of seeking grants but the we created a friends of seat in park recently as the park was falling into into heavy disrepair and there there seems to be no drive at all to help us with grants partly probably the the group itself has not got the the skills to go back buying on doors to either to the ground company itself or even to the Aberdeen council things may change a little bit as there's been an hour change in the management group but it just seemed like they were happy to have the group because it looked good for the Britain in bloom competition and we had a little rubber stamp on but there was no great you started now here's all the tools you can have there was no outward sort of giving really it was a pattern the head enough you go and in terms of that kind of situation and again I'm going to have to be a little bit parochial and I'm sorry for for this you know in the past there have been groups formed around about a park at Sunnybank for example where there seemed to be much more help given to to the local group do you think participation requests would be helpful from that perspective for you if you were able to find out what they got why you haven't got that and the reasoning behind why you haven't had the same level of service if you like the city bank park group was led by a council officer which meant that he had the inside track of course he knew the systems he knew the people to talk to and he knew how to do it the friend you should say that a council officer not acting as a council officer but in his spare time yes i certainly sorry yes the seating park group is has no council officers on it and although I was instrumental in getting the group started it was really as a as a member of the community council and it was important to me that I didn't run the the the friends because it would become almost like a one-man band I thought it was important that if the if the group of friends who said they wanted us to save the park weren't prepared to stand up and run it then so be it so it's been it's really what people are available to run and run what their skills are and it can be limited mark sorry and that I guess builds into the point I made earlier around who are the best people to give that support and are there occasions where you have found that perhaps there's been a not necessarily a lack of willingness from from local authority but a view from the local authority that they they can't be seen to be supporting a group while at the same time being on the other side of the equation perhaps negotiating with a group has that come up at any point or do you see that being a potential pitfall if there isn't maybe the support available who wants to have a crack at that first mr morgan and to control the group you know we want you to do this amount and and that's it go and paint this go and weed this and we'll put your name on this so it's it's the opposite to providing the support really anybody else want to come in on that one sometimes what we felt is you know if you're after a piece of lander and I say and you're not managing to take it forward you know is it going to be used for something else have the council got other ideas for this and if they have would they please tell us so that we're not wasting their time you know so that's what we've kind of come up against okay in the city wide and undy because we have community officers working all the regeneration areas who basically work for that area my area strath martin so they designated for that area but then they meet with the rest of those officers on I think it's a monthly basis but they meet regularly with the chief executive so they're carrying forward the needs and wishes of the area they're speaking to the volunteers in that area they're speaking to so I think we're evenly divided in Dundee with the support we get for each area I don't think it's one area I prefer to another so in terms of the Dundee aspect you've got all of these for us you've got your own community officers and the community officers themselves are feeding up to the very top to the chief executive who obviously has a major role to play in the community planning organisation in Dundee. I think it would be very interesting for the committee to write to the other community planning partnerships to find out if they are at that level and get that response. Evonne or Ryan, do you want to add anything to Mark's question? The only thing that I could say is sort of about the land. The land that we've were hopefully successfully getting was an old school that got knocked down and it was only through the community that wanted it for a community thing because the council wanted it for housing and they were very adamant at the beginning that they wanted it for housing and that's how we got it because we stuck up. Ryan, do you want to come in here? We're at quite an interesting stage because we're at the very early stages of asset transfer so the key thing I would say there is that for maybe a period of about seven or eight years we knew as an organisation as a small charity that we had outgrown the physical resources we were in and anytime we made an inquiry about possible consultation with North Lancer Council about any asset transfer the result was a dead end meeting with someone in property who said no you're not getting that because that caught we would make too much money from selling that. So I would say there's a cross to purpose there just in terms of speak if you're speaking to those particular individuals the purpose in that department is completely different from what we were looking for and that's a fundamental point I would say the fact that there's no directly responsible individual related to community asset transfer in the past was a problem because again how do you access an entire authority at what level do you go in and what phone number do you call on your phone and also I kind of feel as if in the past you were almost disrupting the activity of the local authority whereas this new process is systematic and you would you'd be going through a process so you're not a kind of peculiar case over here somewhere. Okay that's very useful. I'll pick up on that final point if I may. In the previous session we had heard some evidence regarding the issue of having a person who was allocated to deal with asset transfer and we had some conflicting evidence saying actually well there shouldn't really be a single person but it should be something within the culture of that organisation. Simply going forward and sitting with us with the bill in mind do you think it would be useful to potentially even have that type of person in the short term or even medium term maybe say for about five years or so and then for that job to disappear as such but within that period we tend to actually try to increase that culture within local authorities so more people actually are aware of the whole issue of asset transfer. Does anybody want to? I would say yes. Yvonne, you say yes. Teresa? I would say yes, it's vital. We need one person that we can go and speak to. As Ryan said, we're speaking to a whole authority. You don't know what person in the authority you're speaking to and within the authority and within the departments they don't communicate with each other so you have to communicate with all the different departments. We're just at the stage, a pilot of developing a community asset transfer and we've just taken over an asset basically and we were supposed to take over it in December, we didn't take over it till March, we only get the first management fees in July after fighting for them, we haven't got a service level agreement and we've still got a draft lease and you know so I think there really needs to be someone there that can help through the process and I think maybe probably the longer. So all of that, does that affect the original business plan that you put forward, the fact that are these things having fallen into place? Yeah, it affects everything that we're trying to do basically because we're taking over a building and we required, one of the stipulations was we require the management fees to enable us firstly to run the building and to provide the services that were already being provided, they're expanding and build more services in and if we hadn't the management fees weren't in place then we were going to fall down at the first hurdle. That's where we feel that we are, that we keep getting up down at the first hurdle. Does anyone else want to answer a short question? Just to agree that in a business sense and engineering sense if there were two organisations working together on a project you would always have an interface engineer, you need to know who to go to and somebody who can then disseminate those thoughts out to the other organisation. Stuart, do you want to come back? That's been very useful. Also, with the bill in mind, have each of your organisations actually had maybe an increase in interest of people who actually want to volunteer and get involved and if so, are they bringing forward, bringing with them some additional skills that you maybe don't currently have that can actually help, certainly with the implementation of this when the bill goes through the parliamentary process? Or you can also be brutally honest and say whether or not folk actually know about the bill at all. Although we've tried to disseminate, we know that there are always difficulties in that, so most folk don't know about the bill. So the simple answer to Stuart's question is that has there been only additional volunteers because many folk know about the bill? There's additional volunteers through word of mouth. People who have read the bill and who have taken part in conferences like when you came to Dundee, they can impart that knowledge. We are managing now to encourage some young volunteers, which is your future really, trying to get them on board. It's only for a couple of hours a week, but it's always the new volunteers coming on board. So when you talk to them and you ask their opinion of what they would like to see in there, it's good, and then you go on to explain to them. You don't just suddenly go into it with, this bill was published and this was happening, because young people don't want to be in school for all those years. They don't want all this thrown at them right away. They just want to come in, do their bit for the community, know what's going on and say what they want to do. I think it's up to people like myself who both sit and read, and can they dare to say boring stuff? I'll sit and read it and impart anything that I've picked up from it that is in direct benefit for the community. Can I make an appeal and maybe a wee advert here in terms of the boring stuff? It would be really good if you went back to your communities and told folk about this bill and asked them if they have any views to write in and let us know, because we are still looking for folk's views on this, so if you could do that, we'd be immensely grateful. In your comments earlier, you mentioned the frustrations that you've had, and then you said that you would use elected members eventually. I thought that was very interesting. Can you explain why you didn't go to them at a sooner partner process? I think that there's processes that you have to follow. Jumping right to elected members, we're not popular anyway, basically. I wrote down about all the co-production, participation and empowerment. We are empowered people in our communities, and co-production is something that we've been doing for lots of years, in all the years that we've been in our communities. Is that a word that you would use when you're yapping to folk in your community about what you're doing? Certainly not. I think that you've got to give the opportunity to the person that's in post, basically the person that should be carrying out the job, the person that should be providing the information to you before you take it to the elected members. We do use the elected members a lot, because we've come up against a lot of barriers over the years to try and take on manding assets. The only way that we manage to get through the brick wall is eventually with the elected members, but the reason we don't use them immediately is that we like to follow the processes, and if nothing comes from that, then we certainly would go to elected members. Thank you very much. John Wilson, please. Thank you, convener. Good afternoon, panel. This elected member is the chair of Glenbuig neighbourhood house and has been for a couple of years, so I'm not included in the elected members that Theresa Aitken refers to, she's actually referring to our local councillors that we tend to involve if we're having particular problems. Having said that, I made that declaration, convener. I'd like to ask the panel, if you've read the bill, and which clearly you have read the bill, what would you either add to the bill or what would you like to see strengthened within the proposed bill to make it easier for communities taking forward the community empowerment legislation? Who wants to have a crack at that first? I think that maybe the only thing that I would encourage is that communities having a stronger voice, communities being included in other committees, I'm fortunate that I'm on Dundee partnership management groups, so I can go up to the top, and I'm also on other regeneration committees, but I also worked in tenants movements and children's panel, so it's all gaining knowledge, but you really need an encouragement and, if necessary, public speaking, teaching some of the community members public speaking so that it's not always left to two or three people who will go and give evidence like today. Apart from that, I think that we get all the support that we need, we've got contact with the right people, and if we have a problem, we're not short on going to them and saying, you know, this is breaking down. I mean, if something's not being done after it's gone to the LCPP meetings, then you can follow it through and say, this has not been done, your LCPP meetings are not working, so what are we going to do about it? We're going to have to do something, we're going to have to either get that person to go back to his seniors or her seniors and say, can I make a decision at that level? Because sometimes those hands are tied as well to make a decision on something important that you're asking them to do. So you're in a situation, even without the bill, where things seem to be working pretty well? Without the bill, yeah, they are working pretty well, but unfortunately it doesn't have to be done, it's not legislative, so it doesn't have to be done. This legislation would make councils know that they have got to do this. In Dundee, as I say, we're fortunate, they do it, but they don't have to. So, I mean, it could be a whole new council comes in and decides, we don't want to work with the communities as closely as we've done up to now, we don't want to give them this voice that they've got just now. So, yeah, you've got to watch your back and you've got to look to the future. Thank you very much for that. Teresa, do you want to comment on that because obviously Dundee's working without the bill, do you think it'll help you? I think the bill will help. I mean, we don't have a community asset transfer policy, you know, we need the community asset transfer policies. I think the participation, having a voice, is going to make communities stronger. No, I think it definitely will help communities go forward. Does anybody else want to have a crack at John's question? I would say yes, because the same as Alice, I mean, I've got lots of hearts as well. But somebody that doesn't have so many contacts can actually help their community with this bill. I mean, it's good that I've got contacts, but somebody that doesn't, then this helps them to get forward. Going back to John's question, is there anything else you would add to the bill? Make it shorter. Let's gobble the good, okay? I was going to say that, let's gobble the good. Make it plain English. Anyone else want to come on, Mr Morgan? Yes. I think that there is a problem. The bill is such a portmanteau bell. It covers so many issues. It makes it very difficult for anybody to work out what's going on there. It took me several goes to realise what was there. When you look at the document and the supporting ones, it's about 300 sides of A4 to read through and try and work out what it all means and which bits are relevant to your community, whatever it is. It's not easy, and then, obviously, for that reason, there is the Idiot's Guide one, which is a bit embarrassing, really. I think that we need something a bit between the Idiot's Guide and the rest of it, because it's not just that you can't understand it. We've all read it. We've all understood what's in there. I'll have maybe two or three readings and maybe writing notes down, but we have the time. Again, every community person has to do this. If it's a planning application, you have to go and get the documents. You have to find out what it is. If it's a piece of law, you've got to find it, then find out, well, is a community council actually part of this? Dig, dig, dig. Oh, yes, it goes in through this route. You don't make it easy for us to understand the stuff, basically. Could it help Aberdeen or our community council? I think it could. It depends how the local authority uses something like that. It could use it, as a tool, to give us a harder task. I understand that it's pretty tough going. That's why we've divided it up, I have to say. I'm back to your communities and talking about this. I've been told to mention that it's the other advert. Have a look at a wee video that's been produced. We'll send it to you and pass it on to others. Unfortunately, folk will have to look at my face, but that's the unfortunate bit about all. John. In the earlier session, we heard evidence from Barnardo's and other organisations. In the written submissions, Barnardo's indicated that community planning partnerships should set aside 1 per cent of the overall community planning partnership budget for community engagement. Do you think that there are enough resources there to allow communities to fully participate in the decision-making processes that they want to be engaged in? With the exception of Alice and Yvonne, who seem to be quite steadfast in their engagement, do the other panel members—maybe Yvonne and Alice—who want to comment as well, do you think that there are enough resources there to allow them to fully participate? I'm not just talking about participating on the edges. I'm talking about fully participating in the issues that you want to participate in in the decision-making structures that are out there making decisions for what makes them. I think that the resources are there, not necessarily money resources but assistance. We identify training that we need to take. Whether it be external training or whether it be internal training, every year we have to go through disclosures, food and hygiene certificates and all the extra things that we have to do. There are policies that have to be kept up to date every year, so we have to go through training for that. We couldn't do that just by ourselves. We need support from community officers to do all that. We get the support in kind, not in cash, because all our money is grant funded, all our income is grant funded. In kind, we get lots of support from other people to bring our volunteers on. I know that I'm saying that they don't all read the bill, but they get involved in the policies. They know what the policies should read for a management group running a centre individually with a community-led body. I think that through DTA Scotland, we are members of DTA Scotland, I would say that resources in kind in the training that is available through them has given us a great voice to be able to take part in the decision making. I think that what we have learned has been part of them over the years, has really been what has taken us forward. Obviously, through LXEL and D in different partners, there is other training available. However, to really take part in the decision making and have a voice in decision making to free up your time—you would have to free up a lot more time basically—you are then talking about financial support, which I would say is not there, basically to free up time for people to go out. However, as far as DTA Scotland is concerned, we have got a lot of the expert that has been invaluable to us. If people have not read the bill, they will say that there are issues about the definition of community organisation that local authorities and public bodies should engage with. Do you think that there should be some tightening up of that community body aspect of it? As I said, they are trying to get a definition of who should be able to participate and who should engage in the decision making policy structures of the council or community planning partnerships. The groups in the area that I come from have one that deals with community safety, so that is the place that you direct your questions to. We have one that deals with the planning partnership, which is the management board in the centre. We have other ones that deal with churches, so we can get in touch with local churches. We have one that deals with schools, so you identify the different areas that you are working with—antisocial behaviour. If we are working on an issue in housing to do with antisocial behaviour, we know who to go to to bring them along. It is identifying the right person for the right information and to come along to the right meeting. I might ask the police to come along to an antisocial behaviour meeting, but not in a housing improvement meeting. You are better saving their time, because they are strapped for time now, and inviting the right person in the initial stages and not wasting their time. Does Mdae Aswant have a crack at John's question? Alex Rowley, please. Can you ask the community plans and how they are engaged? Are you aware of the community planning partnership? Are you involved in them? Let's start with Dundee first. Alice, do you want to go first? In 2000, I lived in Arthur, which became a regeneration area. I moved up to St Mary's. That was my first way, because I said that I wasn't getting involved again in anything. That was my first way of being involved, going and getting tenants' shoes and residents' shoes on what they would like—their aspirations for an area—a wish list. If you and the community are a wish list, you write down there what you would like, put the post up on the board, and you will write the community plan. Way way back in the early 2000s, we had written the first community plan. That is where the idea for the community facility came out. Lots of other things that they wanted—belief it or not—want to tidy your gardens in the area. They don't like hanging about in an area that doesn't have tidy gardens and sufficient lighting. They were coming away with simple things like that. You have to consult before you even think on a community plan. There has to be a community plan led by the community. It cannot be one that I represent the community and I go along and say, I think that they need this and I think that they need that. It has to be everybody's shoes. I cannot impart what I want on to them. As I said way back in the early 2000s, before we had the LCPPs, the LCPPs are quite a new body. Regeneration forums came before the LCPPs. They are quite a new body, the LCPPs, to this meeting. I think that every—I don't know how often it is—but we renew what has been done. We have a day that we renew. Has this been done? Has this been carried out? Is this still to do, or has it not been touched yet? Then we create another aspirationalist, basically. In other areas, in terms of the community planning partnerships, and below that, what are you aware of and how are you involved? Well, I am aware of them anyway, and I am involved. We can go to the local area partnership meetings once a month and we can feed in through CLND. We have a partnership through community learning development, where a lot of organisations sit on that at a local level. We have also got a great network in the corporate area, where we have a steering group that involves the NHS, the council, the police and everybody, and we work well at a local level. The reshaping care agenda came up earlier, and I thought that that was a great avenue for participation. North Lanarkshire is really taking that forward in a good way. I think that this bill builds on that for reshaping care, shows what communities can do and how they can work and build on structure and deliver and develop really good projects in that area. I am aware of the community improvement plan and how it works as well in the local area. I do not know of a community plan that is in operation in our area. We get involved in the formal ones, the local area plans and so on, and go through the formal process of putting comments into those fairly touchless documents. I have heard at the community council forum that the central Aberdeen Moffter plan consultation is a plan to rejuvenate the whole centre, and there is no community council involvement. We might pull that together without any community council in it. Ryan, do you want to? I am aware of the CPPs' outcome agreements in the North Lanarkshire area. I have seen all the diagrams and the fancy reports, but no, we are not involved. I was just thinking about why the guys were talking about that. It is probably a blend of a small charity and everyone else is trying to keep their head above water with their own plans that they are trying to get funding for. I can only speak for myself, but it is sometimes hard to see where you would fit in on those big complex diagrams at what meeting should you go and what level should you be discussing things at. I think that there is something in that. If hon. Llywydd, do you want to add anything more for Andy? Yes. For me personally, it started off when I went for a nosey. That is what it came down to. It just grew, and now you do actually fit in, and then you put your point forward and say, right, this is what the community wants, not what the council wants. If the community wants something, you have to fight for it. Our green space, we have been fighting for a long time, and we did do a lot of consultations with that, and it did go to the LCP meeting, and they said that it was a good idea. When we did do the consultation, we got little kids at five-year-old when my boy went, I know what I love. He said, I swim in pool. I said, I do not think that we will get a swim pool in Douglas. He said, yes, but it is all right. When it is winter, it freezes and we get a skating cap. I went, right, what do you say to that, to a six-year-old? That is somebody who is from the beginning. If you empower them, then they will go forward. Absolutely. I probably ended up here because I went for a nosey at once upon a time. The new powers will make a real difference to the communities, the powers from the bill. Who wants to go first? I will have to pick on somebody if somebody does not volunteer to raise a please. I do not know. From my point of view, I think that they will make a benefit to us because of what we have been doing in North Lanarkshire and Glen Boyk over the last years. We need something that will make our council accountable. I definitely think that we need the bill. We need it for communities to make communities stronger and make not only councils but all public bodies accountable. It will help people who are setting up and helping us to help them. If there is a proper document there, it makes the council and NHS and any other body accountable. We can then go to the other small groups that are setting up. It is a big thing setting up and taking on land or starting out projects and looking for funding. We have been there for a long time and we still find it quite scary at times. I think that that will help to get other communities up and empower other communities and enable them to go forward. Before I bring others in, you said to begin with, I do not know, and then you were pretty positive about it. Sometimes they do not know a factor. Do you think that we should revisit this again as a committee after the act is in place to make sure that it is working the way that it should for communities? Yes, because a lot of times bills and different things come in. They are supposed to be operational and they get put in the failing cabinet. I think that you should revisit it. Thank you very much. I think that it will make a fantastic difference for one or two specific cases where we are thinking of the Western Isles and there have been situations where people have been desperate to buy lands. I think that it could make a difference for the smaller community organisations but I will have to wait to see how it is. It is in the council's remit or the local authorities remit as to whether they deliver or whether they go to the letter. If they go to the letter, not much will happen. What about participation requests and some of the difficulties that you have previously faced? If participation requests are in place, you might not have to go through the rigmarole of actually going through participation requests because the council knows that they are there and you have that ability. Do you think that they might give you the answer sooner? We do not necessarily need to participate in a sitting in committee meetings day after day. There is always that desperate problem, but we do not want to get involved in that way. At the forum this week, there was a very good description that we seem to be moving from a representative democracy to a participatory democracy, but we do not want to participate to the end of the earth. Some of us have day jobs and so on or domestic commitments. What we want is just the support that we need. We do not have to sit on a committee unnecessarily. We were asked to sit on the community council forum to sit on the committee for two years to talk about the boundaries of the community councils.  Anybody else want to come in? It is a very useful document to be able to, if you are asked advice from a group that is maybe just starting off—I am not talking about the local area now, but I am still talking about Dundee—I often get asked to go and talk to a group that might be trying to set up a similar group that we have. It is handy to be able to take this document along and refer to it in problems that it might be having. It is down in writing and, as you say, it will become an act. It can be revisited if it is not managing to get the access to officers that we get. Just to reiterate what you had mentioned earlier, knowing how large those communities are and how prominent they are and work hard in your communities, what plans have you put into place to try to gain some or gather some information about the consultation itself, if any? Does anybody want to have a crack at that? I apparently knew that this was going on until the letter came to come and talk here, really. That is it. Then it has been a kind of doing a little bit and then an awful lot yesterday, looking at the videos of the previous meeting, for instance. Has that made you think about how you would try to put that information out into your communities? I did not know what was going on, because I sometimes go into the Scottish Government pages. I am quite interested in what are in Surich's charges, because we had Alex Salmond up to our centre, and that is our main bugbear. We are at 5,000 pounds in debt to them, and he is hoping to get it that our centre will be charitable status. However, I tend to check up on any bills that I have been going through and if they have reached the act stage yet. I did know about it taking. Do you about it through the DTA, asking us to comment on the bill? You were asking how we are going to pass this on to the community, and certainly now, having got to this point of knowledge about it, I will. I have already made a note that this will be in our next newsletter for the area. Therefore, if you have information, the videos, that all helps. Up to what point are you wanting feedback, because newsletters do not happen on a weekly basis. It is a slow process. It would be helpful to have any information and feedback by 12 November, because that is when the minister comes in front of us. However, this is an on-going process, and you have the right at any time to let your elected representatives know what is right and wrong about certain aspects. This is the first stage of this anyway. There will be room for the committee to look at this again later, but beyond that Parliament itself as a whole will look at the final scenario. Do not feel bound by 12 November if some flash of brilliance comes from somebody in their communities, which often happens. Tell them to let us know. I thank you very much for your evidence today. I know that you are all volunteers, and we are very grateful for you giving up your time and coming to speak to us. I hope that we did that without too much gobbledygook. I suspend and we move into the private session.


one shave everyone doesn't here today we've got another one of these suits that was sent to me from Brian and Marla and I'm gonna try this one out so let's get into this okay so we have another pack here this isn't a black packet just this one doesn't have anything up here in the corner about what it is it just says everything they all say except it you know it's in a different color so I'm not sure it is artificially artificial spicy chicken flavor ramen looks like there's a fire on here so this so we're gonna try this one like I said no there's another one I can't wait to try and it's going to be this one this one see up here in the corner it says do type it's got a lot of flames on it so this will be one of the next ones we try but we're gonna try this one day like I said up here in the corner it doesn't say excuse me what what type it is but here's the nutritional facts on the back if you want to pause this you can pause this and read it maybe hopefully okay and here's the instructions I'm not gonna go I'll read them to you but I'm not gonna show you because I already did that in my last video and a link to that video will be at the end of this video it'll be in one of these corners here and you can just click on it and we'll take you right to it and I show you the whole steps but it's pretty easy put noodles into the 20 ounce which is 600 milliliters of boiling water and cook for five minutes please remove the water remain 8 to 8 tablespoons of water they want you to keep 8 tablespoons in it put liquid sauce into noodles stir fry 30 seconds add flakes and stir well and serve you know what I don't know about the one we did yesterday but I don't know if it said stir fry or or what but I didn't stir fry it maybe I should have okay like this one here will be a little different this one says put liquid sauce into the 17 ounce 500 mil water and boil when water starts to boil put noodles and cover for five minutes more turn the range off and put sauce put sachet powder stir well and serve this one says to stir fry it well I don't have a walk but you know what it says to do this and we didn't do that with the one yesterday I can't remember if it said to stir fry so okay well we'll just put it in a skillet and and stir fry it so put noodles put sauce into noodles stir fry for 30 seconds okay oh we just we'll just use a frying pan I mean it's only 30 seconds I'm not sure what what the difference is going to be so alright let's go ahead and get this opened up and I'm going to get the water boiling and once this is boiled to five minutes I'll kick you back on when we're ready to stir fry for the 30 seconds okay and then we'll go from there so hopefully I can't remember what the last one said so anyway let's get into this and see what happens okay so I've got this on here I went over the footage because I don't have the wrapper from yesterday's so I went over the footage of yesterday's video and they didn't say to stir fry it so we're good there I'm just gonna put a little bit of oil in here I'll crank this up it's only going to take 30 seconds I left about eight tablespoons of water in there that says to see we got the sauce it says to put liquid to put liquid sauce into noodles stir fry for 30 seconds well I'm just gonna go ahead and I won't put this in here when we start stir frying it I'm trying to get it real hot here and let's see if it's hot enough yet let me turn it down now right a bit of sauce in this one it also comes with flakes right here but you put these on when you're getting ready to serve so like I said I don't have a walk so we're just going to do it this way this one by the way was in the square like they usually come the one yesterday in the paint package was round all right so this is about done crap I got to get a bowl and I'll be right back with you guys okay guys so this is what it looks like I did put the flakes in it kind of disappeared you can see them close if you look closely mostly what it looked like to me with sesame seeds so I think that's what it was sesame seed and there was some kind of nothing see that kind of green thing there some kind of spice so but smells delicious so it's kind of cool we got to stir fry even though I don't I don't have a walk I've been wanting to get one I've been saying that I haven't had one for a few years so I've been saying that for a while now let's back out and I'll flip you up here so there we go so anyway tomorrow I'll be I'll do a little vlogging with you guys I gotta I'm gonna make some homemade bread a couple of the homemade bread some homemade noodles for Thanksgiving for Thursday so I'm not sure if I'll do it during the day I think your mom wants to make a couple pies so that'll be good and so I may do mine in the evening because I know monkey likes to help me with the noodles I guess she likes the way they come out of the cranking machine but anyway I think most of you guys knew my sister my sister wasn't good she was in very bad condition very bad health but we're going over to her house that's right her house Thursday she's been out of the hospital for a little bit now I'll explain to you more on a later video but she's fine I mean not fine but you know she can't quite walk yet and they didn't think she was gonna be able to talk because they had a trick they had to put a trick in her throat and but she's talking it just kind of sounds like she's got a cold so she really man really fought back of all the things that that was going on with her so proud of my sister so we're going over there Thursday to see her for a while as well so anyway let's give this a shot hmm tastes similar to yesterday's but this one has a bit more kick yeah a lot more kick you can taste the cheese doesn't say this one's cheese but I can taste it you know samyang that bird again so let me give another little shot here that's a big buddy we'll see I mean I feel it's not like super duper hot but it's hot it's kind of the same amount of heat as the same as there is spices you know I mean it's very spicy but there there is some heat in this one man let me tell you guys so we'll get a bite here so this one's very good this one as well gets a two thumbs up my guess is they're all gonna be good we got three more to do after this one yesterday's wasn't was a two thumbs up with eight on the flavor and I'm gonna give this with this one a two thumbs up with an eight on the flavor and a nine on spice which is good to me that means I really like it so far these are awesome thanks again guys for sending this to me and thanks to everybody for watching I'm gonna finish this getting pretty late did a late video today so so yeah anyway she better admit the man legend gone for now stay tuned for more awesome videos I don't know if they're awesome to you but anyway they're fun to make hopefully they're fun to watch we'll see you guys soon and y'all stay safe thanks again guys appreciate it and we'll see you guys in the next one and I guess it's all I got I'm gonna finish my meal bye bye guys and take care


I'm honored to be speaking with among all these wonderful cardiologists that I actually look up to, so this is great. So I have to give a little credit to Dr. Stainback who actually has given similar talks and discussions about Takasubo and he kind of helped me figure out what I was going to do and the approach I would take to presenting Takasubo to you guys. So here's my outline. I'm keeping this a little more clinical to keep it a little fun. So we have a patient case that I'll be talking about and then kind of bringing the etiology and the pathogenesis and all that stuff later on. So this particular case was a 71-year-old female. She was actually a retired pilot. She lived alone. She had chronic medical conditions as you can see here, COPD, hypertension, dyslipidemia, trifecta. She was a smoker. She had recently quit actually but she didn't drink alcohol. She presented initially to the ER because she was short of breath. She called 911. It was pretty sudden onset and she was transported here to St. Luke's ED. They quickly diagnosed her with pneumothorax by chest x-ray.  They called CV surgery. They placed a chest tube. Sounded pretty simple. They admitted her to telly. And this is, you know, the ED EKG, which was actually pretty normal, as you can see. After her chest tube was placed, she said, oh gosh, I feel so much better. They gave her some antibiotics for maybe some bronchitis and then they sent her up to the telly for her. On telly, she was actually doing quite well. She was stable. Here is just a picture of some EKG, some telly strips from her stay when she was there. Again, everything was going okay at this point. Fast forward about a week in hospital day 8 here. They could never really remove this chest tube. She had a persistent leak. It was just a complicated course. She was getting subcutaneous emphysema. This course was complicated by a UTI. So surgery at this point was probably frustrated like the patient and said, you know what, you just need to take you to surgery. And the surgery is obviously not a simple one. They were going to resect these blebs that caused her pneumothorax and then, you know, do a pleurodesis. This troubling conversation obviously caused the patient to feel terrible. And then she developed some mild moderate chest pain. So they got an EKG and the EKG had some changes that were concerning. So cardiology was called. So here this is the EKG initially they got when she was having this chest pain and shortness of breath. And right there in lead 3, you can see there are definitely some changes from her initial EKG. You see some elevation there, which is concerning. Here, this is another EKG that was obtained. When she was still having chest pain, you can see these ST changes have worsened. Most notably, you see there in AVF, the elevation is quite easy to see. I'm a first year fellow and I could pick that one up quite easily. Here we go, Hospital Day 8. She's clearly not feeling good still. And then we see this on the tele strip. And subsequent EKGs, again, very clear that we're concerned for a STEMI here or there's ST elevation that is developing. It's not going away. So here we obviously when anyone has ST elevation and has a good story with no other reasons to have it, we need to take them to the cath lab. So here this is her coronary angiography from the cath lab. And we see here, there's the image of the left system with really non-obstructive coronary arteries, but the timmy frame count is 31 and 19. Not super impressive, but on the right system you see here, again the coronary looks okay, but the timmy frame count is 41. Here is the money shot, obviously. And it's pretty impressive, again, for when we're doing the LVGram. She has a classic, beautiful picture of Takasubo cardiomyopathy. Here you can see her, let me get my little pointer, it's obvious, but in case, she has this really vigorous squeeze here near the base of the heart and then this huge ballooning at the apex, which is actually pretty awesome and impressive. Here again is just the diagram, and it was actually a pretty nice diagram they drew here of this Takasubo-like image we saw in the LVGram. And here her coronary is again really not impressive, just a mild plucking. So here Takasubo, where does it come from? That's why we call Takasubo cardiomyopathy that. It's a, if you didn't know, it's a Japanese octopus pot, and it's really perfect this imaging. It's like a replica of what these pots look like. And again Takasubo is what we say a weakening of the heart muscle, which leads to achnesis and aneurysmal dilatation or ballooning, apical ballooning, is another term we say we use often. Again the basal segments, the base of the heart is hypercontractile and can actually lead to an LVOG gradient. So here some other terms people use to describe Takasubo as a stress-induced cardiomyopathy. Again it's a transient LV apical ballooning, and transient is a really important term here because a lot of these people who develop Takasubo ultimately get better. Most of them do. It's often called broken heart syndrome as well because as I'll talk about later a lot of these people have either experienced emotional or physical stress right before the onset of their cardiomyopathy. It's also has been described as a neurogenic myocardial stunning, and again I'll talk a little bit about why later. This is an interesting point that 90% are peri or post-menopausal women, which is quite interesting. Here are some subtypes of the Takasubos that we talk about in the literature. We most classically see the apical ballooning, but again there's reverse Takasubo, so it's the opposite, it's exactly what it says. You have a hyperdynamic apex and then you have achnesis at the bases. The mid-LV Takasubo is a little less common, of course, and it spares the base in the apex, and your mid-LV, of course, is just quite hypokinetic. And then localized affecting the anterior wall, and you could see how that would propose or would pose a diagnostic dilemma in someone who has maybe an EKG and an echo that you get with these findings, and then you go to the cath lab and you don't see anything to explain your findings. So the acute presentation in general is usually for the majority in the emergency room, and they have a sudden onset of chest pain or chest discomfort and shortness of breath. Of course, most of them end up getting troponins and they're elevated. EKGs very commonly show ischemic changes like our patients did within the ST elevation. They also, interestingly, don't often show ST depressions, so it's mostly elevations. And again, they're always admitted as an ACS acute coronary syndrome, because that's what we would all do in someone with chest pain and elevated troponins. So this disease is actually quite new, and it was first described in Japan, the way it got its name, Takasubo, in 1990. Subsequently, we all kind of agreed that this was a distinct disease and we kind of caught up with them and began diagnosing and really describing it for ourselves. In 2006, it was formally classified as a cardiomyopathy, as a primary acquired cardiomyopathy. This here just shows from 2000, 10 years after it was initially described, kind of how the literature really caught on and people began being interested in describing Takasubos and what is causing it, or really being excited about having a diagnosis for these patients that just have a cardiomyopathy and we don't know why. So it really kind of blew up in the literature and the research at about 2006, and it's still ongoing. The Mayo Clinic has their diagnostic criteria, and these are listed here. So it's a transient hypokinesis. Again, transient is that very important word or dyskinesis of the LV segments without apical involvement. Again, you're cath and you do not have obstructive CAD or reasons to be having this cardiomyopathy by cath, at least obstructive angiography. And again, ECG abnormalities, SC elevation and or two-haven versions, and it's, again, not SC depressions very often. And then they always say you have to make sure they don't have a pheo or myocarditis, which can be also diagnostically hard. Here, this just discusses how the EKG cannot reliably differentiate transient LVA apical ballooning or Takasubos from ST segment elevation like we saw in our patient. Here again, they're just describing these ST elevations that you often see in patients that come in acutely and are diagnosed with Takasubo, and you wouldn't be able to say it wasn't a STEMI or an NSTEMI. Here is an interesting discussion about the biomarkers, troponins, in Takasubos. It's similar, the peak that you have is similar to that when you have an NSTEMI, but the BNP often is more elevated and more persistent than in a STEMI. And I don't think any of us really focus on BNP when you have someone come in or the trend in BNP when someone comes in with a STEMI or an NSTEMI, but that's an interesting finding. Maybe if you have a female that you are really, you think probably has Takasubo, you could trend this. Maybe they can't get angiography, maybe they have a contraindication and you would like to know if it is Takasubo or obstructive disease. And then the catecholamines are usually higher, which goes in line with the thought that this is a stress-induced disease. So the troponins, while they're elevated, they usually do not exceed 6 for the troponin TSA or 15 for the troponin ISA. And some of the literature here says if you do have levels that are higher than this, it's probably not Takasubo. So what is the role of imaging? And as this disease is found and kind of most classically noticed by the echo images or the cath images, obviously it's important. Imaging is an important part of this. We use the cath lab of course with the ventriculography or the LV gram. With this echo, we can use cardiac MRI and then myocardial perfusion imaging as well, the less likely to be used. The cath lab, again, this is what you will see. You will see normal coronaries. Less than 50% luminal stenosis is what they often see when they have patients who present with this. But you can have some obstructive disease and still have this syndrome. And again, cardiac cath is usually necessary if not you need to do it. It's a part of the workup. Echocardiography supports the diagnosis. You will see those characteristic wall motion abnormalities that I spoke about. Again, there are different subtypes, but most classically you're going to see that apical ballooning. Some associated findings in patients with Takasubo's LV thrombus. Obviously you have this big hypochymetic apex, which is a wonderful breeding ground for thrombidiform, especially if your disease is more protracted. That LV outtrack obstruction, again, is very common because you have that hyper-dynamic base of the heart. Which, again, would make you a little weary in using some inotropic agents or some oppressors in patients that might come in in cardiogenic shock with this syndrome. You can also have some mitral regurgitation or RV involvement. Those are less common. Again, on ECHO, it's a good way to verify that your patient has recovered. Usually in a month, a month and a half, you're going to reimagine these people. If they're in a hospital and they're improving or not improving, getting another ECHO is also useful. So again, here's our 71-year-old female. And here was her ECHO. It's classic apical hypokinesis here and this hyper-dynamic base. And you can see her outflow tract is actually small. And here's some color through that outflow tract. You can see some suggestion that the speeds are elevated. The velocities are increased. Here's just another good picture. So her illness was protracted like we said. She initially came in for pneumothorax, had turned into a mess of UTI and bronchitis and persistent air leak, and her repeat image was not better. It was actually looked a little bit worse. So cardiac MRI is another imaging modality that is used and it's a good one for it. It can help you confirm or it can confirm on its own if you see the classic findings. Again, the RV involvement or the RV thrombus detection is cardiac MRI can be good for helping you see this. This is actually, the MRI is probably key reason why it can be used because in when the gadolinium is given in myocardial infarction, you have the delayed subendocardial or transviral hyper enhancement. It's different patterns of the gadolinium that help you in this case. In acute myocarditis, you have the patchy hyper enhancement, which is classic for that. And then in Takasubo, you don't have hyper enhancement. You actually have edema. So this can be helpful in these patients where it's not clear cut or they have an atypical presentation of Takasubo. And here is some MRI, some imaging that will show you what you see here. And it's very clear here in this bottom right picture that you still have this apical ballooning and then this more contractile base. Same here. And there is no hyper enhancement. I think their beautiful picture is actually. So there's no scar. And no scar. Yes, no scar.  Just going for a few more images here. So the myocardial perfusion imaging, again, is something you can use. I don't know how often clinically that this is used. I think there are reports, they differ in a physician's preference as to if they think this is helpful or not, but it can be used. And this just shows the initial EF here. These are serial exams. So the initial EF of 29 and then, you know, two days later. And then 96 hours, it's a very fast, a very quick recovery. And then a couple, a little more discussion about the forms. Again, the typical form is 70 to 80%. Those atypical forms, again, very uncommon, that inverted the basal ballooning very rare, 1 to 2%. So if you see this, it's obviously less likely on your radar that it would be Takasubos. And you should maybe think about other things. And then 20 to 25% for the other types. And this just kind of shows you the segments that are involved in Takasubos and they used MRI to image them. Obviously, we aren't surprised that the basal segments are often not involved and it's mostly the apex here and some involvement of the mid-LV. This is an interesting case where the right ventricle was actually involved and you see that here. You have clear hypo or, you know, achinesis here at the apex and then the contracting basal segments. And here's the reverse Takasubo. I think it's a little hard here because you can't see the apex well. And this patient, this case was here, here with us here, but had an acute cerebral bed. So what triggers these, what triggers patients to have this? And again, I think I've described lots of words that we use stress-induced cardiomyopathy that would describe this disease and it's kind of the same. There's physical stress for sure, which undoubtedly leads to emotional stress, but then there's just emotional stress in itself.  But there's also patients where they might just be experiencing grief or stress, and that's the only thing that you can really tie to their onset of their cardiomyopathy. This is an interesting comparison of the triggers in different countries. So here's California, so the U.S., versus Hiroshima, Japan. And it's quite interesting if you look at just the difference here. So singing in a public area or singing in a public space or playing a guitar in public, these are real examples that they attributed to the onset of the cardiomyopathy. Versus here, there's so much more, there's so much more like tactile, you know, like burns, seizures, death of two sons, a little more harsh. And I don't know if that speaks to the cultural differences, but it's very interesting to see the differences in geography and what people are attributing this cardiomyopathy to. And that gets us to the pathophysiological mechanisms. What really does cause this at the base of it all, at the cellular level or, you know, the muscle level? What is causing it? Today, we don't exactly know, which is frustrating but also makes for an interesting thing to study. So a couple of the proposed mechanisms is the stress hypothesis, the adrenergic stress hypothesis. You have excess catecholamines, which you find in patients with this, which can directly lead to the beta receptor changes and the cardiomyopathy itself. People suggest it's epicardial coronary dysfunction and vasospasm that could cause this. And this is quite interesting. Most of these patients are peri or postmenopausal. Some think it's an estrogen depletion or the lack of estrogen that your body was used to. And then, of course, the brain-heart interaction, which is undoubtedly a part of this, we just don't know exactly how, but they think that this catecholamine response has some involvement in it. But the brain-heart interaction is definitely there. Most of these patients have something going on. This is taken from actually the Takasubo Registry, which I don't know if you haven't just Googled Takasubo Registry, you should do it. It's multi-, many countries, many medical centers or hospitals or physicians. You can go on this Takasubo Registry and you can report your patients that have Takasubo. You have to tell your patients, of course. But it's this large registry, thousands of patients with patient data, and they are all working for the same cause to try to figure out more about this disease and what they can do to maybe prevent or help diagnose or help treat the disease. They also have their publications on this website that they the data that they got was from this registry. One of the interesting papers that they published was about microRNAs. They found, to get to the meat of it, they described the first time that a signature of for circulating microRNAs were biomarkers to distinguish Takasubos from STEMI. Now how clinically relevant is that now we don't check microRNAs in the ER, right? It would be kind of fun if we could, but we don't. But this is just showing you that there are cellular mechanisms and biomarkers maybe that in the future we might be able to use to make the diagnosis of this easier or to at least follow these patients and make the follow-up of these patients better. So, gender and triggering events. I talked a lot about this but again, for females there's a little bit of a difference between females and males. For females it's usually mostly an emotional event or they can't figure out what caused it. For men it's more of a physical event or a physical illness, a little more tactile event that causes them or that we attribute to them having this. 90% of current of these patients or Takasubo cases occur in women and again that mean ages is post-menopausal or perimenopausal of the patients that do meet that criteria for ACS that diagnostic dilemma you have when they first come in for women, 69% will have Takasubo's and then compare that to men where only 0.5% or less than 0.5% will actually have Takasubo's. Men when they have it they will more likely than women have an out-of-hospital arrest which I found quite interesting. Alright so treatment again why the registry exists we don't really know what the best treatment is for Takasubo's at this point it's extrapolated how do we treat normal patients who have decreased scallic function so in any patient with heart failure we give them an ACE inhibitor or beta blocker. If they have cardiogenic shock we're going to probably if they need it put some sort of advanced mechanical circulatory support. It's not common that these people come in cardiogenic shock but if they do that's something you can do again because of that LVM outflow tract obstruction inotropic agents are very difficult because you might worsen that obstruction and actually make them worse. Patients who come in with an LV thrombus of course are going to anticoagulate them you're going to make sure that they don't have any arrhythmias from their underlying prolonged QT which is common not common but can happen in these patients and then post-recovery of course if your repeat echo shows that their LV is back to normal most people stop that ACE inhibitor and say we'll keep following you. The beta blocker it's again controversial but they most suggest you can consider continuing that beta blocker so the prognosis again it's good most people most recover and they recover well. Mortality however it still is one to three percent for these people recurrent episodes and this is important actually we just had a patient in the hospital with this four years ago had Takasubo recovered beautifully EF went back to normal came in again in acute heart failure and had a recurrence of her Takasubo took her to the cath lab again because she presented like a stemmy and she was Takasubo so the recurrence is about ten percent they say and that's a four year recurrence rate here is a New England journal article I forget exactly oh here we go September of last year quite recent and it came from this registry that I was talking to you guys about they looked at all the clinical features and the outcomes of all the patients that they had in this registry which was huge so up here you see 1700 about patients and they took them down and they got their clinical profile they got their in hospital complications and they figured they tried to decipher what characteristics made some patients do better or some patients do worse so I'll spare you from trying to read this but the most interesting points of this article was more than half of the patients with Takasubo's had an acute former or chronic neurologic illness and that's that brain heart interaction that we know exists we just don't know exactly why consistently and this speaks to that point consistently histopathological findings in the cardiac tissue resemble in patients that died of an unexpected epilepsy or seizures or subarachnoid or some large event in their brain resembled those of patients who died during an episode of Takasubo cardiomyopathy so those patients that died from just a neurogenic event had very similar histopath histology that resembled these Takasubo patients and here are from that same article the data from the registry the death from any cause per patient year in patients with Takasubo's was 5.6% the rate of major versus cardiac events was 9.9% per patient year and the rate of stroke or TA was 1.7% per patient year the recurrence rate again per patient year was 1.8% with a span of 25 days up to 9.5 years to the first event so that the increased risk sticks with you even if it doesn't happen in 4 years down the line or 4 years down the line like the patient we just had and then interestingly men had an increased rate of death from any cause compared to women if they had prior Takasubo and this this point helped me in dealing with a patient that we just had in the hospital the use of Acer ARBs pretended a mortality benefit but a beta blocker didn't in patients that had Takasubo so if you put them both on both Acer and beta blocker the beta blocker patients or the patients who were kept on a beta blocker didn't do better the ACE inhibitor was the only thing that pretended any mortality benefit down the line so maybe keeping them on a beta blocker is not helpful and then with all of this are we under diagnosing Takasubo it's such a new disease a lot of these patients just get admitted with the thought they had a STEMI or an NSTEMI or maybe they had an NSTEMI and then they recanelized we do need perspective studies this is just going to show you that in patients who came in post-menopausal patients with an ACS at a community hospital non-ACS in 75% and Takasubo in .3% of those ACS with troponin and EKG with troponin and a clinical story but Takasubo in .6% about .6% of those it's pretty impressive actually so how you know how concerned should we be and what could we do to prevent Takasubo in patients who you might identify as high risk who is at high risk we don't know about that and then who really gets it like that comparison of the patient or the patients in Japan or the patients in California what amount of stress actually causes this heart-brain interaction or this emotional stress to become physical and this is just another example should this patient have Takasubo or should this patient have Takasubo again we don't know so here are some key points Takasubo is relatively relatively new it's I guess now 26 years later since its first was described 90% of the patients are women greater than 50 years old you have to have a clinical suspicion and if you look at that Takasubo registry website they have a little risk score so if you have a patient that you're taking care of who comes in with a troponin and ST elevation you can put their clinical features in and it'll say the probability that they have Takasubo and the data that they use from the patients they have the complications while they're not quite not that frequent they are real and you have to monitor the patients for them especially that alvephorombus and the hallmark if you have a patient with them as you can tell them they're probably going to get better and there are plenty of review articles and you can go online and look and read more about Takasubo and thank you very much for listening thank you


Meanwhile, Baselona have submitted a complaint to the European Commission in a bid to stop a resumption made from signing a Lionel Messi.


They eat where the police command has trained more of its personnel in riot handling and tactical combat readiness to strengthen their job performance in the line of duty. The three-week training is coming barely a month when the command also trained over 50 officers in arms handling to address the increasing wave in illegal arms discharge in command. Speaking of the brief parade exercise ceremony held at the Isaac Borough Park in Port Huckett to hear out the end of the three-week training exercise, the State Commissioner of Police Ola Tsungji Disu said the three-week training had exposed the officers on how to combat riot and other societal crisis in the state. I'm excited at the outcome of the training of these officers who have been here for the past ten, three weeks polishing their trade, their profession. They have gone around all police stations to ensure that their men are trained on this drill. I'm so happy at the outcome. You can see the swiftness and you can see the readiness and you can see the morale of the officers very, very high, they are waiting to go. You know all over the nation you can see what is happening at the moment. We have our own peculiar situation here in the river states. The officers have been trained in riot drills and tactical combat information exercises I'm sure they are looking forward to putting this into practice. We have a lot of situations that training and skills are highly needed and the officers are waiting to go. Now the State Police bus express happiness over the high performance exhibited by the officers who took part in the training, straining or stressing rather that it will help the commentary to reduce crime and criminality to the barest minimum. We are combat ready, we are ready to do our jobs, our men have been trained again and again. About a month ago we embarked on the training of our men on how to undo their firearms and talk to them on the use of them when they could deploy their firearms. Now we have gone a step further. Officers have been trained in riot drills and tactical combat operations that will assist us in bringing down crime to the barest minimum. At the same time I want to ensure that our sure members of the Republic that we are going to ensure that the human right of every citizen is taken into cognizance. Nobody will be harassed with the deployment of these our skills. The state government has given us the assurance to assist and to command in providing some of the things we have demanded. The spectacle of police recently to just acquired some vehicles and riot drills and equipment that have been sent to the command, I assure you that they will be able to respond swiftly and decisively to all lawlessness as they unfold.