Well, thank you to everybody who joined, and thank you to my colleagues. It is great to see this circle of physicians interested in specificity management growing. Thank you to AAP for inviting us to do this again. When Jewel reached out, I was very excited because I think that spasticity fellowships are a little bit of a lesser known secret. And so this is a time when we can tell you about these programs. I'm so pleased to say that we now have four programs nationally to offer this advanced training. Yes, yes, applause. So I am Kimberly Heckert, and I am practicing at Jefferson in Philadelphia, Pennsylvania. And I have a little summary about our program. Let me just share it with you. Okay, hopefully everyone can see my slides. Our program is a one-year program. At this time, we are accepting applicants who will have completed a PM&R fellowship. And it is a clinical fellowship that is very focused on all aspects of spasticity management soup to nuts. So what I mean by that is we get into the nitty gritty with oral therapy and modalities. Our fellows are doing a lot of chemo denervation. They select appropriate candidates for intrathecal baclofen trials. And when those trials produce good results, they can observe the implantation. They're not doing the surgeries. But then they're doing all aspects of the management, including troubleshooting, including preparing people for pump replacement surgeries, and even when the occasion arises to handle an urgent matter in the hospital setting. We teach neurolysis, and this is done with chemoneurolysis with phenol. And I'm also pleased to say that our fellows are now learning cryoneurolysis as well. And we are very fortunate in Philadelphia that we have a number of really excellent centers for surgical procedures done for sequelae of neurologic problems. So we have teams of surgeons that do things like tendon transfers, nerve transfers, tendon lengthening, and nerve transfers. So it's great that our fellows get exposure to those procedures and understand when to refer to our surgical colleagues. So it's a very clinical fellowship. There is a requirement only for one scholarly activity. Every fellow has done more than one scholarly activity. There's no research requirement for this fellowship. It's very heavy procedurally based. We put a lot of emphasis on making sure that our fellows are competent in the procedural aspects as well as evaluations. And as I mentioned, it's located in Philadelphia, although our fellows do see some clinical work in Delaware and New Jersey. And right now we are currently training our seventh fellow. So we've been through this six times. I think it keeps getting better and better. Our grads are some of my best friends. They are all involved with spasticity management in their clinics with teaching. Some of them are doing clinical research and some of them are also doing advocacy. So I'm super proud of them. And this is a very busy slide of our fellows and fellowship grads and some of our faculty members. I would say that our program is, you know, we're very close. We're very much like a family. There's only two of our babies represented here, but we have had many fellowship babies that we call our little tone squirts. And I'm the auntie of all of them. And you know, I'm just very pleased that we've been able to stay close. So this is some of our fellows in action. And I thought it might be important to note that if you should be interested in our program and you should email or call, you will probably first hear from Catherine Rahman, who's our education coordinator. So I included here my information and Catherine's, and you are certainly welcome to email us for more information. And you might also note that there is an email at the bottom, spasticityfellowshipatjefferson.edu and that is an account that if you email that she and I can both look at. And finally, I just wanted to say that we are in open season for applications. If you would like to know more about how to apply to our program, you are free to scan this QR code. We are still accepting applications. And every application that comes through, I reach out to that person and, you know, see if they have questions. It is not necessary to do an audition rotation with us. However, many of our applicants have chosen to come out and take a look in person. So if that's something that you would want to do, please reach out and I would make every effort to try to accommodate someone who would like to see the program. So that's really all I have to say for the moment. I want to open it up to my colleagues. I'll stop share and turn it over to the next person. I don't know who would like, I know Cindy wants to go last. So John. It doesn't matter. Either way. Go ahead, John. I'm learning from you guys. Well, it's great to see everybody. It's great to be seen, actually. So I'm back down to earth. I decided to come back to earth. I got my computer, took that learning boot up my computer. That was the delay. And so I don't have I didn't prepare a slideshow. Sorry about that. So you're just going to have to rely on my delightful personality to present. But Kimberly did a nice job of going over. We do all the it's very everything is the same, except it's in Milwaukee and not Pennsylvania. And then one thing that that we do a lot of is is diagnostic blocks, which I don't think you included on your slide thing. It's my my passion. I love doing them on inpatients and outpatients, although I forgot to do it on the patient today. And so Ryan will probably bring that up. But anyway, we but anyway, I love doing that. It's a precursor to sort of help to see if a toxin injection or a phenol injection might be useful. But our program, very similar. We're now in our 16th fellow who is fabulous. So thank you for sending her our way, Kimberly. And so she's she's getting settled into Milwaukee and and she's she's going to be wonderful. She is wonderful. It's not going to be Shardia. So even more wonderful. And we put it I I do like the fellows to get involved in a research project. I think it's I've always sort of felt like because I did a fellowship before fellowships were cool and before fellowships really even existed, I think. And so it was at and it was an unnamed fellowship and at the Rehab Institute of Chicago. That was sort of a how you can sort of make your own way or you can make it how you want to do. So a lot of people chose because we didn't have sports back then. That's how old I am. We didn't have a sports fellowship, believe it or not. So people chose to do spinal cord or brain injury, the good old nuts and bolts stuff. And I chose to do stroke and spasticity because there was an anesthesiologist there that was doing a lot of phenol injections. And at that same time, I was doing my fellowship. That's when Botox came out and the pump came out. So it was a great time to sort of have a year to sort of design it and follow people around and how you want to do it. So I've kind of mirrored my fellowship or the fellowship here at the medical. I should probably say who I am. I'm John. I'm at the Medical College of Wisconsin in Wisconsin. It's in Milwaukee, Wisconsin. And so I want to mirror this fellowship in the same way and so forth. We've been able to get funding to support that in a way that we can design it how the fellow wants to do it. And my number one criteria is you have to commit to getting really good at something ideally related to spasticity management. And that's where we kind of look at that and say you because it's the one time when you're not a resident and you're not an attending because I can tell you when you get on the real world, it's all about RVUs, no matter how they sugarcoat it or that sort of thing. And so you're going to you're forced to sort of and now it's it's and you're getting not to hate to be the very bad news, but you're actually getting paid less for what you do. So you basically have to do twice as much as so it's getting it's getting harder. The fellowship, I've been able to protect our fellows and not forcing them to do any more clinical work than they want to. But the way to really get good at this is to see a lot of patients, as Kimberly suggested. So you're going to. So ours is very heavy on the clinical thing, too, but it's it's designed and how you want to do it. So we have a PEDS component if you want to spend more time in pediatrics. We have heavy EMT component if you want to do that. We have gate labs. We have imaging areas and we have a close affiliation with Marquette's biomedical engineer department. So a lot of our research are done in collaboration with them. We have a couple of full time researchers in our department that are in the cardiovascular center. And so we have a sort of a breadth of areas that you could theoretically get involved with. And so the medical colleges is a surprisingly large place for you don't think much about Wisconsin or Milwaukee other than beer and cheese and probably the Packers or something. But it's actually quite a large academic place and a lot of opportunities to kind of take it. The fellowship is being like a smorgasbord of of what you can sort of pick and then and then we set it up and do it how you want to do it. So there's inpatient and outpatient sort of components to it. The inpatient part, we have a free and relatively new freestanding rehab hospital, 50 beds. And so and then we also have a large level one trauma hospital where there's lots of specificity patients. And so doing the inpatient is worthwhile and that sort of thing. So but other than that, it's very similar. It's one year long. Our recruitment, let me see. I went out a little bit. Where is it? If I can find it. Okay, right here. Okay, let me see. Let's see. Okay, so, so this is our, just like, recruitment material, and so, and I also have, well, pardon me for interrupting. Are you, are you wanting to share your slides? Do you, do you see my slides? We don't. You don't? No. I'm sharing them, so. Can you try again? So, let's see. Go back and. Hit stop sharing and share it. Okay. Sometimes it takes a couple times. It's, let's see, it's coming. Well, I don't see. Let me go back and start sharing again. You could also email them to me real quick if you want and I could bring them up. I had this issue with them last week. Okay. Well, anyway, I just somehow it's just not coming up. So, our fellowship is kind of new. We just started our last year we have our first fellow, she started late, and she just about to finish and fellowship next month. So, just like my other colleagues we do all the procedures and spasticity management and like the all the toxins and then the peniles and we have a quite large intertickle baclofen program and we have close to 400 intertickle baclofen patients and do all the diagnoses and then we just started doing the prior procedure and also one of my hand surgeons, hand surgeon is interested in starting the hyper selective urectomy program. So, we just kind of collaborating with him and we do the blocks and then to see just like a preparation of the procedure and then validate the patients together and he's about to start doing his first patient. And our faculty is all multi-specialty. We have all the PM&R faculty and neurosurgery, neuroradiology and our program just like at Jones has an optional of the pediatrics. There we have a pediatric hospital and pediatric PM&R faculty and also a movement disorder faculty and neurology movement disorder faculty and they also do all the procedures and our chair and all of you know that Dr. Kim is a you know big spasticity grew and she's well supportive and she's actually starting the cryo program herself and so when I just getting preparing this spasticity fellowship program and started with the you know learning objectives and what the fellow needs to learn and write the goals and learning objectives and also have the faculty and set the lecture series and I'm sure all of you they have this formal educational program and then we also are expect the fellow to some kind of publication or presentation and it may not be necessarily the the big research activity because of one year is not going to be long enough and to do anything and you know IRB related research but fellow can choose anything wanted to do and so we obviously mentor and help and then also we have to do of course the program evaluation and to see as as I said we are quite new and to see how we have done and with the program and to see and as Kimberly said and spasticity management is I mean the spasticity of the world is small we know most of each other and I mean Cindy and I we just kind of started this 30 years ago and then and I always just tell the people how brave we were and without any indication yeah and he's treating the kids with the toxins and I mean we did start treating the kids and then of course it just kind of evolved to the adult world in that time and so anyway that's just the fellows and even just in our former residence and chose to do the spasticity management and they in the family we are always mentoring and then we always help them and just including just like finding a job and that you know we are always there for them if they have any questions I'm sure all of you and you hear from you know residents and fellows and when they need to have confirmation you know what they're doing and so our fellow is doing like procedures and also doing consultations and helping the consult team actually is an inpatient that's the most important job for the fellow to support the consult team on spasticity management and mainly just like a troubleshooting of the you know intertical backlip and patients so that that has been a great addition to the consult team and having talking about just like just like challenges you know starting the program and my most challenging was the finding the funding for the fellowship so I have a call and ask my colleagues just I talked to Kimberly and you know some others and so that that has been challenging first and trying to have my institutions and to invest to spasticity management and so it took a while but so with the determination and great work it has come true so thank you so much so glad that it came through it is hard it is hard to get the funding that is a big step yeah all right my turn I suppose yes for those of you who might be interested in the fellowship look at the dedication in this room because room because it is hard to get funding and it is to get it started up so I'm Cindy Ivanhoe I am at that's a long story but I'm at UT and I am at Tierra Memorial Hermann where I have always been let's see if I sent Candice my slides just in case don't panic when you see my desktop because people say that it gives them ajna as we used to say in the east coast all non-view all right I threw these together so I did a fellowship in a different century quite frankly in brain injury and partly because I was interested in spasticity much like John John I don't know if you remember that when you were at RIC and I was a resident I went and met with you to talk about the fellowship I bet you don't remember that judging by the look on your face but that is totally do no because I mean that was they had two unnamed fellowships and so I did spasticity stroke and uh and Hoke Zini did sports she was the first one to do a sports fellowship with Joel Press that's funny so I did a brain injury fellowship as part of Baylor that was largely at Tierra John Cianca who some of you may have heard of um was the other fellow and he did musculoskeletal so there's the good news and the bad news we have funding for a fellow we have no fellow because we are waiting for the state of Texas medical board to bless the fellowship and I'll have to talk to Fatma about that in the background it's supposed to come through any day now so I don't want to make a promise but I think it will be up and running for the next um academic year so I am in theory the co-director of the spasticity fellowship that we're offering with Sheng Li who is big in the cryo world now uh Gerard Francisco Rada and and Argy Stampas um our spinal cord docs Mary Beth Russell also teaches uh the steps spasticity certification amongst other things Abana Azariah is our DOC director disorders of consciousness Stacey Hall is the director of PEDS Sudha Talavijula is on there but mainly she is a neurologist who does the ITB trials for us because there are not enough hours in the day and Brian Bruhl is um adjunct faculty and um one of my go-to implanters who is a physiatrist who went into pain management I think Fatma knows him um before it was like the sexy thing to do so that's and Abana came from our our uh right she did her fellowship she was our resident she did her fellowship at Moss and then she's back now yeah so um seem to be have a the like a junior Brian right now so you started you have a bunch of our brain injury fellows too so it's a little um a little bit of nepotism here but anyway in addition to the what I would call the basics you know like um taking care of patients oral medications botulinum toxins etc um there is an expectation for the fellow fellows to participate in some of the ongoing research projects but I think it was Fatma said it's very hard to have your own research project with one year um but there's a lot going on a tier spasm is a committee that I run um when I I took a year away when I came back as UT faculty instead of Baylor faculty um I started a committee and we meet monthly to try and make the spasticity delivery in our system a little bit more cohesive because a lot is the philosophy of care and then periodically I will have there'll be presentations uh where hopefully our therapist has to represent the whole team on a particular patient because I didn't want OT does this and PT does that they had to see how the big picture comes together so we have those presentations and I'll warn those of you whose cameras are closed that I make everybody open their camera when we do that so I know they're at least pretending to watch um we do a weekly neurorehabilitation lecture series that's along with the spinal cord and brain injury fellows um their department just UT PM&R things that go on um I'm very involved with the real abilities film festival in Texas in Houston so next month their didactics is going to be analyzing um disability uh through the films for a couple weeks anyway um the fellow is expected to meet with his or her research mentor on a regular basis Shang would like it to be more frequent than I think is going to be feasible because I put that up there um and to deliver at least one paper from from their fellowship um there are always opportunities that come up somebody needs help on a book chapter or or what have you and then there are assorted other sort of social events probably through the year um and and these are pretty much the the presumed goals and you I don't think there's anything here that you wouldn't expect or haven't heard about from the other programs I think it's also very important for people to understand not just because that hand is tight I'm going to inject it but functionally where does that fit with where your patients are with their diagnoses etc um the fellow will be um doing at least four or five different sorts of botulinum toxin injections nerve blocks lidocaine uh phenol managing intrathecal baclofen pumps troubleshooting hopefully hopefully it'd be nice if we didn't have to um to function independently and be able to direct a clinical team or work with a clinical team to become a leader of that rehabilitation team um to learn somewhat of the administrative and organizational skills that go along with trying to run a program and participate in again research that may be going on so um some of our skills would be using or acquired skills hopefully would be um exposure to all the different toxins that are available intrathecal pumps are predominantly medtronic we still have a few with fluonics being able to do those refills know how to program those pumps motor point blocks nerve blocks cryoneurolysis and then of course be able to use the different localization techniques and then something Kimberly talked about that I think is really important is for people to understand how to not lose your shirt using toxins in the short version this is a slide that Shang made that I think is really busy and overwhelming but you get the idea and that's I think all I've really got on our fellowship so the goodness is we have funding the bad news is we're still waiting to get our first fellow um hopefully by the time um that it's time stop sharing um for people who are would be applying right now for for a fellowship so that's all I got thank you so much um so you know I also wanted to say to those who are on the call and to those who may be watching this pre-recorded later um we really appreciate your interest uh the world needs you um there are you know spasticity is very undertreated globally but you globally but you know especially for a nation with as many resources as ours um it's very undertreated so we have great need to train the future generation of physicians who can manage spasticity and as uh Cindy mentioned so well to lead the teams in the treatment um and so anything that you can do to make yourself better in that area it will be good for you um because as John pointed out this is the bread and butter of physiatry all your skills are used in this and um and then some that you really don't get to um fine tune as much as is really needed to do the job in a typical residency you know the residencies there's great variation in what each program uh can offer in terms of hands-on experience for physiatrists so perhaps you know you might be one of the lucky ones that gets great exposure but to really be good at it in the way that you know like John was describing um you really need to do some of these procedures again and again and see different presentations um to understand so um I wondered if we should open up for some questions how are the rest of you feeling is this a good time to get some questions are there any other comments sure uh so my question is uh or actually uh it's a challenge for us uh we get some patients uh intrathecal bacloven patients and uh move to to Dallas metroplex area, and then they cannot find any provider. Unfortunately, some of them we cannot accept because our facility is not in the network. So, and I think this is just kind of challenge for us and some mothers, is willing to pay cash for pump refill because she's frustrated she can't find anybody, especially some Medicaid patients and Medicaid exchange program and nobody in the world is in the network of this programs. So I think what I will ask, how do you, if your patient is moving and a different facility, I mean, with different town or different state, and how do you manage the referral? Is, I mean, we usually, when our patients wanted to move, when we are aware of that, and we refer them to Medtronic, the reps, and try to get the providers where they are moving and try to give the patient choices and those are the providers and can manage you. So, but I don't know what the rest of the world is doing. That's an American problem, frankly. We're in an interesting situation right now because we are UT faculty working at Memorial Hermann. Memorial Hermann has decided to only contract with one of the Medicaid providers and UT won't. So basically it would be patient abandonment if we don't treat them. So my RVUs will continue, but the collections won't because I can't turn people away like that at this point. And while everybody's making, having meetings about things like Epic and I don't know what else, US News World Report maybe, those patients get stuck. But I've actually had patients move to like the Pacific Northwest who have Medicare and a good supplemental and can't actually find physicians anyway where I've had to call physicians directly and see how long it'll take. I had one patient who for about a year had to come back to Houston to get his pump refilled because he couldn't find a physician. They were too busy. So I think it speaks to a frustration that we may have. I don't know if it's better in the East or the Midwest, but it also speaks to the need and value that we have for people to be more interested in treating these patients. These are long-term patients. And if you enjoy having a long-term relationship with patients, I personally do, it's one of the things I liked about rehab in the first place, then it can be incredibly rewarding. Healthcare in general can be incredibly frustrating. And sometimes depending on the Medicaid and the institution and the doctor, you can get them to negotiate some sort of special contracts. It takes a lot of effort. I'm just noticing that there's a question in the chat. Thank you both for those comments. There's a question that said a participant is interested in comments on the current job prospects for spasticity trained fellows. So I have seen what our grads have been offered and they're all making more money than me, but I am grateful that actually a couple of our recent grads are on this call. So in fact, I would rather turn this over to Dr. Martinez and Dr. Mulhern. Dr. Martinez, would you like to comment as the most recent grad first? Yes, I would be more than happy to. Hi everybody, I'm Bianca Martinez. I did my PM&R residency at Temple and Moss and I was privileged enough to do the spasticity management fellowship at Jefferson. And I have to admit, I was very, very interested in spasticity management. And just like you said, Ryan, afterwards, I thought, how do you get a job in this? And the fellowship is really key because it equips you with the tools that you need to be an expert in the field. And you can market yourself as such. And I had no problem doing that. And I had ample support from so many wonderful attendings. But really spasticity management is so nuanced. I felt like I got really good training as a resident, but not enough to be confident enough to go to an academic institution or private institution and just solely focused on that, like I plan to do at my current job. You have to know functional anatomy, gross anatomy, really understand ADLs, patient goals. And of course, all of the procedures like intraphecal baclofen pumps, the phenol, the diagnostic blocks. It's really, really nuanced and it requires you to see new patients, follow-ups. And I think I got excellent training and I'm really lucky that I had that. And I had no problem speaking with attendings and medical directors at both academic and private institutions and explaining to them that this is something that is important. And it's also very financially viable in any setting. And I'm excited to bring it to, do more of this in the Jersey Shore, which is where I am right now. And our fellows have been able to negotiate really good salaries for starting out. Dr. Mulhern, do you have a follow-up comments? The same thing, by the way, Dr. Martinez, thank you for that. So I was one of the Jefferson Spasticity Fellows as well. Currently I work in a private practice, joined one of the attendings who's part of the fellowship as well. So as far as jobs prospects, I think you really could approach any already established practice and make the argument of how you could add to improving care for the patients that they already have. I know a couple of the spasticity fellows approached like neurology-based groups that aren't as comfortable managing the spasticity component especially the pump component. So going into it that way or going into an already established rehab program in ways that I'm supplementing income while I build up my practice because it is a private practice. I do subacute rehab consults, which is something Dr. Heckert was able to share a lot of wisdom with because she has a lot of experience with that too. So that has been incredibly flexible as I have two little ones at home. So being able to have flexibility with schedule in a private practice as well as the subacute has been incredible. So having that flexibility because you have such an unknown and not really tons of people have this skillset, you are in demand. So you can kind of dictate what kind of position you're looking for. Our fellow was able to get a job so easy. I wasn't really involved in her job seeking. However, so she was hired in one of the seven physiatrists and has very little spasticity management going on. And she was hired to expand and actually just start the intertical back-to-back program. So, Dr. Vaino. Ryan, you'll have no problem finding a job. None of my fellows are unemployed. Let's put it that way. That, no, you in all seriousness, because as you, I think, you know, for the residency, you can be a dabbler in spasticity management, but if you want to be a champion and a real advocate for patients that really need it, and if you really want to make a difference in a population that really needs help, this is, I mean, I think, you know, why there aren't more spasticity fellowships? Because the skills that you will learn in this are really just scream and cry for a fellowship training, because in all these programs that you've heard about, you will learn and you will get really good at doing it. But the main thing is, you're gonna become an advocate for patients that really need it. I mean, I was recruited to come to Milwaukee. That wasn't like there were all these patients that needed, they're there, and they just need someone to go out there and shake the tree and show them and educate the therapists and say, here's a service that we can provide. So you can go into almost any group practice that's affiliated with a hospital, and you start shaking the tree, talking to therapists, and I tell you, you're gonna have more patients than you can deal with, because it wasn't like, you know, I mean, I've hired, what, five of my previous, I mean, just to manage the patients. And so you can build it if you are savvy enough and just by doing a good job. And with a fellowship, you will do a good job. But, you know, residency, like you say, there's too many other things to learn that you can be a dabbler and kind of do it, but you're not gonna get really skilled at it. Or, and the other skill is sort of, like a good scout in baseball, or how do you find a good, appropriate patient that'll benefit from the treatment? It's having that eye for who's gonna benefit and who isn't. And then once you train your therapist, then they become your eyes and ears for it too, and that's how it grows. And, but it's grossly, grossly underserved in so many areas, except our hospital, because we're a spasticity-free zone, and we've made it that way, but we have the man-woman power to sort of service that. And so if you're in a place that sort of has an eye for it, you can grow a very big practice. You can go into a lot of different areas. I just know it's underserved. Like you say, when pump patients go out there, you try to find a place, and there's no one there that's really skilled, unless you're in a bigger metro area. And so, go ahead, yeah. Yeah, I mean, if you just look at the number of just pick stroke survivors a year, and a large percentage of those patients have spasticity, or for me, I always often say, once you're an injector, you're an injector. So you end up getting also potentially migraine, and dystonia, and funky tremors, and interesting patients to manage in different ways. And so it's not like they're, depending where you would want to end up practicing, there is no dearth of patients that would benefit from the skillset. I couldn't agree more with John that spasticity management, you have to, as a physician, and you have to be the advocate of the patient. So, and I have a long private practice experience somehow where I was, and thrown in the situations, I developed this spasticity program in private practice. When I made the change to academics, and we have a very big county hospital. So when I saw that, there was a big need of the spasticity management in that county hospital, and indigent patients, and like non-insured and under-insured patients. So, and I quickly approached my department, and luckily, without much resistance, we were able to start the spasticity clinic. And years, years, years later, we start with the toxins, and had a resistance for ITV program, but working on it, and just kind of showing the need, need, need, and then I was able to get approved the ITV program for indigent patients. So, and I think that the spasticity clinic at the Parkland County Hospital, it's a well attended clinic, and just like a, you know, those type of patients and no-show rate is very, very high in a patient setting, but spasticity clinic, no-show rate has been very low because patients know what they're getting, and they're getting better. They cannot miss their injection appointment. They cannot miss their, you know, pump refill appointment, so. And just, I'm talking to the young people I'm interested in, and just put that in your peace of mind. And so, just as Cynthia said, and it is a lot, a lot, a lot of patients, and they don't have, they don't have access to spasticity management. I think that's our, you know, the older people's goals to improve that and give the patients what they deserve and have them have access. Dr. Shields, I'll add that I get a lot of emails from outside practices, institutions, asking if we have anyone who's interested in coming to work for them because people are seeking someone with expertise in spasticity management and neurorehab. So, I do know that practices are searching for individuals with that skillset. So, I'm just noting the time. Are there any final comments from our panel of directors or our residents listening or our recent grads? Should I, I could send you some, the details about our program. I'm sorry, I should have had that ready for tonight, but I was slacking. Well, I'll have, put that together and send it in so it can be part of this or added later or indexed somewhere or referenced somewhere that at least I, due diligence. Yes, we'll add it. We will add it somehow, whether it's on the virtual campus or as a final slide. I would do the same, Candice. Yeah, if everyone would like to send any information, I can attach it to the recording. And I'll send all the baby pictures of our baby fellows too. I think it's a great idea. Yeah, it's great. We're a family. And for our, for those listening now and later, we're seeking current PGY-4s. People have just begun their PGY-4 year for next year who can apply, so. Okay, well, thank you, Candice. Thank you to AAP. Thank you to the listeners and thank you to the program directors and- Thank you all, this was wonderful. We so appreciate your time. Have a good night, everyone. Thank you all. See you, everybody. Have a great summer. Vote early, vote often.

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