 Well, it's exactly 10 o'clock and I want to welcome you all. I'm Beverly Mitchell I'm a professor of medicine in the school of medicine and also the director of the Stanford Cancer Institute And it's my incredible pleasure today to talk to you about the Jill and John Friedenrich Center for translational research This is something that has been in our view for a number of years and we are opening this wonderful facility in a July of this year, so we're going to give you a Real explanation of what this facility will do and then you will hear more specifics about the facility itself Which is an incredible Wonderful building that will I think really amaze you in terms of what it can accomplish so this will be a virtual tour since the building is not yet quite complete and What I wanted to do was tell you about the reason for this building So translational research is something that we're all committed to you hear the term the question is what does? Translational research really mean and it's an interaction of clinicians and scientists that will take our fundamental research and apply it to all facets of patient care and Improvement of patient care so as diagnosis treatment and prevention So this involves clinical trials unless we take knowledge and actually test it in patients It really doesn't have the same significance So our goal is to use this information to test in patients and to improve our ability to diagnose and treat disease In addition, there are studies on larger populations in the community that really inform what our needs are That will tell you basic causes of disease in in populations So population science is also a part of what we want to accomplish but what my view of Translational research is that it's at the interface of basic science and clinical medicine So we take those findings from the basic science We think about how to apply them and then we implement them in clinical trials So today we're going to focus really on that interface between Translational medicine and clinical research and this is where we are today We have a pipeline of scientific discoveries. That's phenomenal Just at Stanford you can find five or six investigators at any given time who have ideas That they want to take forward and apply in clinical medicine And yet those ideas are actually being stymied and the numbers of new therapies as you undoubtedly read about is really relatively small In fact, many pharmaceutical companies are pulling back from this kind of research because of the expense and the inability To do the clinical research themselves, so we're going to fill an important niche This is what we call the valley of death and on the left You'll see the likelihood that new discoveries are translated into improvement of health That's the y-axis and the x-axis are the stages of translational research So we have the ability to find new targets We have the ability to Validate those in mouse models and as many people have said if you could cure people the way we can cure mouse mice We'd be in wonderful shape, but that's not the case So there's the preclinical testing and then we get into the clinical trials and that's the first valley of death translating those discoveries into Applications for patients then we go through several stages of clinical trials. We call phase one phase two phase three They get progressively more sophisticated Our goal in the Friedenrich center is to really take the ideas into phase one trials Test them evaluate them rigorously and then move them forward in larger patient populations in companion with institutions like pharmaceutical companies and biotechnology companies and then the second valley of death is when you get to Having a drug really emerge from the FDA and apply to large Patient numbers and again that is a problem in terms of getting drugs into widespread clinical use So we're here with the Friedenrich center to overcome these valleys of death So the challenges basically are to develop these therapies I think you'll see that we don't have that as a particular challenge to determine the efficacies in clinical trials That is where we're coming in and then also an important goal is to train young physicians in clinical and translational Medicine we have just a wonderful Group of people who are trainees here really bright who really need that kind of intensive training So stanford strains. I think you've heard a lot about I think they're absolute They involve terrific science. They involve a number of very very smart people Our clinical services we think are excellent and certainly Now we're spending a lot of time improving those for the community And we have tremendous expertise across the university chemistry engineering Informatics and health policy And we have clinicians who really want to take these Incredible strains and use them for patients So and I think this is not news to anybody. We also have new emerging technologies I know a number of people have asked whether these technologies are actually going to increase the cost of medical care We really believe that when we have these technologies and are able to apply them At least some of them are going to actually result in improvements in cost effectiveness of clinical care So it's not that we're just trying to go to the newest and fanciest device But these involve engineering We have a tremendous department of bioengineering at stanford that interfaces between the school of engineering and the school of medicine Genomics that I'm sure you've heard very much about in terms of developing therapies that are personalized that are targeted to individuals proteomics Imaging high throughput screening and nanotechnology. They're all here and they're all here to be applied to patients So the Friedenridge center is going to stand at the center of our basic science and our ability to treat patients It is that crucial interface It's going to provide something we have not had before and we are tremendously excited about this potential I'm going to give you just two examples of things that will go on there These are things obviously that have gone on but the the kind of things that when this opens in july Will be able to do The first is an example from the department of pediatrics Carrie nadu whose md phd the kind of physician scientist that we really want to encourage Here she has developed a stanford alliance for food allergy research So called saffar and she's engaged in the study of how one can detect and treat Allergies that exist in children Her the definition is that the adverse reaction to food involves an immunologic response and her background really is in immunology And how to apply that knowledge of basic immunology to patient care What she's developed is a test which is called the rapid assessment test Involves a peripheral blood cell called a basophil and a basophil is that cell that releases histamine It's why we all have to take ni histamines when we have allergic reactions It releases substances that that include histamine that cause allergy So she wanted to determine whether how children Basically manifest an allergic response and when you take a history, you know, many of us have had Allergies perhaps a little hives nothing very specific She wanted a test that would actually be able to determine the specificity of an allergic response So she looked at this basophil and she found that if you look at the The these little granules within the basophil You can see the granules there this large blob is the nucleus They are coated with a material that is really Called well, it's called cd 203 c what that means is not really important But when that basophil is stimulated those surface granules move to the surface of the cell and can be detected by an antibody So the ability to activate basophils can be measured by the movement of these small granules to the surface So when you measure the granules on the surface, which is shown on the y-axis You can see that children who are allergic to peanuts and this applies to other allergens as well Have a markedly different response than do controls So here's a simple laboratory test based on a basic observation in the laboratory that allows us to look at specificity And then allows us to look at desensitization So as they take these children into trials of desensitizing agents, this is a way to read that out In addition, we have a technology. This is an example of applied technology Gary Nolan, who's one of our brilliant People in the in the flow cytometry area where you can detect surface markers on single cells Has devolved a new way of looking at all components of the immune system So he can separate all of the separate sub types of immunologic cells And determine where a block or a defect occurs in the development of those cells So these are all different kinds of t cells and b cells and monocytes all peripheral blood immune cells That kerry is actually Using to determine again which children need Interventions for immunologic problems. So example of applied technology And then close to my own heart is the development of new treatments for cancer This is an example of a observation that was made in the laboratory by jim ford And that is that a breast cancer that has what we call a triple triple negative phenotype That is the absence of receptors for Hormones estrogen and progesterone It's negative for those and negative for another marker and it's a particularly aggressive kind of breast cancer So that breast cancer responded in cell culture To an inhibitor of dna repair As you all know when dna replicates there's some susceptibility to it not repairing itself normally And if you enhance that in these triple negative patient cells You can actually kill those cells much more readily and shown up at the very top Is the killing of the triple negative cells where you see it going down Compared to cells that don't have the triple negative phenotype So this laboratory observation was taken by allison curian Who's a wonderful medical oncologist who deals with the genetics of cancer? She looked at risk factors For patients developing triple negative breast cancer And on the basis of these observations and the risk factors melinda telly Shown here in the bottom right developed a clinical trial where a inhibitor of this dna repair called a PARP inhibitor Was used in with chemotherapy very early in the disease and then the disease was re biopsied The site of disease was re biopsied and she's now treated over 80 patients And found that a large number of these patients go into complete remission even before the re biopsy That comes actually as a as a therapeutic maneuver as a surgical intervention So this is a very exciting study. We've enrolled over 80 patients at present it's gone into a national clinical trial And this is an example of the kinds of things we want to do One of the outcomes of this is that this patient shown in the left louisa golger Who who had this uh experimental treatment went on to develop a program called a triple step Toward the cure and this is a local program Which is to encourage african-american women who are particularly susceptible to this kind of breast cancer To get involved in clinical trials And it's a mechanism for disseminating the information that we gain from clinical research to the community So she is a true heroine We have a number of clinical trials that are coming down the pike And these are going to be some of the trials that we will initiate in the Friedenrich center. We're incredibly excited about shown in the upper panel is a Concept that was developed by irv weisman's group Which is that if you can inhibit A certain receptor on the surface of tumor cells These are stem cells in some cases But tumor cells in others that you will actually enable those cells to be eaten by the immune system So we have a phagocyte macrophage that eats Damaged cells and the expression of this cd-47 actually is inhibitory to that Phagocytosis to that eating process So what we have there is an antibody that will block this that will enable phagocytosis And in preclinical models this target validation. This is really exciting. It's resulted in a number of cases of Again cure of mice So this is something we want to take into the clinic. We're developing this antibody for clinical application A second example is shown in the lower panel And this is another monoclonal antibody as many of you know monoclonal antibodies as therapies Was a concept that was actually originated here and put into the clinic by ron levy So this is a trial of an antibody that actually enhances the immune system It enhances natural killer cell ability to take tumor cells and release Certain substances that actually kill those tumor cells again an immune mechanism And this antibody is particularly exciting and you can see some of the mice where the tumor Actually results in a glow of the of the mouse. That's the tumor emitting a light source When you actually use this antibody alone you get some mild responses But when you use it in conjunction with other antibodies that are known to be effective in lymphoma Had a neck cancer breast cancer you get a synergistic response You get the immune system weighing in and you get the primary response of the monoclonal antibody So one of our young investigators holbrook court who got his MD is phd here Is an md phd is actually taking that into clinical trials and again That will be done in the freed and rich center So these are examples of things that we're tremendously excited about that I think will Really take medicine to a new level So we have the freed and rich center really combining The efforts of investigators from the stanford hospital and clinics from lucille packard From the stanford cancer institute, which I represent and from spectrum Which is a organization that is led by harry greenberg that involves clinical trials across all disciplines So this isn't just a facility for cancer You'll hear in a minute that this is for all diseases including as I mentioned pediatric diseases So again a very inclusive center I'm going to introduce now to talk about this center Niraj nangoria who has led the effort to build this building to make it a wonderful environment for patients I'm sure you're all here to hear more about the building itself Niraj is the associate dean for facilities and Development of facilities. He's been an integral part of the whole development of the freed and rich center So niraj, thanks for coming. Thank you, babe So I'm not a doctor. I'm not a physician. I'm not a researcher. My background is in planning and architecture And so I understood that you go from finding something in the lab to eventually having a cure but I had to understand what happens in between and the more I started to Understand the process of translation. It was amazing to me how you had to first Go through mice models and then you sort of scaled up your research and then you got Other partners involved and you got biostatisticians involved and you got nurses involved By the time you actually came to clinical trials What had started as a small lab group doing work Had really scaled up to a much bigger group of individuals working towards a common cause And the school of medicine being as space constrained as it is People would find a little cubby here a little closet there and you know, cram people left right and center And so the image on your left Each dot represents all the places where this translational work was happening on campus currently our actual Trials facilities portrayed to the right one great. They were very very modest And so that's what we were starting with The site chosen for this particular building Is on welsh road and I wish I had a map of welsh road, but I don't But you can get a sense. It's it's sort of on the edge of the campus It's not on the school of medicine campus. It's not on the hospital campus It's sort of on the edge and welsh road right now is this fairly ugly collection of Clinical buildings that we needed to start to transform and so this building had many responsibilities, but the primary responsibility of this building is going to be that Whereas it sort of intersects between the school and and the hospital The people who are going to be coming to this building could be coming from all over the world And so this building had to create an atmosphere that That helps people get over a lot of cultural issues a lot of other personal issues And so this building really has Even though it's small has very very heavy responsibilities. So that's what we started with And so on welsh road. We're really trying to create a focus of Creating a place for clinical work. We're starting with 800 welsh road Which is shown here to your left But we are also doing a companion building called the wine center, which is shown on the right Which together will form a really interesting nucleus of of clinical work that happens on our campus The first floor of this building includes 27 stations where people can go in for clinical trials And you saw the earlier slide. It was just these chairs that were not very comfortable And one of the really key things about This building is that it is not a hospital It is not where only sick people go We have many many trials where perfectly healthy individuals Go and volunteer and are part of clinical trials. So this building We were very particular in trying not to create a hospital environment But to create a hospitable environment And so when you are in the space, you're going to be looking out into a green garden You're going to be looking out into very comforting spaces The the quality of the space had to be such that when a cancer patient was there And they were going through some kind of chemotherapy There is a tremendous feeling of being very cold And so the space had to be one that allowed them to feel warm and comfortable And yet if there was right next door a perfectly healthy individual who was just volunteering And had three hours to sit there and do nothing they may want to choose to watch a movie And so you had these very different kinds of things that will go on in this building And so to be able to create a space that met all those needs was a challenge We think we are going to be successful But of course we won't know till the building is absolutely done The upper two floors of the building for the first time Are going to enable us to bring all these individuals who are working on clinical trials That have been spread out here there and everywhere Organize them as disease teams so they can work collectively and as a team to really help the process along The process is hard enough with all the regulations and everything else that they're involved in that it it's it's Long and arduous To not have these people in one place so they can act and Feel as a team was really a challenge We will we will make significant progress in overcoming that challenge in in the completion of this building You're sitting in lksc the likashing center, which is Perhaps the first building that has really Turned the ship of the school of medicines architecture Today you walk out onto the school of medicine And there is a very distinct feel to the campus Dean piezo for the last 10 years has been Trying very hard to create the front door to the school of medicine With the completion of this building with the completion of the loki stem cell building with the completion of the discovery walk We truly believe we have created this new wonderful welcoming entry to the school of medicine So this particular building had to speak to that And so it is no surprise that there are elements to this building even though it's much smaller That are reminiscent of this particular building with the way it sort of sits on the street the roof overhang It's not an exact replica, but the stone is the same that we used on this building the sort of color of the Window details etc are all the same, but it is not Exactly the same building so we've been very very careful in how we have detailed this building to really create A connection back to the school of medicine because that was really really important to all of us The building is almost complete. It's going to be Ready in about 30 days. We'll be moving in over the course of the summer By september it'll be fully functional and we would have Merged all our clinical efforts or most of our clinical efforts into this building in the next two to three months So this is a very very exciting time for us Um, just as an example on your upper right, you know, those were the sort of offices that these poor nurse practitioners Were housed in they were crammed. They were terrible. They were windowless. They were you know, and and The business of clinical trials is even today in today's day and age a very paper intensive business We are finally creating a space for all of these individuals. That's going to be contemporary That's going to be comfortable. That's going to be conducive to their work and so not only do we want to take good care of the People who are going to go through the clinical trials but also the staff the faculty and everybody else who's engaged in the business of clinical trials And we truly believe that the Friedenrich center is successfully going to help us do that The last point I want to make is that The cancer center is one of five institutes in the school of medicine The one which is perhaps the most mature the one that has developed the most Stem cell is coming along just fine with the completion of the stem cell building, but we have three other institutes neuro innovation and translational neurosciences Immunology transplantation and immunity and cardiovascular as these institutes mature The point I want to make is that the pipeline of translational work is only going to get bigger And as that gets bigger, hopefully we will overcome more successfully the value of death that Dr. Mitchell Spoke to and we will be on the forefront of more discoveries So this is a very very exciting time for us We are looking forward to the completion of the building and i'm going to turn it back to dr. Mitchell Thank you, nirash. I think the the lesson is that we have wonderful strengths We have not had the ability to bring those strengths together This building is going to be transformational for us It's going to allow research across the campus across the school of medicine It's going to help patients. This is a patient survivorship reunion And we we were just thrilled that all these people return these are all bone marrow transplant survivors But we want survivors of all diseases to obviously have reunions here at stanford and to actually look back at the Friedenrich building and say this is where we got our treatment You know, we are so excited. I have to say at one at the groundbreaking We had some incredible testimonials from people who've been on clinical trials who feel those clinical trials have really saved their lives Have enabled their children to Grow up and they can see them in the case of cancer or really improve the quality of life in a number of other disease types So we are incredibly grateful to jill and john. This would not have happened obviously without Their ability to foresee the future for us and I think as part of the school of medicines future This is going to stand out as a transformational event We'll we'll invite you to ask any questions unless you've got another comment Yeah, I was just going to say that we've also taken very particular care that The facility is respectful of both adult clinical trial participants as well as children because there's a there are going to be many clinical trials involving pediatrics and so There are portions or elements of this facility that are Not childlike but are certainly welcoming to children which is also an equally challenging thing to do so We we do believe we've paid a lot of attention to those details and We'll know in a couple of months Yes, it's a wonderful side Entrance for children with a garden outside and the landscaping in this building is going to be really terrific So we wanted to leave lots of time for questions about clinical research clinical trials or the building If any of you have any questions about what we do, yes Defined primarily by FDA protocols or are there possibilities for innovation and And streamlining. No, no, so this is exactly what we want to do is take new ideas So the process is that if you have an idea That has to go through pre clinical testing of some kind to validate the idea And that can involve cell culture animal models. Cell culture itself is never sufficient You then say this is a new treatment if we're going to use it in a clinical trial You have to get an what we call an ind investigational device approval Even though it's not it's drugs Investigational drug approval from the FDA once you have that the idea is to take Stanford ideas And to take those into the clinical trial not that the FDA will dictate They provide the safety measure obviously they have to approve it before we can actually use it in patients But these what we really want so there are a number of different kinds of trials I'll just quickly mention. There are Pharmaceutical sponsored trials where the idea comes from the company We have a number of those but those are not what we're encouraging. That's not what this building is about There are In the case of cancer cooperative groups Where groups come together and decide on a trial and all the institutions in that group do the trial And then the type we really want to encourage that this building is meant for our investigator initiated trials Where the ideas come from the investigators there may be pharmaceutical involvement in providing drugs But the ideas are all those of the individuals Well, I'm intrigued by the idea of putting all the clinical trials in one place And it seems to me you've got economies of scale of technology And of expertise and I'd wonder I'd like you to go into more details about those kinds of economies You'll achieve with this So economies of scale of uh technology and Yes Yes So, uh, I think in in terms of the physical co-location That's what's critical right now. For instance the bioengineering group There's a person there who is on the main campus who is actually developed engineering proteins that will be able to Attach to specific receptors. She is not in physical Proximity to us. She needs to come over and and be involved with the clinical research team So the clinical research team are all of the people who are going to be interacting with patients And they're on the second and third floors of this building. They are the implementers But the initiators the innovators can come to this building. We have wonderful conference rooms They'll be able to talk to the clinical research investigators themselves So I think is does that answer your question? This is the co-localizing capability that we have not had I would also say that over a period of time disease teams will shrink and grow depending on what stage of clinical trials They are in and this space is designed to allow for That to happen much more effectively if they were all remote You can imagine that you you have no efficiencies there or no economies of scale But with this particular sort of building where all of them are going to be together You can take advantage of that those economies I know there's some research being done involving more integrative medicine for instance the impact of yoga on You know chemo And meditation and stress reduction and the recurrence of cancer, etc Is this the would the facility be used for things like that as well? And does it have the space or is it more for the hard science? No, I'll start No, this is very much for integrative sciences as well Dr. David Spiegel is actually the head of our institute of Of integrative medicine and so sleep studies will be done here for instance the impact of sleep on Cancer in one case or other other kinds of diseases in addition We have a wonderful Immunologist who's interested in stress as is as is Dr. Spiegel So we have this ability to look at the immune components of our Immune system as I mentioned and those can be actually analyzed in conditions of stress You can look at effects of drugs on the immune system Under stressful conditions. So it's very much part and parcel of what we do I would say that just as we were Careful to design the spaces for all kinds of treatments It goes both in terms of whether it is Internalized or it is behavioral or you know like sleep is more behavioral So the facility is flexible And because who knows what the future is going to bring Bev, could you comment a little bit about the operating costs? Not just the of the facility, but the programs How are the how is this research going to be paid for is it government funded? Is it from the school of medicine? Is it from contributions? Because obviously There's an operating cost to Exactly so one of the Obviously one of the reasons that pharmaceutical companies come to academic centers is to provide the venue for them That is partially funded. What I the figure that I just received for funding for clinical research In certainly among cancer centers is that 50 percent is actually reimbursed from Operations pharmaceutical companies, but there's a 50 percent that is not at all Philanthropy has to play a major role in that so our goal is to have have an infrastructure Which will be partially supported by the trials themselves Partially supported by philanthropy It's not a self-sustaining enterprise And especially the investigator initiated trials require additional support These cooperative group trials that I was telling you about have been funded At a very low level and not enough to sustain the costs of the trial And those are now the national cancer institute is going to increase the funding to a margin by a certain percentage It's still not going to be sufficient to cover costs So we have to find additional mechanisms to do that One of the great facilitators here has been a slight reduction in the cost of things from the hospital for clinical research And in addition as you know insurance companies are mandated to cover the costs Of clinical research when it's an approved protocol So it's not that they are totally without coverage and certainly in the case of cancer. That's true So I think we will end up in a situation where we have partial reimbursement But we need to find sources of funds for the rest I would just add that we do our part to contain the costs a small example if We had patients Who stayed for over 24 hours in this facility? It would be classified as a hospital facility and it would completely Be very different in terms of the rules and regulations required to build it So we can have overnight stays in the facility to help with the sleep studies But we can't have stays for more than 23 hours That's the limit. So, you know, we have tried hard to sort of fit this facility into the right Space in order to, you know, have the maximum flexibility and have the maximum Efficiency but not really escalate costs as you, you know, the hospital space is much more expensive to build Like a picture up there since my wife is in it. So you can just keep it there A great group of people in a great program Just a technical question about phase one phase two Can't hear me Hello, sir Is that is this working? Oh, sorry about that. Um I think I have a misunderstanding. I thought phase one was compatibility and second Phase two was the effectiveness of the treatment and I I'm and I'm also kind of wondering about the The trial that jaron pulled the plug on if you if you might use that as an example of how Was that a phase one trial or a phase two trial and what what's happening in each one? so phase one is defined as Perhaps not first in man, but it's proof that a intervention is safe And that in the past has just been a very standard kind of design where patients come in Started a very low dose which might not be an effective dose and then that dose is escalated In subsequent groups of patients that trial design has come under a lot of criticism because a lot of patients are this is Perhaps more cancer specific but patients are subjected to therapies that may not be effective phase two is To take those safe levels and determine efficacy And phase three is when you compare that efficacy against a standard of care and those involve large numbers of patients So the the phase one trials rather than just being looking at safety is also a mechanism to look at whether a certain new idea is actually Hitting its target if you will whether that idea is the correct idea We have ways of assessing as you saw with the immune response Whether or not an intervention is affecting that immune response We have a wonderful immune monitoring core that does that so you can actually look in phase one For proof of principle, which is a scientific concept, but it really shows that something has potential It's not just is it safe. So we want to do both at the same time These new antibodies that I talked about although they've been through primate testing certainly in the case of both of those They've they've been safe for monkeys But would I hope that doesn't offend anybody But that's a way of really being sure that something is safe before it goes into man and it's one of the FDA requirements so the the hope is that once it gets into human Testing that we can determine not only that it's safe, but that it's really doing what we think it should do And so phase one is where we really hope to make an impact in nationally and internationally Then phase three which requires large patient numbers usually gets disseminated among many institutions And there are institutions whose only goal is to turn out large numbers of phase three trials That's not where stanford belongs stanford belongs up front with new ideas So i'm sorry did i answer i didn't answer the second part there's jaron part Yes So my only information on the jaron trial, which is a stem cell Trial actually the specific trial that was done here was with neural stem cells looking at neural regeneration for spinal cord injury a very important trial And jaron, this was the The former ceo of jaron who talked to us at our retreat Talked about not being able to take the stem cell concept further because it was too experimental was based on Scientific concepts that were valid, but it wasn't financially good for the company And so that ceo actually said, you know, I thought this was going to revolutionize medicine But the company says, you know, no, it's not cost effective. We're going to go with a more standard drug that so that's where academic institutions really come into play because we're here You know not to make we are here to come out in a cost-neutral way, but we're not here to make money We're here to really test new ideas and we're not deterred by the fact that you know This is not perhaps a great bonanza of a drug for making Revenue I'm sorry. Why don't we start or you've got the microphone one Eric I was wondering Exactly how you develop your body your lists of the human test subjects Since you're on the smaller end phase one Are you just drawing them from people currently in treatment from the hospital or Do you um, I've seen you know ads in the campus paper For volunteers to come in and be you know, maybe control subjects or something like that Is that that how you develop to listen second question is um Are you going to target diabetes at all in this as well? Thank you Yes So the questions are where we get our patient population from so the idea is when we have a new study that involves Normal volunteers, which is certainly a part of what's being done here That you advertise and you've seen those ads We have a trial and we are looking for volunteers We have as i'm sure you know very detailed informed consent for all clinical trials And so normal volunteers as well as people with various diseases would have to understand all of the implications Before they were entered into a trial With the with patients with diseases that have been become refractory to treatment Again across the whole disease spectrum Those patients may be at stanford. They may be in a community physicians office And our job is to make sure everybody knows what's available at stanford So that the community physicians said i've done, you know, I've Used everything I know we're not this isn't working. Why don't you? Go to stanford for this trial and that in fact is how we got all those patients on our breast cancer trial That became known in the community as something that was unique here Those 90 patients I would say at least Two-thirds of them came from outside of the stanford environment So this is this is really an important contribution to the community as a whole Dr. Mitchell I was wondering if your slide presentation would I'd be able to get a copy of it or Yes, I think actually we're taping this isn't that correct with the slides So we'd be glad to give you a copy available online or Uh, yes, I we can we can put it online as well. I'd be glad to send it to you Other questions If not, thank you all for coming this is We'll invite you all to anybody who's interested put down that you'd like to come to the to the Opening this is going to be a very exciting event and we are just thrilled to have this facility And we certainly thank jill and john again without whom this would not be possible Thanks very much The preceding program is copyrighted by the board of trustees of the lilin stanford junior university Please visit us at med dot stanford dot edu