 The final item of business is a member's business debate on motion 3472 in the name of Mariah McNair on Ovarian Cancer Awareness Month. This debate will be concluded. Without any questions being put, I would ask those members who wish to speak in the debate to please press the request of speak buttons now. I call on Mariah McNair to open the debate. Miss McNair is joining us remotely. Up to seven minutes, please. Thank you, Presiding Officer. I apologise for not being physically in the chamber to leave this debate as I am currently self-isolating. It is a privilege to leave today's member's debate on Ovarian Cancer Awareness Month. I would like to thank all colleagues who have decided to speak in support. I also thank the minister for what I am sure will be a welcome and thoughtful contribution. This month marks Ovarian Cancer Awareness Month. We know that Ovarian cancer is the sixth most common cancer faced by women in the UK. According to local cancer research UK, there are around 7,400 new cases of Ovarian cancer each year. This number equates to approximately 20 diagnoses per day. The key symptoms of Ovarian cancer include persistent bloating, feeling through quickly, loss of appetite, pelvic or abdominal pain and urinary symptoms such as needing to urinate more frequently than usual. Other symptoms include unexplained weight loss, tiredness and changes to your bowel habits or symptoms of irritable bowel syndrome, especially when it starts after the age of 50. Sadly, Ovarian cancer is often diagnosed too late. I can advise the Presiding Officer that I am very aware of the suffering that this horrible cancer causes. I will never forget the two women that I had the privilege to care for when I was part of the nursing team at the Samaritan of Scotland hospice in my constituency. The women were only in their late 20s and early 30s. They both sadly died of Ovarian cancer. It was so tragic to see these young women endure the misery that this cancer causes and the impact that it had on their families. A majority of women will be diagnosed when they notice symptoms typically when they visit their GP. A lot of symptoms can occur at every stage of the disease. They are nonspecific and can be hard to pinpoint. A woman's route to diagnosis is key to their survival. Like many cancers, the earlier Ovarian cancer is diagnosed, the better the survival route is. Put simply, the earlier, the better. The differences in survival rates between early and late diagnoses is substantial. Statistics show that around 93 per cent of women are diagnosed with Ovarian cancer at the early stage to five or five years or more compared to only 30 per cent of those diagnosed at stage four. In Scotland and the UK more widely, we have an exceptional NHS screening programme that has successfully helped to save many people's lives. However, that only covers three main types of cancers and overall 6 per cent of cancers diagnosed happen during this route. We need to consider what can be done that better enhances all the options that can see an even better approach. In leading this debate, I am highlighting the need for early diagnosis. I am also sharing the experience of my constituent, Denise Ripper, and her ideas of what can be done to improve diagnosis. On behalf of Denise, I want to raise her belief that there is scope for testing of CE125 in the detection screening of Ovarian cancer. This is something that Denise campaigned on for some time, previously raising a petition with her Parliament. Denise was back and forth to her doctor for six months with IVS symptoms in the centre for an ultrasound and an MRI. I was given the all-clear and advised that the mass found was likely to be a fibroid, but, due to her age, it was recommended for a hysterectomy. At Denise's pre-op, her oncologist noticed that her levels of CE125 were high during the blood test taken prior to this and informed her that this may be an indication of ovarian cancer. Denise had her hysterectomy and was diagnosed with stage 3 ovarian cancer. CE125 is a protein often found on the surface of ovarian cancer cells and some normal tissues room of ovarian cancer often have a high level of this protein in their blood. A small sample of blood is taken from your arm and sent to a lab where a simple test will measure the level of CE125 in your blood sample. In most healthy women, the level of CE125 is usually between 35 units per milliliter, but for some women to have a naturally high level of CE125 in their blood. The level of CE125 in your blood can rise for many reasons, including endometriosis, menstruation, ovarian cysts and sometimes ovarian cancer. That is one reason why it can't accurately be used as a sole screening test for ovarian cancer. However, we want to see its presence leading to better screening as a matter of course. If the level of CE125 in your blood is 35 units or higher, your GP should arrange for you to have an ultrasound scan of your tummy and pelvis. The ultrasound scan will create pictures of your ovaries so that they can be checked for anything unusual and will help your GP to gather more information. In some areas of the UK, a CE125 blood test and ultrasound scan will be ordered at the same time. The National Institute for Health and Care Excellence recommended that women with symptoms of possible ovarian cancer be treated for CE125 in a primary care setting typically at their GP surgery. While the CE125 test has been studied in women in secondary cancer, the test hasn't fully been evaluated for women who have seen their GP with symptoms that could be ovarian cancer. Cancer Research conducted a study that looked at 50,000 women who had seen their GP and took the CE125 test. Research found that 10 per cent of women with a higher level of protein biomarker were diagnosed with ovarian cancer, making it a normal test 12 times more predictive than previous SMSs suggested. As well as helping to diagnose ovarian cancer, CE125 blood tests are sometimes used to monitor the treatment of ovarian cancer as well as other types of cancer such as fallopian or checking for signs of reoccurrence. The CE125 test should be routine. What has not been suggested here is that it should be the be-all and end-all. Instead, the yeast is asking that we consider part of the test and the routine screening for ovarian cancer. That would work alongside other screening methods often used to diagnose such as ultrasound and transvaginal scans. What is clear is that everything possible should be considered that has the potential to improve the detection of this horrible cancer. As I have said, I will never forget the misery inflicted on those young women and nurses at the end of life. We must pull out all the stops to increase awareness, have a step change in diagnosis and provide a gold standard in providing the necessary care for those with ovarian cancer. In concluding, I commend organisations such as Target Ovarian Cancer and many other campaigners and charities for their tireless efforts to raise awareness of ovarian cancer. I thank the other speakers for taking part in tonight's debate. I thank my constituent Glees for sharing her story and for her bravery and determination to secure improvements to the efforts to diagnose as early as possible in their foresave lives. I now call Jackie Dunbar to be followed by Sandy Schulhani, both of whom I am joining us remotely up to four minutes, please, Ms Dunbar. I also accept my apologies for not being in chamber this evening. I thank my colleague Mary McNair for bringing this important subject forward for members' debate today. Ovarian cancer is not my friend. I first met it back in August 1977, when I was nine years old. I didn't know where it was at the time, but I knew that it wasn't good. Mam and Dad sat me down to tell me that I would need to go and live with my granny and granda for three weeks, while Mam went into hospital to get a small black spot removed from her belly. I know now that the explanation wasn't very factual, but at nine years old, it's good enough for me to get a grasp of it. Mam had her operation on 16 August 1977, the day that Elvis Presley died. My sister still remembers this, as Mam was a huge fan of him, and it's always stuck in her mind. I came home after Mam got home from hospital to find Mam and Dad's bed in the living room, and I couldn't work out why. Mam was getting better, wasn't she? After all, she'd had the operation that she needed. Eight weeks after her operation, and 17 days after my 10th birthday, my Mam passed away, aged just 34 years to ovarian cancer. To know that ovarian cancer is not my friend. What do I know about it now? I know that ovarian cancer is one of the most lethal of female cancers. I know that it is most often diagnosed at a late stage. The symptoms are commonly experienced as a result of other conditions, but letting your doctor know how often your experience in symptoms is an important step in helping them to know when they should consider ovarian cancer as a possible cause. I know that when it is detected at an early stage, when the cancer remains confined to the ovary, up to 90 per cent of those diagnosed are likely to survive for more than five years. That compares to 17 per cent surviving five years or more when the cancer has spread to other parts of the body. I also know that there is still no routine simple screening test to accurately detect ovarian cancer. Contrary to popular belief, cervical screening will not detect ovarian cancer. Although cervical screening is effective in early detection of cervical cancer, it is not a test for ovarian cancer. There have been no advances made in the last 40 years in the diagnosis or treatment of ovarian cancer. It is time that it got as much publicity as others. That is why I am telling my, but more importantly, my mum's story tonight. We need to have a consistent approach to testing. Why does it have to rely on doctors taking the decision on whether you fit the bill for testing? My sister used to get a CT125 blood test done routinely. I never have. Why? We both come from the same mother, but we have different doctors and different health authorities, and I urge the minister to look into this as a matter of urgency. I started off my speech tonight by saying that ovarian cancer is not my friend, and I am determined not to allow it to have the last say in my speech tonight. I dedicate this to my mum, Elizabeth Maidenbar, Ni Watt, wife to Jimmy and mum to Elaine, Andrew and Jacqueline, born on 10 May 1943 and died on 19 October 1977, aged just 34 years. You may be gone, mum, but you are definitely not forgotten. Thank you. I call Dr Gohani, a Sandish Gohani, to be followed by Evelyn Tweed, both of whom are joining us remotely. Dr Gohani is not yet with us, technology. Dr Gohani, up to four minutes please, thank you. Thank you, Deputy Presiding Officer. I wish to draw members' attention to my register of interest as a practicing NHS GP. I am not drawing this debate to a close, so it won't answer some of the questions that have come before me. The ovaries are two small organs, and they are each about the size and shape of an almond located in the lower area of the tummy, in the pelvis. However, as with most things in the body, it is not the size that matters. They produce the eggs that we need for babies. They also produce estrogen and progesterone, which is the female hormones, and they are very busy organs. A variant of cancer arises from the cells in and around the ovary and fallopian tubes. The cells tend to spread onto the surface of the tummy and the transparent tissue that surrounds the organs around the abdomen. They form lumps on the surface of the bowels, a fatty tissue that extends down the stomach, delivering the spleen, the lungs, and these lumps are metacities. They often produce excess fluid inside the tummy, and this causes significant bloating and other uncomfortable symptoms. This is what a patient of mine presented with when she came to surgery. A young woman in her 20s complaining of random bloating and feeling uncomfortable really quickly after eating, and these could be symptoms of anything, including IBS. Fortuitously, I had been reading about ovary and cancer that very morning, so that was the first thing that came to my mind, and I added a CA125 blood test to the checks, and unfortunately that came back very raised. You have all heard about CA125 from previous speakers, so I will not continue with that. When the test came back positive, I organised urgent ultrasound and referral to gynaecology. You might think that this was very fortunate that she has received a possible diagnosis after just one visit to the GP when most women had to present repeatedly, but that was not to be. She died because she put up with her symptoms for too long. The feeling of being full too quickly, loss of appetite, bloating, going to the toilet more tiredness, weight loss, change of bowel habits, all are ovarian cancer symptoms, and she felt embarrassed to seek help when the cancer had spread, and that is what caused her to die. Each year, we have heard 7,400 women diagnosed with ovarian cancer in the UK and 600 in Scotland, with a very difficult to detect cancer because of the vague symptoms. If you are worried, do not hesitate. If you have symptoms that I have spoken about, you need to go and see your GP, you need to ask for help, and please keep a symptom diary, because that is really helpful for me when I see it. We do not have a screening test for survival of cancer, but for women and people with the cervix, we do have a survival screening test for the human papillomavirus, the HPV virus. It is really important, as HPV causes 99% of all survival cancers, and 4 out of 5 Scots will have HPV at some point in their lives. With the screening and also with the smear test, it is something that we can check for. If you have not had your smear in the last five years, please book with your GP today. I digress from ovarian cancer, but as this is a women's health issue, I thought that I would take the opportunity as a doctor to encourage women to get their smears. Deputy Presiding Officer, in conclusion, it is very clear that early diagnosis and timely intervention leads to better outcomes and saves lives. If you have any new symptoms, if you are worried, then please do not delay. Please come forward. It could well save your life. Thank you. I now call Evelyn Tweed, who is joining us remotely, to be followed by Carol Mocken. We await Ms Tweed. Thank you, Deputy Presiding Officer, and thank you to my colleague Marie McNair for securing this important debate. Despite a welcome decree in its instance, 1 in 59 women in Scotland are still diagnosed with ovarian cancer, and there is a striking lack of awareness of this disease. That is why I would like to start by paying a warm and heartfelt tribute to Jenny Godly, who is currently undergoing treatment for ovarian cancer, whilst openly and admirably sharing her experiences on social media. Jenny has done a huge amount to raise awareness, as well as offering comfort to others. Jenny is an inspiration, and I wish her all the very best with her on-going treatment. As Jenny says, it is a sneaky cancer. Symptoms can be complex and misdiagnosed, as other less serious conditions. Some of the symptoms have already been discussed this evening. In recent years, Scotland has led the UK in improving early diagnosis of ovarian cancer with the shortest diagnostic pathway, with the CA125 blood test and ultrasound carried out at the same time, but there is no one viable screening tool. We need to focus on finding an effective screening tool and raise further awareness of the disease, as the earlier the diagnosis, the better the prognosis. One person who knows the importance of early diagnosis is my Stirling constituent, Gillian McLaren. A keen netball player with an active lifestyle and healthy eating habits at the age of 33, Gillian felt at low risk from cancer. She visited doctors for over 18 months with bowel changes, exhaustion, nausea, pain and symptoms of urine infections. In early 2020, a blood test showed raised levels of CA125 and she was diagnosed with ovarian cancer. Gillian said, there is nothing that prepares you for the words that you have cancer. I was told in a very gentle and sensitive way, but it was still a shock. I had always hoped that one day I would have a family of my own. I was told I would lose my fertility during treatment. Cancer was threatening my life, but it was also taking away my choice to one day have children. That fertility loss felt like a death. At age 35, Gillian launched to raise awareness of the signs of ovarian cancer, especially in younger women, and to help other young people with the disease to feel less isolated. Gillian's advanced diagnosis was life-changing and affected her prognosis, but thankfully her surgery was a success and she is grateful to be in remission just now. In Gillian's own words, I believe that it is not that it is a silent killer. There is a lack of knowledge on what to look out for amongst public and health professionals. It is about adding up the various symptoms with a potential ovarian cancer diagnosis. It is really important to listen to women when they say they know their bodies. That should really be respected and heard. Crucially, Gillian says that if you or anyone you know is experiencing symptoms that are abnormal or unusual, head straight to your GP. Be as persistent with them as your symptoms are with you. I would like to thank Gillian and my colleague Jackie Dunbar for sharing their very personal experiences with us today. Only by continuing to have these very open public conversations can we work to raise awareness and tackle ovarian cancer together. I now call Karen Mocken to be followed by Gillian Mackay up to four minutes please. Thank you, Deputy Presiding Officer. I also thank Mini McNair for bringing this important debate to the chamber and for the contributions so far. I think that we can see how important, as everyone has just said, these debates are to talk about these issues in public forums. In the first instance, I recognise on behalf of Scottish Labour the importance of ovarian cancer awareness month marked here in March. That is a cancer impacting over 600 people in Scotland every year. It is important to be where we seek to raise awareness, as has been said. I would highlight the symptoms again, but I think that it has been covered very well by the previous members. The key fact is that it is important that women go and seek help. Should they have any of those symptoms and not feel that they are bothering any of the medics or the nursing staff, because I am sure that they would rather came forward and made sure that they were getting themselves checked. As the motion states, those symptoms usually occur frequently and defined as more than 12 times a month. It is important that they come forward. As with many symptoms, they are very common and can be caused by many conditions, but it is important to have them checked out by GBP. As we have learned more and more in recent years, the earlier an individual has their cancer of any sort diagnosed, the more likely they are to be treated and to recover. As mentioned in the motion, despite significant research efforts and trials, there is currently no screening available for ovarian cancer. However, I was very interested in the contributions because I am not overly familiar with that, and so I certainly will seek to find out a lot more about the points that Marie and others were making. In order to take more preventative measures to obtain quicker rates of detection and to deliver better levels of treatment, it is crucial that we invest further in research because knowledge is power, and the more we can understand the better chance we have of achieving ovarian cancer actions aims of making that a more survivable cancer. That is also why raising public awareness is so important when regular screening services do not exist, as with other potential cancers. It is vital that members of the public are encouraged to be conscientious to symptoms and to act accordingly and promptly to ensure that they are working in their own best interests. According to ovarian cancer action, although five-year survival rates for ovarian cancer are improving, other cancers such as breast cancer had better survival rates two generations ago than ovarian cancer does today. I thought that that was quite striking when you read that. That should be a concern to us all. It is a staggering truth, and it shows that, although we have made progress, there is still a long way to go to ensure that the better treatment, ideally personalised treatment and survival for women, happens. I once again, on behalf of Scottish Labour, recognise the significance of ovarian cancer awareness months and stress the importance of not stopping our efforts of raising awareness as we do so often in the chamber, but to regularly bring to the attention of our constituents the symptoms of the illnesses and that they are treatable when early detection progress has been made. That is testament to the work of campaigners and organisers who have done a significant amount of work to raise awareness of ovarian cancer, but we must not stop. We must keep making more progress, invest more in research and deliver early diagnosis and improved treatment. I now call Gillian Mackay, who will be the last speaker in the open debate. Up to four minutes, please, Ms Mackay. Thank you, Deputy Presiding Officer. I thank Marie McNair for bringing the debate to the chamber today. As the motion states, ovarian cancer is the sixth most common cancer faced by people with ovaries in the UK. It is important that we highlight the symptoms and causes of cancer, so everyone knows what to look out for. This is particularly important for ovarian cancer, as we have already heard. Symptoms can be difficult to recognise, particularly in the early stages, because they are so often the same as symptoms of other conditions such as IBS. The earlier ovarian cancer is diagnosed, the better at the outcome. When diagnosed at its earliest stage, 98 per cent of people with ovarian cancer will survive their disease for one year or more, and 93 per cent will survive for five years or more. However, according to ovarian cancer action, 90 per cent of women and people with ovaries cannot identify the main symptoms. Cancer is a worrying subject and it can be difficult to talk about, but in order to raise awareness, we need to have those difficult conversations. If someone who knows experiences the symptoms of ovarian cancer, they may not identify them as signs of cancer, or they might be worried about going through GP when they are so busy. We all have a role to play in raising awareness of the symptoms and encouraging people to seek help when they are experiencing them. Starting a conversation with someone about cancer can seem daunting, but it may save a life. It is also important to raise awareness of risk factors so that people can determine their own level of risk. Between 5 per cent to 15 per cent of ovarian cancers are caused by an inherited gene, and if your mother or sister had ovarian cancer, you are around three times more at risk. The risk of ovarian cancer also increases with age, with most cases occurring in people with ovaries who are over 50 years of age. However, as we have heard from Jackie Dunbar this evening, it does not discriminate with age. Other risk factors include certain medical conditions such as endometriosis and hormonal factors such as starting your periods young or having a later menopause. I encourage anyone who has concerns to visit the NHS-informed website where more information about risk factors can be found. The Macmillan Cancer Support website can also offer helpful information and advice. It is worth noting that, unlike cervical bowel and breast cancer, there is still no reliable, effective screening method for ovarian cancer. That is why it is so important that people are aware of the signs and risk factors. GP practices are open and they are seen patients, so if you have persistent concerning symptoms, please do seek medical advice. Ovarian cancer action recommends that people with concerning symptoms keep a record of what they are experiencing and have their notes to hand when they speak to a doctor. As we have heard, the 62-day cancer referral standard is not currently being met with any health boards and performance against it has actually worsened since December 2020. It is concerning and obviously the pandemic has had an impact. Staff are working extremely hard to work through the backlog and we need to ensure that they have the support to continue to do so. I am aware that the Scottish Government has set out plans to address workforce issues in the national workforce strategy and NHS recovery plan, but we need to make sure that we retain staff across the NHS, particularly in nursing. We need to ensure that there is a joined-up integrated workforce so that we are not simply moving existing staff from one service to another. Given that this is ovarian cancer awareness month, I think that it is worth ending my speech by reiterating the main symptoms of ovarian cancer. They are increased abdominal size and persistent bloating, persistent pelvic and abdominal pain, difficulty eating and feeling full quickly or feeling nauseous. If you are experiencing these symptoms regularly, please make an appointment with your GP. Women's pain is not always taken seriously but you know your body better than anyone. If something does not feel right, seek help. I now call on Minister Marie Todd to respond on behalf of the Scottish Government. Up to seven minutes please. Thank you, Deputy Chief Presiding Officer. I want to thank Mary McNair for raising this motion in the chamber today and for my colleagues' important contributions. It is a brilliant opportunity to reflect on the work that we have achieved so far and where there are opportunities to improve. I have to particularly commend Jackie Dunbar's very moving child's eye view of the experience of her mum being diagnosed and dying so rapidly with ovarian cancer. It is vitally important that each and every one of us uses our life experience to improve the current treatments and work for our constituents nowadays. I am very grateful for that moving contribution. Unfortunately, ovarian cancer continues to be prevalent throughout Scotland and the rest of the UK, with about 600 women being diagnosed every year in Scotland. We know that the earlier that cancer is detected, the easier it is to treat and raising awareness of ovarian cancer and its common symptoms, which have been outlined by members, is absolutely crucial in detecting this cancer early. Particularly, as many have said, because the symptoms can be vague. The Scottish Government is committed to detecting and treating cancer as early as possible, and raising awareness of the symptoms of cancer, including ovarian cancer, is a focus of our £44 million detect cancer early programme. As services continue to recover from the impact of the Covid-19 pandemic, we recognise that our efforts in this area have never been more important. That is why we have committed an additional £20 million to our DCA programme as part of our NHS recovery plan, published in August 2021. That funding will enable us to provide even greater public awareness for the signs and symptoms of cancer, and it will support the development of optimal cancer pathways to improve earlier diagnosis rates. Traditionally focused on bowel, breast and lung cancers, other areas have more recently been added to the programme. We are currently working on a number of awareness-raising initiatives through the programme, and that includes redesigning the DCA website, which is available at getcheckedearly.org. That will feature an updated version of our symptom checker tool, which is complete with links to relevant third sector organisations. The online checker tool was first launched in 2018 and includes symptoms of ovarian cancer. Additionally, research is currently being undertaken to better understand the possible barriers and levers to early diagnosis that any new DCA campaign should focus on. Once those results are available, we will be seeking new solutions to improve access. We have also recently formed a new early cancer diagnosis programme board chaired by Catherine Calderwood, national clinical director at the Centre for Sustainable Delivery. That group will be responsible for shaping and supporting the delivery of Scotland's early diagnosis agenda over the coming years, including the development of any new and additional public awareness campaigns. Recognising the importance of primary care clinicians in finding cancer early, a clinical review of the Scottish referral guidelines for suspected cancer was completed and updated, and guidelines were launched in early 2019. Those included guidelines for suspected ovarian cancer. In terms of other engagement, we are in regular contact with target ovarian cancer as a valued member of the Scottish Cancer Coalition. I was very pleased to become a teal hero myself by participating in target ovarian cancer's event to promote ovarian cancer awareness month at the Scottish Parliament a few weeks ago. My officials and I continue to laze with the charity and its work to raise awareness of ovarian cancer. Over the course of the pandemic, we saw urgent suspicion of cancer referral rates fall below pre-COVID levels, in order to increase uptake. Public awareness campaigns and messaging have run throughout the pandemic to encourage people with possible cancer symptoms to seek help. I would absolutely encourage any individual who might be experiencing the common symptoms of ovarian cancer to present to their GP. Not only is it important for those to come forward with symptoms, but it is equally important to be aware of the risk factors in developing ovarian cancer. According to target ovarian cancer, two of the main risk factors include age and genetic factors. Age is the primary risk factor with an increased risk as a woman ages. The majority of diagnosis occur in women over the age of 50. Additionally, 15 to 20 per cent of cases are linked to mutated genes, primarily BRCA1 or BRCA2. There are some other risk factors such as being overweight, using HRT and having endometriosis, which can marginally increase an individual's risk. However, it is really important to note that those factors do not always result in developing cancer. More generally, women's health is a key priority for this Government, and that is why Scotland became the first country in the UK to publish a women's health plan. The plan was published last August, and it is an exciting step forward in our ambitious aim to raise awareness around women's health, improve access to health information and to services for women and girls, and to reduce inequalities in health outcomes for all women. The plan focuses on a specific set of priorities where there is particular evidence of inequalities and where women have told us improvements are needed, such as menstrual health, menopause and endometriosis care. Alongside our work, the Scottish Government works closely with a number of organisations to raise awareness of ovarian cancer, such as Target ovarian cancer and the Scottish Cancer Coalition, as previously mentioned. Our partners are key contributors in raising awareness and providing support for those suffering from or at risk of ovarian cancer, as well as providing assistance, education and information to those who need it most. The work that they do is absolutely invaluable, and I wanted to take this opportunity to acknowledge and thank all those involved. I am very glad that Evelyn Tweed mentioned Janie Godley, who is currently undergoing treatment for stage 3 ovarian cancer. In sharing her experience, even at this really tough time for her and her family, she is doing a power of good for raising awareness of this devastating condition. As Public Health Minister, I am very grateful for that, and I am sure that all of us in the chamber wish her well in her recovery. It is appropriate to acknowledge the continued hard work of our health workers who, in the face of a pandemic, have continued to provide high-quality care and support to all those people who have a suspicion of cancer. As we have heard this evening, the Scottish Government, along with all of us here, is absolutely committed to increasing awareness of ovarian cancer and improving cancer patients' experience and outcomes. I want to thank all of our partners that help us in achieving those goals. We will continue to work together and to further improve our services and awareness.