 One class of drugs are some of the tyrosine kinase inhibitors in oncology, which there's been some recent labeling of SGS within that group, and there's a lot more new ones coming on board as far as active surveillance with cancer patients, often having a lot of genomics work and that done as well, so be curious to hear from Howard and other experiences within those kind of networks as far as a patient population to try to maybe be a little bit more active in some surveillance within. Howard, do you have a follow-up to that comment? We're seeing a lot of dermatologic disorders, but I haven't seen the SGS signal at our institution, so I was actually just emailing some folks to go and look harder because I know it does occur, but I'm wondering are we seeing it and it's being shipped out the back door to TEPA general's burn unit or are we basically what we're doing, so I guess I don't know the answer, but certainly the TKI, the tyrosine kinase inhibitors are bringing a lot of additional dermatologic problems, a lot of it's hand-foot syndrome type work. Lars. I can confirm with the TKI as we haven't seen any Stevens-Johnson TN. We've had one interesting case and we're going to report that. We had an SGS-like clinical picture occur in a melanoma patient receiving NTPD-1, so check block blockade, and that's also on the scores, that being on the list, and we worked it up and we've been running microarrays on skin biopsies of patients with maculopapular rash, TEN, adgep, and graft-versus-host disease, and could see that really TEN and graft-versus-host disease segregate completely differently, so although there may be some salamilarities, they are molecularly different, and then we ran the same set of genes on this case because we were wondering if the NTP1 was lifting tolerance and inducing a sort of graft-versus-host, and the genes that came up were those that you see in TN, so it really seems to classify on that side. So it's only one case. I don't know if you've seen any. You have seen two, so that's really interesting. We didn't call it Stevens-Johnson syndrome, but we're definitely seeing what you described, and we did a lot of the early phase 1, 2, and then two of our, we led the melanoma and lung cancer big phase 3s, and so we ended up with a disproportionate number of patients there, but they definitely have it. It's a the histology there. You also have a histology with necrolysis or developing? I don't know. So Bob, as the other co-chair, do you have any specific points you'd like to raise? No. I heard you say you were struck by some fact, so what was it? I was struck by the desire to say no. So I'm wondering, you know, one of the things we probably didn't do in our in our works, I was on working group three, and thanks, Simone, for going through that so carefully. Did we identify sort of our top priority research need? Did we kind of pick out one or a few that we felt were really the sort of the most important? I mean, I remember discussing race-ethnic breakdown of data in the FDA databases and then some difficulties that they have in collecting that information, but what were sort of the kind of the highest priority ones? And I'm going to let the chairs answer, and then Mark, you can I thought at risk of sort of showing my biases, I thought there were three take-home suggestions that seemed to resonate with people or with the group. One was the need to if to develop pharmacosurveillance to really begin to address the race-ethnic breakdown of SJSTE in the United States. I think, you know, the unsaid thing here is that there's, I'm not aware of any data, honestly, in the United States that's been published over the last 20 years that actually speak to that, and it's critically important given what we now know about sort of the race-specific risks in other countries. So that's one thing. The the second one was the point that I think Mark may make in a more articulate manner, but just the real idea to to begin to focus in on on a standardized case definition, and I guess I I interpreted the discussion a little bit differently. I thought that the discussion was really saying let's focus on a minimum set of criteria that could be useful for both retrospective and prospective studies so that we're not constantly comparing apples to oranges, because that's just, but there's always this trade-off between sensitivity and specificity, and I'm not sure that we're going to have a whole lot of success solving that issue more because this comes up in every sort of large at big epidemiologic question that I've been involved in. And the third, I think, was an idea of to really look at the utility of burn units that seemed to really resonate with people, and that I did, I didn't have access to the new journals I went to Wikipedia instead today and found out that there are less than, there are about five dozen burning nuts that cover the United States, and you know that's that's actually a tractable number to begin to think about. So, and we didn't really explore that in any great detail, but it seemed to really strike people's ideas as in terms of being able to do active case validation and cruel specimens in a relatively pragmatic fashion. Simone, anything you want to add? No. Mark. I was going to say is I think the first action item which is less about research and more about infrastructure was the recognition that there are a number of case definition forms that are currently in use. And so the first step was to aggregate all of those, compare them, and then see what the commonalities are. And so we don't start from a tabula rasa, but we actually take what's being used as we've heard about from Manir and from Maya and others and begin there. So, I think that that's exactly what we should do. We should do it in the Delphi exercise where you take all the different statements and then everybody get together and they agree on how appropriate the statements are and then you just do the math if there's agreement at the end and then you just publish your little consensus statement saying these are the things that should be collected when a patient comes in with TEN. Howard. I just wanted to mention that I think I think ENED GMS still has a burn research program that interacts with a lot of these burn units. And not all of them, but some of them. So it might be worth reaching out. I didn't see Dick Okita or any of the GMS folks in the room at the moment, but you might be able to have a short reach to them through some of the existing relationships at GMS. Yeah. And we have members from GMS on the NIH working group that's been formed to be talking about SGS-10, so we can also follow them. Other questions or points? Okay. Well, I think I'm going to turn it over to the next session. Hi, everybody. My name is Santa Timania, and I work here at the NIH at the National Eye Institute, and I just wanted to thank everybody for a very, very informative and educational two days' worth. I really learned a lot from all of you, so thank you. So now I have the pleasure of re-welcoming Terry Minolio to the podium. Terry is Director of the Division of Genomic Medicine at the National Human Genome Research Institute, and she's going to lead us through a discussion of next steps and where we go from here. So, Terry? Thanks. And actually, it may take me a minute to get booted up here, so if you all want to, like, talk or check your email or whatever. Yeah. So, because it's not coming up. Yeah, it's not it's not reading it. Mark told the story. Is that it? This is not working. Oh, fine. Oh, right. He did. I saw him do that. But, oh, really? Yeah, I saw him do that, and I thought it was just look at that. All right. So, Soraka Muth has figured out a way to overcome the security thing here. So, he's a man to watch out for, that's for sure. Yeah, that's right. I don't see it, though, and I know it was here. So, I'm sorry. Which drive would this be? Is it removable disks, Soraka Muth? Because it's not... No, we put it. Okay, because we couldn't get this to work. Oh, it's not there, and I know I just sent it, so I have to save it again. Can I just pull it out here? No, no problem. So, I will say, I can't remember if yesterday it was Mark, but somebody was talking about how ophthalmologists take terrible, terrible notes, and I want you to know that, okay, well, there were a couple of ophthalmologists in the audience, and I was watching their body language, so they did hear you. I'm sure I'm going to hear about it when I go back, but I just wanted to let you know. They heard you. I think that the comment was that their notes are very difficult to draw from in an electronic form because they're pictures, so they're not something that's in a form or even that you can do natural language processing on because they're hand-drawn pictures. So, I don't disagree with you. We actually have a network where we have clinicians from around the United States send us documentation for their patients, and the drawings range from quite artistic and beautiful, so we can actually tell it's an eye, and then somewhere even, you know, the eye would be a, you know, a challenged stick figure, so we do appreciate the commentary.