 Okay, perfect, that was easy. As an outside expert, being able to transition to my slides is an important perspective. So I wasn't exactly sure what an outside expert is, but I think what I'm actually doing is carrying the torch for all of the clinical geneticists that are looking to this group and this program to be able to help things for our patients. We know that there are many people that we would love to have answers for and this is a priceless opportunity to accomplish this. So I'm essentially an outsider looking in at the goals and strategies and also the opportunities that this place is for the people that I care about. And so with that in mind, I framed my discussion around the questions that were asked and some things, thoughts that this brought to mind for me. Also the question, when is it complete, well it's easy to say it's complete when there's a diagnosis, I want to say that may not be true at all because there's much to be learned just as Brendan's example showed you that once he had a probable causative, there was so much to be learned in terms of the biology and science from each of those individuals. Some of that can go on in the absence of the patient, but other parts of it are going to be impacted by continuing to interrogate or find out new information about a person as they continue through the lifespan, particularly as you access children and diagnoses in children. Maybe it's just when all the tests you can do are finished without achieving a diagnosis, but is that enough and what if a new test comes along ten weeks later or two years later or ten years later. I know we kind of only can think in ten year blocks, but all these people live a long time and so we have some continuity obligation. I'm learning this as I think about long term follow up in a broader sense and we don't do a very good job with long term follow up of almost anything. So points to consider in this are how do you maintain continued contact with the subject or in the absence of that with an appropriate provider because that's part of the transition process that you're thinking of. When I think of transition as a pediatrician I was thinking of kids to adults but that's not what you were thinking of at all in this question. All right, what's an appropriate management when a diagnosis is not made? So what is management? What is management in that setting? Is it continuing to provide symptomatic care? Is it continuing to provide interrogation? I don't think we know the answers to those things but those are things I would bring up to the group for some discussion. Who's responsible for the management? Well how did they get to you in the first place? Did they self-apply and carry their records to you but not involve their investigating geneticist or other specialist provider? Did their physician in rural Tennessee send them along and is there no accomplished subset provider if you will? So who's in the information loop as that goes forward? And so this is a second point that I'm going to have as a recurring theme which is how do you facilitate congoing communication between the subjects, between the program and between the providers who I would argue are part of that information loop. And if there is a diagnosis who becomes responsible for that if there's a potential treatment plan, particularly if it's experimental, some places will be able to take things like that on but others won't and do you not offer the potential for an experimental intervention just because of access and what resources are used to do that? How long are patients followed? That is a really good question speaking as somebody who's interested in newborn screening and who's watching us decide to screen for disorders that may not emerge until adulthood. So what is follow-up? Is it when the diagnosis is made? Do you follow ones where they're made so you can continue to expand that phenotype? If a diagnosis isn't made, do you follow them up because you want to learn more? And most importantly, we heard a little bit about this, are there avenues for re-interrogation and how do you facilitate a two-way street to help you potentially choose an opportunity for re-interrogation of information? If there is, how do you make that occur? I've heard a little bit more about where the data live and who has access, but I don't know who has access to them. Presumably all of the investigators do, but so what patient center outcomes should be documented? It depends on your goals and how you've identified patient needs and input and so fortunately we're going to talk more about that. What are the formats and means for communication to the patient and to the external provider so that you potentially could facilitate some of that two-way dialogue? And what information do you have a standard report that you provide to people who referred? And what does that look like? What information comes? What access do they have in there? We know the EMRs are not lovely, but is there some way to connect those to the EMRs so that that data is carried somewhere with the patient? Is there a patient portfolio? And just some perspective. If a patient is truly self-referred and I don't think that's really true, then you could have some problems with continuity of care. Information exchange is critical. Communication is going to be key. If you want to continue the learning process from these, identification of a spectrum or a team of clinical care providers after is really critical to making this useful to the patient subject beyond the science that we learn. And if this is in part four, and I hope it is for the patients, then we have to have a way to make that more effective. And the satisfaction of both the subjects and their providers will be very dependent on clear and respectful communications. Just because you have more resources doesn't mean you're smarter than somebody else. You just have more ways to learn things. And you have to share that information in ways that are useful and received well. So with that, I'll turn it over for discussion.