1 00:00:06,506 --> 00:00:12,379 THEY MAYBE AT LEAST A FRAMEWORK OR A BEGINNING FOR, FOR WHAT WE 2 00:00:12,445 --> 00:00:14,180 WANT TO TALK ABOUT. 3 00:00:16,149 --> 00:00:16,683 OK. 4 00:00:17,951 --> 00:00:21,020 AND THIS IS BASICALLY A SUMMARY OF OF WHAT HAS BEEN OUR 5 00:00:21,087 --> 00:00:24,357 DISCUSSIONS OVER THE LAST FEW MONTHS THROUGH THE BIOMARKERS 6 00:00:24,424 --> 00:00:27,360 WORKING GROUP AND ALSO THE DISCUSSION THAT TOOK PLACE 7 00:00:27,427 --> 00:00:30,497 EARLIER TODAY AND REALLY OVER THE LAST COUPLE OF DAYS. 8 00:00:31,398 --> 00:00:36,436 AND WHAT I WOULD LIKE, I THINK MANY OF US WOULD LIKE, BUT I 9 00:00:36,503 --> 00:00:40,940 WOULD LIKE OUT OF SESSION IS THAT IT, IT CREATES THE 10 00:00:41,007 --> 00:00:46,212 ENTHUSIASM THAT OVER THE NEXT FEW WEEKS, THE NEXT FEW MONTHS, 11 00:00:46,279 --> 00:00:51,151 WE HAVE SOME DISCREET PROJECTS THAT PEOPLE DECIDE TO WORK 12 00:00:51,217 --> 00:00:52,218 TOGETHER ON. 13 00:00:52,585 --> 00:00:55,722 AND THAT INCLUDES GRANT PROPOSALS THAT PEOPLE WANT TO 14 00:00:55,789 --> 00:00:59,392 PUT IN PAPERS THAT THEY WANT TO WORK TOGETHER ON KNOWLEDGE OF 15 00:00:59,459 --> 00:01:03,129 THE PROJECTS THAT ARE ONGOING BUT THAT NEED ADDITIONAL EFFORT, 16 00:01:03,196 --> 00:01:06,866 THAT NEED ADDITIONAL PEOPLE TO PUT THEIR SHOULDER TO THE WHEEL 17 00:01:06,933 --> 00:01:10,437 AND CRANK THINGS FORWARD AND THAT NEED ADDITIONAL EXPERTISE 18 00:01:10,503 --> 00:01:13,506 THAT MAY NOT BE READILY AVAILABLE OR MAY BE OPEN TO 19 00:01:13,573 --> 00:01:14,641 PEOPLE IN THE ROOM. 20 00:01:14,707 --> 00:01:15,175 SO. 21 00:01:15,241 --> 00:01:15,909 SO THAT'S GREAT. 22 00:01:17,944 --> 00:01:21,815 BEFORE WE GET GOING, ANY ANY PRESSING COMMENTS FROM ANYONE IN 23 00:01:21,881 --> 00:01:25,752 THE ROOM AS TO WHAT YOU WOULD FEEL IS A GAP YOU WOULD FEEL IS 24 00:01:25,819 --> 00:01:29,656 PARTICULARLY IMPORTANT THAT WE HAVE MISSED THAT IS OF BURNING 25 00:01:29,722 --> 00:01:30,857 IMPORTANCE TO YOU. 26 00:01:33,193 --> 00:01:35,228 YOU DON'T FEEL SHY AND THERE'S A MICROPHONE HERE IF YOU'RE GOING 27 00:01:35,295 --> 00:01:35,628 TO USE IT. 28 00:01:39,666 --> 00:01:44,471 OK, WELL, WE HAVE SOME SLIDES FROM CHERYL WELLINGTON TALKING 29 00:01:44,537 --> 00:01:49,108 ABOUT THE ISSUE OF REFERENCE INTERVALS AND AND AND CHERYL 30 00:01:49,175 --> 00:01:54,214 THIS IS YOUR DATA, I DON'T WANT TO TOO MUCH EXPLAIN HERE, BUT I 31 00:01:54,280 --> 00:01:58,117 JUST TO PUT EVERYBODY INTO THE SAME PERSPECTIVE. 32 00:01:58,184 --> 00:01:58,485 SO. 33 00:01:58,551 --> 00:02:03,156 SO CHERYL IS A COLLABORATOR ON AUO 1 THAT I RECEIVED THROUGH 34 00:02:03,223 --> 00:02:07,660 THE UNIVERSITY OF PENNSYLVANIA BACK I ACTUALLY THE PROJECT 35 00:02:07,727 --> 00:02:12,165 STARTED IN MARCH 1 OF 2020, SO JUST A FEW WEEKS BEFORE THE 36 00:02:12,232 --> 00:02:17,070 COVID SHUTDOWN STARTED AND AND AND THROUGH THAT PROJECT, CHERYL 37 00:02:17,136 --> 00:02:21,274 STARTED QUITE A BIT OF WORK INCLUDING A PAPER THAT WAS 38 00:02:21,341 --> 00:02:25,311 PUBLISHED A FEW MONTHS AGO ENROLLING ABOUT 900 OR OR 39 00:02:25,378 --> 00:02:29,349 ANALYZING DATA FROM 900 PARTICIPANTS IN THE CANADIAN 40 00:02:29,415 --> 00:02:31,050 HEALTH SPECIAL SURVEY. 41 00:02:31,117 --> 00:02:34,487 CHERYL, DO YOU WANT TO TAKE THE MICROPHONE AND INTRODUCE PEOPLE, 42 00:02:34,554 --> 00:02:37,724 MAKE SURE EVERYONE KNOWS WHAT THIS IS, WHAT YOU FURTHER WANT 43 00:02:37,790 --> 00:02:40,860 TO DO WITH THIS PROJECT, WHAT WHAT THE OTHER POSSIBILITIES 44 00:02:40,927 --> 00:02:41,160 ARE? 45 00:02:41,861 --> 00:02:42,195 SURE. 46 00:02:42,262 --> 00:02:46,466 SO FOR BASICALLY, YOU KNOW, YEAH, WHY DON'T YOU COME UP 47 00:02:46,533 --> 00:02:46,900 HERE. 48 00:02:51,471 --> 00:02:55,208 SO, SO BASICALLY WHAT WE'RE DOING HERE IS TO TRY TO BRING A 49 00:02:55,275 --> 00:02:58,845 LITTLE BIT OF THE FIELD OF LABORATORY MEDICINE TO TO TBI 50 00:02:58,912 --> 00:03:02,582 AND KIND OF BREAK THINGS DOWN FOR CLINICIANS TO BE ABLE TO 51 00:03:02,649 --> 00:03:06,519 EVENTUALLY ORDER AND INTERPRET WHAT A BLOOD TEST OR ACSF TEST 52 00:03:06,586 --> 00:03:07,287 MIGHT MEAN. 53 00:03:08,187 --> 00:03:11,524 PART OF THIS IS TO DETERMINE WHAT THE NORMAL RANGE IS IN A 54 00:03:11,591 --> 00:03:15,261 PARTICULAR RELEVANT POPULATION TO THE ONE THAT YOU'RE STUDYING. 55 00:03:15,662 --> 00:03:20,600 SO FOR THIS EFFORT WE WERE ABLE TO LEVERAGE AN EPIDEMIOLOGICAL 56 00:03:20,667 --> 00:03:25,338 STUDY OF OF CANADIANS THAT SPAN AGES 3 TO 79 THAT IS RUN BY 57 00:03:25,405 --> 00:03:29,776 STATISTICS CANADA AND THEY COLLECT IN A CROSS-SECTIONAL 58 00:03:29,842 --> 00:03:34,447 MANNER ABOUT SPLIT SPECIMENS FROM AROUND 6000 PEOPLE EVERY 59 00:03:34,514 --> 00:03:35,315 TWO YEARS. 60 00:03:35,782 --> 00:03:40,553 SO WE GOT A FULL CYCLE OF THOSE SPECIMENS AND WE HAVE RUN NOW 61 00:03:40,620 --> 00:03:45,325 REFERENCE INTERVAL STUDIES THAT MEET CLINICAL AND LABORATORY 62 00:03:45,391 --> 00:03:50,229 STANDARDS INSTITUTE RIGOR FOR NEUROFILAMENT LIGHT, GFAP A BETA 63 00:03:50,296 --> 00:03:55,001 40A BETA 42P TAU 181 AND WE PUBLISHED THAT THAT WORK AND NOW 64 00:03:55,068 --> 00:03:59,973 GOING FORWARD, OK, SO BASICALLY WHAT WE THE THE DATA USUALLY IF 65 00:04:00,039 --> 00:04:04,744 YOU ORDER A BLOOD TEST OR ANY SORT OF LABORATORY TEST YOU'LL 66 00:04:04,811 --> 00:04:09,649 YOU'LL HAVE A CUT OFF WHERE YOU KNOW YOU CAN INTERPRET THIS AS 67 00:04:09,716 --> 00:04:11,184 NORMAL OR ABNORMAL. 68 00:04:11,884 --> 00:04:17,190 THERE ARE NEWER METHODOLOGIES NOW THAT ARE MUCH MORE GRANULAR 69 00:04:17,256 --> 00:04:22,829 THAT CAN BREAK THE THE CUT OFFS DOWN IN A CONTINUOUS WAY USING A 70 00:04:22,895 --> 00:04:25,965 QUANTILE REGRESSION METHODOLOGIES. 71 00:04:26,666 --> 00:04:31,571 SO THIS WAS THE CANADIAN HEALTH MEASURES SURVEY SAMPLES THAT WE 72 00:04:31,638 --> 00:04:32,805 HAVE LEVERAGED. 73 00:04:33,406 --> 00:04:37,143 THIS IS VERY SIMILAR TO THE N HAYNES STUDY IN THE UNITED 74 00:04:37,210 --> 00:04:41,014 STATES FOR THOSE OF YOU WHO MIGHT HAVE HEARD OF N OF OF N 75 00:04:41,080 --> 00:04:45,351 HAYNES, THERE ARE A LOT OF OTHER VARIABLES COLLECTED ON THESE ON 76 00:04:45,418 --> 00:04:49,088 THESE PARTICIPANTS AND AND WE HAVE NOW COMPLETED, SO WE 77 00:04:49,155 --> 00:04:53,159 PUBLISHED ON THE 900 AND NOW THAT WE HAVE COMPLETED 2500, SO 78 00:04:53,226 --> 00:04:55,161 THAT'S 50% OF THE TOTAL CYCLE. 79 00:04:55,228 --> 00:04:59,432 WE WILL NOW HAVE ACCESS TO ALL OF THESE OTHER VARIABLES AND 80 00:04:59,499 --> 00:05:03,202 THEN BE ABLE TO DELIVER MUCH MORE GRANULAR LIKE EACH 81 00:05:03,269 --> 00:05:07,674 PERCENTILE AS A FUNCTION OF AGE PLUS DEVELOP A TOOL SO THAT IF 82 00:05:07,740 --> 00:05:11,844 YOU ORDER A TEST ON A SPECIFIC PLATFORM AND IT GIVES YOU A 83 00:05:11,911 --> 00:05:15,682 NUMBER, YOU WILL THEN HAVE THE INTERPRETATION OF WHAT 84 00:05:15,748 --> 00:05:19,819 PERCENTILE OR WHETHER YOU'RE OUTSIDE THE NORMAL RANGE FOR 85 00:05:19,886 --> 00:05:20,286 THAT. 86 00:05:20,353 --> 00:05:27,326 FOR THAT ANALYTE, WE'VE ALSO WORKED WITH KOSRO DELI. 87 00:05:27,627 --> 00:05:31,064 HE WAS INSTRUMENTAL IN INITIATING A WORLDWIDE OR OR 88 00:05:31,130 --> 00:05:35,134 CANADIAN STUDY CALLED CALIPER THAT REALLY LOOKS AT PEDIATRIC 89 00:05:35,201 --> 00:05:38,838 REFERENCE INTERVALS BECAUSE CHILDREN, ESPECIALLY YOUNG 90 00:05:38,905 --> 00:05:41,808 CHILDREN, ARE QUITE DIFFERENT THAN ADULTS. 91 00:05:42,275 --> 00:05:48,548 AND HE'S RECRUITED ABOUT 13,000 CHILDREN FROM BIRTH ALL THE WAY 92 00:05:48,614 --> 00:05:49,916 UP TO AGE 19. 93 00:05:50,383 --> 00:05:54,520 AND HE HAS IMPLEMENTED PEDIATRIC BLOOD TESTS AND AND LABORATORY 94 00:05:54,587 --> 00:05:58,257 TESTS, CLINICAL CHEMISTRY TESTS IN HOSPITAL LABORATORIES 95 00:05:58,324 --> 00:05:58,991 WORLDWIDE. 96 00:05:59,859 --> 00:06:04,163 AND SO FOR FOR THESE DATA, THIS IS AN EXAMPLE OF WHAT WE HAVE 97 00:06:04,230 --> 00:06:08,434 JUST ALSO PUBLISHED FROM THE FROM THE CALIPER COHORT YOU CAN 98 00:06:08,501 --> 00:06:12,872 SEE HERE IN THE LEFT ARE THE ARE THE ACTUAL RAW DATA WITH MALE 99 00:06:12,939 --> 00:06:17,009 AND FEMALE PARTICIPANTS LISTED AND THEN THE CONTINUOUS AND 100 00:06:17,076 --> 00:06:19,112 DISCRETE REFERENCE INTERVALS. 101 00:06:19,645 --> 00:06:24,250 SO WHAT YOU CAN SEE IS A PATTERN WHERE KIDS UNDER 4 HAVE ACTUALLY 102 00:06:24,317 --> 00:06:28,688 VERY HIGH CIRCULATING LEVELS OF GFAP JUST NATURALLY THESE ARE 103 00:06:28,755 --> 00:06:30,223 NOT INJURED CHILDREN. 104 00:06:31,190 --> 00:06:34,861 AND THE PATTERN FOR P TAU AND TO A SLIGHTLY LESSER EXTENT NFL 105 00:06:34,927 --> 00:06:36,596 LOOKS QUITE SIMILAR TO THIS. 106 00:06:37,029 --> 00:06:41,434 SO I THINK WHAT THIS IS TELLING US IS THAT FOR EXAMPLE ELEVATED 107 00:06:41,501 --> 00:06:45,838 GFAP WILL BE HARD TO DETECT IN VERY YOUNG CHILDREN, BUT BY THE 108 00:06:45,905 --> 00:06:50,309 TIME YOU GET TO SCHOOL AGE THE THE, THE, THE NORMAL VALUES KIND 109 00:06:50,376 --> 00:06:54,547 OF CONDENSE DOWN TO WHERE WE SEE IT VERY SIMILAR TO ADULTS. 110 00:06:54,981 --> 00:06:59,285 THIS IS IMPLICATIONS POTENTIALLY FOR HOW WE MIGHT BE ABLE TO 111 00:06:59,352 --> 00:07:03,356 EXTEND THE AGE AT WHICH SAY TESTS LIKE THE ABBOTT I STAT 112 00:07:03,422 --> 00:07:07,727 GFAB AND UCHL ONE TEST IT COULD BE POTENTIALLY MOVED DOWN TO 113 00:07:07,794 --> 00:07:11,297 SCHOOL AGE CHILDREN BUT PROBABLY NOT BELOW THAT. 114 00:07:11,864 --> 00:07:15,668 SO WHAT WE'RE TRYING TO DO IS ENABLE THE THE THE FIELD HERE IS 115 00:07:15,735 --> 00:07:19,505 TO USE AGE ADJUSTED REFERENCE INTERVALS AND ONCE WE HAVE OTHER 116 00:07:19,572 --> 00:07:23,042 VARIABLES THAT WE CAN TRY TO UNDERSTAND SOME OF THE NOISE 117 00:07:23,109 --> 00:07:26,712 HERE, CONTINUE TO REFINE HOW WE CAN USE AND INTERPRET BLOOD 118 00:07:26,779 --> 00:07:29,849 TESTS FOR WHATEVER POPULATION THAT WE'RE LOOKING. 119 00:07:30,416 --> 00:07:32,485 AD THESE ARE THE NFL DATA. 120 00:07:32,552 --> 00:07:37,190 AGAIN THE PATTERN IS THAT IT'S IT'S IT'S IT'S FAIRLY HIGH IN 121 00:07:37,256 --> 00:07:40,059 KIDS UNDER 4 AND SO ON AND SO FORTH. 122 00:07:40,126 --> 00:07:44,697 SO WHAT'S NICE HERE IS WE ALSO HAVE FAIRLY GOOD CONGRUENCY 123 00:07:44,764 --> 00:07:47,166 BETWEEN CALIPER AND CHMS DATA. 124 00:07:47,800 --> 00:07:51,103 EVEN THOUGH WE'RE USING DIFFERENT MATRICES, THEY'RE NOT 125 00:07:51,170 --> 00:07:54,841 TOO FAR OFF AND HAVING THESE DATA NOW THIS IS ALL DONE ON THE 126 00:07:54,907 --> 00:07:56,108 QUANTERICS PLATFORM. 127 00:07:56,676 --> 00:08:00,880 BY DOING CROSSOVER STUDIES, WE CAN THEN DETERMINE HOW A TEST 128 00:08:00,947 --> 00:08:05,017 RUN ON A QUANTARIS PLATFORM COMPARES TO ROCHE OR ABBOTT OR 129 00:08:05,084 --> 00:08:09,422 SIEMENS OR ANY OTHER OF THE UP AND COMING ANALYTICAL PLATFORMS 130 00:08:09,488 --> 00:08:13,492 THAT MIGHT BE MORE WELL PLACED WITHIN HOSPITAL LABORATORY 131 00:08:13,559 --> 00:08:15,795 SETTINGS TO DO THESE CLINICALLY. 132 00:08:16,729 --> 00:08:20,233 SO ANY QUESTIONS FOR CHERYL, I THINK THIS IS IMPORTANT STUFF 133 00:08:20,299 --> 00:08:23,402 THAT CAN ACTUALLY ULTIMATELY HAVE A LOT OF REGULATORY 134 00:08:23,469 --> 00:08:24,237 SIGNIFICANCE. 135 00:08:24,670 --> 00:08:24,837 YEAH. 136 00:08:26,806 --> 00:08:27,039 SO. 137 00:08:27,273 --> 00:08:30,743 SO DO YOU THINK THAT IN THESE SMALL CHILDREN THIS IS A 138 00:08:30,810 --> 00:08:34,847 CONSEQUENCE OF A IDIOSYNCRATIC BEHAVIOUR OF A SINGLE ANALYTE OR 139 00:08:34,914 --> 00:08:38,651 ARE YOU ACTUALLY SEEING A MARKER OF CHANGE GLIAL DYNAMICS. 140 00:08:38,718 --> 00:08:42,421 IF YOU TAKE ANOTHER GLIAL MARKER S 100 OR SOMETHING LIKE THAT, 141 00:08:42,488 --> 00:08:45,157 WHAT HAPPENS IT'S IT'S ACTUALLY NOT UNCOMMON. 142 00:08:45,224 --> 00:08:48,494 THE CARDIAC MARKERS ARE LIKE THIS AS WELL LIKE THE SO KIDS 143 00:08:48,561 --> 00:08:50,363 UNDER 4 ARE JUST UNIQUE SPECIES. 144 00:08:50,696 --> 00:08:53,399 AND SO WE THINK THAT THERE'S A, THERE'S A, THERE'S SEVERAL 145 00:08:53,466 --> 00:08:54,166 THINGS AT PLAY. 146 00:08:54,834 --> 00:08:56,936 ONE IS NEURODEVELOPMENT OF COURSE THAT IS THAT IS 147 00:08:57,003 --> 00:08:57,436 HAPPENING. 148 00:08:57,737 --> 00:09:00,740 ANOTHER THAT WE HYPOTHESIZE MIGHT BE HAPPENING IS JUST 149 00:09:00,806 --> 00:09:03,910 MATURATION OF THE BRAIN CLEARANCE PATHWAYS THAT WE DON'T 150 00:09:03,976 --> 00:09:04,911 KNOW IN IN PEOPLE. 151 00:09:04,977 --> 00:09:08,447 HOW LONG THAT TAKES TO REALLY ESTABLISH BLOOD BRAIN BARRIER IS 152 00:09:08,514 --> 00:09:11,684 ONE THING, BUT ALL THE DRAINAGE PATHWAYS MAYBE ANOTHER. 153 00:09:12,084 --> 00:09:16,188 THERE'S ALSO, YOU KNOW LITTLE KIDS NEWBORNS ARE ALMOST ALL 154 00:09:16,255 --> 00:09:18,057 HEAD AND VERY LITTLE BODY. 155 00:09:18,124 --> 00:09:23,429 SO YOU HAVE THAT SORT OF ANATOMICAL SCALE TO TO, TO MODEL 156 00:09:23,496 --> 00:09:24,230 AS WELL. 157 00:09:25,464 --> 00:09:28,701 WE DON'T KNOW THINGS LIKE, YOU KNOW, KIDNEY FUNCTION CLEARANCE, 158 00:09:28,768 --> 00:09:30,803 YOU KNOW HOW THEY TACKLE THESE ANALYTES. 159 00:09:30,870 --> 00:09:33,539 SO THERE'S A MULTITUDE OF THINGS THAT HAPPEN IN SMALL CHILDREN 160 00:09:33,606 --> 00:09:34,941 THAT WE HAVE YET TO UNDERSTAND. 161 00:09:35,841 --> 00:09:38,477 YEAH, HI. 162 00:09:38,544 --> 00:09:40,012 SO WE'RE, WE'RE HAVING NICE DATA. 163 00:09:40,079 --> 00:09:42,882 I'M JUST WONDERING ABOUT UCHL ONE, DO YOU SEE THE SAME 164 00:09:42,949 --> 00:09:44,517 ELEVATION IN THE VERY YOUNG? 165 00:09:44,583 --> 00:09:48,888 WE DID NOT DO UCHL ONE IN IN THIS STUDY BECAUSE THE AT LEAST 166 00:09:48,955 --> 00:09:53,025 ON THE QUANTERICS PLATFORM WE GET A LOT OF READS THAT ARE 167 00:09:53,092 --> 00:09:54,994 BELOW LIMIT OF OF DETECTION. 168 00:09:55,061 --> 00:09:56,829 SO WE DID NOT CARRY THROUGH. 169 00:09:58,597 --> 00:09:58,698 YEAH. 170 00:09:58,764 --> 00:09:59,398 I'M BRINGING UP. 171 00:09:59,465 --> 00:10:01,167 HOW DO YOU HANDLE SEX? 172 00:10:01,233 --> 00:10:01,701 DO YOU. 173 00:10:02,001 --> 00:10:02,134 YEAH. 174 00:10:02,201 --> 00:10:05,471 SO SEX IS WAS FOUND NOT TO BE A VARIABLE. 175 00:10:05,538 --> 00:10:07,640 MALES AND FEMALES WERE EXACTLY OVERLAID. 176 00:10:07,873 --> 00:10:11,877 WE WILL DETERMINE IF THAT STILL REMAINS ONCE WE GO FROM 900 TO 177 00:10:11,944 --> 00:10:12,912 2500 SPECIMENS. 178 00:10:13,579 --> 00:10:16,782 BUT SEX WAS NOT FOUND TO BE A VARIABLE IN ANY OF THE COHORTS 179 00:10:16,849 --> 00:10:17,817 THAT WE'VE TESTED. 180 00:10:18,150 --> 00:10:20,720 PLUS OTHER LARGE REFERENCE INTERVAL STUDIES FOR NFL AT 181 00:10:20,786 --> 00:10:21,087 LEAST. 182 00:10:22,154 --> 00:10:22,288 YEP. 183 00:10:25,257 --> 00:10:27,460 BEAUTIFUL STUDY CHERYL. 184 00:10:28,027 --> 00:10:28,561 DON'T RUN AWAY YET. 185 00:10:28,861 --> 00:10:33,299 SO THE FDA MAKES US WHEN WE DO UPPER REFERENCE RANGE TRIALS 186 00:10:33,366 --> 00:10:37,536 DICHOTOMIZE OR TRY SPLIT THE POPULATION UP TO BEING WHAT 187 00:10:37,603 --> 00:10:42,008 PERCENT AFRICAN AMERICANS GOT TO BE 15% FIFTEEN OR PROBABLY 188 00:10:42,074 --> 00:10:46,178 HIGHER PERCENT HISPANIC 10% ASIAN AND WE HAVE TO REPORT 189 00:10:46,245 --> 00:10:50,683 RESULTS AND THEY WON'T LET US USE OTHER COUNTRIES SPECIMENS 190 00:10:50,750 --> 00:10:55,287 UNLESS IT'S LESS THAN 20 OR 30% DEPENDING ON THE ON THE STUDY 191 00:10:55,354 --> 00:10:59,625 HOW MANY HISPANICS YOU HAVE IN CANADA BUT DID YOU LOOK AT 192 00:10:59,692 --> 00:11:01,127 VARIATIONS IN RACE. 193 00:11:01,193 --> 00:11:02,461 THIS IS A GREAT QUESTION FRANK. 194 00:11:02,762 --> 00:11:06,298 WE WE DO HAVE, WE DON'T HAVE ACCESS YET BY STATS CANADA TO 195 00:11:06,365 --> 00:11:10,069 ALL OF THOSE ETHNIC AND RACIAL VARIABLES, BUT THE COMPOSITION 196 00:11:10,136 --> 00:11:12,938 OF THE CANADIAN POPULATION IS VERY DIFFERENT. 197 00:11:13,506 --> 00:11:16,876 WE DO HAVE AFRICAN AMERICANS, OUR HISPANIC POPULATION IS VERY 198 00:11:16,942 --> 00:11:19,879 LOW, BUT WE HAVE A HIGH PROPORTION OF SOUTH ASIAN AND 199 00:11:19,945 --> 00:11:21,447 EAST ASIAN PEOPLES AS WELL. 200 00:11:21,747 --> 00:11:25,618 SO I THINK FROM A GLOBAL SCALE OTHER REFERENCE INTERVAL STUDIES 201 00:11:25,684 --> 00:11:29,588 THAT I KNOW THAT ARE HAPPENING IN ANHENES THAT IS US BASED SOME 202 00:11:29,655 --> 00:11:33,092 OF THE EUROPEAN POPULATIONS TOGETHER THEN WE CAN KIND OF 203 00:11:33,159 --> 00:11:37,096 DRILL DOWN AND AND YOU KNOW AND TRY TO UNDERSTAND HOW TO MAKE IF 204 00:11:37,163 --> 00:11:40,800 WE DO NEED TO ADJUST FOR ANY DIFFERENCES IN RACE OR RACE OR 205 00:11:40,866 --> 00:11:43,636 ETHNICITY FOR A REFERENCE INTERVAL CUT OFFS. 206 00:11:44,036 --> 00:11:44,570 SO IT'S COMING. 207 00:11:44,637 --> 00:11:50,609 I WONDER IS IS BETH IN THE ROOM BETH WAS UPSTAIRS. 208 00:11:50,676 --> 00:11:54,613 OK, HERE'S YES BETH, THIS IS SOMETHING THAT FDA BROUGHT UP 209 00:11:54,680 --> 00:11:58,717 WITH YOU GUYS IN ANY OF YOUR DISCUSSIONS WHEN IT'S THE GFAP 210 00:11:58,784 --> 00:12:02,321 AND UC AND JILL ONE TEST ARE BEING CLEARED REFERENCE 211 00:12:02,388 --> 00:12:03,489 INTERVALS BY AGE. 212 00:12:03,556 --> 00:12:06,459 IN FACT THE PRODUCT IS CLEAR. 213 00:12:06,525 --> 00:12:12,565 THEY LOOKED AT ALL OF THOSE DATA AND THEY LOOKED AT IT IN HTTP 214 00:12:12,631 --> 00:12:14,767 FOR THOSE THAT ENTIRE. 215 00:12:15,701 --> 00:12:19,505 SO THEY LOOK BIG FORWARD THROUGH AND WE SEND IN AN FDA SUBMISSION 216 00:12:19,572 --> 00:12:20,439 OF STACK DATAS. 217 00:12:21,006 --> 00:12:21,807 NO, THEY TURNED IT ALL OUT. 218 00:12:22,007 --> 00:12:23,843 NO MY EXACTLY HEARD LIKE THIS A LITTLE BIT. 219 00:12:24,443 --> 00:12:28,347 SO THEY LOOKED AT ALL OF THAT QUITE POTENTIALLY FOR NOT JUST 220 00:12:28,414 --> 00:12:32,551 THE CARE DEVICE FOR THAT DEVICE FOR THIS PARTICULAR CUT OFF FOR 221 00:12:32,618 --> 00:12:36,555 THAT PARTICULAR CERTIFICATE SPECIMEN STATED THEY WERE ALL IN 222 00:12:36,622 --> 00:12:38,824 AN AGE OF 18 TO 92 FOR OUR ESSAY. 223 00:12:39,225 --> 00:12:42,761 NOW, YOU KNOW, WE LOOK AT OTHER PEOPLE'S ESSAYS AND IT'S NOT 224 00:12:42,828 --> 00:12:45,731 LIKE AN ANALOGY WOULD BE AT A DOLLAR BILL, RIGHT. 225 00:12:45,798 --> 00:12:50,469 A DOLLAR IN THE UNITED STATES VERSUS A DOLLAR IN CANADA VERSUS 226 00:12:50,536 --> 00:12:52,138 A DOLLAR AND A RIGHT. 227 00:12:52,204 --> 00:12:53,072 AND THEY'RE NOT EXACT. 228 00:12:54,039 --> 00:12:58,477 WHEN YOU LOOK AT THE ESSAYS, YOU HAVE TO LOOK AT WHO MADE THE 229 00:12:58,544 --> 00:13:03,215 ESSAY BECAUSE G BAP IS NOT GBAP IS NOT GBAP, CHO ONE IS NOT CHO, 230 00:13:03,282 --> 00:13:04,316 ONE IS NOT CHO. 231 00:13:04,383 --> 00:13:09,955 ONE HAS TO LOOK AT WHERE MANUFACTURING AND YEAH, FOR 232 00:13:10,022 --> 00:13:10,489 SURE. 233 00:13:10,556 --> 00:13:11,090 THANK YOU. 234 00:13:11,157 --> 00:13:11,590 THANK YOU, BETH. 235 00:13:11,657 --> 00:13:16,529 I MEAN CERTAINLY WHAT OUR PLAN GOING FORWARD IS TO DO A LOT OF 236 00:13:16,595 --> 00:13:21,333 PLATFORM COMPARISON AND ASSAY COMPARISON FOR TO DETERMINE WE 237 00:13:21,400 --> 00:13:26,172 DO SEE A RAISE OF GFAP BY AGE AND OLDER POPULATION, YOU KNOW, 238 00:13:26,238 --> 00:13:30,409 NO MAN, IT RAISES A VERY IMPORTANT POINT, YOU KNOW IN 239 00:13:30,476 --> 00:13:30,876 ORDER. 240 00:13:30,943 --> 00:13:34,847 SO, SO AT OUR HOSPITAL, I MEAN I REACHED OUT TO OUR CLINICAL 241 00:13:34,914 --> 00:13:38,184 CHEMISTRY DEPARTMENT AT UNIVERSITY OF PENNSYLVANIA 242 00:13:38,250 --> 00:13:42,087 HEALTH SYSTEM TO SAY GEE, WE HAVE THIS FDA CLEARED TEST FOR 243 00:13:42,154 --> 00:13:46,091 GFAP AND NEW GHL ONE, LET'S START USING IT AND AND THEY TOLD 244 00:13:46,158 --> 00:13:49,995 ME WE'RE NOT AN ABBOTT SHOP, THEY SAID WE DON'T HAVE ABBOTT 245 00:13:50,062 --> 00:13:53,966 EQUIPMENT, WE'RE NOT GOING TO PURCHASE AN UNLIMITED JUST FOR 246 00:13:54,033 --> 00:13:54,767 YOU, RIGHT. 247 00:13:55,501 --> 00:13:58,437 SO, SO THAT THAT'S DISAPPOINTING ACTUALLY VERY DISAPPOINTING. 248 00:13:58,504 --> 00:14:02,408 YES, RIGHT, RIGHT. 249 00:14:04,443 --> 00:14:07,646 THEY ALSO THEY ALSO DIDN'T LIKE THE HANDHELDS EITHER IT'S IT 250 00:14:07,713 --> 00:14:10,849 WAS, IT WAS A BARRIER RIGHT NOW I I I THINK EVERYONE KNOWS. 251 00:14:10,916 --> 00:14:16,522 SO BIO MERU HAS CE MART CLEARANCE FOR A JFAPUC HO1 TEST 252 00:14:16,589 --> 00:14:17,523 IN EUROPE. 253 00:14:17,590 --> 00:14:21,927 ABBOTT HAS YOUR CE MART CLEARANCE AS WELL AS I 254 00:14:21,994 --> 00:14:25,831 UNDERSTAND IT, THIS IS THE DEVICE, RIGHT. 255 00:14:25,898 --> 00:14:31,303 AND THEN YOU HAVE, LIKE, A PARTRIDGE THAT YOU JUST, YOU 256 00:14:31,370 --> 00:14:37,476 KNOW, IF YOU WANTED TO CREATE, OH, OH, BETH, I'M REMINDED THAT 257 00:14:37,543 --> 00:14:43,582 YOU NEED TO USE THE MICROPHONE SO PEOPLE ONLINE CAN HEAR YOU. 258 00:14:48,287 --> 00:14:48,454 YEAH. 259 00:14:48,520 --> 00:14:49,755 BUT ONLINE'S A DIFFERENT DEAL. 260 00:14:50,022 --> 00:14:50,422 YEAH. 261 00:14:54,326 --> 00:14:54,460 YEAH. 262 00:14:54,526 --> 00:14:54,760 COME UP. 263 00:14:54,827 --> 00:14:55,294 COME UP HERE. 264 00:14:55,361 --> 00:14:56,562 SO YOU CAN SHOW IT FROM THE CAMERA. 265 00:14:56,629 --> 00:14:56,962 OH, OK. 266 00:14:57,029 --> 00:14:57,363 THAT'S RIGHT. 267 00:14:57,429 --> 00:14:59,398 I HAVE A NEW ANSWER. 268 00:14:59,465 --> 00:14:59,598 MOM. 269 00:14:59,665 --> 00:15:00,432 THANK YOU FOR ASKING. 270 00:15:01,233 --> 00:15:03,235 SO THE ONE DEVICE, HI EVERYONE. 271 00:15:03,302 --> 00:15:06,338 NOW THAT YOU CAN HEAR ME AND BETH MCQUISTON, I'VE MET A LOT 272 00:15:06,405 --> 00:15:09,575 OF YOU GUYS BEFORE AND ALSO VERY INTERESTED IN MEETING ANYONE 273 00:15:09,642 --> 00:15:09,775 NEW. 274 00:15:09,842 --> 00:15:11,910 SO PLEASE REACH OUT TO ME AND IT'S NICE TO SEE YOU AGAIN, 275 00:15:11,977 --> 00:15:12,244 CHERYL. 276 00:15:12,645 --> 00:15:15,080 AND WE HAVE, THIS IS ONE OF OUR DEVICES. 277 00:15:15,147 --> 00:15:18,050 WE DEVELOPED THIS IN CONJUNCTION WITH THE UNITED STATES 278 00:15:18,117 --> 00:15:20,419 DEPARTMENT OF DEFENSE, SO KUDOS TO THEM. 279 00:15:20,486 --> 00:15:24,123 THEY ACTUALLY USE OUR DEVICES IN THE FIELD AND THEY CAME TO 280 00:15:24,189 --> 00:15:27,593 ABBOTT IN 2011 AND THEY ASKED US IF WE COULD MAKE THESE 281 00:15:27,660 --> 00:15:31,230 BIOMARKERS ON A HANDHELD DEVICE DOWN, MEASURED DOWN TO THE 282 00:15:31,297 --> 00:15:35,067 PICOGRAM LEVEL AT THE SAME TIME WITH TWO DROPS OF BLOOD IN 15 283 00:15:35,134 --> 00:15:35,567 MINUTES. 284 00:15:35,634 --> 00:15:40,572 SO WE WORKED DILIGENTLY WITH THEM FOR YEARS AND WE WERE FDA 285 00:15:40,639 --> 00:15:41,307 CLEARED. 286 00:15:41,707 --> 00:15:44,610 WHAT WAS IT ABOUT A YEAR AND A HALF AGO, TWO YEARS AGO ON THE 287 00:15:44,677 --> 00:15:47,112 POINT OF CARE DEVICE, THE HANDHELD DEVICE WITH THIS 288 00:15:47,179 --> 00:15:49,848 CARTRIDGE AND THEN IT'S ALSO ON THE CORE LAB PLATFORM. 289 00:15:50,382 --> 00:15:53,419 AND WE ALSO WANT TO DO A SHOUT OUT TO TRACK TBI BECAUSE THEY 290 00:15:53,485 --> 00:15:56,522 HELPED US WITH OUR TRAINING SET AND WITHOUT EVERYBODY IN THIS 291 00:15:56,588 --> 00:15:59,525 ROOM AND WITHOUT THE DEPARTMENT OF DEFENSE AND WITHOUT THE 292 00:15:59,591 --> 00:16:02,695 PARTNERSHIP WITH ACADEMIA AND WITHOUT THE BRILLIANT SCIENTISTS 293 00:16:02,761 --> 00:16:04,396 AT ABBOTT, WE WOULDN'T HAVE THIS. 294 00:16:04,463 --> 00:16:08,133 SO KUDOS TO EVERYONE IN THE ROOM, FDA CLEARED, CE MARK, TGA 295 00:16:08,200 --> 00:16:10,035 REGISTERED, ETCETERA, SO FORTH. 296 00:16:10,102 --> 00:16:13,839 SO ON ANY OTHER QUESTIONS, NO THANKS FOR THAT. 297 00:16:13,906 --> 00:16:16,842 AND REALLY BETH, THANKS FOR ALL THE SUPPORT TO THE FIELD. 298 00:16:16,909 --> 00:16:20,612 I THINK BETH PERSONALLY AND ABBOTT MORE GENERALLY DESERVES A 299 00:16:20,679 --> 00:16:24,650 LOT OF CREDIT WHERE WE ARE NOW I MUST SAY THIS WORKS AS AS WE'VE 300 00:16:24,717 --> 00:16:28,220 HEARD AND AND IT'S GOING TO ATTRACT A LOT OF COMPETITION, 301 00:16:28,287 --> 00:16:28,620 RIGHT. 302 00:16:28,687 --> 00:16:31,924 SO THERE ARE, I'M I'M AWARE OF AT LEAST THREE OR FOUR COMPANIES 303 00:16:31,990 --> 00:16:35,060 THAT ARE WORKING HARD ON GFAP ASSAYS THAT ARE TRYING TO GET 304 00:16:35,127 --> 00:16:37,996 INTO THE MARKET, WHICH IS I THINK ULTIMATELY WHAT WE'LL 305 00:16:38,063 --> 00:16:38,230 NEED. 306 00:16:38,297 --> 00:16:41,400 I THINK IN ORDER FOR ME TO USE THIS AT PENN, WE'RE GOING TO 307 00:16:41,467 --> 00:16:44,436 HAVE TO REQUIRE BECKMAN TO DEVELOP SUCH AN ASSAY, WHICH I 308 00:16:44,503 --> 00:16:47,406 KNOW THEY'RE WORKING ON IT AT SOME POINT IT MAY MAY COME 309 00:16:47,473 --> 00:16:50,576 THROUGH, BUT BUT THERE ARE SEVERAL OTHER COMPANIES THAT ARE 310 00:16:50,642 --> 00:16:52,311 CLEARLY WORKING ON THIS AS WELL. 311 00:16:53,746 --> 00:16:58,951 SO ONE THING WE AGAIN GOING BACK TO THE ISSUE THAT FRANK BROUGHT 312 00:16:59,017 --> 00:17:03,055 UP RIGHT, THAT THE UNDER REPRESENTATION OF AFRICAN 313 00:17:03,122 --> 00:17:05,457 AMERICANS IN THE CHMS COHORT. 314 00:17:05,858 --> 00:17:09,962 NO, ONE OF THE THINGS THAT WE HAD TALKED ABOUT, I THINK WE PUT 315 00:17:10,028 --> 00:17:13,966 IT ON OUR GRANT IS THAT WE WERE GOING TO TRY AND GET SAMPLES 316 00:17:14,032 --> 00:17:17,736 FROM THE FRAMINGHAM OFFSPRING STUDY WHERE THE FRAMINGHAM 317 00:17:17,803 --> 00:17:18,704 CONTROL STUDY. 318 00:17:19,104 --> 00:17:22,775 SO I BELIEVE THAT IS HAPPENING OR IT'S IT'S EITHER IT'S BEEN 319 00:17:22,841 --> 00:17:24,710 DONE OR WILL WILL SOON BE DONE. 320 00:17:25,110 --> 00:17:29,615 THERE ARE A LOT OF ESSAY, THERE ARE A LOT OF PROSPECTIVE STUDIES 321 00:17:29,681 --> 00:17:33,919 LIKE FRAMINGHAM, ERIC, IF WE HAVE ANDREA HERE, MAYBE SHE CAN 322 00:17:33,986 --> 00:17:35,087 COMMENT ON THAT. 323 00:17:35,154 --> 00:17:41,727 ERIC HAS OBTAINED NFL AS WELL AS TAO AND P TAO ON THE EQUINTERI 324 00:17:41,794 --> 00:17:42,661 PLATFORM. 325 00:17:42,728 --> 00:17:43,395 IS ANDREA HERE? 326 00:17:44,296 --> 00:17:44,830 MAYBE SHE'S NOT. 327 00:17:44,897 --> 00:17:47,900 SHE MUST HAVE BEEN ON THE OTHER SESSION, RIGHT, AND THAT'S 328 00:17:47,966 --> 00:17:49,401 THAT'S GOING TO BE AVAILABLE. 329 00:17:49,468 --> 00:17:53,305 THAT WAS ALSO RUN IN THE QUINTERIX PLATFORM IN IN BAYLOR 330 00:17:53,372 --> 00:17:57,309 BY CHRISTY BALENTINE'S GROUP, WHICH IS THAT ALSO BEEN BEEN 331 00:17:57,376 --> 00:17:59,077 VERY ACTIVE IN THIS FIELD. 332 00:17:59,144 --> 00:18:02,181 SO THERE'S A LOT OF THIS DATA THAT'S GOING TO BE COMING. 333 00:18:02,247 --> 00:18:05,284 IT'S CLEARLY GOING TO HAVE AN IMPACT IN OUR FIELD AS WELL AS 334 00:18:05,350 --> 00:18:07,519 MANY OTHER AREAS OF NEUROSCIENCE AS WELL. 335 00:18:10,355 --> 00:18:13,292 ANY OTHER COMMENTS ON THIS WHOLE ISSUE OF OF REFERENCE INTERVALS 336 00:18:13,358 --> 00:18:15,961 WHICH I I DO THINK IT'S GOING TO BE IMPORTANT TO GET WIDE 337 00:18:16,028 --> 00:18:16,595 APPLICABILITY. 338 00:18:16,662 --> 00:18:22,301 CHERYL, MICROPHONE, I'M, I'M SORRY, MICROPHONE, DO YOU WANT 339 00:18:22,367 --> 00:18:27,806 TO TALK ABOUT MATERIALS, REFERENCE MATERIALS SO THAT LABS 340 00:18:27,873 --> 00:18:29,741 CAN CALIBRATE WORSE? 341 00:18:30,242 --> 00:18:34,713 YES, I DIDN'T HAVE SLIDES FOR THAT, BUT BUT ONE OF THE THINGS 342 00:18:34,780 --> 00:18:39,585 THAT ARE ALSO GOING TO BE NEEDED ARE REFERENCE MATERIALS THAT ARE 343 00:18:39,651 --> 00:18:43,722 INTERNATIONALLY RECOGNIZED, DEVELOPED UNDER VERY ROBUST 344 00:18:43,789 --> 00:18:47,292 CONDITIONS THAT CAN BE SHARED INTERNATIONALLY. 345 00:18:47,359 --> 00:18:51,296 THIS, THIS WAS PIONEERED BY KAI BLANOW AND HENRY ZETTERBERG FOR 346 00:18:51,363 --> 00:18:55,234 A BETA AND THAT MADE AN ENORMOUS DIFFERENCE IN THE ALZHEIMER'S 347 00:18:55,300 --> 00:18:56,635 FIELD MANY YEARS AGO. 348 00:18:57,736 --> 00:19:01,773 AND I YOU KNOW WE CLEARLY NEED TO DO THAT IN THE IN THE TBI 349 00:19:01,840 --> 00:19:06,211 FIELD AND KEVIN WHO WAS HERE IS SORT OF GOING TO BE LEADING THAT 350 00:19:06,278 --> 00:19:10,415 EFFORT HAS ALREADY BEEN WORKING ON THAT AND WILL WILL DEVELOP 351 00:19:10,482 --> 00:19:14,019 SOME MORE OF THESE REFERENCE MATERIALS AND THESE ARE 352 00:19:14,086 --> 00:19:18,323 RECOMBINANT PROTEINS THAT CAN BE QUALIFIED AND AND CALIBRATED. 353 00:19:18,390 --> 00:19:19,191 IT CAN BE SHARED BROADLY. 354 00:19:19,258 --> 00:19:22,995 I THINK THE OTHER THING THAT WILL BE NEEDED AND WE'RE 355 00:19:23,061 --> 00:19:27,266 PROBABLY A LITTLE LESS FAR ALONG IN DOING THIS IS TO DEVELOP 356 00:19:27,332 --> 00:19:31,103 MATRIX SPECIFIC REFERENCE MATERIALS MEANING PLASMA AND 357 00:19:31,169 --> 00:19:35,707 SERUM AND POTENTIALLY CSF BUT AT LEAST PLASMA AND SERUM THAT FROM 358 00:19:35,774 --> 00:19:40,212 FROM LARGE POOLS WHERE THE VALUE IS IS WELL RECOGNIZED AND KEPT 359 00:19:40,279 --> 00:19:40,979 CALIBRATED. 360 00:19:41,046 --> 00:19:45,450 KEVIN, YEAH, I KNOW JUST TO PEGGY BACK ON THAT, YOU KNOW THE 361 00:19:45,517 --> 00:19:49,888 OBVIOUSLY THE NORMATIVE CONTROL HUGELY USEFUL AND THEN THE, 362 00:19:49,955 --> 00:19:53,992 YEAH, WE'RE TRYING TO DEVELOP THE RECOMBINANT PROTEIN. 363 00:19:54,626 --> 00:19:57,930 SO WE'RE FINDING OUT THAT WHEN YOU SPIKE IN THIS PROTEIN INTO 364 00:19:57,996 --> 00:20:00,933 NAIVE YOU KNOW CONTROL PLASMA, A LOT OF IT DISAPPEARS. 365 00:20:00,999 --> 00:20:01,166 SO. 366 00:20:01,667 --> 00:20:05,137 SO IT'S NOT TO SAY THEY'RE NOT USEFUL, BUT THEN IT'S A LOT OF 367 00:20:05,203 --> 00:20:06,738 GETTING ABSORBED BASICALLY. 368 00:20:07,072 --> 00:20:11,076 SO THAT REALLY ARGUES FOR HAVING A POOL OF TBI OR YOU KNOW, 369 00:20:11,143 --> 00:20:14,713 DISEASE, PATIENT SERUM AND PLASMA FOR THAT PARTICULAR 370 00:20:14,780 --> 00:20:18,650 INDICATION AS A POSITIVE CONTROL, AS MUCH AS THE NEGATIVE 371 00:20:18,717 --> 00:20:22,521 CONTROL, IMPORTANT, POSITIVE CONTROL, HUGELY IMPORTANT. 372 00:20:23,155 --> 00:20:28,160 SO I'M CURIOUS WE WE HAVE A PRETTY GOOD TURN OUT HERE AND AS 373 00:20:28,226 --> 00:20:32,898 WELL AS PEOPLE ONLINE AND AND HOW MANY OF YOU IS IN YOUR 374 00:20:32,965 --> 00:20:38,203 HOSPITAL USING GFAP FOR CLINICAL INDICATIONS NOT RESEARCH OR OR 375 00:20:38,270 --> 00:20:43,508 AT LEAST THINKING ABOUT IT OR OR MAKING THE THE STEPS TO TO GET 376 00:20:43,575 --> 00:20:47,913 IT, GET IT ONLINE AT YOUR HOSPITAL IT'S FASCINATING. 377 00:20:47,980 --> 00:20:51,750 SO, SO NO ONE AT LEAST IN THIS ROOM PEOPLE ARE VERY INTERESTED 378 00:20:51,817 --> 00:20:55,454 IN TBI IS YET USING GFAP AND NEW CHL ONE AS A CLINICAL TOOL. 379 00:20:55,520 --> 00:20:57,923 I AM AWARE THAT THERE ARE A COUPLE OF HOSPITALS THAT ARE 380 00:20:57,990 --> 00:20:59,391 DOING THIS BUT BUT NOT VERY MANY. 381 00:20:59,458 --> 00:21:03,095 THERE'S THIS HAS BEEN A CHALLENGE IN BEEN IN 382 00:21:03,161 --> 00:21:06,732 DISSEMINATING AND GETTING THE THE ADOPTION. 383 00:21:06,798 --> 00:21:09,001 I THINK THERE ARE A NUMBER OF REASONS WHY THAT COULD BE. 384 00:21:09,768 --> 00:21:12,471 OBVIOUSLY THINGS ARE SLOWING AND AND GETTING ADOPTED. 385 00:21:14,539 --> 00:21:18,243 YOU KNOW THOSE OF YOU WHO WERE HERE FOR THE LAST COUPLE OF DAYS 386 00:21:18,310 --> 00:21:21,346 SINCE THE INTEREST AND ENTHUSIASM TO FEEL AS A WHOLE 387 00:21:21,413 --> 00:21:24,716 FOR BIOMARKERS TO HELP CLASSIFY TRAUMATIC BRAIN INJURY. 388 00:21:25,517 --> 00:21:29,054 AND IT'S SOMETHING THAT AT LEAST THE YOU KNOW, FDA CLEARED THE 389 00:21:29,121 --> 00:21:32,457 ABBOTT TESTS COUPLE OF YEARS AGO, ALMOST TWO YEARS AGO AND 390 00:21:32,524 --> 00:21:36,028 AND WE'RE WE'RE NOT DOING IT YET AND THEY'RE GOING TO BE SOME 391 00:21:36,094 --> 00:21:39,765 BARRIERS AND I HOPE THAT SOME OF THE WORK WE CAN DO CAN CAN HELP 392 00:21:39,831 --> 00:21:41,800 ALLEVIATE SOME OF THOSE BARRIERS. 393 00:21:42,467 --> 00:21:46,304 I THINK A A MAJOR INTERNATIONAL QUESTION WILL BE WHAT'S THE 394 00:21:46,371 --> 00:21:49,908 FUNDING MODEL TO BRING IN THESE NEW LABORATORY TESTS. 395 00:21:50,909 --> 00:21:54,379 AND IN SOME PLACES IT MIGHT BE POSSIBLE TO SAY WELL, WE COULD 396 00:21:54,446 --> 00:21:58,016 REDUCE MRI BURDEN OR INCREASE, YOU KNOW, AND THAT SAVINGS COULD 397 00:21:58,083 --> 00:22:01,687 GO TO THAT AND OTHER PLACES LIKE IN BRITISH COLUMBIA, THAT'S NOT 398 00:22:01,753 --> 00:22:02,220 POSSIBLE. 399 00:22:02,287 --> 00:22:05,857 YOU CAN'T PUT ONE MONEY LIKE ONE SOURCE OF FUNDING INTO. 400 00:22:05,924 --> 00:22:07,292 I MEAN THAT'S THAT'S GOING TO BE THE OTHER BARRIER. 401 00:22:07,359 --> 00:22:11,496 SO NOT ONLY DO WE HAVE THE INFRASTRUCTURE, DO WE HAVE A 402 00:22:11,563 --> 00:22:15,834 QUALITY PROGRAM THAT WE CAN MONITOR HOW WELL THESE ASSAYS 403 00:22:15,901 --> 00:22:20,572 ARE BEING PERFORMED AND DO WE HAVE THE PERSONNEL TRAINED IN IN 404 00:22:20,639 --> 00:22:21,540 DOING THEM. 405 00:22:21,606 --> 00:22:28,213 ALL OF THIS NEEDS TO BE BUILT UP PLUS THE FUNDING MECHANISM A, A 406 00:22:28,280 --> 00:22:29,648 RELATED ISSUE. 407 00:22:29,715 --> 00:22:33,752 SO OBVIOUSLY S 100 BETA HAS BEEN PART OF THE SCANDINAVIAN 408 00:22:33,819 --> 00:22:37,789 GUIDELINES FOR FOR REALLY QUITE A WHILE, OVER A DECADE. 409 00:22:38,590 --> 00:22:42,994 AND I'M CURIOUS, I KNOW I SEE WE HAVE ERIC FILENE REMOTELY. 410 00:22:43,628 --> 00:22:46,798 ERIC, I WONDER IF YOU WOULD COMMENT AT THE CAROLINE SCOUT, 411 00:22:46,865 --> 00:22:50,435 RIGHT, HOW, HOW OFTEN OR OR WHAT BARRIERS HAVE YOU FOUND TO USING 412 00:22:50,502 --> 00:22:53,872 S 100 BETA SORT OF ACCORDING TO THE SCANDINAVIAN GUIDELINES. 413 00:22:55,273 --> 00:23:00,045 SO WE HAVE QUITE A, WE HAVEN'T REALLY HAD THAT MANY BARRIERS. 414 00:23:00,112 --> 00:23:03,215 I WOULD SAY AFTER THE IMPLEMENTATION OF THE 415 00:23:03,281 --> 00:23:07,886 SCANDINAVIAN GUIDELINES IN 2013, THEY BECAME QUITE WIDESPREAD IN 416 00:23:07,953 --> 00:23:10,288 TERMS OF SCREENING FOR MILD TBI. 417 00:23:11,456 --> 00:23:16,128 THERE'S SCREENING FOR WHO TO DO ACT SCAN ON IN MILD TBI FOR SORT 418 00:23:16,194 --> 00:23:17,996 OF A COST SAVING PURPOSE. 419 00:23:18,430 --> 00:23:21,967 SO I I THINK THAT I DON'T NECESSARILY THINK THAT YOU IF 420 00:23:22,033 --> 00:23:25,670 YOU HAVE APPROVAL AND YOU HAVE SOMEWHAT SOLID MORE ROBUST 421 00:23:25,737 --> 00:23:28,740 EVIDENCE THAT IS GOING TO BE THAT PROBLEMATIC. 422 00:23:29,407 --> 00:23:33,912 KARLINSKA IS A VERY BIOMARKER HEAVY INSTITUTION IN TERMS OF 423 00:23:33,979 --> 00:23:38,450 THE SEVERE TBI WHERE WE USE S100B FOR SERIAL MONITORING IN 424 00:23:38,517 --> 00:23:42,187 UNCONSCIOUS TBI AND SCH PATIENTS TWICE PER DAY. 425 00:23:42,521 --> 00:23:47,459 SO I I THINK THAT WE'RE SOMEWHAT BIASED, BUT I I ALSO THINK THAT 426 00:23:47,526 --> 00:23:51,963 WE MIGHT BE ABLE TO SHARE SOME OF OUR EXPERIENCE IN A FEW 427 00:23:52,030 --> 00:23:56,968 UPCOMING PAPERS THAT WE HAVE NOW THAT WE WE REALLY CAN SHOW THAT 428 00:23:57,035 --> 00:24:01,473 THIS HELPS US IN OUR CLINICAL ASSESSMENTS OF OUR PATIENTS 429 00:24:01,540 --> 00:24:01,840 WELL. 430 00:24:01,907 --> 00:24:05,043 SO IT'S GOOD TO KNOW THAT AT LEAST IN, IN IN SOME HOSPITALS 431 00:24:05,110 --> 00:24:08,346 IN IN SWEDEN AND OTHER AREAS IN SCANDINAVIA THAT THAT THIS IS 432 00:24:08,413 --> 00:24:11,750 ACTUALLY HAPPENING BECAUSE WE'RE ALL VERY EXCITED TO BE ABLE TO 433 00:24:11,817 --> 00:24:12,484 USE IT HERE. 434 00:24:17,088 --> 00:24:18,623 THERE'S A QUESTION IN THE CHAT. 435 00:24:20,358 --> 00:24:21,459 HOW CAN I SEE THE CHAT? 436 00:24:21,526 --> 00:24:21,993 OH, HERE WE GO. 437 00:24:23,929 --> 00:24:24,529 ALL RIGHT. 438 00:24:25,163 --> 00:24:26,431 THIS IS A QUESTION FROM JONATHAN. 439 00:24:26,498 --> 00:24:30,135 DO EVERYONE CLINICIANS LOVE A NEW GADGET, BUT WHAT IS THE 440 00:24:30,202 --> 00:24:34,105 BUSINESS CASE FOR BIOMARKERS AND TBI, ADDITIONAL COSTS VERSUS 441 00:24:34,172 --> 00:24:34,673 BENEFITS? 442 00:24:34,739 --> 00:24:36,007 SO THAT'S A GREAT QUESTION. 443 00:24:36,074 --> 00:24:38,977 THAT'S EXACTLY WHAT WHAT WE'RE TALKING ABOUT RIGHT NOW. 444 00:24:42,948 --> 00:24:47,385 I CAN GIVE MY ANSWER, ANYONE CARE TO ANSWER BUT OBVIOUSLY THE 445 00:24:47,452 --> 00:24:51,857 THE CONTEXT OF USE THAT IN THE US IS FDA CLEARED IS TO REDUCE 446 00:24:51,923 --> 00:24:56,361 THE NUMBER OF UNNECESSARY CT SCANS AND THE ESTIMATES FROM THE 447 00:24:56,428 --> 00:24:59,898 ALERT STUDY IS THAT APPROXIMATELY 35% OF THE CTS 448 00:24:59,965 --> 00:25:04,469 THAT WE DO IN THE UNITED STATES COULD BE SKIPPED IF WE WERE TO 449 00:25:04,536 --> 00:25:08,974 USE THIS TEST AND AND THAT IS OBVIOUSLY A SUBSTANTIAL SAVING. 450 00:25:09,040 --> 00:25:12,711 NOW WHETHER WHETHER EMERGENCY MEDICINE PHYSICIANS WILL WILL IN 451 00:25:12,777 --> 00:25:16,348 FACT DO THIS, IT'S A QUESTION OR TIMING IT'S A QUESTION OR A 452 00:25:16,414 --> 00:25:17,716 NUMBER OF OTHER THINGS. 453 00:25:17,782 --> 00:25:22,320 I THINK THAT THAT REMAINS TO BE SHOWN IT IT LIKELY WOULD, WOULD 454 00:25:22,387 --> 00:25:23,755 TAKE A WHILE, RIGHT. 455 00:25:23,822 --> 00:25:27,325 I I MEAN I SAY I I THINK AS A NEUROLOGIST AND YOU KNOW SOMEONE 456 00:25:27,392 --> 00:25:30,695 WHO'S WORKING THE ICU AND ALSO IN THE OUTPATIENT SETTING, I 457 00:25:30,762 --> 00:25:32,564 THINK IT WOULD BE VERY VALUABLE. 458 00:25:33,265 --> 00:25:37,702 IT WOULD BE INFORMATIVE TO ME AND CERTAINLY INFORMATIVE TO 459 00:25:37,769 --> 00:25:42,474 PATIENTS AND THEIR FAMILIES IF WE HAD THIS DATA RIGHT, EVEN IF 460 00:25:42,540 --> 00:25:44,776 IT IT CAN HELP DIAGNOSTICALLY. 461 00:25:44,843 --> 00:25:48,914 YOU KNOW MANY PEOPLE THAT HAVE A NEGATIVE CT NONETHELESS HAVE 462 00:25:48,980 --> 00:25:52,784 ATBI AND IF THEY THEY HAD PROOF THAT THEY HAD HAD A TB, A 463 00:25:52,851 --> 00:25:56,321 SIGNIFICANT BRAIN INJURY THAT COULD POTENTIALLY HAVE 464 00:25:56,388 --> 00:25:59,624 IMPLICATIONS FOR THEIR DISABILITY ASSESSMENTS OR 465 00:25:59,691 --> 00:26:03,361 WORKMAN'S COMPENSATION OR MANY OTHER THINGS LIKE THIS. 466 00:26:03,595 --> 00:26:06,798 WE HEARD THIS OVER THE LAST COUPLE OF DAYS FROM THE LIVED 467 00:26:06,865 --> 00:26:10,402 EXPERIENCE CONSULTANTS THAT THIS WOULD BE A VERY VALUABLE THING 468 00:26:10,468 --> 00:26:13,438 FOR HIM TO HAVE EVEN IF IT DIDN'T NECESSARILY LEAD TO 469 00:26:13,505 --> 00:26:14,506 SKIPPING ACT SCAN. 470 00:26:15,307 --> 00:26:15,974 DOUG YEAH. 471 00:26:16,041 --> 00:26:19,678 SO I I ONE EXAMPLE OF OF I MEAN THIS BEING REALLY USEFUL IS LIKE 472 00:26:19,744 --> 00:26:23,348 IN PEDIATRICS WHERE OUR HOSPITAL CHOPPED DOESN'T LIKE TO USE CTS 473 00:26:23,415 --> 00:26:25,417 AND SO YOU CAN SEE THE ALTERNATIVE. 474 00:26:25,483 --> 00:26:28,620 BUT THEN I SAW CHERYL'S DATA AND I'M LIKE OH YEAH, SO IT'S 475 00:26:28,687 --> 00:26:32,090 PROBLEMATIC, BUT THERE ARE MANY, YOU KNOW, AUSTERE ENVIRONMENTS 476 00:26:32,157 --> 00:26:35,427 AND WHATNOT AND MAYBE PEDIATRICS OF A CERTAIN AGE OR WHATEVER 477 00:26:35,493 --> 00:26:38,863 THAT THAT THAT WOULD BE STANDARD FOR CARE MAYBE EVENTUALLY AND 478 00:26:38,930 --> 00:26:41,900 OBVIOUSLY WE HEARD THIS MORNING FROM FROM NEIL GRAHAM. 479 00:26:42,500 --> 00:26:46,204 AND THEN THERE'S OTHER DATA ON THIS THAT GFAP MAY BE USEFUL FOR 480 00:26:46,271 --> 00:26:49,074 ASSESSING THE LONG TERM EFFECTS OF TBI AS WELL. 481 00:26:49,140 --> 00:26:52,777 SO THIS COULD COULD HAVE A ROLE IN THE OUTPATIENT CLINIC, FRANK. 482 00:26:54,279 --> 00:26:54,412 YEAH. 483 00:26:54,479 --> 00:26:58,116 SO IN THE UNITED STATES WHERE MOST OF US CAN GET IT AT ACT IN 484 00:26:58,183 --> 00:27:01,953 A FEW MINUTES, IF YOU WORK IN A TRAUMA PLACE, YOU CAN GET IT IN 485 00:27:02,020 --> 00:27:02,187 10. 486 00:27:03,121 --> 00:27:05,890 AND THAT'S EVER SINCE WE MOVED INTO THE STROKE WORLD WHERE WE 487 00:27:05,957 --> 00:27:08,593 HAVE TO GET A CAT SCAN TO DECIDE IF YOU CAN GET A LYTIC. 488 00:27:08,960 --> 00:27:11,930 OUR ABILITY TO GET CTS RAMPED RIGHT UP BECAUSE NOW IT'S GOT TO 489 00:27:11,997 --> 00:27:12,931 BE WITHIN 10 MINUTES. 490 00:27:12,998 --> 00:27:15,633 SO WE CAN DO THAT IF WE IF WE NEED TO. 491 00:27:15,700 --> 00:27:19,537 NOW NOBODY WANTS TO DO EXTRA CTS AND IT WOULD BE LOVELY IF I 492 00:27:19,604 --> 00:27:21,072 DIDN'T HAVE TO DO THEM. 493 00:27:21,406 --> 00:27:24,909 THE CHALLENGE IS, IS THE CURRENT FORMAT OF THAT ESSAY IS IS NOT 494 00:27:24,976 --> 00:27:26,578 IN WHOLE BLOOD, IT'S IN SERUM. 495 00:27:26,644 --> 00:27:29,481 SO IT'S GOT TO SIT AROUND FOR HALF AN HOUR AND GO TO THE LAB 496 00:27:29,547 --> 00:27:31,616 AND ANYTHING GOES TO THE LAB TAKES AN HOUR. 497 00:27:31,683 --> 00:27:32,917 AND THAT'S JUST THE REALITY. 498 00:27:33,351 --> 00:27:35,687 I KNOW YOU'RE BEST ABOUT TO SAY IT'S GOING TO BE IN WHOLE BLOOD 499 00:27:35,754 --> 00:27:38,056 AND WE WILL HAVE A PARTY THE DAY THAT IT IS BECAUSE THEN I CAN 500 00:27:38,123 --> 00:27:38,390 USE IT. 501 00:27:39,057 --> 00:27:42,093 THE OTHER PART OF THIS COMES, AND I JUST HAD THIS CONVERSATION 502 00:27:42,160 --> 00:27:45,330 WITH DAVID AQUANCO A FEW MINUTES AGO, IS THAT IF THERE'S A NUMBER 503 00:27:45,397 --> 00:27:48,233 THAT TRIGGERS THE CALL OF A NEUROLOGIST OR A NEUROSURGEON, 504 00:27:48,299 --> 00:27:51,002 WE WILL ALL DANCE BECAUSE WE LIKE ONE OF THE REASONS THE 505 00:27:51,069 --> 00:27:53,738 EMERGENCY DOCS LIKE TROPONIN, BECAUSE IF IT'S A CERTAIN 506 00:27:53,805 --> 00:27:56,808 NUMBER, I CALL A CARDIOLOGIST AND THAT PATIENT GETS OFF OF MY 507 00:27:56,875 --> 00:27:57,142 PLATE. 508 00:27:57,809 --> 00:28:00,145 SO THERE'S THE CLEANING THE PLATE ROUTINE, WHICH IS REALLY 509 00:28:00,211 --> 00:28:02,047 IMPORTANT IN A CROWDED EMERGENCY DEPARTMENT. 510 00:28:02,247 --> 00:28:05,150 IF I CAN DUMP SOMEBODY ON TO SOMEBODY ELSE AND SAY GO NOW, I 511 00:28:05,216 --> 00:28:07,052 CAN TAKE THE NEXT GUY, THAT'S HELPFUL. 512 00:28:07,118 --> 00:28:08,086 SO THERE'S A NUMBER. 513 00:28:08,153 --> 00:28:11,189 NOBODY CAN TELL ME WHAT THE NUMBER IS, BUT I'M GOING TO BE 514 00:28:11,256 --> 00:28:14,225 CALLING NEUROSURGEONS AND NEUROLOGISTS IF IT'S ABOVE 400 515 00:28:14,292 --> 00:28:16,061 OR 600 OR WHATEVER THAT MAGIC IS. 516 00:28:16,628 --> 00:28:17,595 BUT WE NEED THAT DATA. 517 00:28:17,662 --> 00:28:20,231 AND THE REASON WE NEED THAT DATA UP FRONT IS BECAUSE THERE ARE 518 00:28:20,298 --> 00:28:22,233 OTHER, IT'S NOT JUST TRAUMA THAT COMES IN THERE. 519 00:28:22,300 --> 00:28:25,637 EVERY DIRTY PATIENT COMES IN AND IF YOU'VE GOT SOME KIND OF 520 00:28:25,703 --> 00:28:29,174 CHRONIC DEMENTIA AND YOUR G FAB IS NORMALLY 700 AND I CALL THE 521 00:28:29,240 --> 00:28:32,744 NEUROSURGEON, EVERY TIME THIS GUY COMES IN, THE NEUROSURGEON'S 522 00:28:32,811 --> 00:28:36,047 GOING TO TAKE A CRAP ON ME BECAUSE THEY DON'T LIKE THAT AT 523 00:28:36,114 --> 00:28:36,347 ALL. 524 00:28:36,648 --> 00:28:39,851 AND SO WE THERE'S GOT TO BE A STUDY WHICH LOOKS AT IN THE 525 00:28:39,918 --> 00:28:42,821 DIRTY EMERGENCY MEDICINE POPULATION, HOW MANY THESE 526 00:28:42,887 --> 00:28:46,591 PEOPLE HAVE ELEVATED G FAPS THAT ARE NOT TRAUMA RELATED AND DON'T 527 00:28:46,658 --> 00:28:47,592 NEED TO BE CALLED. 528 00:28:47,659 --> 00:28:50,728 AND IF I KNEW THEIR BASELINE AND IT THEN IT'S GOT TO BE A 20% UP 529 00:28:50,795 --> 00:28:53,698 FROM THEIR BASELINE 'CAUSE WE HAVE THOSE NUMBERS FOR TROMBONE 530 00:28:53,765 --> 00:28:55,400 AND I HAVE THOSE NUMBERS FOR BNP. 531 00:28:55,834 --> 00:28:59,170 IF YOU'RE ABOVE YOUR BASELINE, THEN I CALL THE CARDIOLOGIST. 532 00:28:59,237 --> 00:29:01,739 BUT IF YOUR PHONE IS THE SAME OLD NUMBERED EYES IS EVEN THOUGH 533 00:29:01,806 --> 00:29:03,108 IT'S ELEVATED, WE CAN IGNORE IT. 534 00:29:03,475 --> 00:29:05,310 I NEED TO KNOW THOSE DATA FOR G FAP. 535 00:29:06,444 --> 00:29:09,314 I MEAN THAT'S A REALLY IMPORTANT POINT, THE ISSUE OF OF STUDYING 536 00:29:09,380 --> 00:29:11,149 THESE BIOMARKERS AND THE ELDERLY BEST. 537 00:29:12,083 --> 00:29:13,084 SO NICE TO SEE YOU, FRANK. 538 00:29:13,151 --> 00:29:14,352 HELLO, IT'S BEEN A WHILE. 539 00:29:15,353 --> 00:29:16,154 THANK YOU FOR YOUR COMMENTS. 540 00:29:16,221 --> 00:29:19,557 I WANTED TO SAY FOR THE ABBOTT POINT OF CARE TEST AND FOR THE 541 00:29:19,624 --> 00:29:22,193 ABBOTT CORE LAB, IT IS NOT SERUM IMPORTANTLY. 542 00:29:22,260 --> 00:29:24,295 WELL, YOU CAN RUN IN SERUM, BUT IT'S PLASMA. 543 00:29:24,362 --> 00:29:26,731 SO SERUM ADDS AN EXTRA HALF AN HOUR, 45 MINUTES. 544 00:29:26,798 --> 00:29:27,565 SO IT'S IN PLASMA. 545 00:29:28,166 --> 00:29:31,302 AND THE OTHER POINT I WANTED TO MAKE IS THAT THE VAST MAJORITY 546 00:29:31,369 --> 00:29:34,272 OF LABS THAT ARE RUN IN THE CORE LAB INCLUDING HIGH SENSE 547 00:29:34,339 --> 00:29:37,208 TROPONIN AND THEY'RE USED TO RULE OUT MI'S AND SO FORTH. 548 00:29:37,275 --> 00:29:39,611 AND EVEN IN THE UNITED STATES, AT LEAST HALF THE HOSPITALS IN 549 00:29:39,677 --> 00:29:41,880 THE UNITED STATES WILL NOT ALLOW POINT OF CARE TESTING. 550 00:29:42,147 --> 00:29:45,450 THAT'S WHY WE HAVE IT ON CORE AND POINT OF CARE BECAUSE THE 551 00:29:45,517 --> 00:29:48,586 LAB SAYS IT HAS TO GO THROUGH THE LAB SO YOU CAN RUN IT 552 00:29:48,653 --> 00:29:51,990 CERTAINLY STATS ON YOUR PLASMA BLOOD TUBE ALONG WITH ALL THE 553 00:29:52,056 --> 00:29:55,293 REST OF YOUR ASSAYS AND SO FORTH THAT YOU'RE INTERESTED IN 554 00:29:55,360 --> 00:29:55,727 RUNNING. 555 00:29:55,793 --> 00:29:58,630 SO I WANTED TO MAKE THAT POINT AND YOU CAN GET IT WITH THE 556 00:29:58,696 --> 00:30:01,366 RESULTS CERTAINLY WITHIN AN HOUR WHEN YOU RUN IT STAT. 557 00:30:01,432 --> 00:30:05,837 SO VERY IMPORTANT TO HIGHLIGHT THAT AND OF COURSE WHOLE BLOOD 558 00:30:05,904 --> 00:30:07,138 IS ALSO SOMETHING. 559 00:30:07,205 --> 00:30:09,707 SO WE LIKE TO HAVE A LITTLE BIT OF EVERYTHING WHEN YOU WORK FOR 560 00:30:09,774 --> 00:30:10,808 A LARGE DIAGNOSTIC COMPANY. 561 00:30:10,875 --> 00:30:14,345 SO WE'LL HAVE THE SERUM IF YOU WANTED IT, BUT ALSO PLASMA AND 562 00:30:14,412 --> 00:30:17,782 ON A POINTED CARE DEVICE AND ON A CORE LAB DEVICE AND WHOLE 563 00:30:17,849 --> 00:30:18,750 BLOOD IS COMING. 564 00:30:19,117 --> 00:30:20,919 SO WHOLE BLOOD, FINGERS CROSSED. 565 00:30:21,352 --> 00:30:21,953 STAY TUNED. 566 00:30:22,020 --> 00:30:24,856 WE'VE BEEN WORKING VERY CLOSELY WITH THE DEPARTMENT OF DEFENSE 567 00:30:24,923 --> 00:30:25,256 ON THAT. 568 00:30:25,557 --> 00:30:26,758 BUT THANK YOU FOR YOUR POINTS. 569 00:30:26,824 --> 00:30:30,361 JUST WANTED TO HIGHLIGHT THAT THE CORE LAB IS INDEED THE 570 00:30:30,428 --> 00:30:34,365 CORNERSTONE OF ALL OF THE, THE VAST MAJORITY OF THE BLOOD WORK 571 00:30:34,432 --> 00:30:34,999 GLOBALLY. 572 00:30:37,835 --> 00:30:41,072 MEET YOU, JAMIE JAMIE HUTCHISON FROM SICK KIDS IN TORONTO. 573 00:30:41,339 --> 00:30:42,273 YEAH, I JUST WANTED TO. 574 00:30:42,340 --> 00:30:46,544 IT WAS VERY INTERESTING, RAMON, TO SEE THAT NOBODY IN THE ROOM 575 00:30:46,611 --> 00:30:49,981 HAD IMPLEMENTED THE USE OF BIOMARKERS CLINICALLY. 576 00:30:50,281 --> 00:30:53,818 AND I JUST WANTED TO MAKE A COUPLE COMMENTS ABOUT THAT TO 577 00:30:53,885 --> 00:30:57,422 ADDRESS THIS ISSUE AND MAYBE ASK A QUESTION OF THE ROOM. 578 00:30:57,722 --> 00:31:02,260 SO I THINK WHAT'S MISSING MY TAKE IS THAT WHAT'S MISSING IS 579 00:31:02,327 --> 00:31:06,531 THAT THERE'S NO CLINICAL, THERE'S A LACK OF PAUCITY OF 580 00:31:06,598 --> 00:31:11,302 CLINICAL IMPLEMENTATION STUDIES TO SHOW THAT THESE BIOMARKERS 581 00:31:11,369 --> 00:31:14,005 ARE CLINICALLY VALUABLE IN SAY 6. 582 00:31:14,305 --> 00:31:17,342 WE CAN LIST 6 OR MAYBE MORE CONTEXT OF USE. 583 00:31:17,909 --> 00:31:22,914 AND SO THAT WAS INTERESTING TO HEAR THAT THE CAROLINA INSTITUTE 584 00:31:22,981 --> 00:31:27,952 HAS IMPLEMENTED S100B AND THAT THEY HAVE SOME DATA THAT I THINK 585 00:31:28,019 --> 00:31:29,988 THEY'RE ABOUT TO PUBLISH. 586 00:31:30,221 --> 00:31:34,192 SO MY MY QUESTION IS, ARE THERE OTHER PEOPLE DOING CLINICAL 587 00:31:34,259 --> 00:31:38,396 IMPLEMENTATION STUDIES LIKE A KNOWLEDGE TRANSLATION TYPE STUDY 588 00:31:38,463 --> 00:31:40,331 THAT'S IN PROGRESS RIGHT NOW? 589 00:31:40,398 --> 00:31:44,802 IS THERE ANYBODY IN THE ROOM DOING, DOING THOSE TYPES OF 590 00:31:44,869 --> 00:31:49,307 STUDIES 'CAUSE I THINK BESIDES THE ANALYTICAL VALIDATION 591 00:31:49,374 --> 00:31:54,178 STUDIES THAT ARE IN PROGRESS, THIS IS THE NEXT STEP TO FOR US 592 00:31:54,245 --> 00:31:58,750 TO PROVE TO CLINICIANS, RIGHT, THAT THERE'S A, THERE'S AN 593 00:31:58,816 --> 00:32:01,886 IMPORTANT CONTEXT OF USE, RETEST ODDS. 594 00:32:02,420 --> 00:32:02,553 YEAH. 595 00:32:02,620 --> 00:32:02,720 GREAT. 596 00:32:02,787 --> 00:32:05,723 CHRISTIAN, I MEAN I'M NOT AWARE OF ANY OF THESE IMPLEMENTATIONS 597 00:32:05,790 --> 00:32:06,457 THAT ARE GOING. 598 00:32:06,524 --> 00:32:10,094 FRED CORLEY ISN'T HERE, BUT I KNOW FRED WAS INTERESTED IN 599 00:32:10,161 --> 00:32:13,931 LAUNCHING SOMETHING LIKE THAT IN THE ED AT THE UNIVERSITY OF 600 00:32:13,998 --> 00:32:14,565 MICHIGAN. 601 00:32:15,433 --> 00:32:17,902 WE SHOULD MAYBE REACH OUT TO FRED WITH THAT QUESTION. 602 00:32:18,503 --> 00:32:19,003 AND RUSH. 603 00:32:19,470 --> 00:32:19,704 YES. 604 00:32:20,204 --> 00:32:23,808 ON THE SCANDINAVIAN PERSPECTIVE, YES. 605 00:32:24,208 --> 00:32:28,313 SO BASICALLY I THINK THAT THE THE BIOMARKER TO BE A GAME 606 00:32:28,379 --> 00:32:31,649 CHANGER SHOULD BE LIKE THE ISAT AT THE SITE. 607 00:32:31,716 --> 00:32:36,554 SO POINT POINT OF CARE DEVICE, IF YOU SEND THE PROOF TO THE TO 608 00:32:36,621 --> 00:32:41,326 THE SAMPLE TO THE TO THE LAB, THE B PLASMA, B SERUM, IT WILL 609 00:32:41,392 --> 00:32:43,261 TAKE TIME AND THE OTHER. 610 00:32:43,928 --> 00:32:48,566 THE MOST IMPORTANT THING WOULD BE BESIDES HAVING THIS POINT OF 611 00:32:48,633 --> 00:32:53,204 CARE DEVICE EVERYWHERE TO KNOW THE PRICE OF OF THE INDIVIDUAL 612 00:32:53,271 --> 00:32:57,308 TEST, BECAUSE THAT WILL DEFINITELY DEFINE DEFINE IF WE 613 00:32:57,375 --> 00:33:01,646 CAN USE IT WORLDWIDE TO FIGHT A GLOBAL PROBLEM GLOBALLY. 614 00:33:02,480 --> 00:33:08,553 THE OTHER PROBLEM IS OR A PROBLEM TO BE SOLVED PROBABLY TO 615 00:33:08,619 --> 00:33:10,855 IF I RECOLLECTED WELL. 616 00:33:10,922 --> 00:33:15,326 THE EYE STAT WILL GIVE YOU A NUMBER IF YOU HAVE, IF YOU'RE 617 00:33:15,393 --> 00:33:16,828 OVER THE THE LIMIT. 618 00:33:17,328 --> 00:33:21,933 SO IF IF THERE IS A A TEST CT IS NEEDED OR SO. 619 00:33:21,999 --> 00:33:26,504 SO OVER THE THE THRESHOLD BUT UNDER THE THRESHOLD YOU WILL NOT 620 00:33:26,571 --> 00:33:30,942 GET THE NUMBER IF I'M CORRECT THAT MEANS THAT BASICALLY WHAT 621 00:33:31,008 --> 00:33:35,313 WE WHAT WE DEFINITELY WILL USE OUR BIOMARKERS TO HAVE THESE 622 00:33:35,380 --> 00:33:39,450 THESE A LITTLE BIT CONTINUOUS CATEGORIZATIONS FOR FOR CT 623 00:33:39,517 --> 00:33:42,553 NEGATIVE PROBABLY CT NEGATIVE PROBABLY MR. 624 00:33:42,620 --> 00:33:48,126 POSITIVE PATIENTS WHO CAN BE IN HARM'S WAY AND THE LONG TERM CAN 625 00:33:48,192 --> 00:33:49,660 BE APPLIED OR NOT. 626 00:33:49,727 --> 00:33:55,166 BUT IF I HAVE TO DO A NICE STEP FOR EXCLUDING CT POSITIVITY AND 627 00:33:55,233 --> 00:34:00,171 THEN A A LABORATORY TEST TO EXCLUDE THE POSSIBILITY OF OF 628 00:34:00,238 --> 00:34:00,838 NON MR. 629 00:34:01,105 --> 00:34:03,541 POSITIVITY SO THAT THAT CAN COMPLICATE. 630 00:34:03,608 --> 00:34:06,144 SO BETH BETH IS AGAIN PROBABLY IN THE BEST POSITION TO ANSWER 631 00:34:06,210 --> 00:34:06,778 THAT QUESTION. 632 00:34:06,978 --> 00:34:11,082 YEAH, ACTUALLY I WANTED I HAD ONE OF MY COLLEAGUES DR. 633 00:34:11,149 --> 00:34:14,619 CASSINI, HELLO, WHO'S LISTENING ONLINE AND SHE REMINDED ME SHE'S 634 00:34:14,685 --> 00:34:17,789 BASED IN EUROPE THAT THESE THESE TESTS ARE NOW BEING USED 635 00:34:17,855 --> 00:34:18,856 ROUTINELY IN SPAIN. 636 00:34:19,157 --> 00:34:21,526 THE CONSENSUS STATEMENTS IT ALSO IN GERMANY. 637 00:34:21,592 --> 00:34:24,896 AND REGARDING FRANK'S, ONE OF HIS QUESTIONS THERE WAS THE MIND 638 00:34:24,962 --> 00:34:28,132 STUDY THAT WAS DONE BY PROFESSOR BIEBENTHALER LOOKING AT THE 639 00:34:28,199 --> 00:34:31,369 LEVELS THEY INCLUDED DEMANDED DEMENTIA PATIENTS AND SO FORTH 640 00:34:31,436 --> 00:34:32,837 AND THEY WORKED VERY WELL. 641 00:34:33,137 --> 00:34:36,441 SO I JUST WANTED TO CIRCLE BACK TO THAT AND THANK YOU DOCTOR 642 00:34:36,507 --> 00:34:38,342 CASSINIA FOR YOUR INPUT REMOTELY. 643 00:34:39,277 --> 00:34:42,313 ERIC HAS A STAND UP FROM STOCKHOLM LOWER DETECTABLE 644 00:34:42,380 --> 00:34:42,747 LIMIT. 645 00:34:43,147 --> 00:34:46,951 IT ACTUALLY DEPENDS ON THE PLATFORM, BUT FOR THE CORE LAB 646 00:34:47,018 --> 00:34:49,687 IT'S 3 PICOGRAMS WHICH IS VERY VERY LOW. 647 00:34:49,754 --> 00:34:52,990 AND THEN FOR GFAP IT MEASURES ALL THE WAY UP TO 42,000. 648 00:34:53,324 --> 00:34:58,729 IT DOES THAT IN 18 MINUTES AND FOR USE HL ONE IT MEASURES VERY 649 00:34:58,796 --> 00:35:01,699 VERY LOW, UP TO 25,000 PICOGRAMS. 650 00:35:01,766 --> 00:35:06,137 SO IT MEASURES MANY, MANY FOLD LOWER THAN NORMALS AND MANY, 651 00:35:06,204 --> 00:35:10,741 MANY FOLD LOWER OR HIGHER THAN WHAT IS TYPICALLY SURVIVABLE. 652 00:35:12,443 --> 00:35:12,677 THANK YOU. 653 00:35:13,444 --> 00:35:15,446 SO, ERIC, YES, ALL RIGHT, THANKS. 654 00:35:15,947 --> 00:35:18,282 SO WE PAY ABOUT 30 U.S. 655 00:35:18,349 --> 00:35:23,120 DOLLARS FOR SS100B SAMPLE AND IN TERMS OF CD SCAN, SINCE WE 656 00:35:23,187 --> 00:35:27,725 DIDN'T, IT'S ABOUT 100, ONE $150.00, MAYBE UP TO $200 IF 657 00:35:27,792 --> 00:35:32,730 IT'S A WEEKEND OR AN EVENING, BUT SO IT'S IF IT COMES DOWN TO 658 00:35:32,797 --> 00:35:33,197 PRICE. 659 00:35:33,264 --> 00:35:37,335 AND THESE VALIDATION STUDIES THAT HAVE BEEN DONE ON THE 660 00:35:37,401 --> 00:35:41,906 SCANDINAVIAN GUIDELINES SHOWS THAT ABOUT 20% IN THE REAL LIFE 661 00:35:41,973 --> 00:35:46,410 STUDIES CAN BE YOU, YOU CAN SORT OF SKIP ABOUT 20% OF THE CT 662 00:35:46,477 --> 00:35:46,911 SCANS. 663 00:35:47,578 --> 00:35:51,782 BUT IN IN TERMS OF THE MORE SEVERE TBI PATIENTS, I THINK IT 664 00:35:51,849 --> 00:35:56,320 ADDS AS AN ADDITIONAL MONITORING TOOL ESPECIALLY MAYBE IN A LOW 665 00:35:56,387 --> 00:36:00,858 COST SETTING WHERE YOU CAN'T DO ICP MONITORING OR IF YOU CAN'T, 666 00:36:00,925 --> 00:36:05,196 IF YOU HAVE LIKE PROBLEM WITH MULTIMODAL MONITORING THAT YOU 667 00:36:05,263 --> 00:36:09,300 CANNOT ADD THESE IT IT'S ACTUALLY A VERY GOOD SORT OF NON 668 00:36:09,367 --> 00:36:12,470 INVASIVE GLOBAL MONITORING TOOL THAT WE USE. 669 00:36:12,537 --> 00:36:16,474 SO I I THINK IT ALL DEPENDS WHAT YOU WANT AND IF YOU COMPARE IT 670 00:36:16,541 --> 00:36:20,278 TO A LOT OF OTHER THINGS THAT YOU DO IN THE YOUR INTENSIVE K 671 00:36:20,344 --> 00:36:22,914 UNIT, IT IS ACTUALLY NOT THAT EXPENSIVE. 672 00:36:23,481 --> 00:36:27,151 IF YOU THINK LIKE SERIAL SAMPLING, I DON'T KNOW WHAT IT 673 00:36:27,218 --> 00:36:31,455 COSTS FOR THE GFAP COST, BUT I MEAN IF IT'S ABOUT 30 DOLLARS, I 674 00:36:31,522 --> 00:36:35,092 THINK IT'S IT'S PROBABLY PROBABLY LESS EXPENSIVE THAN 675 00:36:35,159 --> 00:36:37,628 SOME OF THE OTHER TOOLS THAT WE USE. 676 00:36:40,464 --> 00:36:44,168 YOU KNOW, OBVIOUSLY HEALTH ECONOMICS ARE A WHOLE DIFFERENT 677 00:36:44,235 --> 00:36:48,039 ISSUE AND AND SO, SO THE RAMON, LET ME ADDRESS REIMBURSEMENT 678 00:36:48,105 --> 00:36:51,742 SYSTEMS IN IN EUROPEAN EUROPE AND OTHER COUNTRIES IS VERY 679 00:36:51,809 --> 00:36:54,679 DIFFERENT FROM WHAT WE HAVE IN THE US FRANK. 680 00:36:55,179 --> 00:36:59,483 I LOOKED UP MY CHARGE FOR RESEARCH CATEGORY CT, WHICH IS 681 00:36:59,550 --> 00:37:04,388 BY FAR A FACTOR OF 5 LOWER THAN WHAT WE REALLY CHARGE BECAUSE I 682 00:37:04,455 --> 00:37:08,359 GET A DEAL FOR RESEARCH, IT'S $355 FOR A CAT SCAN. 683 00:37:08,793 --> 00:37:11,529 SO IF YOU CAN GET A S 100 BETA FOR 30 BUCKS, IT'S A HELL OF A 684 00:37:11,596 --> 00:37:11,829 DEAL. 685 00:37:12,196 --> 00:37:16,767 AND WHAT WE CHARGE FOR A PATIENT IS 18156. 686 00:37:17,368 --> 00:37:19,203 SO THESE ARE CHARGES, THESE NOT COSTS. 687 00:37:19,270 --> 00:37:21,238 COSTS ARE PROBABLY 100 BUCKS BECAUSE IT'S. 688 00:37:22,039 --> 00:37:23,040 I'VE GOT ACT MACHINE. 689 00:37:23,107 --> 00:37:24,809 I'D APPRECIATE IT IN THE LAST DECADE. 690 00:37:25,042 --> 00:37:27,311 I HAVE TO PAY THE RADIOLOGIST TO READ IT AND THAT'S ABOUT IT AND 691 00:37:27,378 --> 00:37:28,512 A FEW ELECTRONS TO MAKE IT RUN. 692 00:37:28,879 --> 00:37:32,416 SO COSTS AREN'T REALLY THE PICTURE BUT $1800 FOR ACT. 693 00:37:33,017 --> 00:37:35,419 SO THERE'S A HUGE MARGIN IF YOU CAN AVOID ACT. 694 00:37:35,486 --> 00:37:38,456 BUT BETH, I WANT TO POINT OUT IT'S NOT JUST DEMENTIA. 695 00:37:38,522 --> 00:37:40,925 IT IS EVERY OLD PERSON WHO JUST HAD IT. 696 00:37:40,992 --> 00:37:43,894 BETH LISTEN HERE, BETH MCQUISTON, IT'S EVERY OLD PERSON 697 00:37:43,961 --> 00:37:47,331 WHO'S GOT NOT JUST DEMENTIA, BUT SOMEBODY WHO JUST HAD A SEIZURE 698 00:37:47,398 --> 00:37:49,634 5 MINUTES AGO AND THEY BRING THEM IN NOW. 699 00:37:49,867 --> 00:37:52,069 AND I DON'T KNOW, HE'S SORT OF UNCONSCIOUS AND HE FELL DOWN AND 700 00:37:52,136 --> 00:37:54,205 HE'S GOT A BIG OLD THING ON THE SIDE OF HIS HEAD IS IT IS A 701 00:37:54,271 --> 00:37:55,172 TRAUMATIC BRAIN INJURY. 702 00:37:55,239 --> 00:37:55,740 I DON'T KNOW. 703 00:37:55,806 --> 00:37:56,874 AND WHAT IF HE HAS MENINGITIS? 704 00:37:56,941 --> 00:37:59,043 WHAT IF HE'S GOT COVID THAT SOMETIMES EATS YOUR BRAIN. 705 00:37:59,276 --> 00:38:02,013 AND THE LIST OF THINGS THAT EATS YOUR BRAIN IS ABOUT 200 THINGS 706 00:38:02,079 --> 00:38:04,548 LONG, JUST LIKE THE LIST OF THINGS THAT EATS YOUR HEART. 707 00:38:04,915 --> 00:38:07,551 AND SO WE HAVE TO IT'S A IT'S REALLY NICE WHEN YOU'RE A 708 00:38:07,618 --> 00:38:09,320 NEUROSURGERY, CAN YOU GET A PATIENT? 709 00:38:09,387 --> 00:38:12,223 BECAUSE THEY PROBABLY REALLY HAD TRAUMA, BECAUSE SOMEBODY SORTED 710 00:38:12,289 --> 00:38:13,858 IT OUT AND CALLED THE NEUROSURGEON. 711 00:38:14,125 --> 00:38:16,460 BUT FOR THE ER DOC, IT'S EVERY FREAKING FOOL WHO WALKS IN THE 712 00:38:16,527 --> 00:38:18,696 ROOM, NO MATTER WHAT'S WRONG WITH HIM, WITH A BEER IN HIS 713 00:38:18,763 --> 00:38:18,963 HAND. 714 00:38:19,196 --> 00:38:20,197 AND THAT'S MY POPULATION. 715 00:38:20,264 --> 00:38:23,768 AND SO IT'S GOT TO BE SHOWN IN THE DIRTY REALITY OF MY WORLD 716 00:38:23,834 --> 00:38:27,138 WHAT THE PERFORMANCE OF A POSITIVE MEANS, BECAUSE I DON'T 717 00:38:27,204 --> 00:38:28,072 KNOW RIGHT NOW. 718 00:38:28,305 --> 00:38:29,306 THAT'S, THAT'S THE CHALLENGE. 719 00:38:29,507 --> 00:38:32,243 AND UNTIL WE GET A REGISTRY AND WE LOOK AT THIS IN 2000, 720 00:38:32,309 --> 00:38:35,146 PATIENTS PROSPECTIVELY OF ALL COMERS, NOT JUST THE ONES WHO 721 00:38:35,212 --> 00:38:37,982 LOOK LIKE THEY HAVE TBI, BUT EVERYBODY YOU MIGHT ACTUALLY 722 00:38:38,049 --> 00:38:38,816 DRAW A LEVEL ON. 723 00:38:39,517 --> 00:38:42,186 WE'RE GOING TO BE SITTING THERE LOOKING THESE NUMBERS GOING, IS 724 00:38:42,253 --> 00:38:42,520 IT HIGH? 725 00:38:42,586 --> 00:38:46,023 I DON'T KNOW, DAVID. 726 00:38:46,524 --> 00:38:49,360 SO IN THE COURSE OF THE RECHARACTERIZATION AND 727 00:38:49,427 --> 00:38:53,264 CLASSIFICATION MEETING, ONE OF THE SUGGESTIONS TOWARDS THE END 728 00:38:53,330 --> 00:38:56,333 WHICH I MADE, WELL, THERE'S A PREAMBLE TO THAT. 729 00:38:56,400 --> 00:38:59,570 IF THIS GETS RELEASED INTO THE WIRE, IT'S GOING TO BE USED FOR 730 00:38:59,637 --> 00:39:02,406 MORE THAN THE PRECISE INDICATIONS THAT THE FDA HAS HAS 731 00:39:02,473 --> 00:39:03,040 PRESCRIBED. 732 00:39:03,708 --> 00:39:06,711 BUT IF IT'S USED MORE WIDELY, I CAN'T SEE ANYONE FUNDING THE 733 00:39:06,777 --> 00:39:09,547 SORT OF STUDY THAT FRANK WANTS EVEN THOUGH I THINK IT'S 734 00:39:09,613 --> 00:39:11,315 ABSOLUTELY, ABSOLUTELY ESSENTIAL. 735 00:39:12,049 --> 00:39:14,518 AND BECAUSE WE'VE GOT SOME FRIENDS FROM INDUSTRY HERE. 736 00:39:14,585 --> 00:39:17,188 THE QUESTION I'D LIKE I'D LIKE TO ASK THEM IS HOW WOULD THEY 737 00:39:17,254 --> 00:39:18,556 FEEL ABOUT FUNDING A REGISTRY. 738 00:39:18,789 --> 00:39:22,293 NOT SO MUCH TO GIVE ANYONE ANY MONEY, BUT YOU SAY TO THE 739 00:39:22,359 --> 00:39:25,896 CENTERS THAT ARE USING IT THAT IF YOU DO CONTRIBUTE SOME 740 00:39:25,963 --> 00:39:29,967 COVARIANCE AS THE PATIENT COMES IN AND A SIX MONTH OUTCOME WHICH 741 00:39:30,034 --> 00:39:33,671 YOU RING UP FOR, WE'LL GIVE IT TO YOU 20% LESS FOR THE 1ST 742 00:39:33,738 --> 00:39:35,306 10,020 THOUSAND PATIENTS. 743 00:39:37,475 --> 00:39:39,477 AND BE INTERESTING TO HEAR WHAT THEY HAVE TO SAY TO THAT. 744 00:39:40,344 --> 00:39:44,014 SO I'VE DONE REGISTRIES WHERE WE PAY $100 FOR EVERY BLOOD SAMPLE 745 00:39:44,081 --> 00:39:47,451 DRAWN AND WE PAY THAT TO THE ER SECRETARY WHO THEN GETS THE 746 00:39:47,518 --> 00:39:50,955 PATIENT'S CHART AND LOOKS AT THE FINAL DIAGNOSIS AND RECORDS 747 00:39:51,021 --> 00:39:51,322 THAT. 748 00:39:51,622 --> 00:39:53,958 AND IT'S THE CHEAPEST STUDY YOU'VE EVER DONE IN YOUR LIFE 749 00:39:54,024 --> 00:39:55,593 AND YOU CAN DO IT FOR $100 A PATIENT. 750 00:39:55,826 --> 00:39:58,629 SO THAT THE COST TO A COMPANY THAT'S GOING TO MAKE A BILLION 751 00:39:58,696 --> 00:40:00,631 DOLLARS FROM THEIR MARKER IS NEGLIGIBLE. 752 00:40:00,831 --> 00:40:03,667 SO FOR FOR 10 GRAND YOU CAN ENROLL 1000 PATIENTS AND THAT 753 00:40:03,734 --> 00:40:05,469 PROVIDES ALL THE ANSWERS YOU NEED. 754 00:40:12,343 --> 00:40:14,111 BETH IS NOT ON THE BUSINESS SIDE AT ABBOTTAS. 755 00:40:14,178 --> 00:40:15,679 SHE STOLE THOSE MANY, MANY TIMES. 756 00:40:17,047 --> 00:40:19,517 YEAH, BUT BUT I MEAN THESE, THESE ARE ALL, THESE ARE ALL 757 00:40:19,583 --> 00:40:20,818 CRITICALLY IMPORTANT ISSUES. 758 00:40:21,152 --> 00:40:23,020 YOU KNOW, I THINK WE'VE IDENTIFIED SOME PRETTY 759 00:40:23,087 --> 00:40:25,456 SIGNIFICANT BARRIERS, A LOT OF EXCITEMENT HERE, BUT THERE'S 760 00:40:25,523 --> 00:40:27,992 ALSO SOME BARRIERS THAT WE'RE GOING TO HAVE TO OVERCOME AND I 761 00:40:28,058 --> 00:40:28,959 THINK WE CAN OVERCOME. 762 00:40:29,593 --> 00:40:31,962 LISTEN, I DON'T DO NOT SPEND ALL OUR TIME ON THIS. 763 00:40:32,029 --> 00:40:36,634 I DO WANT TO MOVE ON TO AND AND ANOTHER THING THAT IS THAT I 764 00:40:36,700 --> 00:40:41,038 REALIZED I'VE MISSPELLED CANDIDATE APOLOGIZE FOR THAT TO 765 00:40:41,105 --> 00:40:45,643 TO PART OF WHAT WE WE BELIEVE IS GOING TO BE A AN IMPORTANT 766 00:40:45,709 --> 00:40:50,080 PAYOFF IN THE FIELD WHICH IS TO UNDERSTAND THE EFFECTS OF 767 00:40:50,147 --> 00:40:54,985 GENETIC VARIATION IN IN OUTCOMES FROM TBI AND YOU KNOW WE DON'T 768 00:40:55,052 --> 00:40:59,824 REALLY KNOW BUT I THINK THE BEST ESTIMATES ARE PROBABLY THAT'S 769 00:40:59,890 --> 00:41:04,295 SOMEWHERE AROUND 25% OF THE VARIANTS IN OUTCOMES FROM TBI 770 00:41:04,361 --> 00:41:09,366 AND THAT MAY BE AN UNDERESTIMATE IS IS GOING TO BE DUE TO TO HOST 771 00:41:09,433 --> 00:41:12,203 DIFFERENCES IN IN GENETIC VARIANTS. 772 00:41:13,604 --> 00:41:18,175 SO RUCHI JHA WHO'S NOT IN THIS CALL BUT I THINK THIS IS AN AREA 773 00:41:18,242 --> 00:41:22,646 WHERE SOME EXPERTISE WITHIN WITHIN THIS GROUP ACTUALLY COULD 774 00:41:22,713 --> 00:41:27,017 COULD GO A LONG WAY TOWARDS MAKING SOME SOME REAL ADVANCES. 775 00:41:27,084 --> 00:41:31,055 AND SO EVERY AREA OF HUMAN MEDICINE ALMOST ALL AREAS OF 776 00:41:31,121 --> 00:41:35,326 HUMAN MEDICINE DID LARGE GUI STUDIES OVER A DECADE AGO AND 777 00:41:35,392 --> 00:41:39,797 THEN THEY HAVE HAD SOME SOME VARIABLE IMPACT CERTAINLY IN THE 778 00:41:39,864 --> 00:41:43,601 DEMENTIA WORLD AND AND OTHER OTHER FIELDS AS WELL. 779 00:41:43,667 --> 00:41:49,106 WE'RE WE'RE PROBABLY THE TBI FIELD IS PROBABLY A LAGGING AREA 780 00:41:49,173 --> 00:41:53,510 LAGGING DISEASE IN IN HAVING G US HAVE AN IMPACT. 781 00:41:53,577 --> 00:41:58,782 WE DID DO AG US OR ABOUT 6000 SUBJECTS WHICH WE ALL RECOGNIZE 782 00:41:58,849 --> 00:42:03,654 AS SMALL BUT I I DO WANT TO REACH OUT TO EVERYONE IN THIS 783 00:42:03,721 --> 00:42:06,257 ROOM AND EVERYONE ON THE CALL. 784 00:42:07,358 --> 00:42:10,060 YOU KNOW WE ALL HAVE OUR SMALL LITTLE COHORTS OF A COUPLE OF 785 00:42:10,127 --> 00:42:11,996 100 PATIENTS EVEN MAYBE UP 1000 OR MORE. 786 00:42:12,897 --> 00:42:17,701 I I I DO THINK THAT THE HISTORY OF GENETIC ASSOCIATION STUDIES 787 00:42:17,768 --> 00:42:22,239 IS THAT IT TAKES MANY, MANY GROUPS OFTEN THESE PAPERS HAVE 788 00:42:22,306 --> 00:42:26,744 100 AUTHORS OR MORE THAT IT TAKES MANY GROUPS CONTRIBUTING 789 00:42:26,810 --> 00:42:31,615 THEIR DATA SHARING THEIR DATA COOLING ANALYTICAL RESOURCES AND 790 00:42:31,682 --> 00:42:36,353 THAT IS WHERE THE ULTIMATE THE REAL ADVANCES COME FROM RIGHT. 791 00:42:36,420 --> 00:42:40,157 OBVIOUSLY TAKE SOME FUNDING BUT IT'S MUCH LESS THAN IT USED TO 792 00:42:40,224 --> 00:42:43,327 THE THE COSTS OF THESE ANALYTICAL STRATEGIES ARE ARE 793 00:42:43,394 --> 00:42:46,964 MUCH LOWER THAN THAN THEY USED TO AND I THINK IT'S SOMETHING 794 00:42:47,031 --> 00:42:50,434 THAT WE JUST HAVE TO DO AND AND AND PIERRE I THINK IT'S A 795 00:42:50,501 --> 00:42:52,436 PERFECT FORUM IN WHICH TO DO IT. 796 00:42:52,803 --> 00:42:55,139 DAVID, I KNOW YOU'VE BEEN VERY PASSIONATE WITH THIS FOR MANY, 797 00:42:55,205 --> 00:42:55,639 MANY YEARS. 798 00:42:57,274 --> 00:43:00,678 IN FACT, WHEN I FIRST MET DAVID, AND THIS IS ALMOST TWO DECADES 799 00:43:00,744 --> 00:43:03,180 AGO, THAT WAS OUR FIRST TOPIC OF DISCUSSION. 800 00:43:03,580 --> 00:43:06,951 AND BOTH OF US RECALLED HOW WHEN WE TOLD OUR COLLEAGUES THAT WE 801 00:43:07,017 --> 00:43:09,987 WERE INTERESTED IN GENETICS OF TBI, WE WERE TOLD YOU'RE 802 00:43:10,054 --> 00:43:10,888 ABSOLUTELY CRAZY. 803 00:43:10,955 --> 00:43:12,589 TBI HAS NOTHING TO DO WITH GENETICS. 804 00:43:22,032 --> 00:43:26,003 SO THIS IS SUCH A BIG ELEPHANT THAT I THINK WE HAVE TO EAT IT 805 00:43:26,070 --> 00:43:27,404 IN VERY SMALL BITES. 806 00:43:29,239 --> 00:43:32,710 AS AS RAMON SAID, WE'RE GOING TO NEED 10S OF THOUSANDS OF 807 00:43:32,776 --> 00:43:36,513 PATIENTS TO REALLY HAVE ROBUST CONCLUSIONS BECAUSE THE EFFECT 808 00:43:36,580 --> 00:43:40,484 SIZES ARE GOING TO BE GENERALLY SMALL, BUT THEY'RE GOING TO TELL 809 00:43:40,551 --> 00:43:43,721 US QUITE A LOT ABOUT WHAT THE UNDERLYING BIOLOGY IS. 810 00:43:43,787 --> 00:43:46,890 THERE WILL OCCASIONALLY BE PATIENTS WHO TELL US A LOT 811 00:43:46,957 --> 00:43:48,826 BECAUSE OF OF A SINGLE MUTATION. 812 00:43:49,927 --> 00:43:54,164 BUT THE THE ASK THAT WE'VE DONE FOR MOST UK STUDIES AND WE HAVE 813 00:43:54,231 --> 00:43:58,635 A BIG COLLABORATIVE PLATFORM NOW IN THE UK CALLED TBR REPORTER ON 814 00:43:58,702 --> 00:44:02,940 WHICH MY GOOD FRIEND HERE WILLIE STEWART AND PETE HUTCHISON WHO 815 00:44:03,007 --> 00:44:07,144 IS IN THE BACK ARE ALSO ALONG WITH DAVE SHARP AND FIONA LECKY 816 00:44:07,211 --> 00:44:10,981 EXECUTIVE COMPANY MEMBERS AND AND THE CONTACT PI AND THE 817 00:44:11,048 --> 00:44:15,252 FORMULA THERE IS THAT WHATEVER STUDY YOU DO WE'RE GOING TO GET 818 00:44:15,319 --> 00:44:18,622 THE THE CLINICAL CHARACTERIZATION AND OUTCOME FOR 819 00:44:18,689 --> 00:44:19,023 FREE. 820 00:44:19,323 --> 00:44:23,460 ALL WE WANT YOU TO DO IS TO STORE ONE EDTA SAMPLE SOMEWHERE 821 00:44:23,527 --> 00:44:27,731 AND ONCE WE'VE GOT UP TO 20,000 OR 30,000 SAMPLES, WE'LL RUN 822 00:44:27,798 --> 00:44:31,902 AGVAS ON IT OR EXOME SEQUENCING OR HOLD GENOME SEQUENCING. 823 00:44:31,969 --> 00:44:35,039 IT'LL DEPEND ON MONEY THEN AND WE WILL HAVE THE PHENOTYPE AND 824 00:44:35,105 --> 00:44:38,442 THE OUTCOME AND WE'LL BE ABLE TO DO REALLY, REALLY GOOD SCIENCE. 825 00:44:39,076 --> 00:44:43,580 SO WHAT I WOULD ENCOURAGE IS ANYONE DOING A CLINICAL STUDY, 826 00:44:43,647 --> 00:44:46,550 FIND A WAY TO BANK 5 MILS VDTA BLOOD. 827 00:44:46,817 --> 00:44:50,721 IT'S TRIVIAL TO BANK AND KEEP AND WHEN ONCE YOU HAVE 20,000 828 00:44:50,788 --> 00:44:54,491 SAMPLES, IT'S RELATIVELY EASY TO GET THE MONEY TO DO THE 829 00:44:54,558 --> 00:44:56,493 GENOTYPING RELATIVELY I SAY. 830 00:44:56,560 --> 00:45:02,433 SO YOU KNOW WE MAY NOT BE THAT FAR FROM 20,000 SAMPLES NOW. 831 00:45:02,499 --> 00:45:05,335 I MEAN OBVIOUSLY WE'VE TALKED TO, YOU KNOW TALKED TO JAMIE 832 00:45:05,402 --> 00:45:07,838 HUTCHISON THIS MORNING AND TALKED TO VALI TENUVU. 833 00:45:07,905 --> 00:45:11,442 YOU KNOW, YOU KNOW PEOPLE HAVE A COUPLE OF 100 HERE, 500 THERE 834 00:45:11,508 --> 00:45:12,843 AND IT KIND OF ADDS UP. 835 00:45:13,677 --> 00:45:17,047 AND I THINK ONE OF THE THINGS THAT WE NEED TO DO, AND I THINK 836 00:45:17,114 --> 00:45:20,451 THIS WORKING GROUP IS, IS THE PERFECT GROUP TO DO IT IS SORT 837 00:45:20,517 --> 00:45:23,954 OF HAVE A CLEARING HOUSE AND YOU KNOW WHAT, WHAT, WHAT SAMPLES 838 00:45:24,021 --> 00:45:27,091 ARE OUT THERE SITTING IN PEOPLE'S FREEZERS, WHAT IS THE 839 00:45:27,157 --> 00:45:28,692 DATA THAT IS LINKED WITH IT? 840 00:45:28,759 --> 00:45:32,129 OBVIOUSLY, IT'S GOING TO BE VARIABLE AMOUNTS OF DATA. 841 00:45:32,196 --> 00:45:34,198 THERE'S GOING TO BE A CERTAIN AMOUNT OF MISSING THIS THAT'S 842 00:45:34,264 --> 00:45:34,631 INEVITABLE. 843 00:45:35,699 --> 00:45:39,069 BUT I I SUSPECT WE'RE NOT THAT FAR AND SO SO THAT'S THAT'S 844 00:45:39,136 --> 00:45:42,806 SOMETHING THAT WE CLEARLY HAVE TO DO AND AND PERHAPS IF THERE'S 845 00:45:42,873 --> 00:45:46,376 SOME OF THE THE MORE JUNIOR PEOPLE IN THIS ROOM WILL WANT TO 846 00:45:46,443 --> 00:45:49,880 RAISE THEIR HAND AND WANT TO TAKE ON A A LEADERSHIP ROLE IN 847 00:45:49,947 --> 00:45:53,350 THIS IS TO BE FANTASTIC YOU YOU WILL CERTAINLY GET A LOT OF 848 00:45:53,417 --> 00:45:56,820 SUPPORT A LOT OF HELP BUT IT'S IT'S ALWAYS GOOD IF SOMEONE 849 00:45:56,887 --> 00:45:58,922 DECIDES TO TAKE THE POINT ON THIS. 850 00:45:59,823 --> 00:46:03,460 THE OTHER, THE OTHER ISSUE AND I'VE LEARNED MORE AND MORE ABOUT 851 00:46:03,527 --> 00:46:07,064 THIS OVER THE LAST SEVERAL YEARS IS IS THIS ISSUE OF POLYGENIC 852 00:46:07,131 --> 00:46:08,165 RISK SCORES, RIGHT. 853 00:46:08,232 --> 00:46:12,436 SO ALTHOUGH FOR COMMON ALLELES, WHICH IS WHAT WE'RE GETTING IN 854 00:46:12,503 --> 00:46:16,306 AG WAS CHIP, IT'S IT'S ALMOST ALL COMMON ALLELES EVEN IF 855 00:46:16,373 --> 00:46:20,611 THEY'RE HIGHLY, SIGNIFICANTLY ASSOCIATED WITH A VERY, VERY LOW 856 00:46:20,677 --> 00:46:23,580 P VALUE WITH A PARTICULAR DISEASE OUTCOME. 857 00:46:23,981 --> 00:46:28,585 THE EFFECT SIZE OF THESE COMMON ALLELES ON THE ON THE DISEASE 858 00:46:28,652 --> 00:46:32,890 PATHOLOGY AND THE DISEASE MANIFESTATION IS USUALLY TINY, 859 00:46:32,956 --> 00:46:36,860 WELL BELOW THE LEVEL WILL BE CLINICALLY ACTIONABLE. 860 00:46:37,728 --> 00:46:41,165 ON THE OTHER HAND IT IS BECOMING MORE APPARENT THAT IF YOU LOOK 861 00:46:41,231 --> 00:46:44,801 AT HUNDREDS OR EVEN THOUSANDS OF THESE COMMON ALLELES AND LOOK AT 862 00:46:44,868 --> 00:46:48,172 THE INHERITANCE ALONG THESE HUNDREDS OF THOUSANDS OF ALLELES 863 00:46:48,238 --> 00:46:51,542 THAT YOU ACTUALLY CAN GET EFFECT SIZES THAT ARE SIGNIFICANT. 864 00:46:51,608 --> 00:46:55,445 SO THIS IS LIKE THAT ARE BORROWED FROM COLIN ELLIS WHO'S 865 00:46:55,512 --> 00:46:59,049 AT PENN WHO IS INTERESTED IN GENETICS OF EPILEPSY. 866 00:46:59,316 --> 00:47:03,554 BUT THIS IS A STUDY FROM THE UK BRAIN BANK THAT IS LOOKING AT AT 867 00:47:03,620 --> 00:47:07,324 POLYGENIC RISK COURSE AND MULTIPLE SCLEROSIS AND AND THE 868 00:47:07,391 --> 00:47:11,562 POINT AND THIS IS THE RELEVANT, THIS IS THE RELEVANT SLIDE HERE 869 00:47:11,628 --> 00:47:15,465 IF YOU GUYS CAN SEE IT AND PARTICULARLY THIS ONE, YOU KNOW 870 00:47:15,532 --> 00:47:19,570 THAT THAT THAT ONCE YOU GET TO THE UPPER DECILE OF THE OF THE 871 00:47:19,636 --> 00:47:23,407 POLYGENIC RISK CORPS YOU ACTUALLY ARE ABLE TO ACCOUNT FOR 872 00:47:23,473 --> 00:47:27,578 SIGNIFICANT ODDS RATIOS FOR THE MANIFESTATION OF THAT DISEASE. 873 00:47:27,644 --> 00:47:30,948 YOU KNOW ODDS RATIOS TO THREE TO FIVE OR IN SOME CASES EVEN EVEN 874 00:47:31,014 --> 00:47:31,448 FURTHER. 875 00:47:32,482 --> 00:47:35,953 NOW THERE ARE IN ORDER TO GET APOLOGENIC RISK AURA THAT IS 876 00:47:36,019 --> 00:47:39,590 RELIABLE, YOU OBVIOUSLY NEED A VERY ROBUST GY STUDY THAT HAS 877 00:47:39,656 --> 00:47:40,190 BEEN DONE. 878 00:47:40,257 --> 00:47:43,694 BUT THESE NOW EXIST FOR MOST COMMON DISEASES, CERTAINLY ONES 879 00:47:43,760 --> 00:47:46,563 FOR ALZHEIMER'S DISEASE, FRONTOTEMPORAL DEMENTIA, 880 00:47:46,630 --> 00:47:49,967 PARKINSON'S DISEASE, STROKE, MULTIPLE SCLEROSIS, CERTAINLY 881 00:47:50,033 --> 00:47:51,368 CARDIOVASCULAR DISEASE. 882 00:47:52,169 --> 00:47:57,874 AND GIVEN THAT WE ALREADY HAVE G WAS DATA ON ALMOST 6000 TBI 883 00:47:57,941 --> 00:47:58,809 PATIENTS. 884 00:47:59,276 --> 00:48:03,046 THIS IS, THIS IS SOMETHING THAT IS A A VERY TRACTABLE STUDY. 885 00:48:04,548 --> 00:48:07,551 AND YOU KNOW THAT AGAIN IT'D BE TERRIFIC IF SOMEONE IN THIS ROOM 886 00:48:07,618 --> 00:48:10,387 WHO HAD THE EXPERTISE OR THE BACKGROUND OR OR IN FACT I HAD 887 00:48:10,454 --> 00:48:13,457 MAYBE A LITTLE BIT OF EXPERTISE IN BACKGROUND AND WANTED TO TAKE 888 00:48:13,523 --> 00:48:15,058 THAT ON AND WANTED TO TRAIN THIS. 889 00:48:15,125 --> 00:48:19,196 THIS WOULD BE A VERY COOL STUDY TO DO WHICH THIS NETWORK WOULD 890 00:48:19,263 --> 00:48:22,733 BE OR OR THIS GROUP WOULD BE VERY PERHAPS A VERY GOOD 891 00:48:22,799 --> 00:48:25,135 PLATFORM TO TO TO GET AT THAT DATA. 892 00:48:26,603 --> 00:48:31,441 SO AGAIN IT'S JUST ONE OF ONE OF THE THINGS THAT THAT MY SENSE IS 893 00:48:31,508 --> 00:48:36,046 THAT WE'RE PARTICULARLY IN A GOOD POSITION TO TRY AND PROMOTE 894 00:48:36,113 --> 00:48:40,651 THAT KIND OF STUDY WHICH WHICH CERTAINLY HAS THE POTENTIAL TO 895 00:48:40,717 --> 00:48:45,322 OPEN UP PREVIOUSLY UNEXPECTED AVENUES OR PREVIOUSLY UNEXPECTED 896 00:48:45,389 --> 00:48:49,793 PATHOLOGIES IN IN IN HUMAN TBI AND CAME AND AND REALLY WHAT 897 00:48:49,860 --> 00:48:54,531 WHAT YOU NEED ARE THE GS SUMMARY STATISTICS WE SORT OF HAVE YOU 898 00:48:54,598 --> 00:48:59,136 KNOW THESE THESE EXIST FOR MANY DISEASES OBVIOUSLY SNIP ARRAY 899 00:48:59,202 --> 00:49:03,674 DATA FROM WE ALREADY HAVE WE NEED ANCESTRY MATCH CONTROLS OF 900 00:49:03,740 --> 00:49:07,311 COURSE AND THIS WOULD BE VERY WORTHWHILE DOING. 901 00:49:09,346 --> 00:49:13,784 I THINK WE ALSO TALKED ABOUT THIS IS ANOTHER OPPORTUNITY AND 902 00:49:13,850 --> 00:49:18,488 THIS IS THE THERE ARE THERE ARE A NUMBER OF OF PROSPECTIVE GOOD 903 00:49:18,555 --> 00:49:18,922 POINT. 904 00:49:18,989 --> 00:49:24,928 SO WE HAVE 10 MINUTES, WE STARTED A LITTLE LATE I WE I CAN 905 00:49:24,995 --> 00:49:30,934 WIND UP IN 10 MINUTES EASILY THIS THIS HAS BEEN A TERRIFIC 906 00:49:31,001 --> 00:49:32,035 DISCUSSION. 907 00:49:32,102 --> 00:49:37,074 I CERTAINLY DIDN'T WANT TO LIMIT THE DISCUSSION HERE BUT AGAIN 908 00:49:37,140 --> 00:49:41,311 JUST JUST AN AREA WHERE THIS IS DATA THAT EXISTS AND 909 00:49:41,378 --> 00:49:45,682 COLLABORATIONS WITHIN OUR GROUP CAN BE PROMOTED THERE. 910 00:49:45,749 --> 00:49:48,719 THERE ARE A NUMBER OF STUDIES, LARGE POPULATION BASED 911 00:49:48,785 --> 00:49:52,122 PROSPECTIVE STUDIES THAT HAVE BEEN GOING ON FOR DECADES AND 912 00:49:52,189 --> 00:49:54,591 THAT'S TRUE FOR THE FRAMINGHAM HEART STUDY. 913 00:49:54,658 --> 00:49:56,860 IT'S TRUE FOR THE ATHEROSCLEROSIS WRITTEN 914 00:49:56,927 --> 00:49:57,861 COMMUNITY STUDIES. 915 00:49:57,928 --> 00:50:00,297 THERE ARE ACTUALLY SEVERAL OTHERS THAT BY THE WAY THEY'VE 916 00:50:00,364 --> 00:50:01,064 ALREADY DONE GYS. 917 00:50:01,798 --> 00:50:06,903 THEY HAVE ALREADY DONE IN SOME CASES PRETTY DENSE BIOMARKER 918 00:50:06,970 --> 00:50:07,471 TESTS. 919 00:50:08,505 --> 00:50:12,576 BUT THE TBI RELATED PHENOTYPING IS VERY MUCH IN ITS INFANCY AND 920 00:50:12,642 --> 00:50:16,513 THERE ARE PEOPLE IN THIS ROOM OR PEOPLE IN OUR GROUP WHO ARE 921 00:50:16,580 --> 00:50:20,283 AMONG THE LEADERS IN ASSESSING THE TBI RELATED PHENOTYPING 922 00:50:20,350 --> 00:50:20,751 THERE. 923 00:50:21,218 --> 00:50:25,322 SO, SO THIS THIS IS AGAIN SOMETHING WHERE THE THE THE 924 00:50:25,389 --> 00:50:30,026 PROPER EXPERTISE AND THE PROPER BACKGROUND CAN ESTABLISH THE 925 00:50:30,093 --> 00:50:34,631 PROPER COLLABORATIONS AND YOU KNOW IT'S IT'S IT'S BASICALLY 926 00:50:34,698 --> 00:50:39,403 LOOKING AT RESULTS WHERE WHERE YOU KNOW CREATIVITY SHOULD NOT 927 00:50:39,469 --> 00:50:44,508 BE THE LIMITING FACTOR IN IN THE QUESTIONS THAT WE WANT TO ANSWER 928 00:50:44,574 --> 00:50:47,778 AND MAKE MAKE SOME PROGRESS IN THE FIELD. 929 00:50:51,114 --> 00:50:54,251 I FINALLY THIS, THIS IS THE LAST SLIDE THAT I WANTED TO SHOW. 930 00:50:54,317 --> 00:50:58,922 THIS IS AGAIN ANOTHER TOPIC THAT THAT WE DISCUSSED AND THIS IS 931 00:50:58,989 --> 00:51:02,826 SOMETHING ELSE THAT IT'S NOT TOTALLY NEW, BUT IT HAS 932 00:51:02,893 --> 00:51:07,197 CERTAINLY GOTTEN ATTENTION RECENTLY, RIGHT, THE ABILITY TO 933 00:51:07,264 --> 00:51:10,834 DO VERY HIGHLY MULTIPLEXED PROTEOMIC PLATFORMS. 934 00:51:11,034 --> 00:51:13,470 AND THIS INITIALLY STARTED AT MASS SPECTROMETRY. 935 00:51:13,537 --> 00:51:17,340 BUT THERE ARE NOW OTHER TOOLS EITHER WITH IMMUNOASSAYS OR EVEN 936 00:51:17,407 --> 00:51:21,178 PROXIMITY EXTENSION ASSAYS WHICH ARE STILL BASICALLY AN IMMUNO 937 00:51:21,244 --> 00:51:24,581 ASSAY WITH A NOVEL WAY OF DETECTING IT OR APTAMER BASED 938 00:51:24,648 --> 00:51:26,349 ASSAYS SUCH AS THE SOMA SCAN. 939 00:51:26,416 --> 00:51:28,585 AND I THINK WE INTRODUCED THIS TO MANY OF OUR GROUP. 940 00:51:28,952 --> 00:51:33,623 SOME OF THESE ARRAYS ALREADY EXIST FOR SOMETHING LIKE ERIC OR 941 00:51:33,690 --> 00:51:34,758 OR FRAMINGHAM. 942 00:51:35,459 --> 00:51:39,396 OBVIOUSLY THE THE TBI RELATED PHENOTYPING THERE IS SOMETHING 943 00:51:39,463 --> 00:51:42,999 THAT WOULD BE THAT WOULD BE NOVEL AND AND WORTHWHILE. 944 00:51:44,668 --> 00:51:48,305 I I KNOW THERE'S THERE'S SOME, I KNOW CHERYL YOU'VE HAVE LOOKED 945 00:51:48,371 --> 00:51:51,741 INTO THE SOMA SCAN AND AND TRYING TO SET THAT UP AT UBC OR 946 00:51:51,808 --> 00:51:52,943 PERHAPS IN YOUR LAB. 947 00:51:53,977 --> 00:51:55,846 OTHERS HAVE WELL OVER HAD THIS DISCUSSION. 948 00:51:55,912 --> 00:52:04,454 YOU WANT TO MAKE SOME COMMENTS, YEAH WE ARE LOOKING AT MOST OF 949 00:52:04,521 --> 00:52:06,656 THESE PLATFORMS. 950 00:52:06,723 --> 00:52:09,860 I THINK OUR MOST ADVANCED DISCUSSIONS ARE WITH ALOMAR 951 00:52:09,926 --> 00:52:11,027 USING THE NEW LIZA. 952 00:52:11,595 --> 00:52:14,831 SO REALLY INVITE ANYBODY THAT WANTS TO COLLABORATE WITH SOME 953 00:52:14,898 --> 00:52:17,667 OF THOSE THOSE STUDIES THAT ARE JUST BEING PLANNED. 954 00:52:18,001 --> 00:52:18,368 EXCELLENT. 955 00:52:19,236 --> 00:52:19,569 OK. 956 00:52:20,470 --> 00:52:24,574 NEIL, JUST TO COMMENT ON, ON THE PLATFORMS AND WE'VE HAD SOME 957 00:52:24,641 --> 00:52:29,012 LIMITED EXPERIENCE WITH THE SOMA SCAN IN PATIENTS WHO'VE ALSO GOT 958 00:52:29,079 --> 00:52:33,183 KIND OF QUANTRIX ASCERTAINMENT OF SOME OF THE BIOMARKERS THAT 959 00:52:33,250 --> 00:52:35,285 WE WE'RE MORE EXPERIENCED WITH. 960 00:52:35,352 --> 00:52:38,822 AND WE WE'VE NOT SEEN ALWAYS A GREAT CORRELATION BETWEEN THE 961 00:52:38,889 --> 00:52:39,055 TWO. 962 00:52:39,122 --> 00:52:42,192 AND I THINK THERE IS SOME WORK ON KIND OF QUANTITATIVE TRAIT 963 00:52:42,259 --> 00:52:45,328 LOCI WHICH MIGHT GIVE YOU AN INDICATION FOR THE FOR THE SOMA 964 00:52:45,395 --> 00:52:48,164 PLATFORM WHICH MARKERS ARE MORE RELIABLE THAN OTHERS. 965 00:52:48,598 --> 00:52:52,602 THAT'S LARGELY BEEN THE EXPERIENCE OF A LOT OF PEOPLE 966 00:52:52,669 --> 00:52:57,173 AND SOMOS CAN IS THOUGHT TO BE OK AS A HYPOTHESIS GENERATING 967 00:52:57,240 --> 00:52:59,976 RATHER THAN A TRUE DEFINITIVE ISSUE. 968 00:53:00,043 --> 00:53:02,746 BUT NONETHELESS THIS IS, THESE ARE QUESTIONS THAT ARE OUT THERE 969 00:53:02,812 --> 00:53:03,880 AND HAVE BEEN LOOKED AT. 970 00:53:05,649 --> 00:53:08,952 OK, THERE'S A QUESTION IN THE CHAT. 971 00:53:15,125 --> 00:53:17,994 OK, THIS IS FROM BRENT WINSTON. 972 00:53:18,595 --> 00:53:19,362 WELL, I AM BIASED. 973 00:53:19,429 --> 00:53:21,798 I BELIEVE THERE WILL BE IMPORTANT INFORMATION THAT COMES 974 00:53:21,865 --> 00:53:24,200 FROM MULTIOMICS, ESPECIALLY METABOLOMICS AND LIPIDOMICS. 975 00:53:24,267 --> 00:53:27,237 IT WOULD BE NICE TO SEE A FOCUS GROUP ON THIS. 976 00:53:27,304 --> 00:53:29,139 AND I THINK THIS IS ACTUALLY AN EXCELLENT POINT. 977 00:53:29,940 --> 00:53:33,677 THIS IS NOT SOMETHING THAT THE FIELD HAS, HAS PUT MUCH EFFORT 978 00:53:33,743 --> 00:53:37,347 ON, BUT I THINK THERE IS A LOT OF VERY EXCITING PROGRESS IN 979 00:53:37,414 --> 00:53:41,184 BOTH LIPIDOMICS AND METABOLOMICS IN IN OTHER AREAS OF MEDICINE 980 00:53:41,251 --> 00:53:44,888 AND THIS IS VERY RIPE FOR TBI AND I I KNOW THERE ARE SEVERAL 981 00:53:44,955 --> 00:53:48,692 FOLKS IN THIS ROOM WHO ARE VERY INTERESTED ALONG THESE LINES. 982 00:53:48,758 --> 00:53:52,228 I WONDER IF ANYONE WANTS TO COMMENT ON ANY WORK THAT THEY 983 00:53:52,295 --> 00:53:55,999 ARE DOING ALONG THOSE LINES OR ANY PARTICULAR TOOLS THAT ARE 984 00:53:56,066 --> 00:53:59,603 PLANNING ON USING BECAUSE I I MEAN I I COMPLETELY AGREE. 985 00:53:59,669 --> 00:54:04,074 I THINK THERE ARE MANY MOLECULES BEYOND PROTEINS THAT ARE GOING 986 00:54:04,140 --> 00:54:08,311 TO HAVE IMPORTANT EFFECTS IN BIOLOGY THAT ARE THAT ARE WORTH 987 00:54:08,378 --> 00:54:09,079 LOOKING AT. 988 00:54:09,145 --> 00:54:11,948 AND IN FACT THE OTHER THE OTHER ISSUE THAT WE HAVEN'T REALLY 989 00:54:12,015 --> 00:54:14,851 EVEN TALKED ABOUT MUCH IS THE POST TRANSLATIONAL MODIFICATION 990 00:54:14,918 --> 00:54:15,719 OF PROTEINS, RIGHT. 991 00:54:15,785 --> 00:54:19,589 SO ALMOST ALL PROTEINS THAT ARE PRESENT IN IN, IN THE BODY AND 992 00:54:19,656 --> 00:54:23,193 CERTAINLY THOSE THAT ARE PRESENT IN THE BLOOD ARE ARE POST 993 00:54:23,259 --> 00:54:26,696 TRANSLATIONALLY MODIFIED PHOSPHORYLATIONS, ACETYLATIONS, 994 00:54:26,763 --> 00:54:30,433 GLYCATIONS AND THEN THEY OFTEN HAVE VERY POWERFUL EFFECTS IN 995 00:54:30,500 --> 00:54:34,237 BIOLOGY AND IT'S SOMETHING WE'VE ONLY STARTED TO TO LOOK AT. 996 00:54:35,338 --> 00:54:39,376 SO JUST BUILDING ON WHERE CAN WE GO FROM HERE 11 AREA THAT IS I 997 00:54:39,442 --> 00:54:43,346 THINK ENTIRELY UNEXPLORED IN THE FIELD OF TBI ARE CIRCULATING 998 00:54:43,413 --> 00:54:47,283 STEM CELLS LIKE ENDOTHELIAL STEM CELLS WHICH WOULD BE REALLY 999 00:54:47,350 --> 00:54:50,987 INTERESTING TO PROBE FOR CAN BE DONE USING FAX ANALYSIS. 1000 00:54:51,287 --> 00:54:56,426 BUT IT IT COULD BE THAT THIS MIGHT BE PART OF THE PROGNOSTIC 1001 00:54:56,493 --> 00:54:57,861 ABILITY TO HEAL. 1002 00:54:58,194 --> 00:54:58,361 YEAH. 1003 00:54:59,229 --> 00:55:01,564 AND BY THE WAY, I MEAN THIS IS NOT SOMETHING THAT WE HAVE 1004 00:55:01,631 --> 00:55:02,699 ROUTINELY BEEN COLLECTING. 1005 00:55:03,400 --> 00:55:07,370 WE USUALLY COLLECT SERUM AND PLASMA AND OCCASIONALLY WHOLE 1006 00:55:07,437 --> 00:55:07,837 BLOOD. 1007 00:55:08,304 --> 00:55:13,143 BUT COLLECTING CIRCULATING CELLS IS IS SOMETHING THAT'S NOT 1008 00:55:13,209 --> 00:55:14,377 ROUTINELY DONE. 1009 00:55:14,444 --> 00:55:16,112 I KNOW SOME GROUPS HAVE STARTED DOING THAT. 1010 00:55:16,746 --> 00:55:19,382 I'VE CERTAINLY THOUGHT ABOUT IT, HAVEN'T QUITE MADE THE MADE THE 1011 00:55:19,449 --> 00:55:21,317 LEAP YET BUT IT CERTAINLY HAS A LOT OF VALUE. 1012 00:55:21,384 --> 00:55:21,751 YES. 1013 00:55:23,153 --> 00:55:26,790 I JUST WANTED TO MENTION ONE OTHER MODALITY OR OR ANALYTE 1014 00:55:26,856 --> 00:55:28,358 THAT WE COULD LOOK INTO. 1015 00:55:28,425 --> 00:55:29,759 MY NAME IS NICOLE BJORKLUND. 1016 00:55:29,826 --> 00:55:35,331 I'M, I'M NEW HERE FROM FROM CVB, BUT I KNOW INITIALLY THERE WAS A 1017 00:55:35,398 --> 00:55:38,368 LOT OF PROMISE IN AUTO ANTIBODIES. 1018 00:55:38,835 --> 00:55:42,305 I'M LOOKING AT VERY SPECIFIC AUTO ANTIBODIES THAT THAT DOCTOR 1019 00:55:42,372 --> 00:55:45,608 WANG HAD DONE AND I THINK IN SOME OF THE PRECLINICAL WORK 1020 00:55:45,675 --> 00:55:48,111 THERE WAS SOME SOME VERY PROMISING RESULTS. 1021 00:55:48,178 --> 00:55:51,347 SO I THINK THAT'S AN AREA WHERE YOU COULD HAVE THE NEW 1022 00:55:51,414 --> 00:55:54,651 TECHNOLOGIES HAVE WIDE PLATFORMS OR YOU CAN LOOK AT MANY 1023 00:55:54,718 --> 00:55:58,388 DIFFERENT AUTO ANTIBODIES AND I THINK THOSE COULD BE USEFUL FOR 1024 00:55:58,455 --> 00:56:01,725 LOOKING AT REPETITIVE INJURY AND PERHAPS RETROSPECTIVE. 1025 00:56:03,860 --> 00:56:04,561 YEAH, EXCELLENT POINT. 1026 00:56:04,627 --> 00:56:07,330 KEVIN IS UP AND I KNOW KEVIN YOU HAD SOME PUBLICATION THIS, BUT 1027 00:56:07,397 --> 00:56:09,165 JAMIE, YOU WANT TO MAKE A COMMENT FIRST? 1028 00:56:10,667 --> 00:56:14,537 YEAH, I JUST WANTED TO BUILD A LITTLE BIT ON WHAT BRENT BRENT'S 1029 00:56:14,604 --> 00:56:16,606 COMMENT AND THEN KIND OF PROMOTE. 1030 00:56:16,673 --> 00:56:20,043 HE HAD HIS LAB HAD BEEN LOOKING AT METABOLOMICS WITH THREE 1031 00:56:20,110 --> 00:56:23,379 DIFFERENT METHODOLOGIES AND THE PAPERS JUST PUBLISHED IN 1032 00:56:23,446 --> 00:56:26,750 CRITICAL CARE USING SAMPLES FROM OUR CANADIAN BIOBANK AND 1033 00:56:26,816 --> 00:56:27,350 DATABASE. 1034 00:56:27,617 --> 00:56:31,688 AND SO THE BRAIN IS OVER 50% FAT. 1035 00:56:31,955 --> 00:56:34,157 WE ALL HAVE FAT FOR FAT BRAINS. 1036 00:56:35,225 --> 00:56:40,497 AND SO INTERESTINGLY WHAT HE DID FIND IS THAT THE HE WAS LOOKING 1037 00:56:40,563 --> 00:56:45,568 AT THE HYPOTHESIS WAS THAT THERE WOULD BE METABOLITE PROFILES 1038 00:56:45,635 --> 00:56:49,739 THAT ARE PREDICTIVE OF GOSE AT SIX AND 12 MONTHS. 1039 00:56:50,073 --> 00:56:53,576 AND HE FOUND THAT IT WAS IT DEFINITELY THE HYPOTHESIS WAS 1040 00:56:53,643 --> 00:56:53,877 TRUE. 1041 00:56:53,943 --> 00:56:58,248 THERE WAS A PATTERNS THAT MOST OF THE PROGNOSTIC METABOLITES 1042 00:56:58,314 --> 00:57:02,352 WERE LIPIDS AND THAT THE THERE WAS DAY ONE AND DAY THREE 1043 00:57:02,418 --> 00:57:06,523 SAMPLES AND THAT THERE WAS BETTER PROGNOSIS WHEN YOU WENT 1044 00:57:06,589 --> 00:57:10,160 ABOUT LONGER AND INCLUDED THOSE DAY THREE SAMPLES. 1045 00:57:10,226 --> 00:57:13,797 SO THE LIPIDS APPEARED TO BE EXCELLENT AND YOU CAN READ AND I 1046 00:57:13,863 --> 00:57:16,499 THINK THE THE PREDICTIVE VALUE IS VERY HIGH. 1047 00:57:16,566 --> 00:57:19,035 IT'S A SMALL SAMPLE SIZE, BUT I JUST WANTED TO PROMOTE THAT. 1048 00:57:19,102 --> 00:57:21,070 SO MAYBE FAT IS THE WAY TO GO. 1049 00:57:21,871 --> 00:57:22,672 YEAH, I THINK THAT'S IMPORTANT. 1050 00:57:22,739 --> 00:57:24,674 SO KEVIN AND THEN DAVID WILL BE THE LAST. 1051 00:57:25,675 --> 00:57:29,612 YEAH, THE THE AUTO ANTIBODIES AND SORT OF AN ENIGMA IN THE 1052 00:57:29,679 --> 00:57:33,883 SENSE THAT IT'S NOT EVERYONE, IT'S ABOUT YOU KNOW IF YOU COUNT 1053 00:57:33,950 --> 00:57:37,754 ALL THE SUBJECT FOR ALL THE ANTIGEN MAYBE AROUND 20% THE 1054 00:57:37,821 --> 00:57:41,224 TITLE ARE VERY DIFFERENT FROM PATIENT TO PATIENT. 1055 00:57:41,758 --> 00:57:45,395 SO TO REALLY YOU KNOW IN THE IMMUNE, AUTOIMMUNE DISEASE YOU 1056 00:57:45,461 --> 00:57:48,565 ACTUALLY HAVE TO DO A TITLE YOU KNOW TO FIND OUT. 1057 00:57:49,098 --> 00:57:52,135 AND SO THAT'S VERY TOUGH AND WE HAVE SORT OF ELISA ESSAY, WE 1058 00:57:52,202 --> 00:57:53,469 PUBLISH SOME PAPER ON IT. 1059 00:57:54,737 --> 00:57:57,440 AND THEN THE OTHER THING IS THERE ARE SO MANY DIFFERENT 1060 00:57:57,507 --> 00:57:57,874 ANTIGENS. 1061 00:57:57,941 --> 00:57:59,809 SO THEY'RE ALL CREATED EQUAL. 1062 00:58:00,476 --> 00:58:04,614 WE KIND OF THINK THAT THE MOTOR ANTIGEN TO CELL SERVICE 1063 00:58:04,681 --> 00:58:09,485 RECEPTOR, THEY MIGHT BE THE BAD GUYS, WE HAVE SOME EVIDENCE SOME 1064 00:58:09,552 --> 00:58:13,823 ONES IN HYPOTHALAMUS OR THE ANTIBODIES SEEMS TO GO WITH A 1065 00:58:13,890 --> 00:58:17,260 BETTER OUTCOME WITH HAVING LOW HYPOGONADISM. 1066 00:58:17,760 --> 00:58:21,231 SO, SO IT'S NOT ALWAYS BAD AS WELL AS A COMPLEX STORY. 1067 00:58:21,297 --> 00:58:26,169 AND THEN AGAIN IT MAY BE THAT WAY INTO THE CYTOKINE RESPONSES. 1068 00:58:26,603 --> 00:58:29,606 SO THE STORY IS NOT COMPLETELY DONE YET, BUT THAT'S A VERY 1069 00:58:29,672 --> 00:58:31,040 INTERESTING ANGLE AS WELL. 1070 00:58:32,275 --> 00:58:33,309 OK, SO WHAT IS SAYING? 1071 00:58:33,376 --> 00:58:37,447 SO, SO WE'VE PUBLISHED A BIT ON AUTO ANTIBODIES OF TRAUMATIC 1072 00:58:37,513 --> 00:58:41,718 BRAIN INJURY SHOWN THAT THERE'S AN INITIALLY A VERY BROAD AUTO 1073 00:58:41,784 --> 00:58:43,286 ANTIBODY RESPONSE IGN. 1074 00:58:43,686 --> 00:58:46,990 IT LOOKS LIKE A VACCINE RESPONSE WITH MATURATION TO IGG. 1075 00:58:47,457 --> 00:58:51,160 AND AS KEVIN SAYS THERE'S THERE'S QUITE A LOT OF VARIATION 1076 00:58:51,227 --> 00:58:55,064 THAT INNATE INNATE LIKE ADAPTIVE IMMUNE RESPONSE INITIALLY IS 1077 00:58:55,131 --> 00:58:57,867 DEFINITELY ASSOCIATED WITH BIRTH OUTCOMES. 1078 00:58:58,434 --> 00:59:02,505 SECOND THING TO SAY IS THAT MATTHEW ORASEK WHO WORKS WITH 1079 00:59:02,572 --> 00:59:07,010 ANDRAS BOOKIE IN IN SWEDEN HAS PUBLISHED FROM SANTA TBIA LARGE 1080 00:59:07,076 --> 00:59:11,414 STUDY OF BOTH METABOLOMICS AND LIPIDOMICS AND THERE'S ANOTHER 1081 00:59:11,481 --> 00:59:13,283 PAPER IN IN THE PIPELINE. 1082 00:59:13,683 --> 00:59:18,655 SO IF PEOPLE ARE INTERESTED THEY SHOULD GO LOOK AT THAT DATA IT'S 1083 00:59:18,721 --> 00:59:22,892 WAITING ON FOR WHAT ABOUT THOUSAND PATIENTS, TERRIFIC, 1084 00:59:22,959 --> 00:59:24,027 GREAT TO HEAR. 1085 00:59:24,861 --> 00:59:28,998 WELL LISTEN THIS HAS BEEN A VERY LIVELY DISCUSSION AND I I HOPE 1086 00:59:29,065 --> 00:59:33,169 NO ONE IS INTIMIDATED BY THE THE LOT OF WORK THAT WE HAVE AHEAD 1087 00:59:33,236 --> 00:59:33,569 OF US. 1088 00:59:33,636 --> 00:59:35,805 BUT IT'S ALSO A LOT OF OPPORTUNITY THAT WE HAD AHEAD OF 1089 00:59:35,872 --> 00:59:35,939 US. 1090 00:59:36,005 --> 00:59:39,309 AND AND FRANKLY IT'S JUST GOING TO TAKE A BIG TEAM WORKING 1091 00:59:39,375 --> 00:59:42,111 TOGETHER AND AND GROUPS IDENTIFYING THEIR COMMON 1092 00:59:42,178 --> 00:59:45,214 INTERESTS AND AND TAKING ADVANTAGE OF THE DATA THAT'S 1093 00:59:45,281 --> 00:59:48,584 AVAILABLE AND FRANKLY TAKING ADVANTAGE OF OF THE RESOURCES 1094 00:59:48,651 --> 00:59:51,487 THAT LIKELY WILL BECOME AVAILABLE IN THE FUTURE. 1095 00:59:51,554 --> 00:59:55,925 SO AND THANKS SO MUCH FOR FOR EVERYBODY'S TIME AND WE WILL 1096 00:59:55,992 --> 01:00:00,463 HAVE A SHORT BREAK AND THEN WE'LL RECONVENE IN FOR THE NEXT 1097 01:00:00,530 NEXT BREAKOUT GROUP.