Podcast #69 : Partnering WITH Patients

Here are the topics we discuss on this fine evening at Roy's house:

• What does "Shrink Rap" mean (reader request)?

• Roy talks about an "amazing" conference he went to called Partnership with Patients.  This conference was started by Regina Holliday, patient-advocate-extraordinaire. Here are some links for things that caught his attention:
• HealthCamp: http://HealthCa.mp/kansascity
• http://partnershipwithpatients.com/
• Donate to Patient Pod at Medstartr at http://bit.ly/patientpod where Pat Mastors is trying to raise $4200 by Oct Nov 20 (oops, we missed that deadline) (the date was extended... please help fund the project. ~Roy).

•  Clink talks about a Massachusetts legal case regarding gender reassignment of prisoners

• And finally, we talk about a reader's question about how and why patients test their therapists/psychiatrists.

      

• This podcast is available on iTunes or as an RSS feed or Feedburner feed. You can also listen to or download the mp3 or the MPEG-4 file from mythreeshrinks.com. 
  
  Thank you for listening.
  Send your questions and comments to: mythreeshrinksATgmailDOTcom, or comment on this post.
  To review our podcast, please go to iTunes.
  To review our book, please go to Amazon.

We Have An App

Just thought our readers might like to know that the Shrink Rappers now have their very own iPhone app! If you're tired of repeatedly checking iTunes to see if the latest podcast is up, you can now open this app and have us all right at your fingertips. It works on Android phones too. Just click on the link below and when it prompts you to "install on your desktop," do it.

The My Three Shrinks iPhone App!

Podcast #68: Supermax, Health Exchanges, Statins, and e-Novels

Here's what we talk about:

• Clink talks about the burning issues in corrections, including a class action suit against a federal control unit prison in Colorado, filed by a civil rights organization.  Allegations include the idea that correctional officers were abusive and that mental health services were inadequate.  You can read more about this in Clink's article here.

Clink provides the following links:

1. For the lawsuit at: http://www.scribd.com/doc/97561358/Bacote-et-al-v-Federal-Bureau-of-Prisons on June 29, 2012.

2. For an article from The Atlantic:  http://www.theatlantic.com/national/archive/2012/06/an-american-gulag-descending-into-madness-at-supermax/258323/ on June 29, 2012.

• Roy talks about the Supreme Court decision to uphold the Affordable Care Act (aka ObamaCare) and talks about the Mental Health Parity Act and the delay in getting this clarified.  Roy believes there will be increased access to mental health care.   
  

•  Roy talks about Network adequacy and whether providers are actually available.  Here is his link to his article on Health Information Exchanges. 

•  Dinah talks about statins and depression and and reads from Emily Dean's blog on Evolutionary Psychiatry where she discuss statins and depression and violence and cholesterol.  The guinea pig pictured above has a fine lipid profile.

• Dinah  talks about her new novel : Home Inspection.                

        

This podcast is available on iTunes or as an RSS feed or Feedburner feed. You can also listen to or download the mp3 or the MPEG-4 file from mythreeshrinks.com. 

Thank you for listening.

Send your questions and comments to: mythreeshrinksATgmailDOTcom, or comment on this post.

To review our podcast, please go to iTunes.
To review our book, please go to Amazon.

Podcast #66: The Professional Shrink Rap

Roy talks the top 25 search phrases that lead people to our Shrink Rap blog. 
They include, "Statistics of talking too much on a date,"  "World's largest zucchini,"  "Does Angry Birds make you depressed?"


We talk about when should a psychiatrist call in sick?  How sick is too sick?  How distracted is too distracted?  Are psychiatrists good at self-monitoring?


Roy discusses an article called Professionalism in Psychiatry. 

This podcast is available on iTunes or as an RSS feed or Feedburner feed. You can also listen to or download the mp3 or the MPEG-4 file from mythreeshrinks.com. 

 

Thank you for listening.

Send your questions and comments to: mythreeshrinksATgmailDOTcom, or comment on this post.

To review our podcast, please go to iTunes.
To review our book, please go to Amazon.

Our Interview with Dan Rodricks on WYPR

If you missed our interview on Midday with Dan Rodricks, you can still listen by clicking on the Download link, or clicking on the My Three Shrinks icon to the left will open up a browser player in a new window.

Monday January 16, 1 - 2 pm: Everything you could know about psychiatry in a 50-minute hour

What is psychotherapy, how does it work? What is psychoanalysis, and why don't all shrinks practice it? Our guest this hour three Baltimore psychiatrists -- answer questions about how they work with patients. Our guests: Dr. Steven Daviss, chairman of psychiatry at Baltimore Washington Medical Center; Dr. Dinah Miller, in private practice; and Dr. Annette Hanson, a forensic psychiatrist with appointments at the University of Maryland and Johns Hopkins Hospital. They write a blog together and are authors of “Shrink Rap: Three Psychiatrists Explain Their Work,” published by Johns Hopkins University Press.

Download

Midday producer Michael Himowitz says of the book: "This is a remarkable book. I was prepared to endure it, but it turned out to be well-written without being glib pop-psychology, informative without being overly laden with jargon, and surprisingly candid about psychiatry’s failings and problems. They should have named it Shrink 101, because it really covers the basics about navigating the disorganized and confusing world of mental health care."

 

The Shrink Rappers on Midday with Dan Rodricks: Monday, January 16 @ 1 PM

Midday with Dan Rodricks

We joined will be joining Dan Rodericks on WYPR, 88.1 FM on Monday from 1 to 2 pm.  You can listen to it or download from WYPR. If you're local, please listen.  If you're not, live streaming information is on the WYPR website at http://www.wypr.org/listen-live.

We'll put up a link after the show, and information to call in or email is shown below.

Midday is WYPR's daily public affairs program heard from noon-2pm, Monday-Friday. Hosted by longtime Baltimore Sun columnist Dan Rodricks, the program covers a wide-range of issues selected to engage, inform, and entertain the listening audience.  Topics range from the latest news, to local and national politics, to social, medical and cultural trends, featuring the best new books and most engaging authors, newsmakers and guests.

Dan has won numerous regional and national journalism awards, and he has frequently been cited as Baltimore's favorite columnist by Baltimore magazine and the City Paper. Previously, Dan was a commentator on WBAL-TV, host of a talk show on WBAL-AM, host of documentaries on Maryland Public Television and, from 1995 to 2000, host of the popular Rodricks For Breakfast show on WMAR-TV. He is the author of two books about Baltimore and lives in the city.

Executive producer: Vanessa Eskridge
Engineer and Director: Tom Welch

Podcast 65: Copyrighting the Brain

Roy wants to remind APA members to VOTE! in the APA elections.


Roy talks about our Top 25 Posts for 2011.


ClinkShrink talks about copyright issues with the Mini-Mental Status Exam (MMSE).  We talk about what the MMSE is, what it measures, and why some folks are bothered by the copyright issues. Roy mentions an alternative, the MoCa, which may be used clinically without any permission needed.


Roy mentions his Clinical Psychiatry News article in the Shrink Rap News column discussing the October SAMSHA meeting on electronic health records in behavioral health.  He talks about continuity of care documents (CCD) and XML (Clink and Roy have now lost me in Geek Speak), which gives the outline about what was important about that 'episode of care,' or doctor's appointment, and the 17 categories of things that are documented.  This was a stakeholder meeting to come to a consensus about which behavioral health elements should be included in the CCD.  Roy talks about something called Granular Consent.
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This podcast is available on iTunes or as an RSS feed or Feedburner feed. You can also listen to or download the mp3 or the MPEG-4 file from mythreeshrinks.com. 

Thank you for listening.

Send your questions and comments to: mythreeshrinksATgmailDOTcom, or comment on this post.

To review our podcast, please go to iTunes.
To review our book, please go to Amazon.

Podcast 64: Brain Freeze

Happy Holidays, everyone.  We taped this a few weeks ago, but Shrinky Podcasts always make for good holiday chatter.   Today we talk about 
1) Brain Freeze-- inspired by a Well article in the NYTimes for 11/10 on Rick Perry's Brain Freeze.  You'll note that in this podcast, Dinah reads Roy's mind, and no has brain freeze from eating cold ice cream.  We kind of ramble, and so what else is new?  We talk about memory and attention and learning and Dinah explains why men don't take out the garbage during football games.  Clink talks about the scientific phenomena of "brain overload."

2) Siri-- ah, we did this podcast right after I got my new iPhone and it was new and exciting and I was working on an article on Siri and the Psychiatrist.  We ask Siri where we can buy a duck and when the world will end.  Apparently we have 5 billion years.  And Sigourney Weaver was 62 years, 1 month, and 5 days old at the time we recorded.


3) Prison Food-- inspired by a lawsuit in which a prisoner contends that the soy-based food being served in prison is 'cruel and unusual punishment' which caused him cramps. Clink talks about how prison food is handled.  She also talks about nutrient rich Nutraloaf that can be eaten without utensils and she discusses an NPR story which includes the recipe for anyone who would like to try nutraloaf. 


If you'd like to try it:
Special Management Meal
Yield - Three Loaves

• 6 slices whole wheat bread, finely chopped
• 4 ounces imitation cheddar cheese, finely grated
• 4 ounces raw carrots, finely grated
• 12 ounces spinach, canned, drained
• 2 cups dried Great Northern Beans, soaked,
cooked and drained
• 4 tablespoons vegetable oil
• 6 ounces potato flakes, dehydrated
• 6 ounces tomato paste
• 8 ounces powdered skim milk
• 4 ounces raisins

From Clink: You mispelled nutraloaf. Don't worry, I fixed it. Also, by pure coincidence today's correctional nursing topic on Lorry Schoenley's Blogtalk radio show was all about managing food allergies in corrections. For those of you who want to know what happens to inmates with peanut allergies, here it is directly from someone in the know.

This podcast is available on iTunes or as an RSS feed or Feedburner feed. You can also listen to or download the mp3 or the MPEG-4 file from mythreeshrinks.com. 

Thank you for listening.

Send your questions and comments to: mythreeshrinksATgmailDOTcom, or comment on this post

To review our podcast, please go to iTunes.
To review our book, please go to Amazon.

Podcast #60: On the Verge

Please take our sidebar poll and tell us who you are.
  If you don't know who you are, please guess.  

In Podcast Number 60, we discuss the following:

Questions from readers--

• Sarebear asks: What is a Nervous Breakdown?
• Mary and Max, an award-winning claymation movie about an 8-yo girl and a middle-aged man with Asperger's. Very educational about Asperger's, and extremely entertaining.
• Another reader asks: How are psychiatrists prepared to manage psychiatric disorders in patients with autism?

• The New York Time review of a movie, Beautiful Boy, which led us in to a discussion of guilt and blame and our desire as human beings to believe we have control over what happens to us.  Too bad none of us saw the movie.

• Clink talks about an article that appeared in the Archives of General Psychiatry, National Study of Suicide in All People with a Criminal Justice History.

• Finally, we talk (or perhaps "ramble" is a better word) about the psychology of podcasting.

Thank you for joining us!

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This podcast is available on iTunes or as an RSS feed or Feedburner feed. You can also listen to or download the mp3 or the MPEG-4 file from mythreeshrinks.com. 

Thank you for listening.

Send your questions and comments to: mythreeshrinksATgmailDOTcom, or comment on this post

To review our podcast, please go to iTunes.
To review our book, please go to Amazon.

Podcast 59: A Brief Chat

This is the first My Three Shrinks podcast since the publication of our book, Shrink Rap: Three Psychiatrists Explain Their Work.   We had a little production glitch and the podcast is a bit slow for the first two minutes, and it's a bit shorter than our usual.

• We talk about the process of writing the book and the issues that physicians fact when writing about their patients and whether this is different for psychiatrists versus other physicians.  Clink talks about her post Doctors Who Write and discuss the dilemma doctors face when writing about their patients.
• We talked about how we chose names for our characters in the vignettes.

• An article called  Inside Higher Education, Cornell Proposes Nets for Gorge Bridges got us to revisit a topic we haven't talked about in several years: suicide on college campuses.   We mentioned the case of an MIT student whose family sued the university after she died from suicide.

• Roy talked about AADPRT (he likes acronyms) which obviously stands for American Association of Directors of Psychiatric Training and their link on how to use social media.  Roy notes that he is growing old (the rest of us aren't) because he began a Schizophrenia researcher Listserv twenty years ago on Gopher.
• In the next podcast, we answer reader questions: Sarebear wants to know what a "nervous breakdown" is and we respond to a question about how it may be harder to make psychiatric diagnoses in people with co-existing autism. But we didn't talk about those things in this podcast. 

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This podcast is available on iTunes or as an RSS feed or Feedburner feed. You can also listen to or download the mp3 or the MPEG-4 file from mythreeshrinks.com. Thank you for listening. Send your questions and comments to: mythreeshrinks@gmail.com.

We invite you to review our podcast on iTunes and to review our book on Amazon.

Thank you for listening.

Podcast #58: I Need a New Drug and Happy Five Years of Shrink Rap and Still Blogging

(Belated) Happy Blogiversary to Us!

Five Years and Still Blogging

Shrink Rap quietly turned Five on April 21st. We chatter about this while we podcast. We kept it short again and talked about some new medications. Roy mentioned a new antidepressant, Viibryd that's a bit like a combo of an SSRI + buspirone. Dinah talked about a conference she went to on psychopharm update and she read some of the slides that were presented by Dr. Neil Sandson. This led us to talk about some other new medications, including long-acting antipsychotic medications that are administered by injection.

We then talked about Silenor, a sleep medication which is the re-packaging of an older medication, Doxepin, in a lower dose. A phone call to the pharmacy revealed some interesting information about the cost of these medications, but you'll have to listen, or call the pharmacy yourself, if you want the answer.

This all led us to a discussion of the combination medication for the treatment of obesity, Contrave, that did not get FDA approval, and Steve's post on his psychiatry blog, Thought Broadcast, on Contrave compared to Swiffer floor cleaning system. Huh? Oh, listen and maybe we make sense.


Thank you for listening.
We invite you to go to iTunes and write a review.

And our Shrink Rap book should be available in the next few weeks: our review copies have arrived. Our next line will be "Go To Amazon and write a review!"

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This podcast is available on iTunes or as an RSS feed or Feedburner feed. You can also listen to or download the mp3 or the MPEG-4 file from mythreeshrinks.com. Thank you for listening. Send your questions and comments to: mythreeshrinks@gmail.com.

Thursday Apr 14 7pmET: Shrink Rappers to be LIVE on BlogTalkRadio

You all remember Doctor Anonymous, right?  He's the family medicine doc medical blogger who we've known since Al Gore invented the internet.  Well, he's not so Anonymous anymore, writing a blog called Family Medicine Rocks under his other name, Mike Sevilla, MD.

Mike is interviewing us about our upcoming book (expected to hit the shelves now at the end of May) on BlogTalkRadio. Mike interviewed us before, which we put out as a podcast (#36a), I think.  He'll be asking us questions about the book and the process, which will help us prepare for our Talk of the Nation interview on NPR on May 3.  And we'll be asking him what he's been up to.  I want to find out his experience treating psychiatric illness as a family medicine doc, referring to mental health providers, and such.

So, tune in Thursday (tomorrow) at 7pm Eastern. You'll be able to call in and join us in the conversation.  The link is HERE.  (Note that it says 11pm, but I'm sure we agreed to 7 so he'll probably fix it soon.)

Podcast 56: It's All Your Mother's Fault

Oh, not really.
In this episode, we talk about parenting. Now why do we talk about parenting: this is a psychiatry podcast, did someone forget to tell us that?

We talked about parenting for a few reasons:

It started with the tie in between trying to understand how mentally ill people become violent and we mentioned the very poignant article that Susan Klebold wrote on Oprah.com called "I Will Never Know Why?" about her son's role in the Columbine shootings and the awful toll this has taken on her. Somewhere, as a society, we've decided that parents are responsible for how their children turn out, and parenting topics are frequently addressed by patients in psychotherapy. We hear from patients who feel wronged by their parents and from parents who worry about doing right by their children. Ah, if only we had crystal balls!

This led us to talk about Amy Chua, the Yale attorney who wrote Battle Hymn of the Tiger Mom and whose article "Why Chinese Mothers are Superior" in the Wall Street Journal has gotten everyone talking about parenting styles of the East versus the West. Is this a good thing or does it contribute to student suicide?

We also mentioned Dr. Richard Friedman's article from the New York Times, "Accepting that Good Parents May Plant Bad Seeds" and Susan Reimer's article in the Baltimore Sun, "Blame Jared Loughner's Parents--It's the Easy Way Out."

Mostly we talk about the uncertainty of it all and mention issues related to good-enough parenting, lousy parents who get resilient kids, and good parents who get lousy kids.

Thank you for listening. Please do write a review on iTunes!

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This podcast is available on iTunes or as an RSS feed orFeedburner feed. You can also listen to or download the .mp3or the MPEG-4 file from mythreeshrinks.com.

Thank you for listening

Send your questions and comments to: mythreeshrinksATgmailDOTcom

Podcast 54: Tell Me! Information and Technology

Welcome to Podcast Number 54: Tell Me! Information and Technology

Here's what we talk about:

Roy talks about the Maryland Health Information Exchange (HIE) called CRISP, which stands for Chesapeake Regional Information System for our Patients. Note that your health information is accessible to participating health care providers unless you opt out. You can read more at CrispHealth.org. We ramble about the downside of sharing health information electronically. We also complain about how difficult it can be to get medical information now, so there are pros and cons.

Roy talks about career satisfaction of psychiatrists based on a survey done by Epocrates. Roy talks about the increasing job satisfaction of primary care docs -- it's going up! In psychiatry it's also going up, based on data now compared to 3 years ago. Happy shrinks are up to 83% from 70%. Roy encourages med students to join us. Dinah extols the wonders of the diversity of psychiatry. Read the article about the survey Here.

Dinah brings up the age old dilemma of how to write about clinical information in psychiatry without compromising patient confidentially. We talk about how we deal with this problem in Shrink Rap: Three Psychiatrists Explain Their Work. Ah, but it's not just printed matter, but blogging and tweeting and podcasting.

Finally, Roy talks about healthcare providers and social media, referencing an earlier blog post on What To Do When Your Patient Friends You On Facebook.

Once again, thank you for listening and please do write a review on iTunes.

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This podcast is available oniTunes or as an RSS feed orFeedburner feed. You can also listen to or download the .mp3or the MPEG-4 file from mythreeshrinks.com.

Thank you for listening

Send your questions and comments to: mythreeshrinksATgmailDOTcom

Pull & Pray - zDoggMD's Safe Sex Song

ZDoggMD's rapping video about safe sex is a beautiful example of how to grab the attention of your target audience using a medium and tone that they can get down with.

While you are on ZDogg's site, check out their first News Per Rectum podcast, Potty Mouth (punchline: "I gave a crap today"), about fecal transplants for pre-diabetes. Coincidentally, our first podcast also had the word "potty" in it (Podcasting Makes You Potty).

So, I gotta say... these guys are hilarious. Educational (sometimes marginally so) while being thoroughly entertaining and mildly offensive. Their production value is quite good, as well.

That being said, I don't expect us to follow in their vlogging footsteps.  But keep an eye on these guys.

My Three Shrinks Podcast 52: The Friendly Skies

In Dinah's post Fly Those Friendly Skies she talks about the new FAA policy regarding pilots on antidepressant medication. We found out something about pilot life span. Retired pilots live five years longer than their non-flying peers.

We talk about the New York Times article In Therapy: Cell Phones Ring True. The article discusses what therapists learn about their patients through their cell phone conversations and pictures.

Roy introduced us to the Lanny-yap blog, where we found a picture of Roy's dog, Eddie. This blog has a reference to a Scientific American article on anisomycin, an experimental medication that has been used in rats to wipe out fearful memories. Shades of Eternal Sunshine of the Spotless Mind (2004)!

Finally, we talk about a prospective study of 16,000 adults who started college and tried to guess which psychiatric diagnoses were most associated with failure to complete college. The full study can be found in the April edition of Psychiatric Services.

Once again, we talk about our upcoming book. We still need a title we can all agree on. Help us out by sending ideas to mythreeshrinksATgmail.com!

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This podcast is available oniTunes or as an RSS feed orFeedburner feed. You can also listen to or download the .mp3or the MPEG-4 file from mythreeshrinks.com.

Thank you for listening

Send your questions and comments to: mythreeshrinksATgmailDOTcom

My Three Shrinks Podcast 51: Vegan Gingerbread Cookies

For this podcast I brought some homemade vegan gingerbread cookies that I baked using a recipe from the Steph Davis blog. I'm also looking for a good sugar cookie recipe that doesn't use refined sugar or all-purpose flour. If you've got one, send it along.

We discuss my post Is it malpractice to lie? which involves a surgeon sued for malpractice for allegedly lying to a patient regarding his professional background. We wonder how much, if any, information physicians may some day be obliged to disclose to their patients prior to treatment.

There is a new type of research being done, called "in silica" research, in which people write computer programs to model behavior. We talked about computer models of suicide and how this can replicate suicide epidemics in real life. Roy is inspired to talk about a computer program that models how guys choose urinals in public restrooms, and how people stand in elevators.

We never got to the FAA policy discussion or the cell phones in therapy topic. That was saved for our next podcast.

Last but not least, Dinah takes her dog Max to the new office. Who knew that dogs could be terrified of elevators??

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This podcast is available oniTunes or as an RSS feed orFeedburner feed. You can also listen to or download the .mp3or the MPEG-4 file frommythreeshrinks.com.

Thank you for listening

Send your questions and comments to: mythreeshrinksATgmailDOTcom

My Three Shrinks Podcast 50: More About Geeks

In this show we continue with our guest Dr. Pat Barta of the Adventures in Telepsychiatry blog.

We talk about electronic health information systems and Clink continues her rant which she started in her post Rage Against The Machine. Roy mentions the Certification Commission for Health Information Technology and the American Recovery and Reinvestment Act which provides funding incentives for doctors who use health information technology. We cover developing standards for behavioral health information technology, including personal health records which allow patients to store their own information voluntarily "in the cloud", on a server. Dr. Pat Barta talks Open source health record systems and information security.

Health Data Rights is an organization that developed a proposed declaration of rights for patient data. Another organization addressing this is SpeakerFlower, of which Roy is the spokesperson.

Dinah talks about her blog postWhat's An Emergency? and wonders how flexible psychiatrists should be when a patient says they need to be seen right away. Which situations are truly emergencies? What should you do if a patient turns down multiple appointments offered for that same day? Should your office voicemail tell people to call 911?

Finally, Dinah wonders what has happened in states with medical marijuana laws. She mentions KevinMD's blog post Medical Marijuana Has Doctors Asking Questions. Should marijuana be prescribed for attention deficit disorder? How do you do clinical research on a controlled substance?

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Please go to iTunes and write a review.

This podcast is available on iTunes or as an RSS feed or Feedburner feed. You can also listen to or download the .mp3 or the MPEG-4 file from mythreeshrinks.com.

Thank you for listening

Send your questions and comments to: mythreeshrinksATgmailDOTcom

Things We Argue About

Sometimes, especially on the podcasts, we get heated and go at it. Oh, sometimes on the blog, too. Among ourselves, we refer to these discussions as "The Benzo Wars" --the posts where we've argued about what role benzodiazepines and addictive medications have in psychiatry, and "Who Deserves Care" cause Clink thinks her patients need help more than mine (..if you see me walking around with bruises, you'll know it's me......)

So what else do Shrinks argue about? We've got a colorful history here. Took us decades to decided if homosexuality was a disorder (yes, maybe, no). Is psychosurgery with knitting needles good? Should our patients get special accommodations? What if I'm allergic to your support dog?

Ah, we're writing a chapter and I like the input you all give!

And please listen to our podcast. We're back...probably monthly for now, but weekly once we finish the book and they teach me how to edit them.

My Three Shrinks Podcast 49: Pixelated Psychiatrists

For today's podcast we have guest psychiatrist Dr. Pat Barta talking about telepsychiatry, telemedicine and all things neuroimaging. We ponder how licensure works for telepsychiatry, whether or not you can get reimbursed for it, what the difference is between a face-to-face evaluation versus a telephone interview and why we don't yet have an iPhone app to diagnose schizophrenia. All of these topics (and more) can be found on Dr. Barta's blog Adventures in Telepsychiatry.

We talk about Pauline Chen's article in the New York Times: "Are Doctors Ready for Virtual Visits?"

Roy, Dinah, Pat and Clink discuss electronic health records and who should have the rights to our personal health information. I'm including a link to the Speak Flower web site, an organization dedicated to promoting patient-controlled health information systems.

We also hear from Dinah's new dog. Please go to iTunes and write a review.

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Find show notes with links at: http://mythreeshrinks.com. The address to send us your Q&A's is there, as well (mythreeshrinksATgmailDOTcom). This podcast is available on iTunes (feel free to post a review) or as an RSS feedorFeedburner feed. You can also listen to or download the .mp3 or the MPEG-4 file frommythreeshrinks.com. Thank you for listening.