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Of 40 minutes. I struggled to talk for that long. Um but I'll try and go through a lot about why the topic is important. What what we can do generally day to day um in terms of improvements, what if you're interested in projects, things that you can look at and where to go for methodology and then cover some of the work that we've been doing over the last few years, which hopefully will be helpful. Mm I'm very happy to take questions as well at the end three. So healthcare as a whole is responsible for 5% of all greenhouse gas emissions and that's more than both the airline and shipping industries globally. If our sector was a nation, it would be the fifth largest contributor of carbon emissions globally. Ultimately, that equates to 2 billion tons of CO2 emitted into the atmosphere every year, which is the same as about 56 million return flights from London to UK er UK to Sydney, Australia. And if you look at uh how carbon dioxide relates to global warming. Um and let's, so let's graph. So let's see that's showing you rising temperatures against CO2 concentrations in the atmosphere. Um roughly every two years, there is an increase in uh 0.1 degree of atmospheric temperature. Uh It's been steadily increasing since the industrial revolution. However, if you look over the last decade, um that rate seems to be increasing quite rapidly um which is rather worrying um heading towards that 1.52 degrees of er um limit set by the Paris Agreement, which is um uh I the, the, the, the highest we, we would want things to go, uh give them the detrimental effects. And if you look at what happens if we allow the temperature of the, of the earth to increase. Um So at 1.5 °C that would lead to loss of 70% of the earth's coral reefs and two degrees. Practically, the entire coral reefs across the earth would die between 14 and 37% of the world's global population would experience extreme heat waves you annually, um, talking he wears that are not compatible with life. Uh loss of between three and 7% of the global crop production and between eight and 16% of plant species last forever. And I'm sure there are many more. Uh, it's just a few to mention to by the year 2100, it's estimated that would be 81 million deaths that are expected to be directly attributable to climate change. And that actually places a mortality cost of of almost 4.5 1000 tons of CO2 per death. So any activities that contribute this much are essentially contributing directly um to loss of life to as healthcare providers, it's directly relatable to ourselves in addition to many other reasons. Yeah. So looking at the NHS over the last 30 years, um there's been significant reductions to emissions. Um So, but with net 0 2045 less than two, almost two, just over two decades away, um that does need to be much quicker. Uh I'll circle back to this but um as I said, whilst things are reducing things like patient travel related emissions have almost doubled in that time. Um which obviously is a significant contributor to the problem. So what can we do about this as a um a a healthcare system? Um There are three main areas I guess in, in healthcare, we can look at impacting. Um So we can decarbonise the delivery of healthcare, we can look at the supply chains um and also from the estates and facilities and you see a lot of the work that gets done and public size tends to be around that estates and facilities area and a bit lesser than supply chain, although there's a lot more to be done there. Um Most of what I'll focus on today will be on healthcare delivery side, that's mostly where we can make an impact. Um But there's obviously plenty of discussion to be had about the other two areas so broadly speaking, there are um two main ways really within healthcare delivery. So obviously, the pathways that patients are on um so streamlining and making them more efficient using one stop clinics um along those lines or on the direct care provider to are they providing clinical benefit or by um directly replacing and reducing um uh waste? And uh you looking at more green alternatives to what we're using? Yeah. So there are a number of methods that we can use to uh evaluate cabin footprint. Um So carbon pricing is one. So using cost based estimates um on healthcare activity, which tends to be one of the quicker ways of, of er working out emissions but also um least accurate. Um So ideally not, not, not the best way of doing things. You can do an input output analysis, which is uh good for uh large whole scale um big data. So good if you're a NHS commissioner with access to data across the, the entire health system, but um on a day to day basis, again, quite difficult, um you can do process analysis which um is a bit more um achievable. Um So it's looking at um per patient, so single use um data. So you're collecting one by one. and it obviously can be quite laborious because you're looking at every single individual item that's used and what it's packaged. What's the weight of that, how it's disposed, et cetera. Um But again, a bit more accurate than looking at the c pricing methods. And then finally, your gold standard is your life cycle assessment and that tends to combine the bottom up process analysis. So you've got that rich data um that's prospectively collected. Um And you combine that with the input output that top down um analysis, which is using the national tariffs um which can be applied to your process analysis data. Mhm So ideally you want to be aiming for like life cycle analysis or hybrid um life cycle assessment method methods. Um But again, anything that you can do is is better than, than nothing, I think in, in this stage. And we've got to start somewhere in terms of what we can do as uh as healthcare providers and, and where we should look at certainly in the surgical field. So, um if you haven't seen already, I guess the place I would certainly recommend looking first would be the green surgery report which came out back end of last year um to go very easily Google. Um but um that covers care pathways. So, um what what obviously how to change things, what things are already there also in particular operating theaters? So, anesthesia. So, and what changes can be made um surgical products within theaters, um barriers and facilitators towards screening surgery and other research areas that that can be um can be looked at. So it's a very rich um document with, with lots of information and certainly a good place to start if you're, if you're not sure on, on sustainability projects or, or sustainability actions in general, the other place that's, um, been developed over the last couple of years is the green surgery checklist again if you haven't seen this, um, good, um, good thing to see. Um, I don't know how, what or how much it's utilized and not certainly in, in our theaters. Um, That doesn't seem to be used um that I'm aware of it's quite a good uh uh something to ait against. Um if you need projects um just quite easily actionable looking at. Um Are you looking at any of those or one of those um um items on the list um which is probably good quick projects that can be turned around. Um And if you want to look at specifically calculating carbon footprint, um it's obviously quite a complex area, but um the best place to start probably if you're not sure it would be the sus Q I sustainable Quality improvement um which is um produced by the centers for sustainable healthcare. Again, easily found on Google um quite rudimentary um methodology for calculating emissions, but again, very good place to start, makes it very simple um in terms of calculating things. Uh And then if you're wanting a bit more accuracy and um bit more rich data than beyond their think place to look at, looking at dra emissions factors, which were update year and being beyond that, the difference in man, I behind how um car foot calculated. Um And even where the, the the experts are not really sure what's the best methods between like things like go on potentials over what years or pulse emissions. But again, you're getting a bit more um other end by that point. Um So we've got a couple of projects that we, we've done and I'll um I'll run over them. So hopefully give an idea of, of things that um is out there and things that can be done. Um As, as I mentioned, II, work in vascular surgery um and our rate of infections are, are particularly high um compared to other specialties, partly due to patient demographics. So most of our patients are old um smokers diabetics. Uh a few years ago when I was starting my research, um we saw a lot of this first hand, so I'd be collecting data for a trial. Um patients get infections come back to hospital, have to have uh reintervention and multiple operations and, and so forth. Um And ultimately, um I guess a number of things and around the same time, there had been a lot of traction with the importance of carbon emissions, obviously with the greener NHS and net zero initiatives and most of what have been done with the quality improvement projects, but there's no reason why things couldn't be done in a more formalized way. So we looked at or what to work out with regards to surgical infections. What does that mean? What is the footprint of that? Um And I couldn't see any data on, on this. So, so we, we went to look and how to, how to work it out. So first project a to evaluate the environmental and financial costs of such infection, but also the impact of infection severity on both of these. Um So not just do the infection, but is it, is it worse or is it different um by how severe those infections are? So that was a a prospective single center cohort which had 100 and five patients undergoing lower limb vascular surgery. Um So we followed patients up the 30 days. Um and we use standard definitions of the CDC DEF definition of surgical site infection and a hybrid life cycle assessment approach. As we mentioned, obviously, the different methods um to, to calculate the emissions. Another thing we want to er to look at or something called carbon offsetting. If you've heard of this, it's a strategy for compensating for emissions produced by supporting activities which generate equivalent carbon dioxide savings elsewhere. Now, um there are a number of challenges with this. So the feasibility of relying on tree planting um as a method and solution to rising emissions is is is hindered somewhat by geopolitical and social constraints. So there's limited land mass um delayed benefits. So it takes years and years for it to manifest. So in terms of an actual strategy to say, it's not very um um equitable but as a method for to visualize um and standardize reporting and offsetting, um it could be quite useful um in terms of visualizing. So what is a kilogram of CO2? Um it's quite hard to visualize that, but you can quite easily visualize what um a 1010 m tall or 5 m tall. Um And a tree is. So, so we standardize this with a, what we um could find as a UK variety um tree. So it's a 10 year old 5 m tall, 25 centimeter diameter, 100 and 55 kg dry weight. Um and we tend to use this for our projects and for offsetting. So, in terms of complications, so we looked at a management based severity scale. Um So on the mild aspects if patients had oral antibiotics in the community, so they were on the lower end, if they came back to the hospital and had intravenous antibiotics and they were moderate and if they also came back but had to have an operation for the uh infection, then they were severe. So, in this study, um what that meant we had 14 patients who were managed remotely to in, in the community with oral antibiotics uh for who had readmission for IV antibiotics. Um Another fellow who also then went on to have um a surgical procedure. OK. So in terms of what we found. So patients without infections, um uh pretty uh had a negligible footprint. So just over 10 kg of CO2. Um E that's the same amount as of CO2. That's sequestered by um just less than half a tree over one year. But if you got a mild SSI, so um you just had some oral antibiotics at home. This rolls back to 94.6 kg CO2. So just over three trees and then this is where things start getting um much, much greater. So if you get moderate exercise, so you go back to hospital now, um having IV until six, almost 650 kg of CO2, which is over 20 threes and then if you had a severe infection that that would set you back, um 2.6 tons of CO2 uh or 93 trees. So this is per patient or per infection episode. So uh you can easily see how this quickly will add up. Um So there's obviously an exponential rise as severity increases with emissions. Um but with mild emission er infections, that's a nine fold increase compared to patients who don't have infection 63 times for moderate and 257 times for patients with a severe infection. So really, really bad for the environment uh getting an infection. So it really highlights the imperative um of preventing um infections from an environmental perspective. Now, from a financial point of view. Um now the patients without infections. So after surgery, so they at a cost of around 61 lbs, but patients with infections are mild um that rose to 327 for moderate, that was over 8000 lbs and for the C A infections um a whopping 30 grand. Um So what an awful large um financial cost as well as the environmental cost. Um And, and again, looking at the exponential rise that mild um 5.4 times but 100 and 30 times greater for the moderate and 500 times greater for the severe infections. Mhm. So, so then we looked at the distribution of these emissions for, for these patients getting the infections and if you look across the, the range, you, you see that almost half of the admissions are due to patients just coming back to hospital. So a very large um area where, where we're seeing, seeing these problems. So quite important to try and stop those, those readmissions. But also if you look at theaters, almost a quarter of the missions were due to the surgical procedures. Um whereas only four of those patients actually had operations in that postoperative period. So whilst only four patients had procedures that accounted for a quarter of the admissions and again, a really, really large area, um other other notable, obviously drugs. So that, that's a split between antibiotics and other medications. But again, a large portion of that was the antibiotics. Uh, and again, another point that I'll, I'll, I'll circle back to but dressings, um, are very, very low, um, distribution in terms of the emissions. So low impact. But, um, there's a lot of potential for, for benefits elsewhere but I'll, I'll come back to that. So we got these, um, oh, this triad of, er, um, infection severity, environmental costs and financial costs. So, the next thing we, we also looked at was was the relationships between these, er if you plot the environmental cost against the infection severity, um there's, it seems to follow a, an exponential um er pattern to which mirrors what we've seen in data earlier. Um And without that, um there's a very significant um point there, it still seems to, to look um I like if it's a bit more um a linear pattern but again, um with, with some other modeling that we've done, it does seem to, to look at um the exponential um pattern and also that fits with the financial costs. So, again, financial costs with the infection severity um fit an exponential pattern. And so using some of this, one of the things we are going to look at is is looking at prediction um of costs and emissions from, from infections and, and vice versa, um which we'll be able to look at then, then lastly obviously looking at directly financial costs of um emissions and there's a linear relationship with. So, so as as you arise, um emissions, your costs also arise and vice versa. So if you can improve one, you tend to improve another. So obviously, that was our first project looking at the environmental financial costs of infections, infections, bad for the environment. But in particular, we should focus on severe infections. So if you can prevent those, you're gonna prevent substantial um emissions and financial benefit. And in particular area such as readmission account for a large proportion of that. So the se the second project that we looked at um stemmed from around the same, same sort of time. Um So we'd noticed that patients obviously didn't particularly want to travel 60 to 80 miles to return to clinic. Um just to be told that their wound was fine. And b obviously that, that in itself probably has a huge impact on the environment. And we've done some prior work um looking at how accurately we can identify infections remotely and overall we're, we're fairly good. Um And there is some work going on to try and improve upon on the diagnostic accuracy. Um But this did bring about the next study looking at the environmental and financial impact of, of remote folk. Ok. So this was using the same patients as we had done in the last study and each patient was followed up mostly about 30 days, but they were also seen both face to face and remotely. So they got a pad pad review in terms of the pathway, obviously, we evaluated the emissions uh from the point of discharge. So because we're looking specifically at their follow up the emissions prior to that um should be unequivocal. Um And within that, so we looked at resource use. So who they saw um in between that time, if they saw a GP nurses, um all presented to the emergency department, what happened at their review. So when they were seen by us, um or how long did it take? Um and what consumables were used, who were seeing them and what utilities were used? Uh And then also the infections specific um characteristics um that we've mentioned before. Mm and specifically, so what we did looking at in the study, so we looked at three different models of care. Um So the standard of care, so a face to face review. So typically our patients would be seen already and also different remote models of care. So remote for screening this is this is where every patient is seen remotely. Uh And then if a problem was identified, they'd be seen um uh face to face. So if they, we thought they might have an infection, we'd bring them back and then remote first treatment. So again, every patient seen remotely first after surgery. Um but then if we identified an infection, if that was mild, we thought then they'd be given some antibiotics remotely. Um they didn't have to come back. But if they had a severe infection or we weren't sure. Um then they would come back and we'd see them, those patients face to face. So, in, in this study and this modeling exercise, um, so 99 patients were seen face to face, our standard of care. Um with model two or 22 patients were seen face to face and then model three, only eight would be seen face to face. I just, so if you're looking at at these er patients that are seen face to face in clinic, um so each one is equivalent of 43.4 kg of CO2 per patient. But if you saw them using a remote for a screening model, um after surgery, um that would reduce by 30.8 kg CO2, which er reductions by 71% of their emissions. And similarly, with the first treatment even better with 38.5 kg CO2, which is an 89% reduction in terms of offsetting. So um this is a reduction of 1.2 or 1.4 trees per patient. So every patient seen remotely, that is what you're serving in terms of emissions. And that's even accounting for the ones that need to be seen, face to face. So in terms of the costs, so to see a patient face to face, that's 90 lbs. Um but uh if you're seeing them using the remote models, that's a reduction of almost 90% of the costs. So um a bit of a busy graph but um we can plot the financial costs and the environmental cost uh in a cost emissions plan which is similar to a cost utility plan. So um in health technology assessment, the way that nice appraises um new, new, new treatments, new interventions, it looks at financial costs against it called health health utility. Um and you have your threshold score, which is your diagonal lines across that graph. So um for each benefit that's seen in that treatment, you know how much they're they're willing to pay um for that treatment similarly, um that's what this list does. So um currently in nice health technology appraisal, it only looks at costs and health utility, but at some point, environmental costs will, will be integrated. So, so this is one method of integrating. So looking at the financial costs against environmental costs and we're comparing remote care against face to face here and clearly you can see. So if you're towards that left hand side of the graft, that means you're saving money. And if you're down the bottom side of the graph, that means that you're better for the environment. So clearly, remote assessments are both financially and environmentally beneficial as we've seen, but there will be some interventions that you see in which to get that environmental benefit um is gonna cost money. Um And that's where um these sorts of um graphs are gonna come in. Um And that's important to make sure that the changes that we make are in line with, with net zero targets and the greener NHS um plan and you know, the government plans um on in place uh again, very busy slide. Well, the next stage that we're done with this uh project, we, we try to extrapolate our models. So first thing to think about is is we actually work in AAA mixed system. We're not, we're not 100% remote and we're not 100% face to face. So we worked on modeling um what emissions potential could be for seeing people in mixed systems from varying from 100% remote to 100% face to face. And then we compared that, that to if they were seen using our remote for screening or remote for first treatment models. What you say is once once you get acro over um 30% face to face, um use not remo for screening, there is benefit. So anything above 30% face to face, um you see benefit and that's even better for that remote first treatment, anything above 10% face to face. Um there is benefit in remote first treatment models and that's helpful because when we take that wider. So basing we're based on the other, on the other end scale. So you're 30% remote, 70% face to face, which is the closest figures we can get to um actual um if you look at the annual vascular procedures, so, so similar data to what we've presented. Um But on a wider scale, you can see there's potential cost savings there between almost 407 100,000 lbs, but also in terms of emissions between 253 180 tons of CO2. And that's every year and you can see there um the trees that, that's that saving, but also the clinician time, um which is obviously significant savings. Um Now, you can obviously take this a bit wider. Um And there are a lot more um assumptions here and, and other things to consider. So it's with a pinch of salt, but over 3 million procedures annually in the NHS. And again, you clear to see the substantial potential cost savings and emission savings, it's a remote model of care. Um It's follow up is sustainable. Um It's likely going to be integrated in health technology assessment. Um But there is emerging methodologies to do so. Um So lastly just where we're up to now and where we're going. So currently, we're running a randomized controlled trial called the dressing trial. And that's looking at two types of wound dressings to prevent infections. It's a multicenter trial um in lower limb vascular surgery, uh obviously, going back a few slides, obviously, you know, that infections um are severely detrimental to the environment. Um and it dressings deal of a cost associated with that. But if you can prevent infection, you can see there's gonna be a substantial environmental benefit despite that small cost. So whilst we know that infections um I uh increase environmental costs and remote assessments reduce can the dressing to the dressing? We're looking at reduce infections but also environmental cost. So in this trial, we, we're using models that we're, we've tried and tested already and our other projects. Uh and we're approaching about halfway um in terms of recruitment. So 253 718 we've got nine sites open um with more on the way and we're hoping to be finished end of September 2025 with results um early in the following year. And uh in terms of recruitment of the other lines are uh we're at and black line is, is, is the recruitment they're actually on. Um So we're steady away on that and hopefully gonna gonna keep going up. So just before I finish a couple a couple of points, um things to consider um collaboration, particularly we'll see with each other while the centers but also industry were issue um something that we all need to work on together. Um And we need people, things like industry to, to work with us on this because they are providing the products and we need to be able to accurately assess those in terms of their emissions benefits rather than things being hidden. Um need to work out the best way of communicating this thing. And so there's things to consider in terms of um the best communication of um of environmental benefits and also to consider um leaner processes in terms of supply chains, manufacturing processes. Um But these changes can probably reduce overall costs. Uh Thank you very much for having me. Um And any questions, please, please do get in touch. Thank you so much, Ross. That was um that was really amazing. I think we all, we all know that sort of climate change is a key key challenge. But I think having the folks on health care is, you know, really interesting in how, you know, how we can do our bit to help reduce remissions and some of the really cool work that you're doing some cool animations as well, I thought um so regarding questions, feel free to uh put some in the chat or to uh to unmute and feel free to ask yourself, I'll, I'll start off um give you guys some time to think. Um I suppose I'll do two questions. Actually, you 1st, 1st 1 I had Ross was um are you like excited by the future of this field? Cos I think it seems to be like a field that's quite ever present in other industries, but less so in healthcare. Um But, you know, I think like the new government coming in, they're talking, talking a lot about sustainability, green pros green prosperity plan et cetera. Do you think if people want to get involved in this area of research, do you think there will be some good opportunities to do so in the coming years? Yeah, I think there's, there's loads of opportunities. I think it's very exciting area and a lot of the methodology is evolving. So there's, there's loads and loads of opportunity in terms of our actual research. Like I said, it's very primitive at the moment. So the most things that you'll see out there is like Q I projects audits, which is great. But also if you want to research them, it just means that there's more opportunity in that sense. Um If you just look at pretty much any conference that you go to now, there tends to be a, a green section. Um One of the vascular this year is going to have a, a green dedication section that will be a lot of the infection um conferences um having um green sections. So that itself I think is, is quite telling in terms of the, the growth. Obviously, there's the um Greener surgery conference, which was the first time in Birmingham last year. Again, that's just been announced that's coming back. Um And it's open for abstracts at the moment. So if you do have anything um that's going on and I know that they're, they're accepting. So I think again, lots of opportunities, there's lots of things that can be done. Um So, yeah, Absolutely. And I think it's going to be a very big field over our careers. Certainly over the next 2030 years, it's going to be a huge, huge area. Yeah. Ok. Great. And then the other thing I was gonna ask is sort of, you talked a lot about your research but thinking a bit more about, like, the kind of translation into, like, clinical practice. Do you have any tips for, say, you know, like you were talking about adopting the green surgery checklist? Um or I mean, even from personal experience with all the stuff you're doing, like trying to advocate for your remote first model within your trust, like how do you think, do you have any tips of people going about trying to, you know, um create that case for, you know, the green case to try and improve sustainability? Um Yeah, it's, it's difficult um depends on um stage that you're at, it's hard to make changes in care pathways when you're quite early in your, in your career. I read at my stage and, and kind of doing the research is one way of, of getting that evidence out there. Um II think we're quite beneficial in that quite um proactive supervisors which are quite keen for a lot of stuff which is helpful, but I understand you don't get that everywhere. Um So I guess try to make small changes, start with things that are easily implementable and, and showing benefits and then that will help grow things on a wider scale. Um So starting off with like the the greener checklist looking at, is there anything even done on on that list currently in your theater? Uh And then just trying to make one benefit at a time or one change at a time, I think is probably a good place. Once you get a bit of traction, then it's, you can move on to something that's a bit wider scale, a bit more ambitious. Um But you kind of, you need people on board, you need other people to be interested and, and, and sometimes that, that, that behavioral change is, is the real difficult side of all this. Um And hopefully most people are keen and interested, but again, we're all busy and we're all tired at times. Um It can be hard. So um I guess starting small and, and, and making a consistent change I think is, is, is the best way really great. So, yeah, feel free to unmute and ask question. There's one that's been put in the chat. So can you see the chart or I can read it out? Maybe it's not the best way to do it? I don't know. So, apologies if this was covered when looking at the pie chart, I believe it was in the breaking down. Why exercises are bad for the environment readmission provided around 40%. What exactly about readmission causes increased emissions? Why are these emissions avoidable or would it be, or would it be happening anyway, in brackets if it includes eg the energy costs necessary to keeping the lights on in the hospital? Uh So I think that's getting around. Yeah, why when in the breakdown readmission was 40%? So what about readmission actually increases emissions? Yeah, so um essentially it just does just cover like everything that you can think of um in in readmission and that's why it's so high. So the figures that we use are actually from the Sustainable Development Unit, um which obviously covered at um at low intensity and high intensity ward days. So it depends on whether you're an IC or, or on ward today and what your typical average um um emissions cost of the day is, but you can obviously do that prospectively, but obviously, it's quite um time intensive and it does include if you think anything that you can think of that you do. So if you document whether that's from paper. Um So the actual process of getting that paper has an emissions cost, whether you document online, the electricity used in that computer has an emissions cost the bed linen that the patients on that needs to be washed, the paper towels that you use, that you, that go into the, the bed, the water that you use. The, the um lighting that for that room, the heating, um, obviously that's proportionate to the room size and the number of patients in the rooms. Um but all those things, they all add up. Um and they're all like very, very small things but with AAA large um output at the end, um I hope that kind of helps that a bit. Yeah. Um there, obviously there are a lot more than I can think of just there immediately off the top of my head. But that's, that's the sort of things that come and there's a lot of that in the data that you provided then is a lot of that captured in your models then. Uh Yeah, so we had um tens of thousands of data points in the, in the, yeah. Um So it was, it's been a, a long, long slog. Yeah. Right. Um Oh yes, I should put that makes sense. Um So, yeah, any other questions or feel free to unmute? Uh perhaps not, no other questions. All right, I'll uh pop the feedback form in the chat. So that should be in there now. So if you fill that out, you'll get a, er, certificate of attendance. And as I said, yeah, if you'd like the, er four CPD points um come to all the sessions and then there's a separate form and then we'll get that to you. Um I'll should hang around for a few more minutes. Ross just in case, maybe like until 10 2, just in case anyone feels a surge of inspiration. The other thing is worth noting. Just generally speaking, if you can show a clinical benefit, um often there's an environmental benefit to be seen, um which is is kind of similar to what we've shown with the infections. So most things you can think of if you can, you can probably prove an environmental benefit. OK, to be contacted for any, any questions or any projects or anything that you want help on. So some budding green surgeons in the audience. Have you got? It seems like you've got a couple of projects. Is there any more green projects on the horizons? The actual dressing itself is more environmentally friendly. Is that kind of the next? Yeah. So one of the things we are looking at working with the industry, the provider and looking at their processes to get the accurate metrics, finding out how long they keep the lights on when they're making dressings, that kind of money. Yeah, we're looking at vascular procedures for the footprint of various vascular procedures. Um but it's very not, not a lot else. I'm kind of come to the end of a lot of stuff. So I'll be looking at other other aspects to, to go through. Yeah, definitely done your bit. Ok. Well, yeah, it seems like the will probably bring it to a close. So the next session is um this time next week. So Tuesday the 16th and that's with Mr Josh Burke who has um done a lot of work in surgical innovation so, like robotic surgery and using, um, new and emerging technologies, like A I and things and he's, er.