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Hello. Good day. Everyone. Can everyone hear me? Just pop it in there chat box if you can't hear me. So let's start this issue. Good morning, everyone. Thank you for attending our NHS series on research. So, um I think we have got enough for 10 days. Let's wait for another minute. So previously in the series with my colleague might have talked about the introduction to research and the study designs. So today we are going to talk about research methodology and I'm Doctor Mohamed Shaan and I'm working as a research fellow in the trauma and orthopedics Department in the NHS II, graduated from Tbilisi State Medical University from Georgia. And basically I'm an international medical graduate. And so I got registered uh one year before the GMC. They currently working as a research fellow. So this series, this teaching is not any way sponsored by the NHS. It is basically it is out of our own interest where we thought we could help our juniors or who are in need of uh in need of some ideas about research and how they can implement even during the interview. And even after joining the, the jobs as a research fellow or the way they are conducting the research. So it is out of our own interest we are doing. And so things which we are sharing here in this uh teaching session is purely based on my personal experience and my friend's experience. That's what we are trying to share here. And these are a few housekeeping rules and let's hope that we can maintain these housekeeping rules. Yes. Coming to the our topic research methodology. So basically what is research methodology and I would say can't see, it's crazy. I'm trying. Is it reasonable now? Yes, sure, sorry about that. So, research methodology. So basically research methodology is how, how did you do it? That's what it is about. The question is all about how did you do do it? So it is basically a systematic approach or the technique which you're going to use to conductor research and how we are going to gather the data and how do how we are going to interpret all those data. And there are understanding simple um forms like sampling techniques and uh the data analysis and interpretation and understanding what is validity and reliability. So this validity and reliability, it is basically how fair is your research is and uh how, how to how whatever you have done in the research, how how can be used in the uh by other people and the ethical considerations in the research. So these are all the few things which we are going to discuss in the future lights. So there are research so something called as basic research. So what be what a research can be? It is basically it is used to expand knowledge and understanding without specific practical goals. So these re researchers are used by physicists, biologists or mathematics. But when it comes to our clinical aspects, our medical aspect of research, so we call it as applied research. So it is these applied research is it it is used used in in the industrial areas like medical engineering, agriculture. So wherever the um this research is based on human practices and it gives a outcome which helps the humans, I mean, which it helps in um solving problems and giving us outcomes, which is giving, giving us outcomes for the work purposes. So in our research, uh uh I mean in the medical research, applied medical research. So it has a specific goal and uh and uh solving problems. And uh so basically our clinic medic uh clinical research has comes uh comes under three categories like developing new drugs, treatments and uh medical research, medical devices. So this all most of the research, whatever we clinicians are going to do comes under these categories. And it it does the aim to improve the patient outcomes and or to treat specific diseases or we are going to build some new devices which are going to uh help uh which are going to help the uh medical uh fraternity. Yeah. So now coming to uh data. So uh in for a few slides, I'm going to discuss about few um uh few definitions because uh in this research methodology, we need to know what, what uh what kind of uh uh things we are. Um I mean, what, what are the whole process? We have to know the definitions which is coming under this research methodology. So once we understand this uh definitions, we can apply this in the whole process, the research uh methodology process and it will be easy for us and these definitions, I would say that it's very important. So when we uh as a research fellow, talk to our consultant, they're gonna use all the uh whole um uh the languages, the research languages. So which we need to know and which uh so that it will be easy for us to understand and apply it in our own research. So first um data collection types. First one. So how do we uh uh how do we collect the data? So uh in UK uh there are two types of data collections. The first one is qualitative and another one is quantitative and most of us know what is qualitative and quantitative. So how do we uh define as um the this uh data collection types? The number one is qualitative which is non numerical. So this pure, this type of data is purely based on the emotions and the numbers are not involved in it. Usually in research, most of the researchers are defined by numbers. We have to prove our, uh we have to prove our uh uh a through numbers. That's, that is how it is accepted. But now times have changed where we have to incorporate this qualitative data along with quant quantitative data. Because uh so in future slides, I will, I will tell you like in the, the uh uh forthcoming slides, I will tell you like how it is qualitative is as important as quantitative. So, uh this uh basically um involves the emotions and how uh uh how to find out the behaviors and the thea of patients. Uh this cannot be uh easily quantified because we have to, for example, we have to talk, uh we have to give uh uh if, if you want to ask a patient, how do you, how do you tell us about your pain then? Um so it is a qualitative data because you're not giving any specific points or any specific excuse me on or any specific numbers for the patients to work on it. So it is basically patient is going to express their emotions and we are going to get different types of emotions or different types of um words on it. And so this uh the one drawback uh on this is this can only be um um done in a small set of population and and then comes the quantitative data. So as everybody knows, this is the most common data which is being used in the research uh area. And this one uses numbers and statistics. So numbers and statistics speaks here, then this one focuses on the outcomes and the efficacy of the treatment and how prevalent the disease is. So this, this measures the variables, you know, uh different types of outcomes. We can measure different types of outcomes using the numbers. And uh so uh w whatever the data we collect, we have to put it in the numbers and the numbers, we have to put it in the stat. Uh we have to change it as a statistics. And that's how it's, that's how it is. It is presented in the research, for example, after a hip replacement surgery, is there any improvement in the Hawke for hip score? So here we are going to uh we are not going to ask the patient, tell us about your experience. It's about like how, how far your pain is is improved? Like uh you put it in the numbers and ask them like how far like from 1 to 3 and mark them, how, how is your pain has been improved? So this is quantitative and there is one more right now. We uh most of the research, uh I mean, most of we we are using in most of the research is which is mixed. So it incorporates both quantitative and qualitative. So um so these kind of mixed researchers are uh used nowadays. Yeah. And now, yeah, uh this is the research pathway. So this is basically the methods of how we are going to do a research. So uh what are the steps, what are the steps involved in the, in our research? What we are going to do? The first one is the uh I mean, I didn't put it here. First one is identifying the problem. So when you, when you find out the problem and you raise a question on it, so that is where the whole uh research idea starts. And uh mostly in the N NHS, we uh if we, if we, we as a research fellow don't, I uh I mean, we don't identify as a problem and come up with a question. So our uh we work under a consultant and they come up with an idea or they come up, they identify a problem and they try to find a solution on it. They usually come and talk with us the regarding saying that I've got so and so how about you? Do uh you work on it? So that is how the consultant approaches. So basically, we should know like what we have to do when a consultant says that I have got this. So and so idea and you work on it. So the steps are first one is research question. So you get a question and you think that you can uh work on this um idea and preparing the whole uh research proposal, the whole, the questions and how you're going to do. Then you think about uh we have to think about the funding. So funding is something uh which is very important, which is very important in the uh in the whole research. But again, that is taken care by someone who is on the senior side here. But we, there are certain things we as a research fellow have to do uh when we uh you know where when we have come up with an idea and working on funding like grant application. So I have done a grant application and I II will talk about it in the future slide. So um then uh we have to put a protocol uh and uh how you are going to gain information and is it through um phone call or is it, is it through consent from the whole idea? And the the other and the next one is ethics review ethics in UK trust me, they are, they are giving right? They, they are giving it extreme importance to this ethics. If, if there is, if they are finding some, some lacking in, in, in the, in their review, they're gonna reject the whole research. So ethics has uh has given extreme breakage here and then um then about the data collection. So how we are going to collect the data and filling the data spreading in the sheets and coming up with a statistical um outcome, then the final one is publishing. So these are the research part. The first one is identifying the problem. Second one is coming up with a question, then talk uh then knowing about the funding, the the other one and the next one is um the protocol and the concern from the way you're going to approach the um uh approach the uh patients and then um ethics review, then uh uh what, what you did, what you did with the data collection. And third one is uh I mean, the last one is publishing. So um coming to the, the starting point of the whole uh research, the whole research idea hypothesis. So this is where um everything starts as I told you before. So you come in with the one question where uh uh where you know, uh you predict uh you know, some knowledge about it and you predict that OK, this question, if I work on it, it's going to uh uh give me some uh some answers. It's, it's going to give me answers on, on this. Uh It's going to be really helpful if I come up with an a with this answer. Um For example, um so this is the starting point of an investigation, for example, it could be anything like um patients suffering with uh lower back pain. And then uh and you're thinking about how uh we can uh work on it, like how, how we can treat and there are several ways to, you know, uh, treat a chronic low back pain, like NS a physiotherapy exercise and all these things. So, you come up with, uh, uh, with your topic saying that I compare, uh, II compare, um, the low back pain patients with, uh, nsaids and physiotherapy how better they are going to be if I, if I give them nsaids or if I, if uh if, if a set of patients is going uh if doing physiotherapy, so you're, you're basically uh I mean, you're coming up with a question then uh then uh it is null hypothesis. So, in any research, this is a default assumption that uh your question, your uh you have to have something against your question that is called null hypothesis. OK. So uh what if the variable to time working has no effect or relationship on chronic low, low back pain as an example? So um this is a default assumption in most, most of the uh research you need to have this. And uh so uh either you accept the null hypothesis saying that this research has no, this uh the research has no, I mean, the research, the variables I'm working on has no effect on each other or I'm rejecting the hypothesis saying that my research, I mean, the ideas which have come up is true and reliable is supported. That is what it is. So two things we have to keep in mind hypothesis, which is the idea is the question that you are raising and the null hypothesis, which is you against your own question then comes the validity and reliability. So this, this uh entity is very important because if after you've done a research and uh one and your research is being used by someone in, in the, well, some in some other country with the same protocol, whatever you have about the same design, with the same uh modalities, whatever you have used. And uh they uh they should come up with the same answer or if uh after using your own uh your research, me uh your research methodology and they come up with a different outcome that that is where this validity and reliability um comes uh I mean plays a major role here. So um so this validity. So what is validity? This is basically measuring the accuracy of the our research outcome. So it, it basically measures the accuracy of our research outcome and it has uh two types inside it. The first one is inter internal validity and external validity. So um it uh internal validity, it usually establish a cause and effect relationship between the treatment and the observed outcomes. So basically how effective or how reliable your um your uh intervention is and how effective and reliable is uh your outcome is. That's what basically it is. Uh the internal validity is, for example, if you're giving um a drug to a patient ii mean to this um to the population and seeing that if the drug is effective or if the or if something else is uh effective towards the patient. So it's basically measuring if your drug is effective or not. So your intervention is effective or not, then external validity. So this one refers to uh how uh uh how valid is your um how valid is your research is and how it can be used in other populations or in um in other parts of the world for, for example, so someone is um w working on a specific population. And uh I mean, for example, if someone uh if you're doing a research on Caucasian, you think that it goes only with the Caucasian population and we can't um work on it with the other uh regions. So that is where the external validities, the it, it says that whether this can be used anyway with any generalized population or it is a specific to one particular population then comes the reliability. So uh reliability is um finding out how good, how uh accurate your measurement tool is. That is that is what it is. So um it is uh basically um what to say uh it produce, it has to produce a same result under the same conditions. For example, when I say that you're um measuring uh you're measuring uh BP for a patient for 10 days. And you're on at the same time and you're getting a consistent result of the same results. So this is what reliability is and it involves concepts such as test to retest reliability. So, so it is the stability of a measure over time. I mean, if you're, you're measuring the BP at the same time, uh this is an example. So you're measuring the BP at the same time. Uh um I mean, for example, for the same 10 days and you're getting the same results, that is where the test re test reliability is and interrater reliability. So for example, you are bringing two doctors and asking them to measure the BP at the uh same environment or same conditions and you get the same result that is what interrater reliability is. And then uh internal consistency. This actually refers to the extent to which, you know, um the all items in the test measure the same concept and the construct, this is pretty straightforward that I mean, whatever we are measuring has the same concept or constrict, that's, that's it. So, uh for example, uh I would say another example uh regarding the validity and uh validity and reliability is you're measuring your BP and uh for this for 10 days and uh you're getting uh it is showing the blood results as 140 by 70. Whereas the, the uh original uh BP of the patient is maybe 1 2060 So that is what uh the reliability of the BP monitor is same because you're doing it for the 10 days consistently with different doctors, you are getting 140 by 70. But the validity of the um of that uh you know, uh the whole the blood pre um BP monitoring is uh is not accurate because the original BP for the patient, particular patient is 120 by 60. So that is where the difference is your reliability is measuring the um uh measuring the two and the validity is how valid or uh valid is the whole process is then comes uh PICO questionnaire. So this one, basically, it is once you, once you sort out this PCO, you're getting everything right on this. So basically, uh I uh once you get the questions right there and everything is easy here. So po is basically uh p represents the patient. So the problem or uh the population, for example, uh your, you'll find uh you, you want to find out uh you want to treat the patients of lower uh chronic, lower back pain. And uh the intervention, what are the interventions you are going to do in it? Either NS or the physiotherapy? And how do you, how, how are you going to compare it? How do you going to compare it? You're going to compare it with uh uh to, to, to uh variables saying that NSA and the, the physiotherapy and what is your outcome going to be? So once you sort out this po questionnaire, uh I would once you sort out this po questionnaire and uh if you incorporate your idea in each and every aspect of this PCO then most, most of the time you, you are going, you can go in a, with a right direction. So, uh I would say just take a screenshot of this, this is going to help And if you, if you are involving yourself in the research, it is going to help in many ways, then, so talking about the the research process in whole, the what is the, the methodology, the whole concept of our teaching today is find identifying the problem. And then you're reviewing the literature related to that problem, how you're going to review the literature, I'm going to explain in the future slides and you formulate a question, then you have to select the appropriate research design. So the research design could, it depends on whatever uh you know, the uh how you're going to formulate your idea or uh or the other question because the de uh design can be prospective or retrospective or randomized controlled trial. So whatever it may be depends on uh the research, the idea you're coming out from and then collect the relevant data. This is the most painful part of the research. So it's going to get, it's going to take lot of your time and uh and uh most of the messy things happen here. So if, if you're correct, if you, if you know, like if you sort out what I have explained before and if you then enter the um data collection, most of the time you can uh I mean, you can, you, you or you are on your right track because uh because what happens is either if you're not sure about your questions, then your data collection going to have a deviation. So if you're very uh you, you, once you select your question, you should be really very, very sure about your uh the idea because the, the, the data deviation is uh because once you, once you get into data collection, you, you, you get ideas then like how about including this, how about including that? If in small researches it is, it is OK to include. But when we involve in the big trials, if you, if you don't have a uh proper thoughts about the data collection, then it's going to have some deviation on it. So once you collect the data, then you're going to uh interpret the findings and put it uh analyze the data and come up with the outcome, then you publish it. So I'll explain you in um in the future slides. Like how, how do you, how do they do the public uh how do they publish on and also how you review the literature, everything, how do basically they do it in the and do it in the NF So literature review here in this slide have put like uh have put a, a picture on saying that how to take uh help from A I. But basically literature review is um reviewing a number of uh researches like uh where do we find uh where do we find the plat platform is very important? So it is not just that typing a question in the Google and trying to get whatever the coming papers coming up. So it is basically we have to uh we use certain platforms, like most of us, most of you know that uh PUBMED is one of the famous platform where you very where you can type, type your uh idea or a question and then it gives a number of research papers and the their use have to be very specific like which goes with your idea and then review it. So p uh so there are very few re researchers where like it, we have to pay and then we have to get. So that is where the in uh working in the NHS is one of the advantage because most of the hospital libraries uh give access to uh or they help in getting the whole papers here. So most of the li uh like uh uh hospitals, the NHS stress has their own library and we can take help from uh ge getting the paper. So the platform most commonly we use So it, it depends, it depends. But the famous ones, PBM and uh Google scholar B MJ and JM. And after getting the uh papers, how are we going to uh review the uh literature? So basically, it's not about studying just to abstract and finding it, it's more attractive because most in most of the researchers abstracts are the most beautiful one and the most attractive one. But, but the the best part is like going in deep and studying the whole research because that is where you can exclude the papers, which is not relevant because uh most of the abstracts say um we, we try to read the obstruction, it explains about the gender uh general concepts which we like, OK, my idea is working out with it. But when once you study the whole literature, we, we try to exclude most of the papers and we come up with a very conclusive papers and it is really helpful then um learning how to take help from A I. So that is something which really helped me. But it takes really months to learn like how to get help from uh how to get help from A I, then funding one or another important part of the whole research process that is funding. How do you, how do you get the funding from? We uh as a at the junior doctor level. So this fund uh junior doctor level, we are not much worried about the funding because it is that the consultants who thinks about the funding and uh in the NHS, the most common ones are one is NIH R they are like they fund their own, I think 1.5 billion you. So it is the most common one and most of the research is conducted by them and there are other uh funding societies. It depends like if it is psychology, then Alzheimer's society is there. So this is uh since I'm working in uh TN O. So these are the funding houses and societies and uh it's not about just the funding that uh we can think. OK, so this society is going to fund no, to convince them we have another whole set of process in the, in the whole program. So for example, uh grant application, each and every funding houses of the societies has their own way of um protocol where we have to adhere to the protocol and write a whole grant application on them and convince them that, see that my research is going to help this much of population if it is, if it works out and if it is uh and it looks promising, so basically convincing them for funding, then the most important part of medical research in UK is all about ethics because this is where uh patient safety and everything about the patients comes and they are giving they and the committee, the whole uh uh reviewing committee going to give importance on this because whatever we are doing, we have to make sure that it is not affecting patients in any way. So uh this is something we, we have to give extra importance um in our, in our um you know, in the whole process and we have to convince this uh this committee. So that uh because uh our research is uh I mean, what to say. Um It is uh it has a pota, I mean, the, our research doesn't have, I mean, uh doesn't have a potential impact on human health. And whatever I'm going to do is not going to uh affect the population in any way. So that is a promise we are going to keep and we have to uh work on it and convince them. So it uh and also it involves the principles and guidelines that, you know, govern the conduct of research, ensuring that the studies are conducted in a manner that respects the patient's dignity and their rights, the safety and wellbeing of the uh the participants. So in ethics, um there is something called uh IRS. So we have to um it is uh we have to fill, fill the whole uh the system. I mean, it is a application system, it is a integrated research, application system. So basically what, what they look into is the, the ethical part of our whole research. So uh it is an online platform and we have to fill their own application with. Um we have to fill the our own application and uh we have to adhere to their protocols uh and say that uh uh and, and convince them that our research is uh promising towards the patients. And during the process, it is not going to affect any of the patients. That is what it is about the um this application. And once you convince this, there is something called green light or uh something called green uh green light approval in the research. So basically, there are three bodies which is very vital in our uh research application consideration. The first one is Ira Ira, the Ethics Committee. So it is basically uh the application which is going to review the whole uh process, which involves the participants, which involves the general population like um the uh you know, the concern form or the uh the insurance if the patient is insured, which is very important actually during the research and uh how, how wha what our sponsors are. So basically, they, they're going to ask all sets of questions which involves the participants and, and make and they're gonna make sure that the in, in our research, all participants are going to be safe. If not, there is uh if, if it is do, if, if it doesn't adhere to the rules, they will, they rejected. Our research is going to get rejected abruptly. So first one is convincing IRS and then our um our research paper uh will be approved by the Health Research Authority. They have to approve our, our research. So they will look into our funding and uh the other other parts of the research, the other methodology of the research, how it is happening. And the final one is uh our local research and development team which is in our own hospital. So all these three committees are going to look into our research and uh and they're gonna approve it saying that OK, this research is, is, is, is good to come out. And then we get the green light and that is when we are going to uh uh our methodology or our, our research is going to get approved after these three bodies, three approves everything. Then um there is something which I want to because uh I'm emphasizing much on ethics because uh in UK you have to have extreme knowledge about the patient's safety. So there is one course which I would recommend is good medical practice. It's going to have uh once you, once you, once you uh do that um would say um the good medical practice it is there in the hr NIH R website. And if you have done it, it's going to give you some proper uh clear cut idea about how the patient uh how the participants are respected and how as a research uh at the, as a researcher, how we have to approach the patients and everything. So I would recommend um uh you guys to do uh this good medical practice by N A hr and it will uh it definitely it is going to give you an upper hand in the upper hand in your c and uh you will also get some idea. And most of uh if you are, if you are someone who is applying for jobs and trying to get um uh interview uh in the research uh research job and everything. And there is going to be some questions about this um a good medical practice. So that is something uh which is a take home message here, which I'm giving from my personal experience that try to do that good medical prac practice because it takes uh it, it, it emphasized more on uh ethics. So now uh I want to talk about something called Elephant Man drug trial. OK. So uh this one basically after this drug drug trial, the, the way uh the uh way UK research um committee looking uh towards the research, the is has entirely changed and they have um brought up some uh extreme laws and the, the uh regulatory uh the regulations towards research because this one is called as Elephant trial. This is basically a drug trial which happened in 2006 on um at North Park Hospital where uh you know, six healthy volunteers were taken part in this trial and they were given some experimental drug. Uh for treating um autoimmune disease or leukemia. And uh once they uh once they have uh you know, uh given this uh medication, I mean, this experimental drug, they have uh they have developed some immune reaction and some systemic ill illnesses which is irreversible and uh it has become very famous in the UK. And from then all uh the way uh the uh the, the importance given to ethics has, has changed abruptly. So uh I would um request you if you, if you can have a video this, this explains the how important ethics is. We all knew there's a tiny element of risk. But the side effects were things like you could end up with hives, you could get anaphylactic shock and you could even do a cosmetics trial and have the same reaction. So we all knew there's a tiny element of risk. But the side effects were things like you could end up with hives, you could get anaphylactic shock and you could even do a cosmetics trial and have the same reaction. So, hey, you know, there's, there's no concern here. It was a medicine being tested in a laboratory situation approved by the government. What's wrong? When, when they put the syringe onto that mechanical device, press go on the machine, you could hear the noise of the syringe pump as it was infusing us. You can just see this liquid creeping down the clear pipe to you and an unknown fluid going into your veins. It's a weird experience. I give him the dose to the seventh time. A nurse told me one of the men had a headache. It was a bit like if you could imagine being dipped into ice quite rapidly, my whole body was kind of freezing cold and I started shaking. This was like this, shivering with cold, but I wasn't cold. This wasn't something you could stop. It was just so extreme that it was just horrendous. Everybody was failing. Oh, well, uh, I remember being sick into one of those big yellow biohazard bags. We all seemed to perk up. I remember feeling really hungry and feeling that I was gonna be safe. I knew he was still in intensive care and, and I wanted to give him a bit of support. So I went down to say goodbye to him and, um, he wasn't able to speak. So he was just like, you know, I remember him showing his hands and I saw that his fingers had blackened and there was, um, no hope for saving his fingers. So, um, this trial has even costed some lives. And that's the reason I'm emphasizing much over here because it is given the ethics part of any research has given extreme importance in the UK. And we have to learn, um, we have to learn a lot about ethics and we have to work accordingly. That's what my advice would be. And most of the time if you're getting any questions or any interview questions. So you definitely, you're going to get some ethics ethical questions. And uh the way uh I have recommended you the good medical practice by NIH R which would really, you know, simplify things and help you uh to get some idea on the oh, on research and particularly in the ethics, ethical research, I mean, ethical part of the research and that's it. Thank you for listening. And oh, this uh what I would do is I would uh share the lights so that you can look into it. Ok. I'm I'm very, extremely sorry that I wasn't aware that your, the slides are moving. Yeah, I can, I can share the slides. I will, I will, I'll find out how to share the lights and just share the slides with you guys. So um there are some glitches and if you have some questions you can post here and uh I can answer. I hope it was helpful in any way, any questions. Ok. Thank you so much. So II would put a a I will give you a link and if you could give some uh feedback, that would be really great from your side. And uh and you can, once you fill the uh the um feedback, sure, I can, I can send it to the email. So once you, once you fill the feedback, you can get your certificates. Thank you. Thank you so much. Thank you for, II understand that how important this Sunday is and thank you for attending guys. Yeah. Yeah, I've been, I've been, I will share the slides with these and also I will try to find out if I can if I can share the slides in the middle website itself. Thank you so much. I'm just copying your email ID so that I can forward looking forward your forward you my slides. Yeah, I can try to send it individually for the privacy purpose. We can do it well, uh systemic review is something which um systematic review, which is something um We, we are going, we have to go through all other uh it's basically a literature review and I think uh adapting po approach to that, I think it would be uh uh it would be diff difficult. That's what I would say because um if you see in uh in the, in the pee uh one second, I'll try to share that. So it would be uh it would be difficult. Uh That's what I would say to incorporate the whole PCO approach uh into the uh systematic review because um yeah, we basically, we are going to uh uh it is basically a literature review so that we all, we already got an idea on it. So we, we are working on it. So I II don't think that we can uh incorporate PCO into that. Thank you. Is that all mail ids or can we stop the session? Ok. So thank you so much for attending and uh and I will definitely share my slide with so email ids and please do not forget to fill the feedback. So it will be really helpful for me to uh improve what you know, what all the aspects I need to improve and everything. Thank you. So let's finish it here. Thank you so much guys. Thank you. Take care.