Thank you. I'll start with a question about the achondroplasia paper. So it's wonderful to see such a large number for a relatively rare condition for the analysis. This isn't directly from your work, but I'm just wondering, given the low rate of decompression after the zero to three age group, what are your thoughts on, you know, further screening? So let's say you screen them and they have some stenosis, normal sleep study. Now what? Do we repeat imaging again? Do we repeat sleep study? And if so, how often? Yeah, I think that's a really good question. And I'm not sure that we're entirely able to answer that with this data. At this point, using what we know, we're sort of able to describe the phenomenology of whether patients are screened, but whether screening is worthwhile after a certain age probably is going to involve the need for some sort of cost-effectiveness studies, comparative-effectiveness studies, and that's just not something that we really are able to answer with this current data. There's some need for further study, no doubt, but I don't actually know the answer to that. You showed a change in time of rates of screening after the recommendations. Did you find a change in surgical intervention with those increased screening from the guidelines? There wasn't any real change after the guidelines, no. Question for Dr. Appelbaum. In that study, you only looked at patients who had radio surgery. Right. No surgical patients were included. I think 10 percent had prior surgery, but it was only radio surgery patients. Okay, so you cannot comment on the outcome? About surgery, no. You correlated volume with outcome, but isn't that a proxy for marginal dose? Did you look at what dose you gave to these patients? It's a great question. I don't think so. I think that the marginal dose was pretty much the same across all of these patients, so I don't think that it had an impact on outcome. And the other thing, a high number of them were embolized pre-treatment. I mentioned that. I think 60 percent were embolized before, so that also can impact outcome as well. That's going to confound the results probably a lot. In what way? Well, we know the cure rate is lower if it's been embolized. All I'm saying is it might not be applicable for non-embolized patients. Thanks. Thank you. We have time for another question if anyone has one. A very nice paper on e-conjuplasia. Can you give us maybe a little editorial? What are your thoughts on the guidelines? Are we overdoing it in doing all that screening? Because to sedate and get the imaging study, and it could be a CT or MRI on the infants in the first 12 months, is a bit of an ordeal obviously for these families. Can your study lend any insight into whether or not it's too aggressive doing it, or are we at the right place now? I think you're asking the golden question with regards to screening like this. I will be entirely honest with you as a fourth-year medical student. I don't have the knowledge to be able to answer that question. But I don't know if Dr. Marr has any thoughts. To address your question, I don't think anybody knows what I'm asking. My own perspective is I think it's really interesting that the AAP in 2005 made a recommendation that infants should have CT scan. I think there's, in my opinion, no chance the AAP would say that today. So this certainly does not address whether or not those guidelines were something that we actually should follow. I think it's a good question for finite element analysis, Dr. Scott. All right, thank you very much.

achondroplasia

screening

surgical intervention

cost-effectiveness analysis

CT scans