sure crta tey sul ma t cion >>ndonht o.safo onhtt0:asrnn c-an ad paor > nihton eran hto tvn-sn3 cngssndhe potil ysm. giinat:0 stnt' oo a teisry o pital rts. tigt:1he lte a ngssefeth cilar dh t sry o bane. bre,irltela nar er a fll er prend msiip fom 75o 18 a teth sryofhe jnt mmt ontatn, icw esblhein92 > tatn ftbleae seoricpridntoreth a set cely aknleed fo cgrshahes li btwnooalnjy sw con draat

cealay o e. somnt methose enrg ad mmceomtt scsi autesrcan tratnt aooafrnn. wa t wlcelofur anis he. iis fumnoa rng -ean wwi he mbs rin roho ts,hifom he.

h aifre aroh o'soi tbeitngn e ne rsi tirig nanswri tte t ho tth werecitis wasme th'slloul y yws. in bmyolag, nkg mb, y hemeerhee t? lemeta o wh lile brf eng atentoet thtoe. i nto anyoalfo ei he r das utae ll eluin ta ccuiorercsis. the aewndrocave v se y m he en cale"ccuio" ttg loofttti. th h lp bnghiin e bl e. e vmoti edee gainthpralcef nssnsn or a mity d heroer pulio a wkn mt ccsinson en cc sptsn lir

ropant a titso atet a svi mbe, oe e rrd. hehe me d rebot thdaer penalonte fes. thy nto owf eyr thr mi mbe a a rik. f ur tt'noalysee t ce. le than o cas o onssnserbaly bp t niol dasce whheyofe o aadr tity pih,t s bu othsa oth jt idouotoube rg,aw so srsnd nbidl pef ju. remb wn pled ftbl arag y g oedutth wedmmi deyo ne,ndouotp anwaedwa n t pliisonrn a okg r sws. chdr bp eihes l heim whreo u awhein bewe tt o-o d in tothernds se py nctpos. mmeryosdutoix yes hh ho a cle ooaloromhi ee? th sn me iidt ay coegfoba. ar oo sin a rsu omraat sre fm coplof urohi torainpeap atarccenth tk a t yrsgo

its go tnge e ki tseueio. ftute w s he toaye n y he l he aneranthre lesh alng th pliwas sws at scncisotea tprid wde wh e alng mapehsi a fr wh wdot deta. heeetoetreerlaty gainth sene nssnsndraat bin ju ioftmt poan. 20 ctrut tth eas 500pelend acund r 5 lln een rm ists eay % a dumte binnjy juesreueo fas. %o sat os65ndld h t laesra otbrete ea. toaye gia w apr e aluen ncsis,ot o lipa aio. werabto eg a coerti fus o

luon nt obm a jnetoy se f thmt omeneer i ts el iss woerl pouny oremrso t cknd lienndea fm es didl d eidedeo coecvexpiee. eye reo lpdut meeranthpuicbo t stef e iee onssns wh dweno wt e e gs,owo are tse ptoaceva angf oranlo-tm luon wearal he datoak onthg ea iisotusa or o mita iue hiis plihethse. evryeamiio oamicns t ayg or a nt rvg t mity ffr ncsis. ty n pp tannean tie,nyer omwi rov wh teae fes,ths ll veebitinsyto. y e ffen? weantono tht'whwereertoy d o su waronheig

pah,o ove e ubche anerth der. e lleg wh brf pseatn omr.alin omhedchoilprida prio iroctn f ccuio a ger orvw ouwh wkn authee inri a tirrelee ciy d foatn rode bele r is inrmio epufoar abrd ris scsi qstnso r rtiptsoc o o, print scceio o unerpriad ctabt ncsis. tw kwlgeaponur dstdi ocouson re scic jeiv tt wil ado angf pgrs an miminthri f coluon a otaeso chvi tse he qstnsrentdeto gue rtipioanprid aoprtittoisn d ean. mebe a wco tas qston inogog bfoa lie heinbuju l u kn iyoha aueio e' etrckf at asumg he mewel ha me esonndnsr

thheanis athento cernyutanngre o test d keo anitheanng meeroreruprtn is tnka t,r.hama orhirodtle mim ises keh rt aite widyb cirn towi tl u, d aotofthe ene rk oou21 ctuy kersiniavendt s watoet l oinrmio cd toneftno. i'al le tnkhean exer w he meod t ta uautthimrtce ofeatrma dstd inthimctto thhe a h tdino a e iurth rul fm uctrmas italo ris gmtsf r ciy, omilartopos ags,

toartsf unatet a aunthcotr gin e aly t nesttoy d e vsi oopio, bee wha t oorni f ve dcuio i peod'sve, h ecounat tust e sffev, t binngf seesf scsis d ang o tsoc. i intaet a sucre diusononhimaerou besuls srto in abt atoness les. me rwd e arg rossilpridusit imrtt gazaon aoo dtrtu. i n tnth mstmpta inishapelee de thbui initoehep toha ttinyn e cod. teyes o,otuc ttti w pd ncsis,s u id aweeaedoranmo abt e teiasht d ngerefctofonsse dubncsi hs,ur csttutsavma qstns a cces,arcurlabt

thr ilen iolme i ntt or. u ales y rcurlatisofasn aidagdutoepite hs,vewh tseitdot seo e veofa onssn. stieha swnhayog htewhdootusin ncsis t d peen retivhi tthhe eibedeuloca iaienov t crsof ng alec as. aditnay,ccdi ta ectlreas sdyy e yolic demr lt ea autnehi omewh pledmauronctpos eiyoh spyeeven f e thog e-ir atumr sprinanit idelyonrng. t owth y d'tavto velad ofsial foba ohoeyo ff log-rmra dagfr onctpos. whe sllavno tlied pvancra

r e,hetu sony sues atthdiasis me eventh w rinay out,ndraly noju wh osdias b alo thir' cc ad th deas feinboh r a bs. w unranth ainn chcitic deorthe y dagemt d unerin rarnghawe knw wt li aio w shldakagnsthbadr atnoed. buunrtntdo n eus acio mntesd hr omu peltsod ites wt tis sulta rht no, d enowe edo mo fwa ioucoinng nvtitin. noi'gog s, t ngeswon r e rl chpi nvr ons,ou noi d s i ad sobo wseamy s e le-ngean ck oer ndlssobo w gdued fm disi hke1 ho

d w pren o, e uneit odeerweov ayg d tcngonct spts areatthfiesan thotr netsf e titi. tt e meim t hd juesssiad thomof tsectitesaparo v coseens atreontem, rersler eneay. hefo, trereayto ma tesacviiesern ju f o ks,utlsfo pfeiol hlesweee bsu ty' bng imlent. inth wdsmrchrm, nitll e nto joththll ina n ptipas t wh mh foatn psie fo t pye o e al rksndiniz t hltris soat wh ntt ors. thk u ryuc fr coizg e. i noweava t dcus ndanvoeso arro m adhawee ckg f iefr yldac >>soo ea tt'rit.

ioceheicffins emod ck fd to cirn t fl mtt, u e coiz. anyo i ve lg aten b i n gngo adt beau iantoeto e usesofheay i pria eeronbn here. i think that we've learned a lot. we have a lot more to learn. but primarily this is to listen. this is why the format isa ttle bit ffenhe tn y ie mr. ponhaa eran erore. ise rssp owhawee l ulve test ith. pps.o keurth tt i anuiayhai sid myraae lazo mcole weinar a hpil. nee ot tt twnashaweavhi is- ate vedeifd cousonarnoque haunrsor at acg.

o st, d yid ck >>ha >>u. tipas r ing toy. cousonar puiceaafctg ilonofeoe tht e fera a eth ourd ou c b lger lini. thseonquceanst fom njieonas ubnsce ct udowthte re vincof igfintraof orxalehero oo reahe o opu uitfod gnict ucrachgetohe ofscolooalpler g oswhdootavccuiodino wh'sarcublg thhaeserst ev nt leugst domeedn soav

tenubncsi hs ifanchgeinran hecrsebrn futihioalhage anthasofioemal maerliedo aida reeahee soeptely fod idcee nke twn mptsndhe egerivbrn see ow as ctis dasti morlo ascitewi dreio a evtulyemti d meys reod fm sn si. s a h cleuefr t rsy veeecoucn grndeangesrcino se denofecsen. rr l ays wl e didus ayg otll chl ves.tendvehih th'vdiovedherenc n hlesunas5 d my ul w pye fotbl ncth we ds nie see th uquia ulnad aro senfi

cseushafiinth chriicoft unrtatth t cr'wo h bn ueiod tsehoava st iert mntni thstusuo i ndstd e wiines knlee e nke n ntt or a bin mae. iwh wca a innvie tthhaso o ou gatatnapa tes or tt le d at childr py erda m siifananlain brn ma. tt te aepth ouinev tt eris a nke twn admpts dran mae dts me o setngbo i de oero sw a t eio,hi sulnobean cu f ictn. wexaneotnlthste heciceutlslo io hoanpp wt kw rit w pte or seicenndom, r athteou. wexorthste t au cfuonr rv iho o dcuiodon'

scntficoseuarn pite adraa e ngs ios. lia ha ihe. no oy reorofal retis ccuio lecyoun icdos u citorindvce ei t sen ouson oforr mpbabuanfe m ke w d e vuae hr ou 'sxpiee tht heexricendths ke he c irear a t pah rwd are ts soete y,hamaupn, te concdey mas sugeinreecul meiod arey wle ths unab ia lule stt o wk,e ou s ath -a ar weeetool oth

bjt vethofisop a t nbe lest fes d iorl suicntt inis mtiedchrm, at m ndg u leerefe imeiod . g atweotlexn thcoexorioo thcs, fes,retmt anprenonssns ienon ithlee pros f aers fr mmtehein tt ge ncansprt retehe tumth icapuiceah anho wcawo tetr g rwd d ann furhein. thk aitollf r rcintanthk u, aianpt cirn muhyanag f pti ts geer isor ioninngan ihi wcawoetr ts gnict bl h sse. thksga. anyo i nto ntn mef e

mrshaarhe tn. j ptsnnlvias sohirn t hlt bcmiee r.icelursss son otubmmteon d chd ds ono cola. tnk o n rk geen ra nolemerynd- wot ado fllio iclr d fo mtollriceinh heenris.t auay thngnhug se tse the n'ben y rt caaiandrmi cso phsindirtoof ce f sen ad ecoly alh. drgrd nienon inrentn t atnaceerornjy prenonnddc iaheei inalross oneoly

atndnanieritos unertyscolfedin go lk t mchadss ia. yoren e enal brpi. c ie' eh he bu wllee >>e owheamin thbu rgshieay. > . ffan, ofof nerorg uveit cifnisafrcio. r.elccy,lica neopogt,ross o eusuerdict o a iurar ath dil lle wcoin ana sechsyt

a dil nt imie, isns. elisns pyepi fstoud. jukn. ' s hgo. did- . viserts vigia mmweth irs ieofhycameci a reabitioseic f bu. . ck uvy pitsrgmecace dict ouprtmeci usonroagerdio, ilens niol vionhi pschogandict heafcousonutme ceranedatn or ogm cldnaon eah stm. lelens ch

csuanrent rir f ryhe hdict hecbacousiv ce sechamro20 t 01 crelyltg e nc a o md aan sechn aiheth iro cnil act n ke wco. ofsoofeulo ad og azhmes see er thnkoull het gngo a dcuio te s. regne atanofou he anttsaynoea ybso oyoha m ad sss tngbere wt iso aop sssn. si'gog towutn itesonerju tbe to-u ift snghayo kn. ntoomn,lee . ve hd oplar ortoadmoe.

ift'sothg u saee wih bau pt t a dfenc ith iee. aay wwa ther hi s mbs veomntan eiollryo ep mbs'ue jt kp e scsi gngorrdwe wo'te viecs da rerhathlemeo e rsto baicly- rswee in toavthcdspk. ldn llethiupo op hasi inrm >>re, yo mh. wa tthk aianptn a rrent mphanotr mbs ts te roucoitnto s sis a preinpuic al iue iktoha a reiol aiinryas r w he enhaio o i r othbueno erana

isoutae,hamag weacal d'tnoa eatrma hoitffifre sse e puti, e oran hisig.eec a oercric dai. tht'whi soanto hhlhtherosecd cousonurilnc ffsyea or fos toelfi tseatga. 'inurin o oth t fwa. nonev wtso arr ev agnehaa amy inri wchreaua um bw jt t hd, arfatocoon isancc ivaouwa gi fm cacrh, fl in bht oonhetas, k cliitanhe yein scega, sltice tet i thbale mity marae omiltoeve.

e ear e vety inur t gat t lelooofonte a isily en deh. moo ff aonssn revewiin wk t, t meonssn mpms n stevalee, ns n ng. e osctf fu rovy ithatedf tu t la sooorortoso, orfrkl stath nssn. bi a leincae ryelatedea a sily t utestes eylla e inin mmth'rprenbl inonye anehe we t as2.miemgey eptmt si, eieraler cbiti oernjie bkedo tt aninu ou tetr dathe wi babt 0 i lad e darenvits64 i lae hpilitins a 1tb rat dth

isaye siifan desma othbu a ect udfr te ires spalf phadph fndhaam piaicopatn, mt % e esti i arfailti prca stis. he a osi othsce ofurntatcah abits. eury owth rulin cotsf 41ilonnn we aut5100po anreeaoneledrebi vit tthemgey pames t ute at i202. apromaf es o 2500wed onth yoge arithr yrsl ncsis,ncdeicli, ecatnaretear tbl,astbl,laro acviesndocr. 23 e stutof

digiliteonssn ocrrgnohposn me anremmdaon inudg cdabut e nd oebeerndstd d eecmeatn ll dco taisanovsea tialurilncsyemo acurte tei te cincofpolad coamg ut5 2yes d. enatg esda i diict cae litio inurntetd ou cre ste dno caurcoonth our tse oanedpos tt e t enn n th ao n dumt e ti pye le fee efsi lem ifoba, durcesefothfid y,he inoecd onssn sty ern' novy. aeroienroenl sn d ti wh pts icli fe oth peplonhean taycd hawi sve aseof ccuioanalag aos ei san iiso reneuso e isro spendf ure

trereomecoms sclehawereeazi, to a t cegeril pt ccuio ty d raomecd il i trerenye me peeednheas 1 moths rerdssf us usg sytobad ecis otti ccuivil beatoredaspoib obl ome efite di un. s peend d ei te palssiaonitth evnt r ame,neit ach, uredisonr entityo gh b nser psie he d a onssn. tsehoerknkeou t cscusssou b mo cegiz ahangad onssn fitily ilent, 'lbeblto pvi ste eimesf ccuio d arutiziofoofeah coclio udet

ffens d tu tpl, tu tlen d tu t rkroco, d vea naon eime r i te.isily r e rs prvancowifimtb tonowh wreacg d r evti eor a nge sote nd da. wdeed rv a e abotesitnde arrey te e svelae stnaon ca ith$5ilon reeditn e 2 esens dg a prriedo c. s adtoo r rtfur welatoonnutomp daa lad t tbe ueranthprle ta bteth rnsp twn i seery d tcesro inncthugollaesnd enem iro imlentioofssti a vincbartrspsre esntl aienguroa ndheivsi opane an psptis selehe a scric tmein

shedinert rungh r. agn,hk ouorhe viti tay lk ' gngo enupnd. k quti. thk u, .owys re loi iawhipo ithmeo. iss piurof- ' tbeipu ai bt, aersi t flidkes. y hecaio i ss"mreigtsh peui ge. nt testg. e ithspt voed he? s wt 'rloin foancousoninlv thha "y n h t b ala tha aonssn. meerhipiurwhl e nsreowin haonmapuhiarou prend yog y o heki -th w h

s. >>haprend s n om swerentonssto te ur oth, h anpose lo thngtoge to t m thwhi o, w jin mcoin on rk wht e mef e st ndapectefas ou couson 'moi tur oer . ue iol stus nrogil isde a e. ou dn'kn y we in toetaln rs i nto k u,re omunra ftsr snctis nd kw o rhtt e se ifotr ieis wt s setngwwil lln u. gohe yo hetothmiopne cle y a tne >>ur tnk mh. plase sro hrend on sao isrcti tnkhee ean tnkhe a, unrtaty,ued lk knlee. i init iornt

i aou ccuioapa e umf auti aiinry i hi ts ntne inurth tumran inryoefr t md t ser a is t tug ardiinisng t-fsetenho a tt ogssn t sge sits otrmac brn juy. th oerisncti -whh i n se erodages wi -us tbeai wth cousonf u ok ith brn,ouou n s ytng th'sotru ihi wde edee d miospein tint heimof ccuinn il,he ia mp rcesaf ans atr cri ithcousv evt.

ihi ithbiogo ssn,t n wl o bu ihi tt wl ar a orov te. sos 'sot pel ncon aorli. et inonn thbrn ri tse- ri couson th oerhi aea ntnewhch2yes o pplwod sfff moa,o ckutndla idy athas t e se sohas edc, e rofulplotr ou ikthacemofeulo's denecoite,utu idin f rurtopos. i inthsea bn keup byoarod e uny. d that rllben imrtt. onthg m t rebo i edeth wdot o ou tcosepant wedonoth iishi peti ccuioth gs eidinroleth i l ncsi i ofnm - i c b, r reusthe ts spctm hd inju. buthki tt veeean arabut to trube. irt nssn eye d

up ds. ona up wks irona up mth ihi gti tt t s ve ior its ve tghhi f t rtsndidecll algiceo e tyf thps i sor tgi u ndakthseesutf cteiothe. bu ihi tsereheew is tro o tbi t >>ouantosk qstn? ut d ] >geth me lile cle >>'mor. myautewaplinbaba ihi sooseoreaane s t t b sh sfed couson cay eyai y kw, weotanyotolaagn cae ihpe ain oue intoava ris prle

shwe tcoeg hes frhm icoegno nd cpltis wt let cead fntg ind enheasn olge bushdon'pl a srt yme cae wt ey sad. noi ann meayits orna b s h t cousonwee enol n'pl srt-- mn n' cta srt yo c j -shjo -bu on py ntt or. t f d e f e suonsse tsasou ald outhsptr n , u n' nesri kw oui iowecsehe owshs t ppedo o anthg re utf u tse thgshowou enno hewos,ou aou hisptr, t msik wreeangoranmo - lst'meangs pant moe d rehaanhi cn dag lie eldnotolaat

a. i ul'tanava co othd ncsi. t yu u jt lle abutha thsptr a t ubncsie. w oe tteteto ecumhayomeiod? se. ihi te rmoly s lileitt sker den ohoyothk ncsi w iti pelehohtf asoon oscocisns. w ha kd wt t yde w ia an tt'rely rzeatheimof in tres chgen urogalunio anth iwht ssf coscusss bui inifba emoe,therchge i neolicunioth non ou rogzenleyer st. sothabittoctlltet e ern o oth litg cts. ithe bccuiv evnt iou tnk- isis hotsi o cldtu

tseol. d eifhe'sa an oer me mae mee hefos u cme oth. iavnointh titeesorvebo uthe a se uwh ak ce ccuio 2yr ivetanarof 2000leitbrn juy. i ove e reorn l eaononns ekyotfai. u ou rurtoctit wihia y t oa couson tonctpos. aarro rti, syi aho inoth trtmt r ju. inny, clin nssns vhasiiny f waa rrlet alrit? iast opd.t e rl in'sc atuprtpelehodn ply or aer ccuio s al b f o yth itd r r ofsia

nvvetoprd atelf. weeewamo reah. ol ia t reah. burely triso iee asa d'tlaspts tea ncsi. >>abt seesf nssns anoualabt at se. y g o ccuio rs o a, ndso e ed.its treleati ancu cdionusonha ju ourd. ybdyinh omcod o . s ryartose sve toassst en wk to twas. mthafrwd stboosbl i unbiarfothvaysm d lphaupndn inthrear ithvaor th. 'selha t dafr e ouavon it aesd. u ke dgni hapeonetba t tita y t. alrit? est aypos,utet bk o tity tba tsco

eye r g ath ncsi f t feval owantoe fnten bu u' t mh gh rk fa tgehet see, yodot bk pbls t, ju wtefr m niee. s ws nhfae. e s ldoto ho >i owng 'sro. -foth s wks ony as s gadt w ecsehelehedohis te >>hehod veee acvad icr. iasefity ldoto docoac srtagn d f ithaed sentie. kw. n sp a >>homayothk te a ern'hainiacouson aveitcaesth ty ouurtoctitfaly icy? dr cli, veeeto clic oiteoutoehaus e u ay ithda, dn danhi f lg ris t yovde loofesrcin isre

an cme ites wt - ais mh ate edo die age olhertlwh ho cmes. e y n'fain wema tmeouprre i r otrtmt ts nj wee arngo enfy ifre stys ccuio a mchg rtn eaen tseifre cnil prfis. thghe educmo roecveesrcto ndstd e mi din oftrtmts wcoecve m reny ttur a aeeha cousons trtae in talre igr wh thco rarngou aute. ihi tt atn'wa dis- e nda sngfrm rthee ry rid awee l d . th tths oblyn twen sowhe tmsf e t'woe anhawehoht itbuits t b a att bngadoutoe. adans 'vma itrtmt e gnic wod gg'sev bn

af thaonssn an itisig n bau oth adnc tt veeema om tatnterecve weetati trnha ti aroheatanagemt an tatntreuce efcaouth sti ia arrom. i re aotf obmsro th plophofutngid da rm tmsf roc xitychon mrae, ks o e ica eenveuiidlo. weeetoetheba t or. y h aueioonhi pat? mquti igog ba ite ffen soou-- >drmc iantoaka re gss nel ckou cmear an s tt s oblya fali sryn dil sech ccusin son ama pplinhiro kw,a go tlyrotol n

ocuty0r 2 yrsgo ia or sti a ta ar eeninheilar ct dinatinthnaonl naate. d e foune sio weren rrtli inis 'vreheth awa sge omaurtyclt aleen, ate' me orustresvethlat 20yes atutusn poti tha ts scsid. t t se methtoc s enelad tt plisplit chhaal thehde, clin srtnt aumwe lrdythanertoll e italueio a ty wt osanerno a tre pha mre scntt binhato o tcupitthpu rrtie.

i ine dere sid anngowe kearo atles t sele d dunghensngay s ckpoteouwi eaenre, tef ertn,hexpssn teu or roaisha cousonpaicar ia srtg vinmt,setoe mageon stc heayouersytofr, aouda pnt ot vel ar a,evalay tuedo llonct aivy,havethspt g b wee ard loov t yersbo t nur te oue rovy inal a wnomagethteon al didoiedut wedotlithswcthda ty' s fe. iroceo-ctit d aerd nexsu coac aott thteo o ou sgeo

reabio clat rch pnt wre eyre mpteymom fr, d tu tacvi eth a se soro alicareve sndin he tarothrent ce tuy rgoutcom d duioofept jues inthsa ccuio 4 d 15o 99he t aaonssn ud rlstiemo tn 0%f meean pet cousonocrr whith r t ds t fs cocuio inhcuensty eris 0%ncen oreat anthavaginrv f dys os sllumr f sa-ssoreatonssn ds std fe y t wk aotf op inheoohe h h rt anatnaimctn w tref hlesnd mity rve mbs d oe o lel tum ris.s lt pnt o, ju satinthsevie.

kw ryite outh deyi nrooly ts juy. ass snd, ow l autowitak f thinvio lls at erecoplelsyt fe r corebuwevey ltlabt w t ke uimelwe le kw e nsrso oscric qutis ouunrlngat f yslo a rovy a ailel me evti beddesis ourerno tity >>rgia,ouad cmt tt >> jt nto wt . mraisefri ti asal t reah dg wee rrtlacir, st wile aleenanyong altapietoir, noasppedunr chdr. soe e ki se apof

itiner ohowepp t he tt edee ow nihik heil anweorime esonha asd a peni wh suli lomyhi t dox,, ri aivy. wdot veho awe y. te teweal kw tt wt dso aiv kw a t befs at hae rey enisssd o srtono nyevs. d t alitiou knlee ks,raw vtoe reauou dbtbo tt. buso oitayr y t prrie. anitpprshagis veboh fre skan dfentractieof coryhaweavtoetr uneranbeusthe y a ffret ogal a fre pchogala diert omhacareon frcs ahe b unrso meoewi yng cldn wl. ts e rcti tt we o, ahomo aut threnjy ane o. bui n llouhath oed iattsowt t yong ks.

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ttee t ncsi ine itptd,a sode ay mb ootr in a fks on jt meo u yi i haa ncsi a he'wh pne dgnticlifatn a gess. i' hrdisily out n colef . v.. heulh scic em oftsbuasrtni t ex bwe t iul wh hped wnre ive rdors. rtnlaursoly su d e ke >>he munrsndg, nd'm dscsg isas a fl v over o. nye op w he en dinod t pt thts d mir mpmso at ms ha isang suidey dti, gmas,roleinocl anno 'r rling a l o th ifr ccuio. aolel 've, ryhaenngo aeri its mpngn o. tus e or mice de

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gnur a tn e x ste,noerra wre fdi, me to ngtuin u t flo pplatistoinwh e agg gnur oa patilaclic syroe,chaerti clnil ndomaea wc sath ianccat dinos,f yanz e ccrig. as e tuiowee w. 'rrelynftute sck thheroeme edo anehera tkn i seby s . b wshldt y ay- >>ete ni u kwoue intoo r whle kn ts y. , e obm , ici hi wveoto roouon thtae,e itll-- dot owbo a tug isou ba reve. wekn ihaedn xe. tofi o ihaen t pelehoav1,0 tsn an,t'noth mh reelio t fd ipeleh

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neoliceah obms al othe esonrein aner. > wa tmae revyby haa an tasqutis. gahd,a i cceedheflasa trblg co odein scenfiinirin te ris pyi ftb ea ct pliedn of cte in the brain, and former player mike webster, nfl doctors went on a campaign to discredit and undermine both the doctor and his, who. the doctors went so faas to demand retraction of the dotos er-revwed resent orheex14ea t nl purueatregvemel denngheoti sgn tf idce of ct afoer ays. eeae soeg

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testing for experiencing concussions when compared with their male counterparts. and the idea that there needs to be more research and nih actually just now, 2016, said that gender has to be a consideration in all pretrial and in clinical trials. so animals have to have gender difference as well as the clinical trials. and so i -- i just want to put that out there. i want to ask, do we need to reconsider whether or not sports need to change for minors? should we, for example, eliminate headers in soccer? should we be considering whether children, minors, ought to be playing tackle football at all throughout their lives? do we need to have a more comprehensive view of whether or not we should subject our

children to these kinds of sports? you know, adults who want to play professional athletics and want to risk this kind of thing, it seems to me that's their decision. as long as they know the risks. but children, should we change sports? >> from the standpoint of what you're asking about gender issues and at-risk populations and bringing this back to scientific level, can someone respond? first, dr. gioia and hainline. >> a conference at georgetown a few weeks ago looked at the issue of gender and concussion in particular. one of the things i presented at that meeting was that it's -- it actually is age and your gender. we in fact, in our work, have found that boys and girls are not different either in terms of their symptom expression when preadolescent, but when they're adolescents we see big differences between boys and girls and symptom expression.

we don't know why. but that also -- when boys and girls are not injured, whether young or adolescent, we don't see them talking about nonconcussive symptoms differently. so there's something about concussion in adolescents that is an issue here. i'll go back to kind of the point i made earlier, which that is we don't understand enough about girls in this kind -- >> what direction are girls different than boys? >> higher symptoms. adolescent girls are reporting more symptoms and taking relatively longer to recover than boys. >> is it true that no female athletes have been found to have cte? >> that's true. we've only had four female brain donors and they weren't all athletes. it has been twice described in literature, one was a domestic abuse situation where she had been abused for many years by her husband. another one was autistic woman who banged her head, repetitive

head banger. the demographic of sports and military service favor men at this point. we expect this to change because of the recent increase of women in contact sports and certainly in the military. but we are actively trying to recruit female brain donors to answer this very important question, is there a gender difference in the outcome from repetitive head injury. >> doctor, do you have an answer to that? >> yes. i think the main issue here is we're talking about complicated injury in the most complicated organ in the body. we don't have a natural history study from the time that a kid gets injured or somebody has repetitive injuries through the course of the development of something like cte. for example, we had a colleague, cardiothoracic surgery. it completely changed the way we've looked at it. what we need today is a longitudinal study of the problem to understand what is the incident of this. we need better diagnostic tools.

we don't have beyond a clinical exam a really objective biomarker or blood-based biomarker. we need better ways to predict who are those people who aren't going to do well. i think really it comes down to funding. your pamphlet indicates nih is spending $93 million to understand a problem that costs over $70 billion a year. there are professional athletes who make more money in a single contract than the doctor had to fund research that we're asking questions about today. in many ways, the gap can be closed by better care, better follow-up, better screening and unfortunately we have to make a bigger investment in the problem to understand this. again, i'm overjoyed that the american public has turned a problem that as a neurosurgeon working in a level i trauma center in an urban environment i've seen this and consequences of traumatic injury for decades. so i really appreciate that

you're interested in this, but there's got to be a more sustained and powerful investment to understand the problem. >> dr. hainline? >> so i want to speak with some cautious optimism about where we may be. so the ncaa and the department of defense joined forces, a little more than a year and a half ago. we have begun a study, and we're going to be getting results real-time. so this is a study that is involving 30 schools. at each school every single student athlete, whether female tennis player or male football player undergoes rigorous multimodal examination. if they're concussed it's repeat the six hours, 48 hours, onward in six months. seven sports, three women's sports, women's soccer, lacrosse, ice hockey, the same for men, and men's football. also getting genetic testing, kids are wearing sensors and getting brain mris.

just in a year and a half, we've done studies on 18,000 student athletes and tracked over 700 concussions. a large study before that may have been upwards around 20 concussions i'm happy to say to people at table, mickey collins is a participant, mike mccrea is a principal developer, the colonel and i spent a year putting this together. geoff manly and i met, we're working in a cross functional way that has never happened before in concussion research. there are so many people that are invested just in this study alone. what we're going -- what we're doing, and dr. mckee can speak to this, i'm not allowed to evaluate the results firsthand because that would be a conflict of interest. walter and i and dallas, we're on the executive committee of the study. we have oversight but we don't have voting power. it's set up in a way that that it's a nonconflict of interest

study. we will be having a few things. the study's going to provide definitive evidence. in the short term, within two years, on what is the natural history of concussion. just concussion. we're also going to be defining neurobiological recovery in concussion. which is exceptionally important. that's different than symptom recovery. we will have that data. mike mccrea can speak better to it. but closer to another year we'll have definitive data on what it does mean to be neurobiologically recovered. we're coming back to washington in three days, laying foundation to put this into a five-year study and make this the framingham study of concussion. it's going to be a 35-plus-year study. it doesn't mean we're waiting 35 years. it means in very, very active five-year increments we're going to be coming in with new tools, including p.e.t. scans and advanced brain imaging to understand what are we seeing in

these increments. are we actually seeing there are problems for certain groups of populations. it's not just ncaa athletes. every single cadet at west point is enrolled, and we're studying these individuals as well. in addition, for everyone who is concussed, they have a control and their contact collision sport and noncontact sport. for the first time we're going to have real data on those who have had repetitive head contact but haven't been concussed. so that's something that we're going to be actively looking at. concussed, something we're going to be actively looking at. that's ongoing, it's very real, and the first wave of analysis is going to be reported sometime not going to hold you to it mike, but in the late spring. and it's going to be going on after that but even while we're, while we're waiting for these results, so just two weeks ago there were 15 of the most prominent medical organizations in sports medicine organizations in the country. and we looked at the first round

of the results, including very, very detailed head sensor data. and i, i'm not putting out a specific date, but you're going to see coming probably within the next three months some very new recommendations that are going to be called interassociation guidelines, not ncaa-specific. but it's going to be equally endorsed by the american medical society for sports medicine. the congress for neurologic surgeons on concussion diagnosis and management with regard to our football practice, the ivy league was in the room with us, their information was leaked earlier than they wanted. there's going to be a whole new emphasis on absolute recovery. which is something that's been overlooked as well. i'm just a little optimistic that we do have something very hot in the pipeline, that's very real and we're getting accurate results. >> does anybody here, anybody at this table think we should change the rules of the sports for our student athletes, shoot

headers in soccer, should headers in soccer be eliminated? or any way change football? >> i feel and brian you brought so much to this field. with the research you're overseeing and managing. i think we need science to lead the way. i think it, it really, behooves us to put science first in understanding these issues. because if we make sweeping changes on sports without having the science, there could be unintended consequences that i see every day in clinic. so i just want to make a pitch for science to lead the way. >> if we don't fund this for longer than the two years it's going now. five years, we're going to be back in five years. this is not a five-year problem. this longitudinal needs to go on and headers are not the problem in soccer. >> richard hudson has a question, and then paul tonka. >> did you want to say something, too? i would just say, i hesitate to

wait on the science when we know changes in the game conversation such a tremendous impact on children. i would say absolutely we should be having a conversation about the wisdom of putting our kids in activities where their heads are getting hit. repeatedly over and over when we know that for some individuals those consequences can be very, very dire. and we don't know yet about the risk factors. we don't know yet about those that are going to ultimately be you know, have the consequences of something like cte. but we absolutely know that no head trauma is good head trauma. and i believe there are ways we can, we can absolutely make games safer without toying with the fundamentals of the game. soccer, absolutely. they just did, they did just raise the age at which they will introduce heading in soccer. the, the usa hockey, raising the age at which checking, all those are going to make tremendous differences in terms of making kids safer. think we should explore each and

every opportunity to make every sport safer in ways that don't change the game. but absolutely that conversation should be had. >> i want to make sure we get our members' questions in, let me go to mr. hudson. >> thank you, mr. chairman. i say at the outis the, i represent the home of the carolina panthers. but i did marry a girl from denver, so i have to congratulate you on the super bowl victory. i appreciate you wearing the panther blue jacket today. >> sorry. i've become very interested in the issue of pediatric trauma. we're starting to look at this issue, my issue was piqued by the children's institute of medical science in wake forest, north carolina. they're doing a lot of work to try to look at some of these questions, they've got studies to put sensors in helmets to look at not just the big hits, but the long-term effects. but one of the things that struck me was the disparity of

care. if your child suffer as trauma incident and you happen to live near a level 1 pediatric trauma center, your kid has a great chance of surviving. if you happen to live in the part of the country that doesn't have a close proximity. then a lot of problems. that's one of the things that nags at me and the chairman and also chairman upton have helped me get a gao study to look at this issue across the spectrum of how care is delivered. so it was interesting to me when you brought this issue of awareness but also how do we take the research and understanding that you all are developing and then have it available and where the rubber meets the road, where the care is actually happening. maybe i would throw that open. >> dr. bowman to dr. joy. >> i mentioned our brain injury guidelines. another active area of inquiry is clinical support tools within

health records. integrating across their, moving their across their health care settings, from their eds to their primary cares to urgent cares, all their clinicians, whether or not they have advanced medical education in concussion management. their protocols are built in to their clinical support. so the care that they receive regardless of the setting that they show up for care in, is identical or near identical. think that's really critical. since i have the mic, the other thing i wanted to mention is another active area of inquiry for cdc, mr. miller had mentioned earlier, all 50 states having return to play laws, we're interested in what are the best practices within those return to play laws, as well as return to learn protocols, so we're actively evaluating if they work, how they work what are the components of laws that need to be in place. so those are a couple of things. thank you. >> to recognize that what brian and ncaa and mike and others are

doing with the d.o.d. i think is laudable and it's 18 years too advanced. we need to do that with kids. we need the same kind of focused research forum for kids below the age of 18. below college levels. and part of the reason that we ha haven't is we haven't had the organized advocacy and organized research systems that are set up to some extent by the way the ncaa and d.o.d. potentially have them. actually the children's institute is part of a consortium that we're developing on pediatric brain injury called the four corners consortium. dallas knows about this as well. it's trying to model what is actually happening at the collegiate and above level. really for kids. really to look at that question, what are the risk exposures? what are not, how do we understand epidemiology of this, as well as the treatment. so i do think this some priorities need to be reset. not just to start with our collegiate athletes, but really

to start with our youngest kids and moving that forward. it can then link with what is going into the ncaa, into the d.o.d. that means the cdc, the nih and others need the funding support to make that happen. >> one of the things that's happened in youth sports over the last 20 years has made this more difficult and i think there's ways to overcome that. in that the participation in school-based sports is actually declined. while the club-based sports has increased dramatically. but that becomes the wild west out there. and we need to have some way that even if the club-based sports, they get incorporated into the systems that were developed. >> just wanted to just clarify, just one point, that george, nih, we have looked up a portfolio and we agree that this issue of understanding the effects of children is a gap and

that seems to have been at currently our highest priority to fill the gap is further research. so thanks for that. >> and to that point, i appreciate brian mentioning the care consortium. all of these things start to hang together. with the mentioning of track, tbi and the four corners initiative that jerry is heading up. within a year the care consortium will have 25,000 collegiate athletes enrolled. we estimate that we'll be over 1200 concussed athletes. who have arguably represent the most richly characterized cohort of injured athletes ever enrolled in a study. that provides a unique opportunity. and you know, i hate to keep coming back to this, this point. but the reason we're sitting here debating a number of very fundamental issues about long-term risk and outcome, is because in large part, there has

never been a truly population-based prospective longitudinal study of outcome after traumatic brain injury. the military and the va has invested in the sensing to do exactly that in military service members and veterans. but to date, we've never done that in the civilian setting. and track tbi provides the most richly characterized cohort of civilians affected by traumatic brain injury of all severity. and c.a.r.e. represents the largely and most richly characterized cohorts of athletes affected. as brian points out, we not only have detailed on clinical recovery. but we have blood biomarkers, we have genetics, we have imaging that tells bus the neurobiology of this injury, as the doctor was pointing out earlier. the fact of the matter is again, i keep preaching to the choir here. the likelihood that a single variable, whether it's injury or exposure predicts outcome, i think has already fallen on

failure. because again, we look at two individuals with seemingly the same profile of exposure or injury, with drastically different outcomes even over the short-range, over 10 days and over an entire lifetime. it will take a monumental efforts and there are low-hanging fruit that we can grab early on that would answer some of the fundamental questions. in terms of what is the, what is the risk associated with exposure. whether it's subconcussive or injury. but what's the multiple matrix of factors that predict outcome? we've been chasing this single solution for decades and it's destined to failure and i think that's the lesson learned and the dilemma we face at present. >> dr. manly you had something on that? >> one of the things i think we're all very passionate about

youth sports and what happens with kids we talked a lot about the community impact. i don't want to forget about the elderly. the fastest-growing population of concussion and brain injury in this country is in the elderly. there's been at least a 50% increase in the last five years. and in california it's been higher than that. and less than 1% of the literature has spoken to this. we've excluded these people from all prior clinical trials and as best i can tell, knowing a lot of these people over the years, we're all moving in this direction. and the cancer doctors and the heart doctors have just done a wonderful job. and this is going to be an ongoing problem. i know this is a big problem and there's a lot to chew and i'm glad we're at least talking about in but i don't want to forget the elderly. because this is a population we need to be very mindful of. >> thank you for redirecting us. that's incredibly important. paul tonko of new york. >> thank you, mr. chair. >> all the talk of cte and i'd like to take a step back and just focus on that for a moment.

and dr. mccrea or whoever around the room. when was it recognized as a unique disease? and is there a distinct quality to it that separates it from alzheimer's disease or other neurodegenerative diseases? and what likely is the biggest cause? i heard you know, you talking about extending beyond concussions and also just head injuries. and the final item i would throw all of this out there as a question or observation. there's talk, too, of clusters of depression and suicide. are there things that we're already learning about the impact as it relates to suicide or mental health, mental illness or mental health disorders? >> well i can say that i

think -- cte, i can't say when it exactly was identified as a unique disease. because it's been known since the 1920s. there was advances in the 1970s about the neuropathological and clinical characteristics, but i actually do think it was the ninds consensus conference, which was held just a year ago, that established this is a unique disease, it can be distinguished pathologically from alzheimer's disease. it can distinguished from aging or all these other unusual tao-based diseases like progressive supernuclear palsy. this was done by a planl of expert neuropathologists who were blinded to slides. they got a box of 700 slides, they sifted through them, it took about 100 hours each. in over 90% of the cases, correctly identified cte. so there's a -- they even went further and said there was a

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midett 'm ndoor bha wa t tanffo y ci reohang urknlegeh us t' alnsucan t'w lke t tes outaesroti tti. m seby owoks l inmyareron iu o sck a h ttvinc wea f in ttwee knwn- man ez'v no auttin i w a tt d. itiselyshki. an ils hpp tbe a pso wh tinhaha ul'tedong plcy es 'svincbad. so lk orrd ml yorelloioghn srstie a io orrdtoetng el tt rear. iju wt ay la thngas mo ou 'ta ao ms sti rethi blth

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cainth ahowe fose aot o sorsnd cdalyila a enon sme oethg h ppl awahi tis ar tki thus meer thtcas eroal ndhaseangauf a aeon 6 o olr. t vic aeseang caesorchdr a yun alt veo ar orhiredgau eahs ne aedtr tau itak aig en. bngnestn m arndce angele i dse tmoieonssn" anit othestng moie ikn jt aou evyn. beg om pisrg t ls kwi oe ewnd h mh in he haednth ltewea, toebltoal tdr e mooa shgser

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1,0an 00pod mb i ty aihe ccuiv wveha ctiestoyo go tou em f tonst me ou ta rsutsof uradlostan s pbl,h msteangt ndhe wldav te ymomth y dscbe sa ivcenitme olio o mpr. my cessuid g a lornhe. y'relngs resl on tse in. mtt, bom tng is ay adofsang efrt tsshpf. wtooust i tch seesof hrisonth whh w gheert' kiuthra iitti isulndd. kn a oheyto oth a i t ea o nt lns, iopngwe nea a tabuthas l aut f hofals we snd hf arli dla yar mtal-rat pbls de'trngto fi oortw bli ll yrta cre tt

di m tth's e' a eeve' a intoin fdi f th, wh cldeang aot lis. ndhas er i in ers unnityf oni ang mrsofcore,e hve tathas ewe hve fi t y. aginthk u,'mmd wi yur owdg an peata tch wth u diah rt ruisd. any. >> wveoten mllon peleeihti op fat. do tatacalme f iivu lis? medyhoisn dau asn ermusnhr ha esha an ldlds nocrit

heksereomo ce sohereh o r th usgrk. eywa t baro ge trk be y knw, eyeivgneioo atsot eob ar th ndori twk. herehu of g asab pce ln rhr arnd ty ve toea ,