So, we are — thank you, everyone, for hanging with us until the end of the day. We have very few questions. I'm going to start with one question from an earlier session. Any comments on using general anesthesia to teach endoscopy, specifically in terms of getting patient feedback? I mean, where I work, we use moderate sedation, but Dr. Walsh or Shaw, any comments on how general anesthesia affects teaching endoscopy? Well, I think, from an ergonomic perspective, it's a lot harder if you want to change patient position. So, either you're not changing position, or, for your assistants and yourself, it's a lot of extra work. I think what I'll add is, I think that, first of all, the non-technical skill component changes, because the fellow has to be able to now navigate the talking to the patient as well as managing the team. And I do think, you know, we have to think about giving people exposure to that. I mean, in our program, our fellows get that exposure at a VA hospital, because that's their preferred mode of sedation at that hospital. But I think, without that, we would have to be thinking about other ways to give people that experience. So, I do think that training programs have to consider that, because people may go into practice to places where there isn't a high number of anesthesiologists. Yeah. Dr. Young, any comments on ulnar nerve injury of the left arm after years of endoscopy? Could you repeat that real quick? Any comments on ulnar nerve injury in the left arm after years of endoscopy from an ergonomic perspective? Yeah. I mean, once it's already developed, and it's going to just be the things that you would do typically for an ulnar nerve injury. So, there are glide exercises and other things you can do as far as physical therapy goes, night braces, because your arm often ends up bent, you know, behind you or something like this, and you're compressing your ulnar nerve at night. And so, you know, the simplest thing to do is you can actually take a towel and a couple of rubber bands and roll that around. They also make purpose-made braces for that kind of purpose. But often, you can avoid surgery if you're doing that, also if there are things in your daily life that you're doing that might exacerbate that. Simple things like even writing, you know, with your arm on the car window or something like that can compress it, or sitting here like I'm sitting now, right? So, keeping your elbows off of things, keeping them not bent at their maximum extent are all beneficial, as well as just having a good ergonomic technique. All right. Two more questions. For Dr. May, you mentioned involving health equity experts in the beginning when you're looking at AI systems. Any comments on having community members be a part of that process? On having who? Community members. Community members. That's an interesting question, and I think it's an important one, and I'm glad that whoever asked it is thinking this way, because we often will involve community members and stakeholders in our research, especially when we're doing research to improve equity and access. I haven't seen individuals use or include, I should say, community organizations or community members in AI development. I think that that potentially could add a very important perspective, but I think now the goal is to get the experts in the room, and then I think once those experts are in the room, they're the ones that we'll probably recommend bringing in the actual patients. Thank you. And Dr. Tao, you get the last question. How to treat a bleeding AVM, start at the edges or in the center? I'm sorry, say it one more time. How to treat a bleeding AVM, edges or center, starting at the edges or in the center? Either is fine. Just make sure you get the whole thing. Remember an AVM, people always think of it as an oozing type thing, but remember it's got A and it's got D, so it could actually be an arterial bleed like I saw earlier. So don't underestimate the possibility that you may trigger an arterial bleed as you come upon it. One way, if you really want to make sure that you totally got it, is if you just use, for example, a hemostatic forceps, you can close upon it because, see the hemostatic forceps, I didn't talk too much about it, but it's both mechanical and thermal, right? Because you close on it, so you know you're sealing the vessel and you produce thermal energy. So it is one of the most secure ways to burn something without allowing it to start bleeding on you. So you can consider that option, but you know, APC, spray clog, all of it's fine, middle, edge, I don't really think it makes a difference. Just be prepared that it can actually bleed quite a bit.

endoscopy

ulnar nerve injury

AI systems

arteriovenous malformation

access