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Oak Ridge Reservation

ORRHES Meeting Minutes
December 2, 2003


Presentation by Dr. Paul Charp

DR. CHARP: I’m going to condense the several hundred pages of the health assessment down into one overhead. You’re probably asking why did I have to read the two hundred pages if you’re going to only do it in one, but such is life. This overhead, as I said, is a summary of all the exposures that ATSDR evaluated for the Uranium releases from Y-12. This includes past exposures and current exposures. The past exposures were evaluated based on the State of Tennessee’s dose reconstruction project that was overseen by the ORHASP Steering Panel. What ATSDR did, as well as what the State did, was look at the chemical and radiological issues associated with Uranium exposures. We looked at total pathways which would include air, water, soil, and all that information that were summarized in the dose reconstruction project and, based on what was in those documents, we determined that, for radiation people were being exposed and that was true also for the chemical aspects of Uranium exposure. People were being exposed both through inhalation and through the ingestion pathway. What we did differently from the State is whereas the dose reconstruction project and the State report was carried out to fifty-two years of exposure, we tacked on an additional eighteen years. So, we carried it up to seventy years of exposure. And based on that increased exposure we estimated that the average radiological dose that was received by a member of the public was a hundred and fifty-five millirem over seventy years. We used a screening value for cancer of five thousand millirem over seventy years, which is a topic of a whole other discussion that may or may not come up today. And based on our evaluation, the hundred and fifty-five millirem over seventy years was about thirty-two times lower than our cancer screening value. In the case of the chemical exposure to Uranium, Uranium is a heavy metal and as such it has a chemical effect on the kidneys. We looked at the kidney problems for ingestion and inhalation and also the problems of Uranium exposure to the lung. Based on inhalation it was about one hundred thirty times lower than ATSDR’s minimal risk level, MRL, for inhalation. You see the MRL is listed as eight micrograms per cubic meter of air and our evaluation, based on the state dose reconstruction, was a maximum of about six times ten to the minus five milligrams per cubic meter. That’s point zero, no, point zero six micrograms per cubic meter. So, it’s about a hundred thirty times lower than the MRL. In the case of ingestion, the Uranium would be ingested through food, soil, water, so on, be absorbed, and the Uranium would be deposited in the kidneys. Based on that pathway the maximum amount we found was, this converts to about thirteen micrograms of Uranium per kilogram body weight per day. The ATSDR MRL is two micrograms per kilogram body weight per day. The issue here is that yes, it’s above ATSDR’s minimal risk level for ingestion, but just because it’s above the minimal risk level does not mean you will have an adverse health effect. If you notice, it says that all the doses here were less than the dose at which renal health effects have been observed in the most sensitive mammalian species and I believe that was the rabbit. Where are the toxicology folks here? Was that the rabbit, Jack, for Uranium? Ingestion past, yeah, the rabbit. Remember, for the MRL’s ATSDR adds additional safety factors so although the minimum dose at which adverse health effects were seen were .05 micrograms per kilogram per day, by the time ATSDR added in the safety factors it knocked it down to the two micrograms. Yes, Tony?

DR. ANTHONY MALINAUSKAS: What is the limits of uncertainty on all of these numbers?

DR. CHARP: On the ASTDR numbers?

DR. MALINAUSKAS: Well, on the estimated doses you’re quoting them out to three decimal places.

DR. CHARP: They’re the same number of significant figures that were expressed, I believe, in the dose reconstruction project.

DR. MALINAUSKAS: But is the uncertainty a factor of two, a factor of ten, a factor of a thousand?

DR. CHARP: I can’t tell you that off the top of my head. I doubt if it’s much more than ten, but don’t quote me on that.

DR. MALINAUSKAS: Well, some of those are fairly close. If it is a factor of a hundred and it’s thirty-two times less you’ve got an altogether different situation.

DR. CHARP: Yeah, I agree. Remember, there are uncertainty factors included in the ATSDR MRL’s that could be as much as a thousand or so above, below the lowest observed adverse effect level. Al?

MR. BROOKS: It seems that we’re using the term uncertainty factor here with two meanings. As I understand it these numbers are conservative estimates and as such they should be at the conservative bounds of the values, whereas uncertainty is usually referred to as an estimate of the validity of the central measure. If these things have a safety factor of a thousand in them the question of uncertainty becomes almost meaningless.

DR. MALINAUSKAS: When you start quoting three decimal places I think you’ve got to clarify your position.

DR. CHARP: Right, in some cases you’re absolutely right about the significant figures. One versus 1.0 is a big difference. Barbara?

MS. SONNENBURG: I have a different subject if you’re done with that one.

MR. HANLEY: Responding to your question, Tony, we’re trying to put this all on one slide but in the health assessment we explain where we see the uncertainties and the conservatism built into the assessment and we actually describe that, for example, that past exposures were based on, for the Scarboro community, were actually based on East Fork Poplar Creek sediment samples, which is unlikely to happen. And those are estimated to be at least, the flood plain samples were at least an order of magnitude higher than what was found at Scarboro. So, we had a list of conservative aspects in these estimates. Also, these comparison values have safety factors built into them also. So, the document provides much more detail. Paul is just trying here to capture it all on one slide and keep it simple.

MS. SONNENBURG: Going back to the document we looked at before, is there any medical data included in your work?

DR. CHARP: In the health assessment there is a section on toxicological implications and–

MS. SONNENBURG: No, I’m talking about people. Looking at figures about the health of people, medical data.

DR. CHARP: Jack will answer that.

MR. HANLEY: I was going to get into that a little more in detail later and I can do that.

MS. SONNENBURG: Ok, I can wait.

MR. HANLEY: But just to answer the questions, in estimating these doses in exposure pathway, no, health outcome data was not used. However, the document summarizes a number of investigations and studies that did occur over the last ten, fifteen years.

MS. SONNENBURG: But in all those studies very few of them looked at people?

MR. HANLEY: No.

MS. SONNENBURG: What you did, the soil and the air and so forth and so on, but I haven’t seen very much that looked at people.

MR. HANLEY: There are sections in there where there are investigations and evaluations of people and health outcome data and I’ll point those out to you later.

DR. CEMBER: I’d just like to recommend a book that was written by Alan Brodsky that deals with Uranium and the hazards from Uranium and he cites numerous studies on individuals and on populations who had been exposed and overexposed to Uranium and describes the quantitative relationships between the dose and the response, etc. So Alan Brodsky wrote that and let me recommend that and get it into the record here.

DR. CHARP: That’s B-r-o-d-s-k-y I believe. And also related to that in the last few years the World Health Organization IARC, International Agency for Cancer Research, IARC, just classified Uranium as a non-human carcinogen. It does not cause cancer in humans, natural Uranium. Any other questions on this before I go to the last column, the conclusion category?

MS. SONNENBURG: What about the changed uranium?

DR. CHARP: Enriched Uranium?

MS. SONNENBURG: Yeah.

DR. CHARP: Enriched Uranium, once you get above an enrichment of ten to fifteen percent, I believe, you start having a radiological problem versus a chemical problem. So, if you’ve ingested enriched uranium then you have to take into account the radiological issues and not the chemical carcinogenic issue.

MS. SONNENBURG: So, for Oak Ridge, original uranium really doesn’t–
DR. CHARP: The uranium that came into the facility, the ore, would not be considered a carcinogen. The enriched uranium that came from K-25 or Y-12, depending on the level of enrichment, could. And also since K-25 also used recycled uranium then you’re going to have to take into account some of the other contaminants that may be in there.

MR. L.C. MANLEY: What about depleted uranium, especially the metals? That thing they have given the people in Desert Storm such problem?

DR. CHARP: From a radiological issue depleted uranium is, pure depleted uranium, is about one half as radioactive as natural uranium.

MR. MANLEY: But the metal is an alloy.

DR. CHARP: Metal is an alloy–

MR. MANLEY: Therefore, you’ve got other things that could cause a physical problem.

DR. CHARP: Right. There has been a study going on by someone at the, I think she’s at Hopkins, Melissa McDiarmid, who has been looking at soldiers from Desert Storm that have embedded uranium projectile pieces in their body that cannot be removed through surgery and thus far the only problems they have seen has been, I believe, elevated uranium in the urine and no other problems.

MR. WASHINGTON: That’s not exactly true, is it? You’re talking about heavy metals so when you say no problem that really isn’t exactly true, is it?

DR. CHARP: Exact words, no, that’s not exactly true. No reported problems, no diagnosed problems, no observed problems other than carrying around some depleted uranium. The same thing would occur, as I understand it, from people who have been shot with bullets that can’t have the bullets removed.

MR. WASHINGTON: Oh, if it’s still in there, yeah, but if it’s finally divided then you have an additional problem, don’t you? Because you’re talking about not only whether it’s depleted or enriched. Even if it’s depleted you’re talking about a heavy metal and that heavy metal has the ability to go places that other things don’t generally go. It’s going to act kind of like lead in some respect.

DR. CHARP: I don’t know all the toxicology of the heavy metals. The only thing I do remember hearing McDiarmid talk about is when these depleted uranium fragments are in the body there’s some type of, like a cyst forms around the particles, and the particles fully abcess.

MR. WASHINGTON: I can agree with that.

DR. CHARP: So, I don’t know what the answer is to your question. I would assume some of these metals do leach out into the circulation, but currently there hasn’t been any detected problems associated with that.

DR. DAVIDSON: I would just like to make one statement that, you know, if you have heavy metals and if they are localized within a certain area, if they’re in the urine that means they’re mobilized. If they appear in the urine that means they’re mobilized in the body and they have a potential to distribute to the body, so which means if the person is being exposed because otherwise it could not be excreted.

MR. MANLEY: The depleted uranium, not only that the metal, it burns, oxides rapidly and it burns easily. So, therefore, there are more ways to get into the system other than by, you know, fragments. So, you can inhale it very easily.

DR. CHARP: I believe they’ve also looked at the inhalation pathway. I know the military army up at Aberdeen proving grounds actually has built a building where they can fire a depleted uranium tank round into the building and collect all the fragments and they can measure the air particulate distribution within the building. So, they’ve begun to model the particulate size and the vaporization of the projectiles inside the buildings. That study is going on as you speak.

MR. WASHINGTON: That was the outcome of my patent. The Penetrator is my patent. The Penetrator is really not a weapon per se, it’s just a hunk of depleted uranium with an explosive on it. It hits the tank, the momentum goes in and what blows up really is the ammunition inside the tank.

DR. CHARP: All the Penetrator does is punch a hole in it.

MR. WASHINGTON: Right.

DR. CHARP: It’s a fancy hole puncher at a density of about twenty grams per cubic centimeter.

MS. ADKINS: I just wanted to check in simple terms are we connected in any way to the research with the Persian Gulf soldiers who came back supposedly exposed to dust, and so forth, and who have bizarre symptoms of, just all kinds of bizarre symptoms. I’m sure there’s a study going on of those people. Are we connected in any way to that?

DR. CHARP: This person, Melissa McDiarmid, has been looking at the depleted uranium issues with the soldiers. Is she still a member of the ATSDR Board of Scientific Counselors? She is. She is the Chair.

MR. WASHINGTON: When these studies are going, it’s kind of like agent orange. Agent orange, you know, when it first began, when they first began to study it, you know, nobody was hurt in any way by Agent Orange, but as years went by, you know, scientists soon became a little more credible and they began to tell the truth about it. I believe they’re doing the same thing about the Penetrator because people ate around this stuff. You know, they were in the field. They were eating, drinking, and doing all the sleeping around this stuff and that to me, the study, the first studies that they did it just doesn’t fit my rationalization of what happens to a heavy metal, you know, when you vaporize it.

DR. CHARP: Let me go on.

DR. DAVIDSON: Don has a question, but we need to get back on the subject.

DR. CHARP: Let me say one more thing to Mr. Washington and then we can ask the other question, alright? The U.S. uranium and trans-uranium registries has been following a number of DOE workers who worked in several uranium plants including the big uranium plants at Hanford and when I last talked to the former director of that registry they had not yet found any long-term effects of uranium on these workers who had massive doses of uranium documented in their bodies. Herman, do you want to add anything to that?

DR. CEMBER: No, you’ve covered it except that these studies you’re talking about were autopsy studies. So, they analyzed the various tissues for uranium and then looked at the medical histories of those persons and they found no relationship between, so far I believe, haven’t found any relationships between the symptoms that they, the medical history and the uranium body burden. Is that correct? I believe that’s the case.

MR. BOX: Just a quick question here. On the releases from Y-12 I know there was quite a bit of electromagnetic separations of the plutonium isotopes, plutonium, neptunium, all these. Were any of those considered along with the uranium or is that something separate or is that just not even looked into?

DR. CHARP: The state evaluated a number of the trans-uranics and those were ruled out for further evaluation. That was especially true at K-25, but I faintly remember them reviewing the same information for Y-12 and saying it doesn’t need to go beyond the initial screening that they did. Let me quickly go over the current exposure to radiation. I’m just going to go over the, I’ll go over both of them. One of the issues has been the community at Scarboro, the most relevant community to evaluate exposures to uranium releases from Y-12. Jack will get into some of that discussion, I believe, when he goes over the conclusions and some of the other things he’s going to discuss. The only thing I want to say about Scarboro is that it is the closest community and it’s been a community of great concern both with respect to is our community safe, are the foods that are grown in Scarboro safe to eat, and how does Scarboro compare to other parts of Oak Ridge and other parts of the country. So, we looked at the ingestion and inhalation of uranium. In Scarboro we looked at soil data that was collected by Florida A&M and also validated by EPA. When you compare the Florida A&M data to the EPA data the data are unremarkable which means they’re almost indistinguishable from one another. And when you compare those data to data across the country the uranium in Scarboro is indistinguishable from uranium in Chattanooga or uranium in Kansas or other parts of the country and is very similar to the uranium that DOE detected in their soil background characterization studies. Based on all that we went ahead and looked at the ingestion of foods from a private garden in Scarboro. In the garden that was grown around monitoring station 46 in Scarboro, monitoring stations and private gardens in Claxton and Maryville, around Norris Lake and a few other places and to skip everything else on here all their doses that we could find for current exposure, meaning from about 1990 on up, are well below our screening value and it’s well below the ATSDR MRL for chemical exposures. So, to say that the conclusion category that we selected for both past and current exposures to uranium released from Y-12 we said are no apparent public health hazards. I’d be glad to delve into these in a little more in detail if you have any more questions on it. It’s all well laid out in the health assessment and I don’t want to take up much more time on this part.

DR. CRAIG: Looking at the current exposures, if anything would fit the category of no public health hazard it appears that thawould. Why did you pick the no apparent?

DR. CHARP: Well, the reason why is remember for no public health hazard the very last Category 5 says that you have no exposure, but in Scarboro you had some air exposure. You have some exposure going on. Now, let me get on a different soap box and say that and I’m sure my supervisor sitting over there in the corner will get after me on this one but it won’t be the first time. I’ll just tell her to take a number. ATSDR in the fifteen years that I have been with the agency has had a problem dealing with radioactivity and radiation. All the things the agency has done has been chemically oriented. When I came on the scene and I said if you have something in a drum that’s sealed you have no exposure, but if you put radium in that drum you’re being exposed and they said well, how can that be. I said, oh, you know, gamma rays go through the drum. You’re going to have an exposure whether or not you’re in contact with it. You put a source outside and it’s hot enough, radioactive enough, you can be exposed. So, there are, in essence, if you go by the true definition of Category 5, you will never have a site with radioactive material on the site that you have a no exposure category. So, the minimum exposure for a radiological site is no apparent public health concern. So, really there’s only four categories for that. That’s one reason why it’s no apparent. Just because there’s no quote exposure you’re being exposed to gamma radiation or something else if it doesn’t emit gamma rays.

DR. CRAIG: Yeah, but at that level you couldn’t even determine it from background. I mean, you couldn’t even tell it apart.

DR. CHARP: Right, but it’s still exposure. Let’s see. I don’t know who was up.

DR. DAVIDSON: Don hasn’t spoken.

DR. CHARP: Well, you know, that’s fine. James can wait.

MR. CREASIA: I would just like to point out on these estimated doses in the screening comparison values these are all chronic exposures. Do you take into account any acute exposures?

DR. CHARP: We do not take into account acute exposures because these exposures in Scarboro have been going on for, our exposure pathways covered at least ten years. Now, we did have annual air monitoring results and those annual doses were very low. They would not be considered a public health hazard from a chronic exposure.

MR. CREASIA: But those are still annual doses though. Somebody may get a big whiff one day.

DR. CHARP: Right. We had no instantaneous exposure, we had no information on instantaneous releases. One issue is that
the air monitoring stations are quarterly measurements so you can’t really do a fourteen day on it. Every three months the samples would be collected. I’ve had that issue raised before at another DOE site where they said we released ten kilograms of uranium and I said was that in one shot or over a period of time and so, we don’t know.

MR. CREASIA: And I’m thinking back mainly to, and it gets to the issue about the worker versus the community. The worker can be in the shop and get a massive dose, an acute dose, go home and nothing happens to him right away especially with the uranium, not the uranium but the radioactive doses. But he’s still going to be categorized, when he gets sick he’s going to be categorized in the community as a chronically exposed person.

DR. CHARP: Yes and no. Depending on how good the bio-monitoring is within the lab. If he thinks, he or she thinks they may have gotten exposure they would go to the ratings and safety officer and they would do the nose swabs and that type of stuff to see if he did get a quote body burden. Dr. Cember has been involved in a number of those cases. I’d like to refer to him for those types of questions.

DR. CEMBER: If we believe he’s gotten an exposure we do various kinds of checks to see whether he has. We try to estimate what his intake was. We have a lot of reasonably good mathematical models for doing this based on urine analyses and fecal analyses and whole body counting and if we think he really has a big intake immediately the nose swabs are probably the most effective, immediately right on at the time before he blows his nose, and so on. But we can estimate with a reasonable degree of accuracy what his intake was based on by what they call bioassay and this is based on urine analyses mainly and fecal analyses and whole body counting. And whole body counting doesn’t mean we count dead bodies like we did in Vietnam. It means that we put a big Geiger counter over the person and see how much radiation comes from him. So, we have lots of those data, and enough really to validate the mathematical models that we have.

DR. CHARP: But the other issue too that I think Don is getting to is that if the person doesn’t know they got an intake and they go home then you don’t know whether it was acute or chronic.

MR. CREASIA: That’s right and I’m well familiar with all the mathematical models and the safety hazards and so forth, not safety hazard but the precautions, but I’ll tell you if you really work in the lab you’re not going to report your exposure if that’s what you’re doing. If that’s your research, you skip by it because you don’t want anybody to know it.

DR. CEMBER: I agree with that and I’ve seen that many times. In fact, I’ve tried to do some research in medical health physics and when the physicians would do their what they call interventional radiology and their livelihood depends on doing a cardiac catheterization while someone is under the, being examined with x-rays by fluoroscopy, what they do is they just, if they’re approaching the limit they will just not wear their film badges or TLDs.

DR. CHARP: Yeah, I knew a case of somebody worked out in the Biology Division who would, during the early work of DNA structure and P32 would hang his film badge in the middle of the lab and it would still get over exposed.

DR. CEMBER: But that’s not in the context that we’re talking about here. We’re not talking about the research or the physician who is doing this deliberately. We’re talking, I think you mean the worker who is unknowingly exposed, the carpenter who comes in to fix something and is exposed. Isn’t that the context in which you are making these comments?

MR. CREASIA: It’s both. I mean, I’ve seen people working there and they get close to the exposure but, you know, you got to get in there and you’ve got to get that rat and you just go in there anyway. But then when you go home you become part of the community that you get evaluated on.

DR. DAVIDSON: But you’re also part of the work force as well.

MR. CREASIA: That’s right, but right now we’re dealing here only with the community.

DR. DAVIDSON: But community, we’re dealing with community exposures and what was released in the community. That’s what that dose is based on, not what they were exposed to on the job.

MR. CREASIA: How do you differentiate that when you’re looking at the medical records or the systematic or what have you between the person who lives in the community and the person who works at the lab that goes back and forth. I mean, when he goes in the community and he dies he’s going to be recorded as a death in such and such community A.

DR. DAVIDSON: But he’ll also be recorded as a death of a person who worked at that place.

MR. CREASIA: But we don’t mention that in the paperwork. That’s what I’m bringing up; it’s not mentioned; it’s skipped over, but I agree with you, you know. I think we’re talking the same thing really.

DR. DAVIDSON: We’re also kind of getting off subject as well.

MR. BOX: Speaking from personal experience on exposure, I was working in the laboratory and there was a very small leak in the glove box on plutonium work and we really didn’t know that I had been exposed over a period of time until my badge was read and my urine was analyzed, but it was detected. There’s very close accountability on these things. They do read these things seriously; they do catch these things, and they do whatever possible. I had a number of whole body counts here, at Los Alamos, also at Idaho Falls as a check on these things. So, these things are monitored quite well and it shows up, if not right away, like mine was over a period of maybe a month. I had about three times the body burden over that small period of time and yet it was detected, they did what they could. I received the DTPA to flush the material out of my body but it is caught pretty well even though I had worn my badge and I did, but even if I had put my badge aside if you’re getting an exposure your urine is going to show up.

MR. LEWIS: I have several comments. Number one, I thought this was a pretty good document. I guess in looking at it Tony brought up an excellent point. If you don’t plan to have Jack Hanley tied to this with the explanation and if this gets out as one document I think you ought to put in a caveat to pick up what he said. The other thing is so you’ll know how to get back and as this goes out the question is even over here on past you ought to identify the times, you know, so people have some idea what you’re talking about. And when I got over here to the no apparent conclusion categories my question is there are some recommendations that are associated with this. Are there any recommendations, do you think it would warrant putting whatever the recommendations are from the public health assessment in that category to give people some feel of what it is they’re going to do if this is going to be a summary document? And the last comment I guess that I have is with health effects evaluation. For the kids I guess related to the current, I know some work was done over there; can you identify any health effects evaluation that may have been done to the people that would have been associated with the past in the evaluation of any kind of data with the people in Scarboro?

DR. CHARP: I don’t know where to start with James’ shot gun approach to the questions. We’ll put the past was from plant start up until about 1995. The current was from about 1990 up through 2002 or so. The no apparent public health hazard categories and the recommendations of the health assessment; the major recommendation was to inform the public of what our findings were and this is part of that recommendation. But there’s no, I don’t see any reason why we can’t put the recommendation in with the conclusion. Sometimes the reviewers back in Atlanta say it needs to be in its own separate paragraph or section, but I agree with your point that it should be where you read it, so it doesn’t hurt to repeat it more than once. As for any type of health effects, the major health effect that you would expect to see from uranium exposure would be, from a chemical point of view, would be kidney toxicity issues. So, if there were any elevated rates of kidney failure or kidney disease in Scarboro, or the surrounding areas that should be an indicator. It’s not the only cause for kidney toxicity and kidney issues but it is a potential indicator and other than that, from a radiological point of view, although the kidney is the target organ for the chemical problems, the main storage site for uranium in the body is the bone. So, you could also look for any kind of bone disease related to the radiological properties for uranium. The rest of your question is have they been evaluated? Not to my knowledge.

MS. ADKINS: I just wanted to ask Dr. Cember when were those testing safety checks put into place? Do you know when the safety checks were put into place?

DR. CEMBER: I can’t give you a date explicitly but I was here in 1949 at ORNL and we had all of these things, the urinary monitoring and the weekly film badges and everything else, so I don’t know how much earlier it was but I do know that at least in 1949 we had it.

MS. ADKINS: And another question. Has any testing been done on the health of the wives who hug the husbands when they come home from work in their work clothes and the children who wear the shoes around the house, wear their daddy’s shoes and those kinds of things. Did it ever go home? Did the safety in washing clothes and, you know, ironing the clothes and sending them back off to work in those clothes, has anybody ever looked at that?

DR. CEMBER: Again, as I recall when I was here and I see it still goes on in various places where I go, we wore, when we came in to work we changed our clothing and when we left we were monitored. We did hand and foot monitoring and portal monitoring. So, if we did take anything home it was less than detectable, but you’re right about concern about the families because the wives of asbestos workers, those who were exposed to vermiculite and brought, believe, who brought the asbestos home with them, they found the proper kinds of cancers, lung cancers, in the wives, in some wives, and that’s a pretty unmistakable kind of association. But we were monitored before we left. If the general public is going to look at this it’s already pretty busy but I would suggest one or two more columns here. You can compress some of them geometrically. What would be the average exposure, let’s say, in the United States to uranium generally, both chemically what would be the dose and what would be the radiation dose and what would be the intake? And I think those data are available. Well, the UnScear report has those data in it too. So, I think it would probably be worthwhile clarifying for the general public what we’re getting if you live a thousand miles away from here, let’s say an average for the country. I think that would put things into perspective; better than the below thirty-two times, etc.

DR. CHARP: I’ll turn it over to Jack.

DR. DAVIDSON: Thanks, Paul.

MR. HANLEY: Can everybody just take a two or three minute break until I get set up. We’re way over time and I’m sure everyone needs a little stretch and break.

DR. DAVIDSON: Ok. I’ll call everyone back as soon as Jack is set up.

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