Clinical Trials for Parkinson’s Disease

In the San Francisco Bay Area

               Source: ClinicalTrials.Gov        

Researched by Leonard Ke

Leader, Daly City Support Group

*Deep Brain Stimulation (DBS) vs. Best Medical Therapy (BMT) Trial

This study is currently recruiting patients.

Sponsored by

Department of Veterans Affairs

National Institute of Neurological Disorders and Stroke (NINDS)

Purpose

The goals of this study are to determine if simultaneous bilateral subthalamic nucleus stimulation or simultaneous bilateral globus pallidus stimulation is more effective in reducing symptoms of Parkinson’s disease, and if deep brain stimulation or best medical therapy is more effective in improving Parkinson’s disease symptoms.

 

Location and Contact Information

Gatana Stoner, R.N. CCRC    (319) 353-6679    gatana-stoner@uiowa.edu

California
      San Francisco VA Medical Center, San

Francisco,  California; Recruiting Elaine M. Lanier, R.N., M.S. 415-221-4810  Ext. 2488   elaine.lanier@med.va.gov

       William J. Marks, Jr., M.D., 

Sub-Investigator

      University of California at Los Angeles, Los Angeles,  California; Recruiting

Wes Morrow, MS,MMSc, PAC  310-794-7239    wesmorrow@hotmail.com
 
Jeff M. Bronstein, M.D., Ph.D., 

Sub-Investigator


      University of California at San Francisco, San Francisco, California; Recruiting

Elaine M. Lanier, R.N., MS.,

415-221-4810  Ext. 2488    elaine.lanier@med.va.gov
 
William J. Marks, Jr., M.D.,

Sub-Investigator


      West Los Angeles VA Medical Center, West Los Angeles, California; Recruiting

Alice Cugley, R.N., N.P.  310-268-3975    alice.cugley@med.va.gov
 
Jeff M. Bronstein, M.D. Ph. D., 

Sub-Investigator

More Information

Study ID Numbers  VA-NINDS-01
Study start date: April 2002
Record last reviewed: September 2003
NLM Identifier  NCT00056563
ClinicalTrials.gov processed this record on 2003-10-24

*An Open-Label, Long-Term, Flexible Dose Study of Safety, Tolerability, and Therapeutic Response In Patients with Parkinson’s Disease with an Investigtional Drug

This study is currently recruiting patients.

Sponsored by

(Sponsor Name Pending)

Purpose 

Open-label, long-term, flexible dose study of safety, tolerability, and therapeutic response of patients with Parkinson’s Disease.

Location and Contact Information

Call      1-800-323-4204 

More Information

Study ID Numbers  M/2760/0011
Record last reviewed  October 2003
NLM Identifier: NCT00036205
ClinicalTrials.gov processed this record

on 2003-10-24

*A Clinical Study to Evaluate a New Investigative Drug for the Treatment of Parkinson’s Disease

This study is currently recruiting patients.

Sponsored by

(Sponsor Name Pending)

Purpose

Double-blind, fixed dose study evaluating an investigational drug in early Parkinson’s Disease

Location and Contact Information

Call      1-800-323-4204 

More Information

Study ID Numbers: DA2APD-0075-031
Record last reviewed: September 2003
NLM Identifier: NCT00058838
ClinicalTrials.gov processed this record on 2003-10-24

*Safety and Effectiveness of the Selegiline “Patch” for Decreased Mental Function in HIV Patients

This study is currently recruiting patients.

Sponsored by

National Institute of Allergy and Infectious Diseases (NIAID)

National Institute of Neurological Disorders and Stroke (NINDS)

Neurologic AIDS Research Consortium (NARC)

Purpose

The purpose of this study is to evaluate the use of selegiline transdermal system (STS) in the treatment of decreased mental function of patients with HIV. A decrease in mental function often occurs in patients with HIV. Antiretroviral drugs are used to treat this but are not entirely effective. Some other therapy could play a role. The drug selegiline, in a pill form, is used to treat Parkinson’s disease, a serious brain disorder. It is believed this drug might protect the brain and repair some damage. This study will use this drug in a “patch” form, which has not been approved by FDA, to see if it helps with decreased mental function in patients with HIV.

Location and Contact Information


California
      UCLA CARE Ctr, Los Angeles,  California,  90095,  United States; Recruiting

Susan McCarthy  310-206-8029    smccarthy@mednet.ucla.edu


      Univ of California San Francisco, San Francisco,  California,  94110,  United States; No longer recruiting


      University of California, San Diego, San Diego,  California,  92103,  United States; Recruiting

Jill Kunkel  619-543-8080    jkunkel@ucsd.edu 


      University of Southern California, Los Angeles,  California,  90033-1079,  United States; Recruiting

Luis Mendez  323-343-8283    lmendez@usc.edu 


      Stanford University, Stanford,  California,  94305-5107,  United States; Recruiting

Debbie Slamowitz  650-723-2804    dslam@leland.stanford.edu 


      San Mateo County AIDS Program, Stanford,  California,  94305-5107,  United States; Recruiting

Debbie Slamowitz  650-723-2804    dslam@leland.stanford.edu 


      Willow Clinic, Stanford,  California,  94305-5107,  United States; Recruiting

Debbie Slamowitz  650-723-2804  dslam@leland.stanford.edu   

Study ID Numbers: ACTG A5090;  AACTG A5090
Record last reviewed: August 2003
NLM Identifier: S
NCT00013585
ClinicalTrials.gov processed this record on 2003-10-24

 

PPSG Board Meetings

We welcome anyone to drop by our board meetings and share ideas with us! We meet on the 3rd Wednesday of the month between 1:30 and 3:30 PM at the Parkinson’s Institute in Sunnyvale. To confirm holiday meeting dates and time, please call the PPSG office at 408-734-1593.

Thank you so much for your donations!

 Please use return address labels, to help us acknowledge your donations properly.

If you have any items for sale or donation, such as exercise equipment, wheelchairs, etc., please write to PPSG, call us at 408-734-1593, or e-mail PPSGinfo@yahoo.com.


Berkeley

The group meets on the 3rd Monday of the month at the Northbrae Community Church (new location), at 941 The Alamede, Berkeley, from 10:00 AM-12:00 noon.For information, call Mitzi Cahn at 510-527-9075.


Berryessa

 The group meets at Berryessa Community Center, 3050 Berryessa Rd., San Jose, on the 1st Wednesday of the month, 12:30-2 PM.

Contact: Bob and Jane Pomeroy at 408-263-8485.


Daly City

The Daly City Support Group meets on the 1st Tuesday of the month, from 3:00 to 4:00 PM, at Doelger Senior Center, 101 Lake Merced Blvd., Daly City. For Support Group information, please contact Leonard Ke at 415-587-1285.


Fremont

Our November breakfast meeting was held on Tuesday, November 18, at 10:30 am, at Cabrillo Park Café, 4673 Thornton Avenue, Fremont. If you need any information on the breakfast meetings, please contact Rex and Glo Denton, at 510-792-2242.

There will be NO regular meeting in December.

On Wednesday, December 10, Buz and Dorothy Crain, invite us to a Christmas Party, at 7 PM., at the Hungry Hunter Restaurant, 5339 Mowry Avenue, Fremont. Special thanks to the Crains for their generosity!

The Fremont Support Group meetings are held on the 4th Monday of the month, at 7:00 PM, at the Fremont Senior Center, 40086 Paseo Padre Parkway, Fremont.

If you have any questions, please call Lettie Webb at 510-656-6393 or Bob Coon at 510-794-7988.


Fremont Caregivers

For information regarding the caregiver program in Fremont, please contact Nancy Rothschild, Caregiver Project Coordinator, at (510) 494-4268.


Hollister

Our November speaker was Dorothy Davidson, from Community Relations for “Matched Caregivers.” She brought with her several representatives from Northern California Private Provider Network (NCPPN). She talked about educating seniors on what to take into consideration when getting help for Home Health Care.

The Hollister Support Group meets on the 1st Tuesday of every month, from 1:30 to 3:30 PM, at First Presbyterian Church, 2066 Cienega Road, Hollister.

Please contact John Skinner at 831-637-6755, or Shirley Kennedy at 831- 637-3839.

Deadline for the Jan./Feb. 2004  support group newsletter is Friday, January 9. Articles of contribution must be received by PPSG by the above date. Thanks.


Magnolia-Peninsula

December 11

   Speaker: Daljit Johl, PharmD

   Discussion of Parkinson’s related medications

January 8, 2004

   Speaker: Theo Palmer, PhD

   Asst. Professor of Neurosurgery, Stanford Medical Center

February 12, 2004

   Speaker: Ruth O’Hara, PhD

   Asst. Professor of Psychiatry, Stanford Medical Center

     Will discuss depression and other psychiatric aspects of Parkinson’s

The Magnolia-Peninsula Parkinson’s Support Group meets on the 2nd Thursday of each month, at 1:30 PM, in the West conference room at The Magnolia of Millbrae apartment complex, located at 201 Chadbourne Avenue, corner of Magnolia, Millbrae.

For information call Leon Rosenthal at 650-348-3480.


Marin County

November 25: Donna Schrempp, Family Caregiver Alliance.

No meeting in December.

The Marin Parkinson’s Support Group meets on the 4th Tuesday afternoon of most months, from 2 to 4 PM, at The Redwoods auditorium, 40 Camino Alto, Mill Valley. The telephone number for The Redwoods is 415-383-2741. For information about the meeting, please contact Gloria Rasti, at 415-381-6680.


Monterey

We meet at the S.H.A.R.E Room, at Monterey Adult School, 200 Coe Ave., Seaside. The group meets on the 3rd Monday of the month, from 2:30 to 4:00 PM.

For further information, please call Kathy Warthan at 831-372-7510 or Helen Garrett at 831-657-4241.


Mt. Diablo Parkinson’s Network

Basic meeting: Meets on second Mondays from 11AM 2:30PM at Grace Presbyterian Church, 2100 Tice Valley Blvd., Walnut Creek. The meeting includes a speaker, light lunch, exercise, and discussion groups. Contact Margy Hansell at 925-939-4210.

Early Onset Support Group: Meets on third Saturdays from 10AM – noon at Grace Presbyterian Church, 2100 Tice Valley Blvd., Walnut Creek. Contact Nancy Wall at 510-236-7065, or Philip Wheeler at 510-527-3588.

Caregivers Support Group: Meets on last Wednesdays at Jewel Wallach’s in Rossmoor, Walnut Creek. Call for time and address at 510-236-7065.

Pleasanton Tri-Valley Support Group: Meets on second Saturdays, 10AM – noon at Senior Center, 5353 Sunol Blvd., Pleasanton. Contact Sal Vepa at 925-462-5838.


Oakland

In our December 4 meeting, we are looking forward to having with us Lynn Vail, a nurse practitioner. Lynn has explored alternative medical approaches, including living Native American style for seven years, learning their healing practices.

Because the first Thursday of January 2004 is on New Year’s Day, we will meet on January 8. We are pleased that we have been promised a staff person of the Parkinson’s Institute in Sunnyvale to tell us about its many research and treatment programs. Our next two meetings are scheduled on: Thursday, December 4, and Thursday, January 8.

For our February 5 meeting, we are pleased to announce that Howard Lunche will lead a period of personal exploration and sharing about the changes brought into our lives by Parkinson’s. Mr. Lunche is a licensed clinical social worker with many years of experience in dealing with hospice care and facing loss.

The Oakland Support Group meets on the 1st Thursday of the month, from 1:30 to 3:30 PM at the Easter Seals Bay Area, 180 Grand Avenue, Suite 300, Oakland.  For further information please call Robert Lemon at 510-526-2078. We thank Pharmacia & Upjohn and Boehringer Ingelheim Pharmaceuticals for their generous support of this meeting.


Palo Alto

On November 12, Elaine Lanier, Clinical Research Manager, San Francisco VA Medical Center and Susan Heath, Clinical Nurse, Specialist in neuro-surgery and movement disorder, came to speak to our group. The topics: non-motor symptoms of Parkinson’s disease, The San Francisco VA Parkinson’s Center, and Deep Brain Stimulation Surgery.

On December 10, the speakers for our meeting are Mwezo Kudumu and Jane Kerr.

The topic: Tai Chi for Parkinson’s

On January 14, 2004, the speaker for our meeting is Patricia Kearney of Stanford Medical Center. Ms. Kearney is a Parkinson’s Nutrition specialist.

The topic: Maximizing Your Health Through Diet

On February 11, 2004, the speaker will be Lynn Fieldstein, a Parkinsonian Advocate.

   The topic: The Politics of Parkinson’s Disease

The Palo Alto Support Group meetings are held on the 2nd Wednesday of the month, from 2:00 to 3:30 PM, at Avenidas (the Palo Alto Senior Center), in the dining room (La Comida), 450 Bryant St., Palo Alto. For meetings information call Linda Chen, at 650-493-9095. For directions, call (650) 326-5362.


Did I say that???

Police in Los Angeles had good luck with a rubbery suspect who just couldn’t control himself during a lineup.

When detectives asked each man in the lineup to repeat the words, “Give me all your money or I’ll shoot,” the man shouted, “that’s not what I said!”


Disclaimer

This document is published to promote a greater awareness of the problems caused by Parkinson’s disease. Neither the Peninsula Parkinson’s Support Groups, Inc., its members and employees, nor the individuals involved in its production make any warranty, express or implied, assume any liability or responsibility for accuracy, completeness, or usefulness of any information or represent that it will not infringe privately owned rights. Mention of any product, material, or service shall not, nor is it intended to, imply approval, disapproval, or fitness for any particular use.


Redwood City

PPAP-Positive People Against Parkinson’s-meets on the 3rd Friday of each month, from 12:30 to 2:00 PM, at Sequoia Health & Wellness Center, 702 Marshall Street, Redwood City. Parking available in the rear. For more information, call the Sequoia Center at 650-367-5998.


Salinas

The Salinas Support Group meets every 4th Wednesday of the month, from 2:00 to 3:30 PM at The Salinas Adult School, 20 Sherwood Place, Salinas. For further information, please call Elaine Viens (new contact), at Delmar Research, 831-424-4359 x 10.


San Francisco

The San Francisco Support Group meets on the third Tuesday of the month, from 2 to 4 PM, at Christ Church Lutheran, 1090 Quintara Street (at 20th Avenue), San Francisco. For more information, call Julie Hevezi at 415-476-9276.


San Jose

Vivian Silva, a social worker, who teaches at San Jose State University on science of dealing with elderly, came to speak to our group in November.

December 6 brings us once again to a great program from the ladies singing group from Willows Senior Center. We all look forward to this every year.

The San Jose Support Group meets on the 1st Friday of the month at St. Francis Episcopal Church, 1205 Pine Avenue, San Jose, between 10:00 and 12:00 noon. Please call Betty Havens at 408-269-2167.


San Jose Caregivers

For our Wednesday, November 27, meeting we are planning to meet at Flames Coffee Shop of San Jose for lunch and discussion, at 12:30 PM. The restaurant is located at 1812 Hillsdale Avenue, San Jose, across from Target, and the cross street is Ross. The phone number of the restaurant is 408-723-8393.

The San Jose Caregivers Support Group usually meets on the 4th Wednesday of the month, from 1:30- 3:30 PM at St. Francis Episcopal Church, 1205 Pine Avenue, San Jose. Please come to the meetings, we can learn from one another! For information, call Dr. Linda Filice at 408-978-2859.


San Mateo Caregivers

The group meets on the 1st Wednesday of the month, from 2:30 to 4:30 PM (new time), Ellsworth Room, 100 San Mateo Drive, San Mateo. Call Mills Health Center, at 800-654-9966.


Santa Cruz

The Santa Cruz Support Group meets on the 1st Wednesday of the month at St. Stephen’s Lutheran Church, 2500 Soquel Avenue, Santa Cruz, from 12:30 to 2:00 PM. For information, please call David Donahoe (new leader) at 831-479-4485.


Saratoga

The Saratoga Support Group meets on the 3rd Tuesday of the month at 19449 Via Real, Saratoga, from 2:00 to 4:00 PM. For information, please call Lois McPherson at 408-867-1807.


Sonoma County

The Sonoma County Support Group meets on the 1st Saturday of the month, except July, September, and January, from 1-3 PM, at YMCA, 1111 College Avenue, Santa Rosa. For information, contact Davis Brown at 707-538-4952.


Sunnyvale

 On November 12, Glenda Cresap, Director, Heart of the Valley, Services for Seniors, Inc., spoke to us about the services available at her organization.

On December 10, specialists at the Wound Care Clinic of O’Connor Hospital, San Jose, will come to talk about wound caring. Also, Marilyn Basham, noted Physical Therapist, who worked at the Parkinson’s Institute, will talk to us on tips about getting mobile.

The Sunnyvale Support Group meets on the 2nd Wednesday of the month between 1:00 and 3:00 PM at the First United Methodist Church, 535 Old San Francisco Road, Sunnyvale. For information, please call Dr. Linda Filice at 408-978-2859.


Tulare-Kings (formerly Visalia)

The Tulare-Kings group meets on the 1st Friday of the month, at 10:00 AM, at Visalia United Methodist Church, 5200 W. Caldwell Avenue, Visalia, CA 93277.

 For more information, please contact Mary Dickerson (new leader), at 559-622-9044.

Newly Diagnosed?  Have Questions?  Need Help?

Come Join Us!

By Davis Brown


Sonoma County Parkinson’s

Support Group

Outreach/Programs/General Info: Sue Croel (707) 544-5151

Group Facilitator:  Davis Brown (707) 538-4952

The Parkinson’s Support Group of Sonoma County (PSG-SC) meets from 1:00 to 3:00 pm on the first Saturday of each month (except January, July, and September). Until recently the group has met for many years at the Santa Rosa Family YMCA. However, because of its own membership growth, the Y cannot regularly provide a second room to support our Group’s new meeting format, i.e., one hour all together for a program (speaker, Q&A, etc.), and one hour split into two informal groups. Caregivers adjourn to an adjacent room or space to discuss among themselves topics of current concern, while the People with Parkinsons (PWPs) remain in the main meeting room to share recent experiences, ask questions, and discuss the various individual paths along which PD has been leading. This “split” hour may come before or after the program hour. To learn beforehand the program and/or format for a particular meeting, call our Programs and Outreach Coordinator, Sue Croel, (707) 544-5151. (Our members are notified by e-mail or phone call the week before each meeting.)

Near-Future Meeting Places and Programs (ALL IN SANTA ROSA) are:

Saturday, Dec 6, 2003 - Integrative Medical Clinic, 175 Concourse Blvd @ Airport Blvd

    HOLIDAYS PARTY (ok to bring goodies)!  Briefings & Facilities Tour by IMC staff

Saturday,  Jan 3. 2004 -  NO MEETING  — HAPPY NEW YEAR!!

Saturday, Feb 7. 2004 -  First Methodist Church, 1551 Montogomery Dr (Fellowship Hall)

    SPEAKER:  Elise Stone (Speech Therapist at Queen of the Valley Hospital, Napa)

Under our umbrella, smaller “Sub-Groups” also meet around Sonoma County:

All are welcome; please call ahead to confirm time / locations—phones are area code (707)]

Oakmont and Surrounding Area: 3rd Saturday monthly — June & Bill Court (539-9135)

Cotati/Rohnert Pk/Sonoma State: 3rd Saturday monthly — Wes & Louise Ebert (795-6520)

Larkfield/Windsor/North Area:  2nd Saturday monthly — Bill & Jeri Wylie (544-5329) and

Jean & Bud Suitor (546-4012)

West Santa Rosa/County Area:  (currently dormant) — Dorothea/Gene Rowden (579-4740)

Men’s Breakfast Club @ IHOP:   Every other Fri (8:30) — Bill Court (539-9135)

Mil Veterans & Civil Aviation:    (under development)    Davis Brown (538-4952)

Highlights of recent Sonoma County PSG meetings:

Our October meeting (last at the Y?) became very special when we had a surprise visit from Joan Samuelson, founder and president of the Parkinson’s Action Network (PAN). Joan lives in Healdsburg and has been a member of our support group for many years, even though her schedule rarely allows her to attend our meetings.  Arriving during our “split hour,” Joan visited informally with each group, where she explained PAN’s current advocacy efforts and answered many questions, both about PAN and about her own “travels with PD” over the past 16 years. Earlier, before Joan’s arrival, one of our newer members, Frank Crabbe, gave us a short briefing on his recent Deep Brain Stimulation implant surgery at Kaiser Sacramento. He felt so good within a day after the operation, said Frank, that literally on his way home from the hospital, with his head still swathed in bandages, he asked his wife Shirley to stop as they passed Oakmont so he could “show and tell” his experience to our PSG sub-group — which by chance was meeting then. (Postscript:  Shortly before our November meeting, Frank returned to Sacramento to get his system “turned on.” Since then he estimates he’s regained a remarkable 70% of his pre-PD functionality — and hopes for even more after going back again later in the month for “fine tuning.”  Not only does Frank promise to give us ongoing reports, he also has volunteered to participate on both our PSG Steering Committee and the North Bay Support Center Working Group!  Way to go, Frank!  We look forward to your continuing contributions, enthusiasm, and positive attitude!!

In November,  for our first meeting away from the Y, we met at the Brighton Gardens Assisted Living Community.  This location was chosen to honor Bud Davis, an early member and previous Facilitator of our Support Group, who now lives at “The Gardens.” We were most pleased to have Bud’s wife and sister join in our recognition of his past service. The overflow crowd of 50-60 members wished Bud continued success in his transition from “Pilot in Command” to “(Wheel) Chairman of Brighton!” Our first hour then continued with a short presentation on the local Friends’ House Adult Day Care program and a progress report regarding our ongoing efforts to develop a North Bay Parkinson’s Support Center. (The first potential element of that Center, up and running since last spring, is a special Exercise Class for PWPs every Thursday noon at Memorial Hospital Sotoyome Campus. THEY NEED MORE PARTICIPANTS!  It’s a fun hour and most beneficial; call Barbara at (707) 543-2571 to join.)  A break to sample the excellent Brighton-furnished refreshments then preceded our “split” period.  Finally, we reassembled for the climax to our afternoon — a conducted tour of Brighton’s various assisted living residential apartments, nursing accommodations, and other most-attractive facilities. Our thanks to all the Brighton staff for hosting us so well!


Turlock

The Turlock Support Group meets on the 1st Thursday of the month, from 2-3 PM at Emanuel Hospital, Delbon Street, Turlock. For further information, please call Marion Johnson at 209-634-3157 or Jean Okuye at 209-394-2421.


YOPD

 (for patients under age 50)

The group meets in the Board Room of Lucile Packard Children’s Hospital, at 725 Welch Road, Palo Alto, CA, on  2nd Tuesday of every month, from 6:30 to 8 PM.

   For information, please call Bill Lev at 831-662-3825.


YPSG

Our October meeting featured Lynn Fielder’s mom, Sonia Erickson, who gave a delightful and informative talk  on Informed Consent. She even brought the necessary forms to ensure that one’s final wishes be carried out, whether or not the person wants o be kept alive.

Well, on November 8 we moved to what we hope will be our new permanent meeting place, the United Methodist Church of Los Altos. We meet in the Live Oak Room.

We’ve rented a half dozen Saint Bernards to find you if you ever get lost. These are very motivated dogs. They might even find you if you don’t get lost.

The Young Parkinson’s Support Group meets on the 2nd Saturday of the month, between 10:00 AM and 12:00 noon at the Live Oak Room, at United Methodist Church of Los Altos, Foothill Expressway and Magdalena Avenue, Los Altos. For information, contact Rich Brongel at 650-952-3849, or rbrongel@ccsf.edu


Joan’s Famous Mashed Potatoes

By Joan Sullentrop

Can use instant potatoes.

Use the amount according to the box.

For 16 people use 3 eggs; for 8 people use 1 egg.

For 16 use 1 onion chopped; for 8 use 1/4 onion chopped.

Use 2 Tbs of flour for either number of people.

For 16 people use 8 oz softened cream cheese.

For 8 people use 3 oz softened cream cheese.

Mix all ingredients and put in buttered casserole dish.

Heat 1 hour at 350 degrees.

May be made ahead of time and placed in refrigerator, then

take out 1/2 hour before putting in the oven.

 

Joan made this delicious mashed potatoes at the Sunnyvale support group’s Christmas Party last year. She and her husband, Fred, are members of the Sunnyvale support group. Fred was diagnosed with PSP (Progressive Supranuclear Palsy). Joan was a Microbiologist and worked in the lab, and Fred worked as a Mechanical/Chemical/Aeronautical Engineer. The Sullentrops attend exercises designed for Parkinson’s patients at the new Sunnyvale Senior Center on Tuesdays and Thursdays, as well as the classes at De Anza College, Cupertino.

During summer and winter breaks of the exercise classes, Joan and other volunteers take turns leading fellow exercise classmates in a local park, in order to keep everyone in shape. This summer, Joan even made a special effort to keep the usual classroom at the Senior Center available, so that the class could continue during the break. Thanks so much Joan.