This evening as I was looking through the web for some inspiration for a Hospital Impact blog, I came across a description of a wonderful health care experience.  It was so much fun that I wanted to share it locally, too.

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It was a beautiful, spring morning, and I had just "Gotten My Fix on Route 56" . . . (Well, it was actually a Chai tea from Eat n Park), but, nevertheless, my 90,000+ mile Jeep at that time was less than five minutes from work, just past the cell phone dead zone that I lovingly refer to as Radio Free Windber, when it rang.  On that particular Treo, my first of five, the caller’s personalized ring was a jazz piece that I had down loaded from the web.  Because of the jazz ditty, I Immediately knew that it was Zane, the 78 (now 80) year old, former Publicist for the Pittsburgh Symphony. Zane was living in Columbia, South Carolina, and his first words to me at 7:15 that morning were, "Hey, why aren’t you blogging?" 

To this day he denies ever calling or saying this to me, but that’s how it happened.  You can’t begin to make these kinds of things up.

Now don’t get me wrong, I knew a little bit about blogging from listening to the grand kid’s Ya Ya saying very bad things every time she watched television and her personal favorite politicians didn’t come on, didn’t win a debate or didn’t give the correct answer when it came to the economy, funding the war or world diplomacy.  She actually had informed me about the popularity of some Blogs/weblogs, currently being written about, you guessed it, politics. 

"Why?"  I said to Zane.  "I don’t know why.  Sounds like a great idea.  I’ll do it." 

A few minutes later I was on the phone with "Web Man, my personal super web hero," a professional webmaster with whom I had been working for the past half dozen years or so, Mike Russell.  Mike was responsible for helping us create a website or three, and, if anyone knew about blogging, it would be Mike.

Later that weekend, I started a hospital blog.  It was called Windberblog, but Mike also named it "Nick’s Blog."  In fact, it was the first hospital blog written by a CEO in the world.  If you’re reading this for the first time, don’t be shocked.  Hospital dudes are generally not real fond of risk taking, at least the 3,573 others with whom I have networked at one time or another.  Leading the pack in innovation is usually not a great love of theirs. 

When I tell you that this blog was hospital based, it was.  When I say it was board endorsed?  Well, that’s another story.  That didn’t happen.  In fact, it never really officially happened.  Some of my board members discovered it and liked it, but, for the most part, it’s an older group, that doesn’t hang out much online. Sometimes, it’s just better to ask for forgiveness than permission.

It actually wasn’t until I started writing funny and controversial things that it became internally well known.  Once after spending an entire week-end composing a very objective description of an upcoming major decision making process, my board chair received a call from a business leader suggesting that he fire me before I was sued, but, thank goodness, nothing was on that blog that made me particularly sue-able.  Yes, it was transparent, but that’s the part I love about this new world order. 

So, there is some little risk to this adventure.

After several months, a young Cornell grad by the name of Tony Chen, sent me an e-mail and invited me to become a guest blogger on his Hospital Impact blog at hospitalimpact.org.  At that time Tony was a very erudite young employee of HFMA, and the blog was intended to reach out to hospital leaders in order to give them hints on "how to be the best run hospital in the world."  That blog became my national philosophy soapbox.  It also gave me a chance to spout off about "Planetree," an international organization dedicated to the demystification of health care.  We actually considered calling it Windbercare at Windber, and, in fact, that is now what we do call it  . . . currently under the Planetree umbrella.

It was almost a year later that Mike Russell suggested something called "YouTube."  After about one weekend of exploring that site, we began transferring our advertisements, videos and speeches there.  That went on until we had approximately 15 or so samples of our work under the moniker of Windbercare.  (Is moniker a word?)

It was about the same time that Toby Bloomberg from Diva Marketing contacted me via e-mail for an interview that she ran on her blog, then Bob Coffield’s Health law blog, Trusted MD, HIStalk and several other bloggers linked to us and began to recognize our work and interact with us.  We were invited to speak in Washington, Las Vegas and now Chicago regarding blogging, and word of our work began to spread in other directions as well with podcasts from HealthLeaders and others. 

A new, local weekly newspaper invited me to write a comedy column for them.  Yes, it was gratis, but they let me tag it with our windberblog info, and hits on Windbercare and Nick’s Blog, began to grow as my popularity soared as a local folk hero for these fun, baby boomer, kid-raising, memories at ourtownonline.biz under Nick Jacobs.

That, of course led to some of my blogs being picked up by Blue H News, an industry newspaper that goes to every hospital, except ours . . . but I’m sure it’s an oversight.  George Page, the editor liked my stuff and only rejects about 50% of what I write.  Hospital News of Western PA, Atlanta, Chicago and South Florida began accepting my submissions and I became a regular contributor there.  The Johnstown Tribune Democrat  has begun to print my weekly business-oriented articles, and Tony got me a gig writing for the Worldhealthcareblog.org website that is managed by Hylton and Francois. That’s my international soapbox. 

Two weeks ago Tony also got me hooked on Facebook.com.  That’s been just for fun . . . so far.

Long story long?  This stuff works.  Although it would be misleading to give full and complete credit to the blog, it sure has helped to elevate knowledge about our organization.  Paul Levy of Beth Deaconess does his own blog now and is a CEO.  The difference between Paul and me is that it is his personal blog, and he is living in a big city, my continuous fantasy. 

Someday, maybe someone will pay me to write this stuff, or we’ll get sponsors, but it has been a real trip into Web 2.0, social networking.  I haven’t felt this good about myself since I played trumpet for a living.  As they used to say back in the 60′s,"It”s hip to be cool." 

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Quote from Imelda Marcos: “Doesn’t the fight for survival also justify swindle and theft? In self defense, anything goes.”

Quote from Nick Jacobs: "Gosh, I hope not!"

So much of what we are experiencing everyday feels a little uncomfortable . . .

This is not a political blog.  It is not intended to be.  It is intended, however, to encourage you to explore the real vs. the perceived.  It is intended to point out things that have been bothering me for quite some time as a human being. 

Windber is a Planetree facility.  That means that we embrace the concept of body, mind and spirit; the demystification of healthcare; the concept of not leaving your dignity at the door.  We call it WindbercareTM. Some of our competitors would have you believe that whatever they say they do creates a special center for healing.  We say: come here, then go somewhere else, and feel the difference.

We have a multiple slice PET/CT scanner.  If you’re a lay person, that probably means almost nothing to you.  It’s technical. a PET scanner is one diagnostic machine, and a CAT scanner is another piece of diagnostic  equipment. Combined, they become an extremely powerful tool.  As an FYI, a multiple-slice CT scanner is not the same tool as a PET/CT.  At least for now, Windber Medical Center is the only PET/CT available for many miles around.

How about a three-Tesla MRI?  What is that?  It is a magnet for an MRI that is twice as powerful as any magnet in this area.  Twice as powerful. Here numbers really do count.  So who cares?  Anyone who needs an MRI scan should care.  It is twice as dynamic as a 1.5 T magnet, the standard magnet available in this area.  Brain scans and breast scans are phenomenal on this piece of equipment.  In fact, we have brain surgeons from Pittsburgh and physicians from Johns Hopkins in Maryland who send their patients to Windber.  The University of Pittsburgh has two magnets like this, West Virginia University has one… and the only other one in this part of the country is here in Windber.

On that same note, what is an open MRI?  It is a piece of equipment that has been developed for people who are anxious, obese or who want an examination of small parts of the body.  The major difference for the patient is that there is no tunnel, the device does not surround the patient being tested. By comparison, even a large bore MRI is NOT open.  To my knowledge, the closest open MRI in this area is in Indiana, PA.

Our infection rate at Windber Medical Center is less than 1%. Try that on for size. If you come to Windber for surgery, there is better than a 99% chance that you won’t get a hospital borne infection. Ask our competitors what their infection rates are. Then make a decision. Your life could depend on it.

Finally, the physician who says to you, "We can only do this surgery at ANOTHER hospital because they are the only ones with the equipment necessary for me to do this work," often times is not telling you, the patient, the entire truth.  There are only a small percentage of procedures that cannot be done at Windber Medical Center.  As is the case in most hospitals, if need be, the factory representatives will actually bring equipment directly to us for specific specialty surgeries, but most of the time when we track back that physician excuse, we find out that all of the equipment was already here. 

The real excuse is "If I don’t do a certain number of surgeries at a competitive hospital, I will no longer have a block of time for my other surgeries. It is a use it or lose it philosophy imposed upon them by larger facilities. Consequently, the physician says, "I’ll tell you that they don’t have the proper equipment," and what he doesn’t say is, "I’ll do that in order to preserve my block elsewhere."

The little secret seems to be… "In self defense, anything goes.”  So, ask, and don’t always assume that the answer is not just better for your health. Because, sometimes, it’s just better for their business.

Okay, I feel a little better now that you know.

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Sir Winston Churchill said, "There is something about the outside of a horse that is good for the inside of a man."   

This week-end something wonderful happened . . . the coming together of people from all geographies, all walks of life, all areas of interest.  They came together for one wonderful thing, to help Windber Regional Hospice.  Now, some of you may be wondering what they did, but back up a few lines and read Sir Winston’s quote.  It was the horse show, you know…Pole Bending, Box Keyhole, 50 Yard Dash, Flag Race, Hay Bale Tunnel, Dollar Bareback.

The Greater Johnstown Saddle Club and Golden Star Horse Farm came together once again to raise money for the patients cared for in our palliative care unit and hospice.  The cumulative sum needed each year to cover the costs of the efforts in these two areas is generally over $300,000 and this weekend, thousands of dollars were raised toward this need. Thanks to efforts like this one, neither those who can or those who can’t afford it will ever know the difference in their care and treatment.

As in the movie "Casablanca," our own Frankie Bock and her team generated the list of usual suspects to make this all happen. The list went something like this: our donors, sponsors, patrons, show participants, friends, staff of both the Hospice and Medical Center, businesses, and the greatest volunteers anywhere.  If you have no idea who is represented by this list, simply stop by any function touched by the hospice and you will see these faces, hundreds of faces, who make up that list of volunteers, supporters, and sponsors.  It’s a wonderful list of truly amazing people, all geared toward one goal, helping families who need hospice care.

One of our non-hospice employees walked up to me with a pretty, fifteen year old girl and said, "Nick, I would like you to meet Lori, her mom passed away in hospice. I just wanted to bring her here today."  That’s what we’re dealing with: people who care about their fellow human beings.

As my grandson walked up to the show area to look at the horses, a non-Windber physician came up to me with the tallest horse I’d ever seen and said, "If he’d like a ride, I’d be happy to let him ride my horse for the judging."  He, along with a few dozen other kids, won a trophy, and that trophy never left his hand the rest of the day.  People taking care of people.  People reaching out, sharing, working to help other people.

There was food, plenty of food. There was plenty of great food, prepared, sold and served by this group of wonderful volunteers.  There were children’s games and activities, a Chinese auction and drawings. It was people caring for people: feeding them, nurturing them, watching out for their human, physical needs.

One of the baskets that was being raffled was called a kid’s basket and in it was grooming equipment; brushes, oils and other wonderful accoutrements for grooming horses; for teaching care and nurturing at a very young age.  Groom a horse, love one of the creatures of the universe, and the universe will teach you to pass that love onto others.

It’s all about kindness.  It’s all about giving because in giving we receive. Saint Francis of Assisi once said, "Preach the gospel at all times. When necessary, use words.”   This group of usual suspects live those words as they care for each others, for their patients, their friends, their loved ones.  Hospice is amazing, and unless or until this country understands completely the beauty of this program, we will continue to suffer death in hospital rooms crowded together without support, without nurturing, without love.

From our Hospice physician, Dr. Kelly Warshal…

"So now, after a few days with us, I am sending the patient home on nothing, no drugs, nothing but our own hospice blend of flower essences like angel’s trumpet to help to prepare him for the transition into the spiritual world. He is talking, blowing us kisses, and eating pudding.  I LOVE MY JOB!”

Become a Windber Hospice volunteer. You’ll love your job, too.

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“Everybody wants to go to heaven, but no body wants to die.”  That’s what Jim’s dad, Carl, used to say on Thursdays in the 1970′s when we looked to him for his wisdom and advice.  Actually, he used to say it when we were complaining about how hard it was to accomplish something.  It’s funny, but applies to so many areas of our life.

Creating the future, or at least creating a positive future, is something that everyone wants, but when it’s time to step out and make it happen, it’s a good idea not to stop and look behind you, because, usually, there’s a very short line of risk takers standing there with you.

John F. Kennedy used to refer to the Irish writer, Frank O’Connor, who wrote about his childhood and about the early formation of his risk taking philosophy by saying, “He and his friends would make their way across the countryside and when they came to an orchard wall that seemed too high, too doubtful to try and too difficult to permit their voyage to continue, they took off their hats and tossed them over the wall, and then they had no choice but to follow them.”

It was Henry Ford who said, “If you think you can, you’re right.  If you think you can’t, you’re right.”

As an organization, we are facing our future head on.  We must re-invent ourselves on a daily, weekly and monthly basis.  Business as usual will not cut it here anymore.

Only through our creativity, our persistence, our desire to succeed . . . only through throwing our hats over the wall, putting a stake in the ground, taking a stand and being there for our patients, our physicians, our partners and our loved ones can we be successful.

Dream our future as an International Center of Excellence, and dream individually of our new centers of excellence, the ones that you will work to create.  Then, create and support them.

We’re only in a competition with ourselves, and we are not the enemy.  Let’s start each morning by saying, “If we think we can, we’re right,” because, as Ralph Waldo Emerson said, “A Hero is no braver than an ordinary man, but he is braver five minutes longer.”

Be brave.  Focus on a positive future and it will be ours!

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This e-mail arrived this morning from a friend:

“Well, I have been back to the doctor and the surgeon. They can’t put in a stent because my arteries are too small. They want to do compression wraps for seven weeks which should cause new arteries to grow. Well, the co-pay for each treatment is $40 which adds up to $200 a week. The simple answer is that we don’t have the money. I figured out that next year, when I can start collecting social security, a whole $300 a month, I can save up $1400 and have it done then. Of course, it will probably cost more then. I just wanted to keep you updated and thank you for your prayers.”

In my position as President of both a medical center and research institute, it is obvious to me that filmmaker Michael Moore’s new movie, Sicko, has, in many ways, nailed it. It deals with this country’s health issues. We live in an incredibly prosperous country, but it is a one that has never had a health policy. Many of us in this profession believe that it is unconscionable that we have an estimated 45 million uninsured individuals in our country, and that number does not even include the underinsured.

We are also placed in the uncomfortable position of observing on a daily basis the absurdity of squandering 30 percent of our health care dollars on the last thirty days of life when, in many cases, palliative care is available as the intelligent alternative.

As a profession, we are also sensitive to the fact that the segment of the population that is most negatively impacted by this existing system is a group that does not have political clout; single mothers and their children. More than 8 million children had no health insurance in 2005, according to the latest federal report on the well being of U.S. children. Children who were uninsured were nearly 16 times as likely as those with private insurance to have no ongoing source of care.

Of course, Moore neglects to mention the failures of the Canadian system, or the challenges of paying for a single payer system. He also doesn’t spend much time talking about the single-digit percentage of our nearly $2 TRILLION in health care expenditures that are dedicated to preventative medicine, but, nevertheless, his reality is largely the truth.

So, as the challenge continues, we in health care administration are busy re-arranging the deck chairs while our Federal officials continue to mark time and the uninsured wait hour after hour to be seen and treated in our over crowded emergency rooms, the part of our system that is strained to the breaking point. These people are OUR people, and they need to be treated as human beings, not as cost centers.

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When the crawl moves across your television screen, and you hear a dull, duck-like buzzer sound coming from the speakers, it’s a signal to look up to see where the severe weather —tornados, floods or blizzard conditions— will be hitting next. The National Weather Service lets us know when it’s coming… minute by minute.

On the 4th of July, we rode around the Allegheny River on my kid’s boat as I checked moving radar maps on my cell phone, but as a kid, we weren’t so well tuned in, and we were more dependent on our instincts.

In a discussion with one of my board members today, as I described some inclement weather of sorts that was approaching, he laughed and said, "But before I go after those varmints, I’m gonna sing you this song."

At first I hesitated and was a little concerned that he had lost it until I asked, "Gene Autry?" "Yep," he said, "He’d jump on his horse and say those famous words." For those of you who are half a century too young to know who that was, Google Gene Autry. He was a famous movie, radio and television cowboy who looked a little like my Uncle Bill… or anyone’s Uncle Bill, for that matter.

A review of one his movies described this scene: "There was a bust-up-the-joint fight and a furious stagecoach chase at the end, and then Gene sings the title song When the Bloom Is On the Sage." Yes sir, that about sums it up: Punch ‘em out, shoot ‘em up… and then sing. Those were the days when macho-manhood and the arts worked well together. Now, our society is all about bust-up-the-joint and take no prisoners. We see it everyday in all aspects of life. The unspoken rules have become really unspoken and, in most cases, completely ignored. The lines of ethical consideration are so blurred they remind you of a child’s finger painting efforts. What ever happened to Rules of Civility?

Well, we are not in a position to discuss varmints here, but we are in a position to discuss the challenges of inclement weather. It’s something that we all need to prepare for… because we know it’s just a matter of time until the blue clouds move away and the thunder heads move in from the West.

It’s not enough to have a flashlight, batteries and candles ready. You need to have a commitment. Thirty years ago when the Johnstown Flood hit, I was a volunteer. I worked at first aid centers and shelters for the first few days and then moved into the ugly volunteer job of cleaning up mud and debris.

Well, that experience has made me mindful of the forces that surround us on this earth and has helped me to realize that they can reap great havoc on our existence, and, like the flood, are capable of wiping out our possessions. But the reason that we are still here was not because of our stuff, it was because of our spirit, our willingness to stick with it, and our commitment to creating a future that will be better than our past.

Of course, there will always be varmints and thunderheads, and all forms of pestilence that can be brought down on us, but we need to smile, look directly ahead, and prove that we have the power, the will and the determination to withstand anything that is thrown our way. That’s what made it all work in ’77: attitude. If we get knocked down, we get back up, dust ourselves off, and get on that horse again.

Like Gene used to profess:

I’m Back in the Saddle Again
Out where a friend is a friend
Where the longhorn cattle feed
On the lowly gypsum weed
Back in the saddle again

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Sometimes, when I am dealing with my human frailties —the comb over, the slight paunch or the aching back— I wish that I could have the wisdom of Yoda from Star Wars.  He’s green, kind of scaly, with three fingers on each hand, and surely not a candidate for GQ in his hooded robe, but he’s sooooooooo smart and together that none of that matters to him or anyone else.  I’m not sure how he does with the ladies, but I’m guessing that they overlook his appearance to share in his wisdom.

Because I’m not yet in a position to share deep wisdom or secrets with anyone about anything, let me quote a passage from one of Yoda’s scenes where he describes the journey ahead for his young student, Anakin Skywalker:

YODA: Good, good, young one. How feel you?
ANAKIN: Cold, master.
YODA: Afraid are you?
ANAKIN: No, sir…
YODA: See through you, we can…
ANAKIN: (a little angry) What’s that got to do with anything?
YODA: Eveything. Fear is the path to the dark side… fear leads to anger… anger leads to hate…hate leads to suffering.
ANAKIN: (angrily) I am not afraid!
YODA: A patient-centered health care professional must have the deepest commitment, the most serious mind. I sense much fear in you.
ANAKIN: (quietly) I am not afraid.
YODA: Then continue, we will.

Continue we will indeed, and the future will be everything positive that we decide to make of it.  There is a book or CD called “The Secret” that is flying through the hospital right now, and the secret to the secret is what we all know it to be.  Common sense that is all too frequently uncommon. If you are positive, think positively, work toward good endings, surround yourself with positive people, avoid even thinking about negative situations and keep focused on your goals, you will be embraced by the positive because fear is the path to the dark side, and the truth is, everything we have achieved, accomplished, and completed has been from a spirit of positive commitment.

Watch the movie  Seabiscuit again, or the Miracle on Ice, the tale of the 1980 U.S. Olympic Hockey Team or  The Little Engine That Could. Read about the winners in history.  What you will see is that we are guided by universal laws:  The Law of Intentions states that Your Intentions Will Be Fulfilled.  The Law of Manifestations states that You Will Manifest What You Imagine, but remember the Law of Actions because You Must Act Upon Your Intentions.

My brother constantly talks about what he is going to do when he hits the lottery, and when I ask him the key question, “Did you buy a ticket?”  He always say, “No, I forgot, but when I do…”   Remember, you must play to win.  I had a priest in high school who, in reference to the Catholic sacrament of confession, used to jokingly say, “Remember, you must sin in order to be forgiven.”

Will we make mistakes?  Yep.  Will we hit speed bumps?  Of course.  But will we prevail?  If we focus, stay positive, and realize that we are A TEAM, we can and will prevail.

We need to imagine that all of our dreams have come true.  Imagine that our future will be exactly what we have dreamed of, then move toward those goals, act upon those goals, and your/our intentions will be fulfilled.

As song writer Johnny Mercer, wrote in his lyrics for the 1944 Bing Crosby movie,  Here Come The Waves, “You’ve got to accentuate the positive… Eliminate the negative… Latch on to the affirmative. Don’t mess with Mister In-Between.”

The future is ours.

“May The Force Be With You.”

Yoda Jacobs

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Have any of you noticed how bad customer service has become in recent years?  It is absolutely inconceivable when you place an order for three things and all three are incorrect and/or incomplete.  It’s unconscionable, but, unfortunately, more and more it is becoming a daily reality in our lives. 

Most of these problems seem to have been created by individuals who suffer from a very common disorder, the delusion of adequacy.  It is difficult to explain to people that this state exists; in fact, we Baby Boomers may have unwittingly contributed to it through our child rearing experiments. 

The everyone gets a trophy syndrome was intended to ensure that no child was made to feel like a loser.  A noble experiment intended to produce happiness all around. The problem was, everyone felt like a winner  . . . even when they weren’t, and now we are all suffering from it because, like it or not, there are hundreds of thousands of people who have not honed their skills, not adequately practiced their craft, not developed their knowledge base who, worst of all, go blindly through life believing that they rock.  Heck, they have the trophies to prove it! 

This delusional state doesn’t just exist with kids.  Unfortunately, many adults have their trophy rooms filled with decorative examples of their prowess, yet they can’t write a complete sentence, finish a job on time or ?and this is especially difficult ?are incapable of introspection and blame everyone else for their shortcomings.  Delusions of adequacy.

This is not intended to be a scathing indictment of all of mankind, but it is just pointing out a challenging situation that is becoming more difficult for managers and leaders everywhere.  How do you get six sigma results if the people that you need to do the job have determined that two and a half sigma is perfectly okay. 

Maybe, just maybe, we should let people know when it’s not working.  Maybe we have been politically correct for too long.  Maybe we should stand up for ourselves and demand better service, better products or better care . . . or maybe we need to take a nap, chill out and learn to be more accepting of this condition because it sure doesn’t seem to be going away.

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On the Beach . . . no, not the famous book by Nevil Shute about the world slowly dying from the effects of an atomic war.  My version of on the beach is about the next four days of my life.  Actually, it’s about the lives of 22 people, most of whom I don’t really know or have only seen a few times, living under one BIG ROOF at the beach. This house is so big, it even has an elevator, and because you split the rent 22 ways, on a per person basis, it works out to about the same as a seven day stay at the Comfort Inn.

The trip started out a little rough when the four year old got a fever.  We got him checked out and then started him on antibiotics for strep throat, but that quickly caused lower GI distress.  Because there are four babies here, there is great fear and trepidation that the disease will spread and wipe out the youth of Australia. No, sorry, that was On the Beach, the book again.

Kids are running everywhere, I’ve been on the phone and e-mail now since about 9 AM dealing with ISSUES, and, on Monday afternoon, I get to jump into the car, drive half a day and head back to Washington D.C./Frederick for an all day meeting Tuesday with the scientific leadership from Ft. Detrick.  Then I get to spend the rest of the afternoon with our attorneys and head back to Windber for a board meeting or two dealing with SPECIAL ISSUES.  (Someday, I’ll be able to write about the Special Issues thing, but for now…)

Okay, okay, it’s not a real restful vacation, but, at least I don’t have to go deep sea fishing for Father’s Day with the other Dads.  We did that about 26 years ago and I threw up things I had eaten in First Grade.

Back at the hospital, babies are everywhere, our surgery suites are booming, anesthesiology and the OB nurses are going bonkers from the patient load, the accounting staff is dealing with lots of auditors ( just cause it’s time of the year) and we are heading toward a whole new fiscal year and $45M of new challenges.

So, unless I find a tanning booth, it looks like I’m going to remain pasty white and pleasantly plump as I watch the sun set over the Atlantic Ocean from the windows of Seasar’s Palace, our zillion dollar home away from home.

What was that I just heard?  Oh, it was the sound of a cold beer calling me.  “I’m here, . . .   Over here.”  Gosh, I miss the mountains, deer and work . . . NOT.

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