0:00:00.801,0:00:04.676
What if I told you[br]there was a new technology

0:00:04.700,0:00:09.268
that, when placed in the hands[br]of doctors and nurses,

0:00:09.292,0:00:14.435
improved outcomes for children[br]and adults, patients of all ages;

0:00:15.491,0:00:18.034
reduced pain and suffering,

0:00:18.058,0:00:21.247
reduced time in the operating rooms,

0:00:21.271,0:00:24.124
reduced anesthetic times,

0:00:24.148,0:00:26.046
had the ultimate dose-response curve

0:00:26.070,0:00:27.816
that the more you did it,

0:00:27.840,0:00:30.162
the better it benefitted patients?

0:00:31.340,0:00:33.742
Here's a kicker: it has no side effects,

0:00:33.766,0:00:36.783
and it's available no matter[br]where care is delivered.

0:00:37.505,0:00:40.947
I can tell you as an ICU doctor[br]at Boston Children's Hospital,

0:00:40.971,0:00:43.278
this would be a game changer for me.

0:00:43.302,0:00:47.935
That technology is lifelike rehearsal.

0:00:48.713,0:00:53.259
This lifelike rehearsal is being delivered[br]through medical simulation.

0:00:53.891,0:00:57.892
I thought I would start with a case,

0:00:57.916,0:01:00.626
just to really describe[br]the challenge ahead,

0:01:00.650,0:01:04.021
and why this technology is not just[br]going to improve health care

0:01:04.045,0:01:06.735
but why it's critical to health care.

0:01:07.568,0:01:10.441
This is a child that's born, young girl.

0:01:10.465,0:01:12.225
"Day of life zero," we call it,

0:01:12.249,0:01:14.548
the first day of life,[br]just born into the world.

0:01:14.572,0:01:15.963
And just as she's being born,

0:01:15.987,0:01:18.419
we notice very quickly[br]that she is deteriorating.

0:01:18.939,0:01:21.852
Her heart rate is going up,[br]her blood pressure is going down,

0:01:21.876,0:01:23.518
she's breathing very, very fast.

0:01:24.277,0:01:29.179
And the reason for this[br]is displayed in this chest X-ray.

0:01:29.203,0:01:30.514
That's called a babygram,

0:01:30.538,0:01:33.812
a full X-ray of a child's body,[br]a little infant's body.

0:01:33.836,0:01:35.742
As you look on the top side of this,

0:01:35.766,0:01:38.249
that's where the heart and lungs[br]are supposed to be.

0:01:38.273,0:01:41.050
As you look at the bottom end,[br]that's where the abdomen is,

0:01:41.074,0:01:43.496
and that's where the intestines[br]are supposed to be.

0:01:43.520,0:01:46.249
And you can see how[br]there's sort of that translucent area

0:01:46.273,0:01:49.444
that made its way up into the right side[br]of this child's chest.

0:01:49.468,0:01:53.476
And those are the intestines --[br]in the wrong place.

0:01:53.500,0:01:55.670
As a result, they're pushing on the lungs

0:01:55.694,0:01:58.665
and making it very difficult[br]for this poor baby to breathe.

0:01:59.218,0:02:00.711
The fix for this problem

0:02:00.735,0:02:03.389
is to take this child immediately[br]to the operating room,

0:02:03.413,0:02:05.544
bring those intestines[br]back into the abdomen,

0:02:05.568,0:02:06.983
let the lungs expand

0:02:07.007,0:02:08.888
and allow this child to breathe again.

0:02:09.487,0:02:11.546
But before she can go[br]to the operating room,

0:02:11.570,0:02:14.862
she must get whisked away[br]to the ICU, where I work.

0:02:14.886,0:02:16.754
I work with surgical teams.

0:02:16.778,0:02:18.080
We gather around her,

0:02:18.104,0:02:22.205
and we place this child[br]on heart-lung bypass.

0:02:23.596,0:02:25.217
We put her to sleep,

0:02:25.241,0:02:27.837
we make a tiny[br]little incision in the neck,

0:02:27.861,0:02:30.999
we place catheters into the major[br]vessels of the neck --

0:02:31.023,0:02:34.717
and I can tell you that these vessels[br]are about the size of a pen,

0:02:34.741,0:02:36.646
the tip of a pen --

0:02:36.670,0:02:38.754
and then we have blood[br]drawn from the body,

0:02:38.778,0:02:41.186
we bring it through a machine,[br]it gets oxygenated,

0:02:41.210,0:02:43.062
and it goes back into the body.

0:02:43.086,0:02:44.662
We save her life,

0:02:44.686,0:02:47.210
and get her safely to the operating room.

0:02:49.050,0:02:50.328
Here's the problem:

0:02:51.872,0:02:53.445
these disorders --

0:02:53.469,0:02:56.758
what is known is congenital[br]diaphragmatic hernia --

0:02:56.782,0:03:00.378
this hole in the diaphragm that has[br]allowed these intestines to sneak up --

0:03:00.402,0:03:02.368
these disorders are rare.

0:03:03.293,0:03:07.118
Even in the best hands in the world,

0:03:07.142,0:03:10.652
there is still a challenge[br]to get the volume --

0:03:10.676,0:03:12.574
the natural volume of these patients --

0:03:12.598,0:03:15.120
in order to get our expertise[br]curve at 100 percent.

0:03:15.144,0:03:17.244
They just don't present that often.

0:03:18.729,0:03:21.635
So how do you make the rare common?

0:03:24.101,0:03:25.398
Here's the other problem:

0:03:26.359,0:03:30.960
in the health care system[br]that I trained for over 20 years,

0:03:30.984,0:03:32.169
what currently exists,

0:03:32.193,0:03:35.137
the model of training is called[br]the apprenticeship model.

0:03:35.161,0:03:37.076
It's been around for centuries.

0:03:37.100,0:03:41.048
It's based on this idea that you see[br]a surgery maybe once,

0:03:41.072,0:03:42.600
maybe several times,

0:03:42.624,0:03:45.414
you then go do that surgery,

0:03:45.438,0:03:48.996
and then ultimately you teach[br]that surgery to the next generation.

0:03:50.442,0:03:53.192
And implicit in this model --

0:03:53.216,0:03:55.390
I don't need to tell you this --

0:03:55.414,0:04:00.371
is that we practice on the very patients[br]that we are delivering care to.

0:04:02.303,0:04:03.982
That's a problem.

0:04:07.276,0:04:09.473
I think there's a better approach.

0:04:09.497,0:04:13.862
Medicine may very well be the last[br]high-stakes industry

0:04:13.886,0:04:16.608
that does not practice prior to game time.

0:04:18.308,0:04:22.490
I want to describe to you a better[br]approach through medical simulation.

0:04:24.319,0:04:27.696
Well, the first thing we did is we went[br]to other high-stakes industries

0:04:27.720,0:04:30.590
that had been using this type[br]of methodology for decades.

0:04:30.614,0:04:32.279
This is nuclear power.

0:04:32.303,0:04:36.344
Nuclear power runs scenarios[br]on a regular basis

0:04:36.368,0:04:39.585
in order to practice[br]what they hope will never occur.

0:04:40.112,0:04:43.960
And as we're all very familiar,[br]the airline industry --

0:04:43.984,0:04:47.281
we all get on planes now,[br]comforted by the idea

0:04:47.305,0:04:53.101
that pilots and crews have trained[br]on simulators much like these,

0:04:53.125,0:04:55.686
training on scenarios[br]that we hope will never occur,

0:04:55.710,0:04:57.890
but we know if they did,

0:04:57.914,0:05:00.427
they would be prepared for the worst.

0:05:00.930,0:05:05.335
In fact, the airline industry has gone[br]as far as to create fuselages

0:05:05.359,0:05:06.902
of simulation environments,

0:05:06.926,0:05:10.167
because of the importance[br]of the team coming together.

0:05:10.813,0:05:13.077
This is an evacuation drill simulator.

0:05:13.706,0:05:17.573
So again, if that ever were to happen,[br]these rare, rare events,

0:05:17.597,0:05:20.887
they're ready to act[br]on the drop of a dime.

0:05:22.886,0:05:28.204
I guess the most compelling for me[br]in some ways is the sports industry --

0:05:28.228,0:05:29.860
arguably high stakes.

0:05:30.473,0:05:33.734
You think about a baseball team:[br]baseball players practice.

0:05:33.758,0:05:36.429
I think it's a beautiful example[br]of progressive training.

0:05:36.453,0:05:39.213
The first thing they do[br]is go out to spring training.

0:05:39.237,0:05:41.501
They go to a spring training camp,

0:05:41.525,0:05:44.044
perhaps a simulator in baseball.

0:05:44.572,0:05:47.614
They're not on the real field,[br]but they're on a simulated field,

0:05:47.638,0:05:49.671
and they're playing in the pregame season.

0:05:49.695,0:05:53.192
Then they make their way to the field[br]during the season games,

0:05:53.216,0:05:56.314
and what's the first thing they do[br]before they start the game?

0:05:56.338,0:06:00.769
They go into the batting cage[br]and do batting practice for hours,

0:06:00.793,0:06:04.124
having different types of pitches[br]being thrown at them,

0:06:04.148,0:06:08.480
hitting ball after ball[br]as they limber their muscles,

0:06:08.504,0:06:10.477
getting ready for the game itself.

0:06:10.501,0:06:13.351
And here's the most[br]phenomenal part of this,

0:06:14.525,0:06:17.025
and for all of you who watch[br]any sport event,

0:06:17.049,0:06:18.964
you will see this phenomenon happen.

0:06:19.841,0:06:22.529
The batter gets into the batter's box,

0:06:22.553,0:06:24.674
the pitcher gets ready to pitch.

0:06:24.698,0:06:27.804
Right before the pitch is thrown,

0:06:27.828,0:06:29.037
what does that batter do?

0:06:29.061,0:06:30.965
The batter steps out of the box

0:06:32.277,0:06:34.320
and takes a practice swing.

0:06:34.344,0:06:36.169
He wouldn't do it any other way.

0:06:37.392,0:06:40.807
I want to talk to you about how[br]we're building practice swings like this

0:06:40.831,0:06:41.986
in medicine.

0:06:42.010,0:06:46.192
We are building batting cages[br]for the patients that we care about

0:06:46.216,0:06:47.444
at Boston Children's.

0:06:47.468,0:06:49.961
I want to use this case[br]that we recently built.

0:06:50.484,0:06:54.755
It's the case of a four-year-old[br]who had a progressively enlarging head,

0:06:54.779,0:06:56.056
and as a result,

0:06:56.080,0:06:59.212
had loss of developmental milestones,[br]neurologic milestones,

0:06:59.236,0:07:02.253
and the reason for this problem is here --

0:07:02.277,0:07:03.927
it's called hydrocephalus.

0:07:04.552,0:07:07.423
So, a quick study in neurosurgery.

0:07:07.447,0:07:08.612
There's the brain,

0:07:08.636,0:07:11.184
and you can see the cranium[br]surrounding the brain.

0:07:11.649,0:07:14.993
What surrounds the brain,[br]between the brain and cranium,

0:07:15.017,0:07:18.235
is something called[br]cerebrospinal fluid or fluid,

0:07:18.259,0:07:19.993
which acts as a shock absorber.

0:07:20.586,0:07:21.908
In your heads right now,

0:07:21.932,0:07:25.189
there is cerebrospinal fluid[br]just bathing your brains

0:07:25.213,0:07:27.039
and making its way around.

0:07:27.063,0:07:29.689
It's produced in one area[br]and flows through,

0:07:29.713,0:07:31.004
and then is re-exchanged.

0:07:31.028,0:07:33.925
And this beautiful flow pattern[br]occurs for all of us.

0:07:34.445,0:07:36.490
But unfortunately in some children,

0:07:36.514,0:07:39.017
there's a blockage of this flow pattern,

0:07:39.041,0:07:40.593
much like a traffic jam.

0:07:41.065,0:07:43.888
As a result, the fluid accumulates,

0:07:43.912,0:07:46.428
and the brain is pushed aside.

0:07:47.127,0:07:48.964
It has difficulty growing.

0:07:49.601,0:07:53.094
As a result, the child loses[br]neurologic milestones.

0:07:53.118,0:07:55.529
This is a devastating disease in children.

0:07:56.973,0:08:00.047
The cure for this is surgery.

0:08:00.071,0:08:02.981
The traditional surgery is to take[br]a bit of the cranium off,

0:08:03.005,0:08:04.163
a bit of the skull,

0:08:04.187,0:08:07.130
drain this fluid out,[br]stick a drain in place,

0:08:07.154,0:08:09.882
and then eventually bring[br]this drain internal to the body.

0:08:09.906,0:08:11.122
Big operation.

0:08:12.096,0:08:16.413
But some great news is that advances[br]in neurosurgical care

0:08:16.437,0:08:20.146
have allowed us to develop[br]minimally invasive approaches

0:08:20.170,0:08:21.330
to this surgery.

0:08:21.354,0:08:25.679
Through a small pinhole,[br]a camera can be inserted,

0:08:26.932,0:08:29.660
led into the deep brain structure,

0:08:29.684,0:08:33.637
and cause a little hole in a membrane[br]that allows all that fluid to drain,

0:08:33.661,0:08:35.709
much like it would in a sink.

0:08:35.733,0:08:38.848
All of a sudden, the brain[br]is no longer under pressure,

0:08:38.872,0:08:40.329
can re-expand

0:08:40.353,0:08:43.232
and we cure the child[br]through a single-hole incision.

0:08:44.658,0:08:46.073
But here's the problem:

0:08:46.097,0:08:48.241
hydrocephalus is relatively rare.

0:08:48.910,0:08:51.320
And there are no good training methods

0:08:51.344,0:08:54.968
to get really good at getting[br]this scope to the right place.

0:08:54.992,0:08:59.306
But surgeons have been quite creative[br]about this, even our own.

0:08:59.330,0:09:01.338
And they've come up with training models.

0:09:01.362,0:09:03.087
Here's the current training model.

0:09:03.111,0:09:05.069
(Laughter)

0:09:05.093,0:09:06.750
I kid you not.

0:09:06.774,0:09:09.213
This is a red pepper,[br]not made in Hollywood;

0:09:09.237,0:09:10.565
it's real red pepper.

0:09:11.000,0:09:13.947
And what surgeons do is they stick[br]a scope into the pepper,

0:09:13.971,0:09:17.069
and they do what is called a "seedectomy."

0:09:17.093,0:09:18.860
(Laughter)

0:09:18.884,0:09:24.984
They use this scope to remove seeds[br]using a little tweezer.

0:09:25.812,0:09:28.440
And that is a way to get under their belts

0:09:28.464,0:09:31.460
the rudimentary components[br]of doing this surgery.

0:09:32.116,0:09:34.552
Then they head right into[br]the apprenticeship model,

0:09:34.576,0:09:37.448
seeing many of them[br]as they present themselves,

0:09:37.472,0:09:39.735
then doing it, and then teaching it --

0:09:39.759,0:09:41.776
waiting for these patients to arrive.

0:09:42.527,0:09:44.066
We can do a lot better.

0:09:44.090,0:09:48.817
We are manufacturing[br]reproductions of children

0:09:48.841,0:09:52.747
in order for surgeons and surgical[br]teams to rehearse

0:09:52.771,0:09:55.151
in the most relevant possible ways.

0:09:55.175,0:09:56.550
Let me show you this.

0:09:57.146,0:09:58.654
Here's my team

0:09:58.678,0:10:02.583
in what's called the SIM Engineering[br]Division of the Simulator Program.

0:10:03.320,0:10:06.163
This is an amazing team of individuals.

0:10:06.187,0:10:08.462
They are mechanical engineers;

0:10:08.486,0:10:10.911
you're seeing here, illustrators.

0:10:10.935,0:10:15.507
They take primary data[br]from CT scans and MRIs,

0:10:15.531,0:10:18.861
translate it into digital information,

0:10:18.885,0:10:20.191
animate it,

0:10:20.215,0:10:25.006
put it together into the components[br]of the child itself,

0:10:25.030,0:10:28.824
surface-scan elements of the child[br]that have been casted as needed,

0:10:28.848,0:10:31.433
depending on the surgery itself,

0:10:31.457,0:10:35.348
and then take this digital data[br]and be able to output it

0:10:35.372,0:10:39.120
on state-of-the-art,[br]three-dimensional printing devices

0:10:39.144,0:10:41.414
that allow us to print the components

0:10:41.438,0:10:47.106
exactly to the micron detail of what[br]the child's anatomy will look like.

0:10:47.130,0:10:48.434
You can see here,

0:10:48.458,0:10:50.892
the skull of this child being printed

0:10:50.916,0:10:53.402
in the hours before[br]we performed this surgery.

0:10:54.618,0:10:57.194
But we could not do this work

0:10:57.218,0:11:01.605
without our dear friends on the West Coast[br]in Hollywood, California.

0:11:02.780,0:11:06.010
These are individuals[br]that are incredibly talented

0:11:06.034,0:11:08.458
at being able to recreate reality.

0:11:08.482,0:11:12.906
It was not a long leap for us.

0:11:12.930,0:11:14.506
The more we got into this field,

0:11:14.530,0:11:18.290
the more it became clear to us[br]that we are doing cinematography.

0:11:18.990,0:11:20.867
We're doing filmmaking,

0:11:20.891,0:11:23.115
it's just that the actors are not actors.

0:11:23.909,0:11:26.405
They're real doctors and nurses.

0:11:27.190,0:11:30.569
So these are some photos[br]of our dear friends at Fractured FX

0:11:30.593,0:11:32.062
in Hollywood California,

0:11:32.086,0:11:35.660
an Emmy-Award-winning[br]special effects firm.

0:11:35.684,0:11:38.854
This is Justin Raleigh and his group --

0:11:38.878,0:11:40.526
this is not one of our patients --

0:11:40.550,0:11:41.908
(Laughter)

0:11:41.932,0:11:45.000
but kind of the exquisite work[br]that these individuals do.

0:11:45.024,0:11:48.628
We have now collaborated[br]and fused our experience,

0:11:48.652,0:11:51.058
bringing their group[br]to Boston Children's Hospital,

0:11:51.082,0:11:53.738
sending our group[br]out to Hollywood, California

0:11:53.762,0:11:55.131
and exchanging around this

0:11:55.155,0:11:58.158
to be able to develop[br]these type of simulators.

0:11:58.182,0:12:02.651
What I'm about to show you[br]is a reproduction of this child.

0:12:07.172,0:12:12.300
You'll notice here that every hair[br]on the child's head is reproduced.

0:12:12.324,0:12:16.027
And in fact, this is also[br]that reproduced child --

0:12:16.051,0:12:19.244
and I apologize for any queasy stomachs,

0:12:19.268,0:12:22.128
but that is a reproduction and simulation

0:12:22.152,0:12:24.246
of the child they're about to operate on.

0:12:26.493,0:12:28.931
Here's that membrane we had talked about,

0:12:28.955,0:12:31.114
the inside of this child's brain.

0:12:31.538,0:12:36.506
What you're going to be seeing here[br]is, on one side, the actual patient,

0:12:36.530,0:12:38.809
and on the other side, the simulator.

0:12:38.833,0:12:43.183
As I mentioned, a scope, a little camera,[br]needs to make its way down,

0:12:43.207,0:12:44.608
and you're seeing that here.

0:12:44.632,0:12:46.956
It needs to make a small hole[br]in this membrane

0:12:46.980,0:12:49.689
and allow this fluid to seep out.

0:12:51.155,0:12:55.796
I won't do a quiz show to see[br]who thinks which side is which,

0:12:56.962,0:12:59.266
but on the right is the simulator.

0:13:00.683,0:13:04.481
So surgeons can now produce[br]training opportunities,

0:13:04.505,0:13:07.558
do these surgeries[br]as many times as they want,

0:13:07.582,0:13:10.424
to their heart's content,[br]until they feel comfortable.

0:13:10.448,0:13:14.013
And then, and only then,[br]bring the child into the operating room.

0:13:14.037,0:13:15.206
But we don't stop here.

0:13:15.230,0:13:19.540
We know that a key step to this[br]is not just the skill itself,

0:13:19.564,0:13:24.095
but combining that skill with a team[br]who's going to deliver that care.

0:13:24.119,0:13:26.461
Now we turn to Formula One.

0:13:27.025,0:13:30.275
And here is an example[br]of a technician putting on a tire

0:13:30.299,0:13:33.508
and doing that time and time[br]again on this car.

0:13:33.532,0:13:36.517
But that is very quickly[br]going to be incorporated

0:13:36.541,0:13:38.472
within team-training experiences,

0:13:38.496,0:13:42.705
now as a full team orchestrating[br]the exchange of tires

0:13:42.729,0:13:45.727
and getting this car back on the speedway.

0:13:46.274,0:13:49.551
We've done that step in health care,

0:13:49.575,0:13:53.697
so now what you're about to see[br]is a simulated operation.

0:13:54.760,0:13:57.147
We've taken the simulator[br]I just described to you,

0:13:57.171,0:14:00.572
we've brought it into the operating room[br]at Boston Children's Hospital,

0:14:00.596,0:14:04.251
and these individuals --[br]these native teams, operative teams --

0:14:04.275,0:14:07.798
are doing the surgery before the surgery.

0:14:07.822,0:14:09.559
Operate twice;

0:14:09.583,0:14:10.789
cut once.

0:14:11.119,0:14:12.515
Let me show that to you.

0:14:13.417,0:14:16.530
(Video) Surgical team member 1:[br]You want the head down or head up?

0:14:16.554,0:14:18.258
STM 2: Can you lower it down to 10?

0:14:18.282,0:14:20.931
STM 3: And then lower[br]the whole table down a little bit?

0:14:20.955,0:14:22.209
STM 4: Table coming down.

0:14:24.856,0:14:27.561
STM 3: All right, this[br]is behaving like a vessel.

0:14:27.585,0:14:29.672
Could we have the scissors back, please?

0:14:29.696,0:14:32.997
STM 5: I'm taking my gloves,[br]8 to 8 1/2, all right? I'll be right in.

0:14:33.021,0:14:35.422
STM 6: Great! Thank you.

0:14:36.336,0:14:38.169
Peter Weinstock: It's really amazing.

0:14:38.193,0:14:40.285
The second step to this,[br]which is critical,

0:14:40.309,0:14:43.408
is we take these teams out[br]immediately and debrief them.

0:14:43.432,0:14:44.896
We use the same technologies

0:14:44.920,0:14:49.608
that are used in Lean[br]and Six Sigma in the military,

0:14:49.632,0:14:52.717
and we bring them out[br]and talk about what went right,

0:14:52.741,0:14:54.386
but more importantly,

0:14:54.410,0:14:56.877
we talk about what didn't go well,

0:14:56.901,0:14:58.836
and how we're going to fix it.

0:14:58.860,0:15:01.614
Then we bring them right back in[br]and do it again.

0:15:01.638,0:15:06.829
Deliberative batting practice[br]in the moments when it matters most.

0:15:08.438,0:15:10.460
Let's go back to this case now.

0:15:11.083,0:15:12.460
Same child,

0:15:12.484,0:15:14.874
but now let me describe[br]how we care for this child

0:15:14.898,0:15:16.361
at Boston Children's Hospital.

0:15:16.385,0:15:18.871
This child was born[br]at three o'clock in the morning.

0:15:18.895,0:15:20.902
At two o'clock in the morning,

0:15:20.926,0:15:23.052
we assembled the team,

0:15:23.076,0:15:24.877
and took the reproduced anatomy

0:15:24.901,0:15:28.606
that we would gain[br]out of scans and images,

0:15:28.630,0:15:31.396
and brought that team[br]to the virtual bedside,

0:15:31.420,0:15:33.007
to a simulated bedside --

0:15:33.031,0:15:36.572
the same team that's going to operate[br]on this child in the hours ahead --

0:15:36.596,0:15:38.979
and we have them do the procedure.

0:15:39.591,0:15:41.271
Let me show you a moment of this.

0:15:42.212,0:15:44.372
This is not a real incision.

0:15:45.451,0:15:47.651
And the baby has not yet been born.

0:15:49.113,0:15:50.481
Imagine this.

0:15:52.133,0:15:56.021
So now the conversations[br]that I have with families

0:15:56.045,0:15:58.745
in the intensive care unit[br]at Boston Children's Hospital

0:15:58.769,0:16:00.157
are totally different.

0:16:00.762,0:16:02.498
Imagine this conversation:

0:16:03.649,0:16:08.500
"Not only do we take care of this disorder[br]frequently in our ICU,

0:16:08.524,0:16:10.702
and not only have we done surgeries

0:16:10.726,0:16:13.161
like the surgery we're going[br]to do on your child,

0:16:13.185,0:16:16.899
but we have done your child's surgery.

0:16:17.956,0:16:20.486
And we did it two hours ago.

0:16:20.510,0:16:23.242
And we did it 10 times.

0:16:23.266,0:16:27.087
And now we're prepared to take them[br]back to the operating room."

0:16:28.731,0:16:31.061
So a new technology in health care:

0:16:32.167,0:16:35.035
lifelike rehearsal.

0:16:35.059,0:16:38.613
Practicing prior to game time.

0:16:39.632,0:16:40.812
Thank you.

0:16:40.836,0:16:45.501
(Applause)