1

Welcome

The Chairman – Dr Kenneth Eaton-welcomed the audience to the symposium. He set the scene with the words “I am sure that many of us in the room have been rejected many times by journals and felt quite bad about it and there is an ongoing issue there to try and help everyone concerned in writing and publishing scientific literature to minimise the number of times this happens.” He went on, “so what is the aim of the symposium today? It is to start to answer the question posed at the end of the previous symposia for editors, held during the IADR Seattle and Cape Town meetings and this was how can authors, reviewers, editors and publishers collaborate to improve the quality of papers submitted to journals? What is on the programme for today? After this introduction the first speaker will be Dr Nicola Innes from the University of Dundee who is an Associate Editor of the Journal of Dental Research. Nicola will address the topic of how to improve reviews and that is a big issue in itself. I think that in the future we can have a symposium purely on that topic. Then we have Professor Dr S.M. Balaji from India, who has been doing sterling work particularly with the Indian Journal of Dental Research. He will present the topic of how to approach deans and teachers to help. Courtney Pugh from SAGE publications will talk about how publishers can help and then finally Professor Eino Honkala, who is currently at the University of Kuwait but is originally from Finland. Eino has spent several years working in Africa and the Middle East. He will talk about how to manage proposed changes. Then it is over to you, what ideas have you got, how can we take these things forward?

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Professor Nicola Innes – Associate Editor, Journal of Dental Research

Good afternoon everyone and thank you very much Ken for the invitation to speak here on the subject of how can we improve reviews, a very big question that I know we probably all hold dear. Peer review has been going on for a very long time in some form and so Wikipedia, a very un-peer reviewed source of course, tells us that in 1665 the Royal Society of London first started what we would recognise, even slightly, as a peer review process and that has obviously developed very much over the last few hundred years and decades. However, it wasn’t really until as recently as 1967 that Nature first began the peer review process, very much as we would understand and recognise it as now. I am going to talk a little bit about the peer review process and what we are aiming for when we carry out peer review, what are our peer reviewers like and then I am going to talk about how we might improve the quality of our reviews through the peer review process, about the idea of reciprocation, bottom up approaches which I know is going to be dealt with a little bit more later as well, training resources and other newer things that we might consider to try and reduce research wastage. I will suggest some innovative solutions and how to maximise the talents of those that are already peer reviewing for us. Finally, I hope to give you a little summary and maybe some suggestions, rather than recommendations, that we might want to think about with regard to improving peer review.

Of course our aim in peer review is to select the best research that we can to bring to the attention of our readership.We, as editors make use, great use of our peer reviewers to give us information on the validity, the significance and to some extent the originality of the papers that have been submitted to our journals. The International Committee of Medical Journal Editors (ICMJE) defines peer review as an unbiased, independent, critical assessment by experts who are not part of the editorial staff. This externality is very important and we know that it is an intrinsic part, fundamental to the scholarly work that is carried out. Everyone will of course be very familiar with the situation in which researchers who produce research, submit it to the journal and it then bounces back and forwards between peer reviewers and the authors who submitted the work until finally, hopefully, the work is fit for publication. Peer reviewers lie at the very heart of this process, but who are our peer reviewers? What training have they had and why do they review? Lastly, what influences their decisions to say yes when they are invited to review?

I investigated these questions and found that in 2011, in the UK, the House of Commons Science and Technology Committee held an inquiry into peer review to look at how appropriate it was and how fit for purpose . The committee sought written and oral evidence from a wide range of experts and associations. In their submission, the British Medical Journal wrote: “Many biomedical editors are doctors or scientists with little relevant experience or training before taking on the role, so publishers and journal owners should point new editors to such guidance and support them while they learn.”I think that this reflects the picture with peer reviewers as well. When I looked for what kind of guidance is available for editors, I found quite a lot. There are resources held on the ICMJE website . The World Association of Medical Editors and the Council of Science Editors also have resources as does the Committee on Publication Ethics , a very useful source of information. But what about the peer reviewers? It is most likely that they have had no formal training in peer reviewing and it is widely acknowledged that peer reviewers tend to learn on the job. They come from very diverse backgrounds and don’t always come up through a system where they have received tutoring from more senior people who, themselves, have peer reviewed. They often come in from the side at different points. Some of them have a very narrow focus and some of them a very broad focus from their work, which all lends itself to differing perspectives when they start to peer review. Sense about Science carried out a large survey of researchers and out of 4000 researchers from biomedical and science backgrounds, they found that the vast majority, 84% of them, felt that without peer review there would be no control of scientific communication . So, although we all know that there are many flaws within the peer review system it is still acknowledged as being probably the best that we can achieve at the moment and is generally fit for purpose.

So why do reviewers review and what influences a decision to say yes when we invite them to carry out a review? I had a look at the Publishing Research Consortium’s recently commissioned survey that was carried out in 2009 where they looked at this very question . They found, interestingly, as many of us would expect, that it was mostly for altruistic reasons and the peer reviewers felt that 91% of them in fact agreed that it was important they play their part as a member of the academic community. Three quarters enjoyed being able to review and improve a paper and also enjoyed seeing it ahead of publication and they wanted to reciprocate the benefits that they themselves had received by being part of the peer review system, when they were publishing their own work. What factors increased their likelihood of saying yes when invited to peer review? Well, free subscription, acknowledgement in the journal and payment in kind were by far the most important factors. So this idea of some kind of reward for effort was acknowledged as influential.

I also wondered if there was any way that we could work through the peer review process that most of us use currently, without too much of a strain in the system, to improve the quality of our final manuscripts. Cobo et al. looked at this exact question. They randomised sequential papers that were going through the peer review process into two groups. The first group of papers underwent the usual peer review process but the second group, in addition to the usual peer review process,were sent reporting guidelines appropriate for each type of study and asked to use them to guide their peer review. When the review was based additionally on the reporting guidelines, the manuscript quality did improve, but the observed effect was much smaller than the investigators had thought it would be. Interestingly, again I am sure that most of us are familiar with this, the problem wasn’t that the authors didn’t want to address the comments from the peer reviewer in line with the guidelines, it was that the fundamental research, carried out in the first place, hadn’t had the research rigour allowing the authors to take account of some of the points in the guidelines. For example, maybe they hadn’t dealt with allocation adequately or at all, so, although it was flagged by the reviewers as needing to be addressed, what happened in the research couldn’t be changed at the write-up stage.

Moving on to this idea of reciprocation, our peer reviewers have quite a lot of pressure placed on them especially those who produce very high quality reviews and we have a limited number of them. The idea of reciprocity is perhaps something that we need to make a little bit more visible. When somebody publishes a paper they are actually asked then to give back to the journal and review one in return or perhaps more than one, because of course for every time we peer review a paper it takes three or four reviewers to contribute to that process.

If we consider other ways to improve the quality of our reviews I think that we have acknowledged there are often advantages from using experienced reviewers but we really need to think about “bottom upping” our approach to peer reviewers. I know that this is going to be dealt with much more later when we talk about what we can do at earlier stages. However, for now, I just want to make the point that, in common with the USA, in the UK our General Dental Council in its guidance for undergraduates has explicitly stated that our undergraduate students should leave dental school being able to explain, evaluate and apply the principles of an evidence based approach to learning . In the UK we have tried to put together an evidence based dentistry teachers group and I bring this up because it has been obvious from that process that there is real will to work together and avoid duplicating effort, when we try and produce resources and materials. I think that is something that we should bear in mind when we consider what we can do within our journals in creating training resources for our peer reviewers.

These are some of the existing information and training resources that are available that we might wish to point some of our peer reviewers towards, some of the newer ones perhaps. The Critical Appraisal Skills Programme is more geared towards clinicians actually appraising evidence and making decisions about whether the evidence in a paper or a systematic review can be applied to their particular population. The World Association of Medical Editors and the Publishing Research Consortium also have resources available that we can point people towards to assist with appraising papers in a systematic way. Sense About Science is another excellent website with a number of different tools of interest to peer reviewers. It explains a little bit more about how the system works and what is expected of them. Finally, British Medical Journal has quite a nice resource for training materials.

The British Medical Journal has an extensive training resource for potential reviewers . There are a number of objectives that new reviewers are guided towards. Objective 1 is to inform participants on the state of peer review research and there is a Powerpoint presentation that takes the reviewer through a number of different aspects of peer review. Objective 2 is to make clear what constitutes a good review and again there is a Powerpoint presentation that can just be looked at. Objective 3 aims to help participants to understand what matters to editors about reviews. There is then a series of reviews and the learner is asked to reflect on them and to reflect back on the previous Powerpoint presentation to try and bring out what they think are the positive and negative points about the reviews. Then there is a commentary on that. Finally, Objective 4 gives participants help in producing a good review and here there are a number of papers available, with the option of trying to produce a review and then compare it to those of other people who have reviewed the same paper.

Moving onto some other new things, to think about. There is an issue called “cascade” or “water-falling” of peer reviews. This is where, following rejection of a paper and it being submitted to another journal, the reviews that have already been produced actually follow the paper to help inform an editor about the decision they might make. This reduces wastage within the peer review system. It might be especially useful when we have papers that are submitted to our journal that we think may or may not be a good fit (rather than poor quality). When these papers go for peer review and the peer reviewers come back and say that there are a few things that could be improved, but on the whole they don’t really think that the manuscript is a good fit for the journal and suggest submitting it to somewhere else. These reviews are useful and people have often spent a lot of time producing them but they get lost. Cascading peer reviews doesn’t happen, as far as I’m aware, very commonly in Bio-medical journals but it is more common in the Social Sciences.

Another thing we should consider is how can we get academic credit for these peer reviewers who spend significant time and energy carrying out the peer reviews for us. Ken was kind enough to send me a link to Publons , a reasonably recent resource that has been developed. Publons is a website where people who carry out peer reviews can have it registered and logged and gain academic credit for it. It works by the person submitting, to Publons, the ‘thank you’ or acknowledgement letter they receive from the editor that credits them or that says that they have carried out that peer review. The credit is then placed on their Publons account and they can use that when they go for perhaps promotion at a later stage or on their CV. It is a record or a log of the work that they have carried out.

I also asked a number of people who carry out peer review for us for the Journal of Dental Research what they thought might be useful and make reviewing easier for them and this comment in particular struck me; ‘I feel that editors might come back to reviewers more often to see what they like or did not like about the review, especially helpful for not that experienced reviewers.’ I am not sure that it is something that will ever actually happen, I know that on an individual basis occasionally we go back to reviewers to thank them. It is very difficult to go back to a reviewer to say what you didn’t like about a review when you know that they have gone to a lot of trouble to produce it, regardless of whether it fits in with your idea of a good or bad review and it possibly wont endear them to your journal. It is an option, and something that we might consider formalising as part of the process. At the Journal of Dental Research we sent reviewers the final decisions of other reviewers comments because that allows people to see whether they are fitting in with the general perspective that people have and observe good reviews. I’m not sure how common that is for other journals. We of course have the option for annual joint meetings with reviewers either at the IADR or other forums and I know that certainly goes down well here.

So, finally onto the suggestions that we might consider in the short term.I recommend that reviewers are encouraged to use reporting guidelines to guide their review. There was some success with that in the past and it might be something that we should guide our novices towards using. Running reviewer workshops alongside conferences, I know that works very successfully here and is very sought after. Raising awareness of what support is available for our peer reviewers, perhaps having just a standard link that goes into the bottom of letters of invitation directing people towards where they might find resources. Making it easier to make reviewer selections, as an editor I am very aware that often when I select reviewers based on their profile in the SAGE/JDR archives but that this has perhaps not been updated for many years and they may have completed it when they first submitted a paper for publication to the journal early in their career. However, when requests are sent out to people to update the profile, in an already busy world, it is another bit of time that they have to dedicate with no tangible benefit to them. Perhaps at journals’ stalls in the Exhibition Hall and other at other conferences we might think about having a computer and invite people that come to visit the stalls to update their profiles there and then. Encouraging new authors to be reviewers, using this idea of reciprocation. Perhaps a statement of request to peer review might be included in the acceptance letter that we send out to authors when their paper is accepted for publication might be received well. The authors will be feeling positive about the journal at this time and might be consider being a peer reviewer, appreciating the importance that peer review played in their manuscript acceptance.

In the longer term, I strongly feel that starting early in the dental school curriculum to engage clinicians in research and increasing their research awareness is a very positive thing, not least because it certainly broadens the perspective that people have on the different types of research that are available. It also makes them aware of the different issues with different types of research because if someone specialises very soon in a particular area they can become very narrow in their focus with peer review and not really appreciate some of the breadth of problems that exist. I have also suggested partnering and this is something that has been spoken about at previous symposia, the idea that schools in developed countries can lend their expertise or their resources to partner schools in developing countries to improve research training. I think consideration should be given to developing a one-stop shop where we keep all these training resources for the oral and dental journals in one place or with one link so that we can simply send that to our peer reviewers. Also editors might consider reducing wastage through cascade reviewing and maximising the resources of the people that we already have and perhaps this innovative idea that there is a very real credit and reward associated with peer reviewing, I haven’t of course touched on the financial side of that in this talk. My last recommendation is to say that I feel we should really continue working together, just as we are today and that the series of these symposia that Ken has brought together has been very useful and does begin to get us talking together as one big group about what we might do to share resources and minimise redevelopment of the same thing over and over again. Thank you very much.

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Professor Nicola Innes – Associate Editor, Journal of Dental Research

Good afternoon everyone and thank you very much Ken for the invitation to speak here on the subject of how can we improve reviews, a very big question that I know we probably all hold dear. Peer review has been going on for a very long time in some form and so Wikipedia, a very un-peer reviewed source of course, tells us that in 1665 the Royal Society of London first started what we would recognise, even slightly, as a peer review process and that has obviously developed very much over the last few hundred years and decades. However, it wasn’t really until as recently as 1967 that Nature first began the peer review process, very much as we would understand and recognise it as now. I am going to talk a little bit about the peer review process and what we are aiming for when we carry out peer review, what are our peer reviewers like and then I am going to talk about how we might improve the quality of our reviews through the peer review process, about the idea of reciprocation, bottom up approaches which I know is going to be dealt with a little bit more later as well, training resources and other newer things that we might consider to try and reduce research wastage. I will suggest some innovative solutions and how to maximise the talents of those that are already peer reviewing for us. Finally, I hope to give you a little summary and maybe some suggestions, rather than recommendations, that we might want to think about with regard to improving peer review.

Of course our aim in peer review is to select the best research that we can to bring to the attention of our readership.We, as editors make use, great use of our peer reviewers to give us information on the validity, the significance and to some extent the originality of the papers that have been submitted to our journals. The International Committee of Medical Journal Editors (ICMJE) defines peer review as an unbiased, independent, critical assessment by experts who are not part of the editorial staff. This externality is very important and we know that it is an intrinsic part, fundamental to the scholarly work that is carried out. Everyone will of course be very familiar with the situation in which researchers who produce research, submit it to the journal and it then bounces back and forwards between peer reviewers and the authors who submitted the work until finally, hopefully, the work is fit for publication. Peer reviewers lie at the very heart of this process, but who are our peer reviewers? What training have they had and why do they review? Lastly, what influences their decisions to say yes when they are invited to review?

I investigated these questions and found that in 2011, in the UK, the House of Commons Science and Technology Committee held an inquiry into peer review to look at how appropriate it was and how fit for purpose . The committee sought written and oral evidence from a wide range of experts and associations. In their submission, the British Medical Journal wrote: “Many biomedical editors are doctors or scientists with little relevant experience or training before taking on the role, so publishers and journal owners should point new editors to such guidance and support them while they learn.”I think that this reflects the picture with peer reviewers as well. When I looked for what kind of guidance is available for editors, I found quite a lot. There are resources held on the ICMJE website . The World Association of Medical Editors and the Council of Science Editors also have resources as does the Committee on Publication Ethics , a very useful source of information. But what about the peer reviewers? It is most likely that they have had no formal training in peer reviewing and it is widely acknowledged that peer reviewers tend to learn on the job. They come from very diverse backgrounds and don’t always come up through a system where they have received tutoring from more senior people who, themselves, have peer reviewed. They often come in from the side at different points. Some of them have a very narrow focus and some of them a very broad focus from their work, which all lends itself to differing perspectives when they start to peer review. Sense about Science carried out a large survey of researchers and out of 4000 researchers from biomedical and science backgrounds, they found that the vast majority, 84% of them, felt that without peer review there would be no control of scientific communication . So, although we all know that there are many flaws within the peer review system it is still acknowledged as being probably the best that we can achieve at the moment and is generally fit for purpose.

So why do reviewers review and what influences a decision to say yes when we invite them to carry out a review? I had a look at the Publishing Research Consortium’s recently commissioned survey that was carried out in 2009 where they looked at this very question . They found, interestingly, as many of us would expect, that it was mostly for altruistic reasons and the peer reviewers felt that 91% of them in fact agreed that it was important they play their part as a member of the academic community. Three quarters enjoyed being able to review and improve a paper and also enjoyed seeing it ahead of publication and they wanted to reciprocate the benefits that they themselves had received by being part of the peer review system, when they were publishing their own work. What factors increased their likelihood of saying yes when invited to peer review? Well, free subscription, acknowledgement in the journal and payment in kind were by far the most important factors. So this idea of some kind of reward for effort was acknowledged as influential.

I also wondered if there was any way that we could work through the peer review process that most of us use currently, without too much of a strain in the system, to improve the quality of our final manuscripts. Cobo et al. looked at this exact question. They randomised sequential papers that were going through the peer review process into two groups. The first group of papers underwent the usual peer review process but the second group, in addition to the usual peer review process,were sent reporting guidelines appropriate for each type of study and asked to use them to guide their peer review. When the review was based additionally on the reporting guidelines, the manuscript quality did improve, but the observed effect was much smaller than the investigators had thought it would be. Interestingly, again I am sure that most of us are familiar with this, the problem wasn’t that the authors didn’t want to address the comments from the peer reviewer in line with the guidelines, it was that the fundamental research, carried out in the first place, hadn’t had the research rigour allowing the authors to take account of some of the points in the guidelines. For example, maybe they hadn’t dealt with allocation adequately or at all, so, although it was flagged by the reviewers as needing to be addressed, what happened in the research couldn’t be changed at the write-up stage.

Moving on to this idea of reciprocation, our peer reviewers have quite a lot of pressure placed on them especially those who produce very high quality reviews and we have a limited number of them. The idea of reciprocity is perhaps something that we need to make a little bit more visible. When somebody publishes a paper they are actually asked then to give back to the journal and review one in return or perhaps more than one, because of course for every time we peer review a paper it takes three or four reviewers to contribute to that process.

If we consider other ways to improve the quality of our reviews I think that we have acknowledged there are often advantages from using experienced reviewers but we really need to think about “bottom upping” our approach to peer reviewers. I know that this is going to be dealt with much more later when we talk about what we can do at earlier stages. However, for now, I just want to make the point that, in common with the USA, in the UK our General Dental Council in its guidance for undergraduates has explicitly stated that our undergraduate students should leave dental school being able to explain, evaluate and apply the principles of an evidence based approach to learning . In the UK we have tried to put together an evidence based dentistry teachers group and I bring this up because it has been obvious from that process that there is real will to work together and avoid duplicating effort, when we try and produce resources and materials. I think that is something that we should bear in mind when we consider what we can do within our journals in creating training resources for our peer reviewers.

These are some of the existing information and training resources that are available that we might wish to point some of our peer reviewers towards, some of the newer ones perhaps. The Critical Appraisal Skills Programme is more geared towards clinicians actually appraising evidence and making decisions about whether the evidence in a paper or a systematic review can be applied to their particular population. The World Association of Medical Editors and the Publishing Research Consortium also have resources available that we can point people towards to assist with appraising papers in a systematic way. Sense About Science is another excellent website with a number of different tools of interest to peer reviewers. It explains a little bit more about how the system works and what is expected of them. Finally, British Medical Journal has quite a nice resource for training materials.

The British Medical Journal has an extensive training resource for potential reviewers . There are a number of objectives that new reviewers are guided towards. Objective 1 is to inform participants on the state of peer review research and there is a Powerpoint presentation that takes the reviewer through a number of different aspects of peer review. Objective 2 is to make clear what constitutes a good review and again there is a Powerpoint presentation that can just be looked at. Objective 3 aims to help participants to understand what matters to editors about reviews. There is then a series of reviews and the learner is asked to reflect on them and to reflect back on the previous Powerpoint presentation to try and bring out what they think are the positive and negative points about the reviews. Then there is a commentary on that. Finally, Objective 4 gives participants help in producing a good review and here there are a number of papers available, with the option of trying to produce a review and then compare it to those of other people who have reviewed the same paper.

Moving onto some other new things, to think about. There is an issue called “cascade” or “water-falling” of peer reviews. This is where, following rejection of a paper and it being submitted to another journal, the reviews that have already been produced actually follow the paper to help inform an editor about the decision they might make. This reduces wastage within the peer review system. It might be especially useful when we have papers that are submitted to our journal that we think may or may not be a good fit (rather than poor quality). When these papers go for peer review and the peer reviewers come back and say that there are a few things that could be improved, but on the whole they don’t really think that the manuscript is a good fit for the journal and suggest submitting it to somewhere else. These reviews are useful and people have often spent a lot of time producing them but they get lost. Cascading peer reviews doesn’t happen, as far as I’m aware, very commonly in Bio-medical journals but it is more common in the Social Sciences.

Another thing we should consider is how can we get academic credit for these peer reviewers who spend significant time and energy carrying out the peer reviews for us. Ken was kind enough to send me a link to Publons , a reasonably recent resource that has been developed. Publons is a website where people who carry out peer reviews can have it registered and logged and gain academic credit for it. It works by the person submitting, to Publons, the ‘thank you’ or acknowledgement letter they receive from the editor that credits them or that says that they have carried out that peer review. The credit is then placed on their Publons account and they can use that when they go for perhaps promotion at a later stage or on their CV. It is a record or a log of the work that they have carried out.

I also asked a number of people who carry out peer review for us for the Journal of Dental Research what they thought might be useful and make reviewing easier for them and this comment in particular struck me; ‘I feel that editors might come back to reviewers more often to see what they like or did not like about the review, especially helpful for not that experienced reviewers.’ I am not sure that it is something that will ever actually happen, I know that on an individual basis occasionally we go back to reviewers to thank them. It is very difficult to go back to a reviewer to say what you didn’t like about a review when you know that they have gone to a lot of trouble to produce it, regardless of whether it fits in with your idea of a good or bad review and it possibly wont endear them to your journal. It is an option, and something that we might consider formalising as part of the process. At the Journal of Dental Research we sent reviewers the final decisions of other reviewers comments because that allows people to see whether they are fitting in with the general perspective that people have and observe good reviews. I’m not sure how common that is for other journals. We of course have the option for annual joint meetings with reviewers either at the IADR or other forums and I know that certainly goes down well here.

So, finally onto the suggestions that we might consider in the short term.I recommend that reviewers are encouraged to use reporting guidelines to guide their review. There was some success with that in the past and it might be something that we should guide our novices towards using. Running reviewer workshops alongside conferences, I know that works very successfully here and is very sought after. Raising awareness of what support is available for our peer reviewers, perhaps having just a standard link that goes into the bottom of letters of invitation directing people towards where they might find resources. Making it easier to make reviewer selections, as an editor I am very aware that often when I select reviewers based on their profile in the SAGE/JDR archives but that this has perhaps not been updated for many years and they may have completed it when they first submitted a paper for publication to the journal early in their career. However, when requests are sent out to people to update the profile, in an already busy world, it is another bit of time that they have to dedicate with no tangible benefit to them. Perhaps at journals’ stalls in the Exhibition Hall and other at other conferences we might think about having a computer and invite people that come to visit the stalls to update their profiles there and then. Encouraging new authors to be reviewers, using this idea of reciprocation. Perhaps a statement of request to peer review might be included in the acceptance letter that we send out to authors when their paper is accepted for publication might be received well. The authors will be feeling positive about the journal at this time and might be consider being a peer reviewer, appreciating the importance that peer review played in their manuscript acceptance.

In the longer term, I strongly feel that starting early in the dental school curriculum to engage clinicians in research and increasing their research awareness is a very positive thing, not least because it certainly broadens the perspective that people have on the different types of research that are available. It also makes them aware of the different issues with different types of research because if someone specialises very soon in a particular area they can become very narrow in their focus with peer review and not really appreciate some of the breadth of problems that exist. I have also suggested partnering and this is something that has been spoken about at previous symposia, the idea that schools in developed countries can lend their expertise or their resources to partner schools in developing countries to improve research training. I think consideration should be given to developing a one-stop shop where we keep all these training resources for the oral and dental journals in one place or with one link so that we can simply send that to our peer reviewers. Also editors might consider reducing wastage through cascade reviewing and maximising the resources of the people that we already have and perhaps this innovative idea that there is a very real credit and reward associated with peer reviewing, I haven’t of course touched on the financial side of that in this talk. My last recommendation is to say that I feel we should really continue working together, just as we are today and that the series of these symposia that Ken has brought together has been very useful and does begin to get us talking together as one big group about what we might do to share resources and minimise redevelopment of the same thing over and over again. Thank you very much.