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so were gonna go ahead and get started here and want to take a moment to welcome everybody to the South Texas regional Family Medicine Grand rounds and we are partnering with the South Central ahec and our mission statement is there for those of you um who have joined us please make sure that you do mute your microphone as we get started here and then if you have any questions please feel free to put those in the chat box Ill try to keep an eye on that as we go through here but also if you could help us out in being attentive and engaged in the in the session and I will be putting in a link towards the end in the chat box to provide feedback for our speaker today so if you could help us out with that um for those who are claiming CME credit please just note here this is the activity code for today um and also if you are claiming credit please make sure you do before midnight tonight those who have not yet done this process if you are new to this please make sure that you text your e