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hi my name is Dr Angela Bates Iamp;#39;m a pediatric cardiac intensivist who also takes care of pediatric Palmer hypertension patients up in Edmonton Alberta Canada so I just wanted to talk a little bit about what Iamp;#39;ve learned over the past several years as Iamp;#39;ve embarked on getting to know these patients and their families and I think one of the things that theyamp;#39;ve taught me the most about patients is how important quality of life is and incorporating that in terms of our management strategies seems a bit counterintuitive for the physician to be talking about quality of life because really itamp;#39;s a around what the patients feel is in the best interest of what they see as a management strategy that fits into their lives and as well as the families but I think theyamp;#39;ve taught me a lot about how we strategize around implementing different medication therapies even in terms of constraints of different activities and so what Iamp;#39;ve learned