I'm David Bentley, I'm currently Vice President and Chief Scientist at Illuminao. I was born in Windsor, England, 1958, under the eaves of the castle. My parents at the time, my father was working in the theatre. He was a musical director at the Theatre Royal Windsor and my mother was a biology teacher. But there was, I think my mother started it off because she was actually in Cambridge at the time of certainly the protein, structural protein work that was going on. And she knew some of the people involved, Dorothy Hodgkin and so on. And she had knew of many of the people who were really developing that field. So she started me off. She knew some of the people who were writing popular articles that I was reading. But I'd also single out a biology teacher at high school, my secondary school, which ironically called Watson, no known relation. But Ian Watson was a tremendous, passionate, enthusiastic man. And he had the benefit of almost a whole year off curriculum. We were able to be taught whatever he felt like talking us, teaching us. So he taught us a lot about molecular biology. And also about the whole convergence of genetic inheritance with the molecular basis of it and the chromosomal basis of inheritance. It was clearly one of his pet topics and I just lapped it up. I loved it. So there are many people, too many to tell or even remember. But Cambridge is a wonderful time for me. I read Natural Sciences, which really provides a blend, including chemistry in particular. And my links to the chemistry department, of course, became very important for later on. But really one of the tremendous tutors there, David Hankey, who was in my college, Jesus College, really was a tutor to me throughout the time. It was a lucky break. He was teaching me for much of the first two years. And that one-to-one or one-to-two tutorial was a feature of the Cambridge system that really allowed us to explore areas, in this case, of biology and to really pursue our passions together. He was a tremendous guiding light in that. Then I went on to biochemistry. That was my final year subject. And a tremendous course, which really gave me a broad view of biochemistry without too much specialization, I think. Genetics wasn't a particularly strong feature of that course. But we'd had a lot of genetics already. So that was really the basis for my degree. It was a three-year degree, really rather short, by today's standards. Certainly, by the age of 21, I was considering my next step. So my first PhD year was up at the Laboratory of Molecular Biology. It was in Fred Sanger's division, protein nucleic acid chemistry. Wonderful time to be there, 1979, 1980. And it was just at the time when the whole concept, first of all, being an environment that simply pursued technology. They really were less interested in the biological problems. George Brownlee had been Fred's first PhD student, I think. And so I was one of George's PhD students, so continuing the lineage. And I had the pleasure of both of working with George directly. And George was a great innovator. He liked to do different. He liked to do something no one else was doing. He'd spent a lot of time working on RNA sequencing in his earlier days. And that innovative and adventurous spirit showed through. And this remarkably quiet but enthusiastic man. And his enthusiasm just came through. And so he encouraged me to do something very different as well and tackled a probably in hindsight pretty impossible problem to solve. And I was left to explore and to learn from any of the people in the laboratory molecular biology, which is a tremendous environment for me. Fred is a remarkable man, was a remarkable man. He's quiet, a quiet presence in the LMB. Great to see him strolling down the corridor every morning to get his ice from the ice bucket, ice machine, and go back to his lab. And he was also the holder of the all-important P32, the P32, the ATP, which we used for all the sequencing. And Fred's lab to collect your aliquot of P32. And certainly on occasion I would see him standing there. There's a photograph, in fact, of him, which is just like how I remember him. Standing there with his red cardigan on, staring at an alter-aided graph that to his apparent surprise had really worked rather well. And Fred was a very modest man, but of course at the same time very quiet, very thoughtful, and very direct actually in the way he talked. And it was a pleasure to get to know Fred, to talk to Fred. And I had a number of connections with Fred later on, of course, because later on Fred actually did come to the Sanger Centre. He blessed it, allowed us to use his name. And even more recently, George Brownlee actually was writing his biography. So Small World, we came together again, and George actually asked for some help with a chapter in the book. And then of course that all came to a head when Fred died. So the biography really became very timely and was published shortly afterwards. So it was wonderful really to still be there and to have a chance to perhaps acknowledge and reflect on Fred's enormous contributions in a very quiet way, in a personal way, as well as of course all the scientific achievement that Fred really brought to the whole field. He was a great mentor and guide, as well as a tremendous scientist. Yes, so after a year George Brownlee was already actually about to leave the LNB and set up at the Dunn School of Pathology in Oxford. So my PhD got transferred to an Oxford D-Phil. And four of us, including George, was a small nuclear group that moved across from the LNB to Oxford. And we set up the lab. And that was a remarkable experience. Very enjoyable. We really had to do everything, including borrowing equipment and driving it over to Oxford to set up the lab. And the LNB were very helpful and supportive of George in setting up. So we had a chance to really just set up a lab from empty to doing the first Sanger Dideoxy sequences in the Oxford lab some two months later, which was a sign of success of the transfer that we were able to transfer. What at the time was a fairly sensitive protocol, fairly complex protocol. But it was a great time. And that was actually the same time that Fred Sanger was awarded his Nobel Prize. And there was a very curious moment. I was actually driving back from Oxford to Cambridge on the day and I heard the news on the radio that Fred had just been awarded a Nobel Prize for sequencing. So this was along with Max McGill-Witt as well. And I got to the LNB and I couldn't believe it because the lab was completely empty. I almost thought, it's not a weekend. What's happening here? The lab was completely empty. Nobody was in any of the floors of the laboratory. I thought, this is strange. And of course, sure enough, they were all crammed into the canteen up on the fourth floor. And rumor has it that Bart Burrell and one or two others had bought up the entire champagne supply from Cambridge. And it was being busily used to celebrate Fred's second Nobel Prize. It was a wonderful moment. So the work in the Dunn School of Pathology certainly went back a long way, but I think covered many areas of cell biology, particularly Henry Harris, the director at the time, had put a great contribution of cell biology to it. And so in that sense, there was a breadth of research going on in the Dunn School. And like many things, I think in molecular biology, you come along with the technology. And the question is how it will have an impact on the environment around you. Geology in particular interacted not just with the Dunn School, but with the other departments close by as well, biochemistry in particular. And set up collaborations where we were, we had the chance to see how the molecular biology, the techniques, so cloning as well as sequencing, of course, was a predominant technology at the time. And it had enormous universal applicability to many research problems. So there were great collaborations being set up. One of the very prominent partnerships which George formed was actually with the then professor of biochemistry, was Rodney Porter. And who, of course, he ran a tremendous protein chemistry lab. And so there was a tremendous discipline and tried to understand proteins and characterize proteins through purifying them and characterizing them at the peptide level had been all the rage. But it was getting more and more difficult because the proteins that remained to be discovered, of course, were in much smaller amounts, vanishingly small amounts, difficult to purify, difficult to know if you'd purified the right thing. And so to the protein chemistry lab, the excitement of extending the characterization of the proteins involved in immunochemistry, which is Rodney Porter's particular interest, the complement proteins, became a ripe target for molecular biology to lend a hand and to start to find other ways of searching through the nucleic acid-based approach to find these elusive genes or messenger RNAs. And that spawned the whole field in Oxford of eukaryotic molecular genetics, human molecular genetics through George's lab. George then attracted a number of visitors who were very influential, particularly people who were involved in hemophilia, hemophilia B. And so George embarked on a pretty extensive program to clone the Factor 9 gene. And that was a successful approach, and others after it. And on the back of that experience, that pioneering experience of how to get a gene cloned from a little bit of protein information was something which was replicated time and time again. And so that was the basis for much of the characterization of the complement proteins a few years after that, or perhaps only a year after that. And so I was working then, why I transferred then from George's lab at the end of my D-film, to work directly with Rodney Porter and to continue that gradual dissemination of the molecular biology techniques from one department to another. And so the biochemistry department and the Dunn School were a tremendous axis of collaboration in Oxford, something which I enjoyed for a number of years. So I guess I should put a couple of things together. I'll say one more thing about George and Rod and the contrast, which is a fascinating one. Because I'd mentioned already, George was very much innovative, tried to do something different. Rodney actually was almost on the other extreme. Rodney believed in doing the obvious. The job to do, you should get it done. And you should not hesitate, you should not try to think of the less obvious experiment, but you just march over the ground and characterize things. And we did. We hit a seam with molecular genetics, human genes. And we did a great deal, and it taught a great deal about the productivity that you could actually engender by developing a field and really working with it and expanding the applications and collaborating more and more widely. And that was an interesting contrast in the style of work to George. Both were incredibly valuable and incredibly valuable training. It was still in George's lab, both before and after I moved. George had attracted not only some of the key people involved in hemophilia and one or two other medical genetic subjects, but in particular there were two people who both joined George on sabbatical for a year in George's lab. One was Ted Friedman from UCSD, who was very interested in gene therapy. He'd known George for a long time, I think. And Ted was a wonderful mentor. He was a really great guy to have around and really took some time with us to teach us something of what he thought about where things were going. The other was Francesca Ginelli, a hematologist from Guy's Hospital in London. And he was my next boss, though I didn't know it at the time. And he in particular, both of them actually collaborated very closely with the lady who then became my wife. So I met my wife in the same laboratory as well. And my wife was also working on hemophilia B. And so together there were projects that increasingly became relevant to patients and the move from the appetite to find the gene through knowledge of the protein moved from now we have the gene now we can really get access to the genetics. And of course the genetics really involved. This is a means to identify mutations in conditions. And that's where really George and Francesco, in particular, with others, Charles Ritzer and Oxford, set up the suggestion that they would collect DNA samples from hemophilia B patients and actually characterize them at the DNA level to search for mutations which were involved in the cause of hemophilia B. And that was really for me that began to open my eyes to some of the medical aspects of it. Because Francesco was a hematologist, he worked in a pediatric research unit in Guy's Hospital. Certainly when I got talking to him rather more, it became rather more obvious that this was a whole new direction of research to go in. Well, yeah, the Human Genome Project not by name for three or four years more, I think. I guess I heard about it when I'd already moved to Guy's. 1986 was a very important year for me when really I began to hear more about the discussions of the Human Genome Project. But the concept of mapping and characterizing human chromosomes was actually rather earlier. And in looking back just recently, I've reckoned a few times there was a project way back during my first postdoc with Rod Porter where we actually mapped four of the complement class three genes together in a small contig. But at the time it was a huge effort to assemble a small contig of four cosmids that were shown to overlap and they identified this cluster of four genes. And that was the nature of physically mapping out in cloned DNA to try to replicate or reproduce the pattern of the genes as they actually sat in the chromosome. And this for me was really, it was something you could almost feel physically. It was actually characterizing something that you could definitely prove to be right. Interestingly, it was never the complete picture. There was always more to discover. But that was my first contribution to rather rapid coming together of a contig of clones to map genes, to begin to understand something which really nobody had had a concept of distance along a chromosome before. And from that, this is where Ted Freeman and Francesco Ginelli and George all come in again. They started from sitting on the factor 9 gene and actually the factor 8 gene next to it, which George was involved in for a while, to actually, again, asking the question could we link up genes on the X chromosome? Of course, the X chromosome was particularly an exciting chromosome because of all the genetic diseases that were known to be associated with the X chromosome. The hemizagous nature of the male really immediately manifested, meant the male's recessive conditions immediately manifested themselves. So hemophilia B and hemophilia A were only two of many X-linked diseases. So suddenly the idea of taking this whole concept of mapping rather further, linking genes up and then perhaps being able to search in the material in between and to really begin to capitulate the linear nature of DNA and its ability to code along an entire chromosome and to start to map back the concept of linkage at the molecular level. This is my exciting year at school all over again. The ability to start characterizing the unknown, marching through it is what Rodney Porter taught me. Don't think too hard about it, just do it. And that was an exciting moment. So that was really where the idea of mapping genes and looking really taking advantage of the linear continuity of DNA and walking along the chromosomes in some fashion took root. So this I think was somewhat before the human genome project was properly defined, but nevertheless the concept was there and I'm sure many people around the world were having experiences like this. And so when the concept of the human genome project was vocalized, formalized, it made a lot of sense. The geneticists, I mean, were branding people with particular qualities which I'm sure that it's not really true. But if an individual, let's say, has been working on a genetics of a particular disease which involves a particular gene, then that's one thing. And they rapidly go down the medical route of understanding seeking to characterize the genetics of the disease. But when you broaden the field to applying the concept of what you know a lot about in terms of a gene and a disease and the mutations that may cause it, you recognize instantly that that can be applied to any genetic disease and probably many we don't even know a genetic. It becomes a universal principle. And that's where genomics actually helps. Genomics is not there to steal the genetics from the geneticists. Genomics is there to really help and support and make genetics much more accessible to many more diseases, many more patients, and to provide a much streamlined process for characterizing the molecular genetics of disease. So I wouldn't claim to have been doing genomes before the human genome project. The human genome project was a wonderful description of the concepts, the isolated events, the examples which I had seen, and suddenly it came together. Another very important element in all this, which also on the one hand there's the human genetics that makes the interest and the utility of the human genome sequence potentially so important, the promise of the human genome project is that it will help and revolutionize genetics and medicine. But it was also the work on other genomes that was more advanced that wasn't motivated by human genetics, but it was nevertheless motivated by the same idea of characterizing a complete organism at the genetic level. And here particularly, and I would pick out the nematode worm because that's when I... I didn't really know John from when I was at the LMB, but I did get to know John when I... shortly after I arrived in London. And I was just beginning to absorb the genetics of X-linked disease at Guy's Hospital and become immersed in that. But I was also there actually on purpose to do research on areas that could not be funded from other sources. That was the terms of the Generation Trust, the private trust fund which was funding my research. And so that's where chromosome mapping was really one of the things to try to get our teeth into back in 1985, I guess this was. And I went along to a London Molecular Biology Club seminar and there were three talks at it, Bob Williamston, John Solston and Peter Little. And they all talked about the same thing in the sense that they talked about establishing contigs of clones that represented different organisms. John of course in particular was talking about the worm genome and their work in beginning to assemble contigs of clones to characterize the complete genome. And I'm sure... I don't know this but I anticipate anyway that John's interest was always to characterize everything about a living system. John had previously and he told me on more than one occasion the happiest time of his life was sitting in a tiny room with a microscope at one end actually staring all day and mapping out the lineage of cells in the nematode. And of course he eventually, I believe, established the complete lineage of cells in the nematode as well as discovering a phenomena like apoptosis and so on, programmed cell death as it was originally, I think, coined, the term was coined. But again, the idea that we have done that, so the next thing I do, I'm also going to have an appetite to try to cover the whole thing. And that was clearly behind John's motivation and I love that, the idea of doing the whole thing, getting the whole job done. It doesn't matter how long it takes, maybe a lot of marching but march through and do it and don't stop until you've done it. And one of the other important influences is Maynard. Maynard Olson. Now again, fairly early on in my time at Guy's and there are two or three threads where I met Maynard but this particular one was when he came to Guy's hospital to a course, a well-contrusted advanced genomics. No, advanced genetics course. I can't remember the name of it now. Well-contrusted advanced courses anyway. This particular one, three of us were teaching genomics the technology. Two various people who are very keen to start it. And Maynard was one of the keynote seminar speakers. After the talk, we ended up drinking beer in Guy's hospital somewhere in one of the older parts of the hospital. And he said in his view that the yeast mapping project, which had been going on in parallel to the nematode mapping project, Maynard and John knew each other very well, he regarded it as a failure. And I said, why on earth do you think it's a failure? And Maynard said, well, there are six gaps, or have many there were. The idea was to get continuity and I couldn't close the gaps. I hadn't closed the gaps. He was missing stuff. And it was a bit like, well, it was very like the approach that John Solston was taking to looking at the whole problem and until you've done it, you haven't succeeded. But Maynard was rather more purist about it. And I said to Maynard at the time, well, I don't agree with you. Maybe the job isn't finished in terms of continuity, but look at all the stuff you have done. Look at the value that's in the 99 or so percent that you've got. And I think I said at that moment, I mean, if I had a human genome that had a few gaps in it, I'd still be pretty happy with the outcome. And Maynard thought about it and I don't think he necessarily commented on that much, but clearly it was an interesting concept and a very good one to try to motivate to get complete continuity, not to stop. And of course, these genome, the worm genome and the human genome in particular still has gaps. There's no question. And those gaps become a point of debate. Both are the ones in the eukromatic sequence. The odd percent, what's a one percent? Well, actually that's one hundredth of all the genes, maybe. And then of course we don't necessarily usually refer to the heterochromatic regions and those things which are almost completely uncharacterized. So completeness is certainly a relative term. And so the concept of Maynard and John striving hard to really get the job done and complete it was an important one and probably drove both my understanding of just how determined you have to be, how much you have to slog through and how much you have to be looking very hard at methods that seek to achieve the goal, but don't actually look encouraging when you look at them close up. There are methods that were published that really were claiming long-range continuity, but there were shortcomings and you have to look very hard and critically, self-critically often to actually try to adhere to the concept of doing a really good job and ultimately faithfully representing a piece of DNA in its entirety in some immortalized form, whether cloned biologically or ultimately of course sequenced and stored as information. Maynard's a great thinker and a great communicator and he thinks both very clearly not too much in the detail but he will certainly try to see right through a problem from basic principles and I think try to create something. I think very individually create something almost from scratch. He will not spend too much time basing his own ideas on other people's theories necessarily. He really will certainly question other background information, other theories and really build something from scratch and I think that there's a purity in there and a clarity which is tremendous. He's also a great communicator but he will evolve a whole theory, strategy, whatever, almost without pause. You can sit and listen for 20 minutes and you learn a huge amount and he never really deviates from the subject in hand and it's clear that he just has absorbed a huge amount of background and perspective to enable him to see clearly and to concentrate on the important things in his mind and I think I agree with pretty much everything he thought about and it's a tremendous synergy that I felt or respect for his approach because I fell into his way of thinking quite easily. It was easy to follow the thread. There was a strong thread there, there was logic and it was very easy to follow Maynard's thinking. Also great philosopher particularly on the science and if you've seen Maynard quite often I think gets given the task of summing up an entire conference and he goes around getting opinions from everybody and just in three days he not only managed to absorb all this new information that's coming out of the conference in a very concentrated fashion but to somehow distill it down into some very clear messages and some very strong messages of the conference and that's a remarkable capability. He's also very hard to put off because on one occasion when I think he was doing summing up I think it was a conference that Eric and I were organizing but actually the lights went out in the middle of Maynard summing up and apart from a quick quip and pausing he simply carried on and the clarity and the drive to get to the end of his point was absolutely crystal clear. In the years just coming up to the Sanger Centre I was following John Sulston's work quite closely on the nematode worm and I was again very attracted by the global view of trying to do a complete job on the nematode worm at the mapping level this was this was before sequencing and I did actually meet John a few times and shared what I was trying to do with human DNA and I was trying to really apply a lot of the technology and lessons learned from the worm to mapping human chromosomes and we went further we actually collaborated to start using C. elegans software tools A. C. D. B. in particular it was when I met Richard Durbin and so quite a lot of contacts were formed with John and John was very aware of what I was working on sometime later he actually when I actually published a paper a piece of the X chromosome that I managed to map both in YACS and in Cosmets done by a student of mine Jill Holland and he he actually confessed after that he was very surprised when we got it to work he didn't think we'd get it to work because of all the repeats in the human genome that prevented us from hybridising from one level of the genome to one level of the reagents to another and I don't know how much that counted but he did manage to get a great deal to work we used his fingerprinting techniques we used his filter based hybridisation strategy and employed it all on human chromosomes on the X on 22 and clearly we've been working quite closely with Richard Durbin I can't remember quite when it was 1991 maybe 1990 and as it turns out about the time when the whole the beginnings, the early foundations or perhaps the seeds of the Sanger Centre were sown and the idea that both John and Bob Bob Waterston needed to be given a foundation, a more secure foundation to work on the worm and on the sequencing of the worm genome and so there's a remarkable moment when actually we actually were having a visitor in Guy's Hospital at the time in my department Kay Davies who was being hosted by Martin Bobrow the head of department and happened to be in Francesco Ginelli's office where I was as well and so we were talking and the phone went and Francesco picked up the phone and then passed on the call to me because it was for me and it was John Solston who was directing a call from John and John somebody said hello David, how are you? well yes and he said well come straight to the point he said how would you like to come to Cambridge and join me in setting up an institute and I froze because I felt that well Kay and Martin and Francesco surely had heard the entire conversation going on but it was a remarkable phone call and we realised it was another time we'd better to talk but that was the beginning of suddenly of course when something like that happens you suddenly feel the whole landscape change and of course the mind starts to work very fast on what the opportunity might be it just changes all the conception of the previous conceptions and previous thoughts and a very stimulating time I was very happy at Guy's I was doing a great deal with human genetics at this point but clearly this was another opportunity perhaps a difficult decision but clearly as time went on in a relatively short space of time it was clear this was a very big opportunity and an opportunity to really get much more involved in a very new venture which really drew together many of the early experiences that I had and so I think it was less than a year later the Sangre Centre grant was awarded and they moved some 6-9 months after that to set up a group and to bring some people with me from Guy's who had been working on the X chromosome and chromosome 22 and that was the basis for the human genome component of the Sangre Programme so that's how we really got into the project and I should say as much of the pilot studies we'd done at Guy's were funded by the MRC who'd set up an HGMP ring-fenced program for funding small projects but it was clearly if this job was going to be done it needed a whole different scale of investment and I think both the MRC and the Wellcome Trust really worked together to make that happen and to create the Sangre Centre so at that point I think I was at least involved in genome projects when the Sangre was first set up it was actually set up to support John to sequence the worm and Bart Perel in fact to sequence yeast and I think it was more a question and to work out how to tackle the human genome what to do how to contribute to the human genome and it was I think well I think almost every year after that there were ongoing discussions with the Wellcome Trust and proposals to continue and extend the program and to really start working on the human genome and I guess it was probably about a year after that that we went for additional funding and indeed the Wellcome Trust agreed that it was time to do more directly and more direct work on actually working out how to and actually starting on sequencing the human genome and that was when chromosome 22 and the X chromosome that had been going on for several years before it and had come up from guys became the centre for the human genome program along with a piece of chromosome 4 I recall which had the Huntington's disease lock us in it somewhere that hadn't been found before I think there was no limitation in will there was very definitely a will to do this I think the two major limitations were probably it was resource limited it was funding limited although the Wellcome Trust had been very generous and I think there was still a general sense of caution that actually it wasn't unanimously necessarily the right thing to do or to do it this way or was it going to cost too much and I think there was still some debate about should we be waiting for new technology or perhaps the debate had happened and we moved on but of course not everybody had necessarily really satisfied themselves that the technology was ready and I think there were technology gaps clearly the sequencing was the technology that was chosen and that lasted stood the test of time for the entire human genome but there were gaps Yaks sort of came and went they weren't sufficiently stable to actually contain a faithful copy of the DNA within them although they were quite good for a long range continuity Cosmids were too small perhaps some levels of bias so one of the important gaps that was then filled was the pack and the back system so that was missing at the beginning of the program and that was an important transition filled a really important gap I think one of the other technology gaps was actually a framework to independently verify demonstrate and even create the higher level order of contigs along a chromosome and this is where both first of all the genetic map and certainly in the UK the eyes were on the European initiative in France in the CETA laboratories in Geneton where Jean Weißenbach of course created a micro-satellite based map a very elegant piece of work that really provided a level of continuity albeit the points were somewhat far apart followed relatively quickly by the radiation hybrid mapping which was a very exciting time indeed where we actually went from having a system that could not only make use of non-polymorphic markers and many more of them and achieve higher densities but they also could integrate the genetic markers as well because it was all PCR based it was all STS's concept that Maynard and his colleagues had advanced and suddenly automating very high throughput PCR reactions to map out a a set of markers much higher density than the genetic map that really provided the density of markers needed along a chromosome to allow the clones to then take over and we no longer needed yaks to provide the continuity the distances could be filled with packs and backs and of course John Solston's fingerprinting method which still really enabled us to link clones together and so we suddenly had two approaches orthogonal almost approaches to create the continuity that was so important there was the fingerprinting of the backs and the packs to provide the continuity but there was also the reference points from all the STS's anchor points to actually identify individual clones underneath those markers and if we needed more markers we could now do them we could generate more markers do more PCR and actually add markers to the same map and that integration that very close integration between the genetic the radiation hybrid and the clone maps was a very important area to technology gaps filled in fairly quick succession by the pioneering efforts of laboratories around the world radiation hybrid map famously brought together the David Cox lab and Peter Goodfellow's background and of course the concept actually came in part at least from Henry Harris in the Done School of Pathology some years earlier in constructing these mouse human hybrids that became the the reagents that underpinned the radiation hybrid map so those technology gaps were important to fill they led to very constructive international collaborations we were exploring how to collaborate meeting the whole community through these efforts and that I think quite quickly really stimulated the funding agencies probably to do more and to consider that there was really was a coherent approach that was very step by step the human genome project must be the most step by step hierarchical study of any genome I think that's ever been done but that was partly because we were working every step out at one after another rather sequentially we were relying on different techniques to try to tackle a very large problem and also I think the community in general and perhaps the funding agencies in particular needed to see those levels of evidence the levels of proof the levels of being able to obtain completion at different levels of resolution to be confident to moving on to the next level I think that was a fairly compelling element of the project that enabled us quite quickly to move through the barriers and to confidently expand the program particularly the sequencing technology in multiple lamps and within the Sanger certainly John himself and Jane Rogers took a very personal interest in putting the technology providers through their paces but the sequencing was really coming on a pace I think although it looked a little shaky to start with the automation to get fluorescent detection instead of radioactivity I think some of the early nematode cosmits at least one person who was convinced that the right way to do it was still with radioactive sequencing well the first fluorescent machines were not really delivering so much but it was the right thing to do there's no question embracing a new technology getting away from radioactivity high level of automation they were absolute bellwethers for progress I think it's interesting I think from the very beginning the sense that the human genome could be done from my perspective any of us based very much on the argument well the worm is 100 megabases and that looks like it's going to get done in fact it was probably largely done by the time we came to this point and done to a highly automated sequencing but also finishing and then all the hallmarks of a high quality product were there and each human chromosome is about the size of a nematode genome so all we have to do is divide the project up by 20 or so and we have 20 nematode projects and that seems to be really quite manageable and that's it's one example of the philosophy of going chromosome by chromosome but I think it worked quite naturally because that's what people have been doing for some time we'd been working on 22 and part of the X chromosome at Guy's Hospital and that illustrated two things the reason that we chose chromosome 22 was actually to get away from a busy chromosome where lots of people were working on different parts because fine we would all discuss and work out and some people were working on the same bits as others and we'd figure that out at some point and I think Eric Green and I actually had a go at suggesting that as long as you went stuck within your own gap between two STSs then we would actually carve up the entire genome STS by STS and that never quite worked out and instead chromosomes are the much more logical currency so we moved to chromosome 22 because it was essentially almost unstudied at genome level anyway it was also small so continuity and finishing the map was going to be much quicker than the X or an average size chromosome and at some 33 megabases of course was only a third the size of the worm genome so things were starting to look up that we could actually make progress quite quickly and so between those two examples chromosome 22 we were simply looking at the whole thing the X chromosome bigger chromosome popular chromosome brought with it its problems both in terms of size and the complexity of the community and so those two models rather played out for the whole genome I think I think following probably exactly the same logic David Cox and Rick Myers were interested in chromosome 4 because of an early interest in certain genes on it I think chromosome 6 and others and so gradually the splitting up of the genome organizationally into chromosomes reflecting the natural interest of different laboratories how I think it really took place and I do recall one or two meetings where we got together quite quickly at the beginning of one coordination meeting to try to divvy up the chromosomes between the groups and it kind of worked quite well because most groups were actually working on different chromosomes and there were one or two debates and the X chromosome was always going to be more of a mosaic but some of the others were more straightforward and alliances were formed people began to realize if they were all part of something bigger and actually you had a chance to look at the horizon for the whole genome then it made much more sense to try and get the whole job done than to fight over one chromosome and so I think the idea of splitting it up between chromosomes worked very well and worked at a particular meeting there was a very definite agreement to work on certain chromosomes and this was about I'm not sure on 95 or 96 I would say 95 let's check on that it coincided with the World Contrast agreeing to fund the Sanger for more and so that's when we started chromosome 6 and within a week we had a chromosome 6 team it was astonishing we took people from 22 and from the X team and formed the chromosome 6 team and we suddenly were able to expand on to another chromosome and clearly illustrated the scalability of the whole program at the human level as well as the technology level one of the very things that happened at that time so World Contrast had funded us for a sixth of the genome and the other members of the G5 and other labs as well were funded to varying degrees for other chromosomes and I once drew up a poster which summarized I boxed each of the chromosomes in colors to represent each of the people contributing it and about a third of the chromosomes were not assigned and we had a royal visit of the Sanger, Princess Anne came to visit the Sanger and I think officially opened a building and she walked down the corridor and I had this poster up on the wall and she actually stopped to say hello and Princess Anne is not a geneticist she's not a biologist but like other members of the royal family they're very perceptive they know the questions to ask and she said who's going to take responsibility for the other ones and that was such a good question to ask because of course it was exactly the right question and of course it was eventually the question that got resolved maybe a year later or less than a year later when suddenly everything scaled up to the concept of we need to hold you know we need to do it now we need to have a strategy now we need to make sure there aren't any parts of the genome that aren't covered and then I think the chromosome by chromosome strategy really did expand more resources became available the Sanger was funded for now up to a third of the genome and at the same time I think the NIH must have done a lot to really stimulate that the DOE I think came in possibly more firmly so everything happened at about that time I think it's important to say the G5 didn't do the entire genome there were contributions small and large and I think that was a very important concept and I think the simple solution to it is that if you release your data and you share your data in some standardized coordinated fashion then it is clear that you are working and contributing to the whole and it makes no sense to duplicate and so in that sense a small group can survive under certain precepts like being coordinated and being transparent and showing and sharing their contributions clearly the question of scale and being able to make economies of scale is very important and that's inevitably a driving force this may have been a decent level of automation around the sequencing but there was still a huge amount of potential economy of scale as a result of really building dedicated teams and dedicated laboratories that really did this Sanger was working on two and sometimes three shifts a day and that was not something a small lab was going to necessarily keep up so inevitably there was a question of cost overall but I think it's I'm delighted the smaller labs the labs that contributed smaller parts of the sequence did stay and contribute because they added a great deal I think in other ways to the project and of course one of the latest and most recent members of the consortium China came in late to the game but contributed some sequence to the program and of course the outcome of China becoming part of the Human Genome Project of course had huge ramifications for the future in a very global way and I think clearly if that had not become possible and if they hadn't been welcomed to the community then the world and the Chinese sequencing community would be the poorer for it or would possibly not have evolved and one of the very interesting things that the community tested out somewhat before the G5 back in the first Bermuda meeting in 1996 was the decision to create this framework of data sharing transparency set standards about what was being generated but the data release policy demanded that the requirements of the project were put ahead of the constraints of individual nations or laboratories and that was a hard decision for some people to take and I think one or two people actually couldn't that they had to go back to their national constraints their governments whether they could participate or not but achieving that transparency that sharing really formed the basis for setting of a common standard and that's when both large and small groups could participate as long as the standards were set and the necessary constraints were met I think people were always talking about SNPs to some extent and before the program really SNPs type of variations whether it was an RFLP or not was very important in genetics so in that sense it was always being talked about I think the concept of scaling up clearly became possible I think it was starting to get talked about before the genome was assembled that's certainly the case there's a fascinating transition once the concept had been established it was a really good idea to develop a SNP map of the genome or to collect a large number of SNPs for the genome I guess it embraced the idea that here we were being able to look genome wide here we were the concept perhaps of the STS was really again providing some momentum to the idea of being able to spread markers right across a genome and the power of doing so at an ever higher density plus the fact that there were ways of doing it through sequencing sequencing was now much easier to do at scale and suddenly that was not the limitation only six, seven years earlier sequencing had been an impossible cost-limited element to doing an experiment and suddenly sequencing was a currency you could work with and generate large amounts of sequence data from other individuals to each other and later on to the genome to actually identify variations systematically at speed the fascinating transitions happened during the SNP consortium and we're skipping over the SNP consortium a little bit here into the early part of the experimental strategy but when we first started the SNP consortium the centres that contributed to it we started on an approach that did not assume the existence of the genome sequence we started on a process where experimentally we targeted specific subsets of the genome in a genome-wide fashion so we would simply take restriction fragments of a certain size which was scattered throughout the genome but they sampled a very small subset of the genome and we generated SNPs across those regions and little while later the draft genome sequence was being accumulated all the time and it suddenly became possible to essentially not just compare all the sequences to each other in the defined regions that we had created but also to look right across the genome one read was suddenly enough to call a SNP because it could be aligned to this wonderful free and available draft genome sequence and variants could be called all over the genome with much greater efficiency and so then I think the whole question of developing a dense SNP map became much more reality yes, I was quite involved in the SNP consortium they were probably not actually at the beginning I think at the very beginning there was clearly a series of discussions probably founded from these various meetings to discuss the importance of variation the recognition perhaps of variation was very important not just to genomes and genetics but also to pharma companies as well so there clearly wasn't interest in variation within the pharma companies and I think there had already been some individual investments in individual companies to try to address the problem of getting a reliable comprehensive set of variants to actually answer questions about genetic predispositions variability of drug response whatever it might be and so it must have been at least a year I think that there was this tremendous negotiation going on between pharma companies orchestrated I think largely about Alan Williamson who was another friend and mentor of mine and Alan must have spent I think at least 12 months working on putting together this idea of the SNP consortium of developing both the public-private partnership and also persuading or encouraging the pharma companies to agree that this particular resource of collecting information and variants could be considered pre-competitive and that was a really important element of the program which actually enabled people to agree that yes, A, we can't do this alone B, there's little point in 7 companies doing the same thing so let's pool our resources and do it much more systematically in a much more organized fashion and agree that it is a pre-competitive space and from that moment on I think the concept of the pre-competitive space of course then drew on the concept of rapid data release being able to share the information different laboratories working to a common standard a common set of standards for the quality of the calls methods for verifying indeed there was something of a round robin not quite a round robin, there was something of a verification process anyway for the SNP calling to ensure the quality of the resource was both standardized and high quality so this was the point of which moving from the early negotiations to establish the governance and the guidelines of the consortium to actually getting the job done and that was of course when the academic labs were approached so Sanger and Washington University and the Whited Institute as it was at the time were certainly approached as if we were provided funding from such a consortium how would we approach to do it and I think largely independently two of us at least if not all of us came up with similar ideas or the same ideas for an approach and that lent some conviction to the idea that we could all work within our own laboratory organizations but contribute variants of a common standard that were distributed across the genome as a whole well SNPs can be used in many different ways of course and essentially using SNPs for linkage analyses and pedigrees they have a lot of power over a lot of distance because there are relatively few crossovers that are informative in terms of identifying or finding a way around the genome and inherited a phenotype within a particular pedigree but a much higher density of SNPs essentially the target of the SNP consortium of course was stated as 300,000 I'm not sure how much that was genetic theory and how much that was budget limited but 300,000 was a stated goal it was a good density an average density of SNPs to go for and clearly did match the ability to start measuring linkage disequilibrium in populations and this was a start of something much bigger I think it's it was always going to be true the more SNPs you have the better you could characterize genomes using the linkage disequilibrium in different populations and from my perception the fields evolved somewhat in parallel people were working with small regions or in our case chromosome we were looking chromosome 22 with a set of SNPs and we clearly recognized that calibrated the density of the map at one level but others like Jeffries in particular working at very high density in a very small region of the genome and demonstrating crossovers and demonstrating the ability to really characterize very in very fine detail the pattern of recombination in populations so clearly the denser the maps the more valuable the resource would be so I think from my perspective I was largely involved in data generation for the actual SNP collections two things happened one quite early on in the TSC which was when I've already described to some extent the fact that actually we could make much greater use of the data we had by incorporating the genome and essentially almost overnight we could quadruple the number of SNPs that we had in the same resource so clearly by now the whole concept of collecting SNPs, mapping SNPs using the draft genome that was getting better and better all the time of course really changed the game in terms of what we could do to generate a good resource and at the beginning of the HapMap project or slightly before the beginning of the HapMap project one of the questions surrounding it was David Altschuler and Tom Hudson myself, Mark Daley, one or two others met early one year and discussed the possibilities one of the elements was actually generating more SNPs, higher density and at this point we were able to once again actually take a chromosome by chromosome approach and flow sort more chromosomes and sequence them and align to the draft genome this was again getting easier the currency of sequencing was yielding more and more efficiently so one of the elements of the HapMap was the recognition that with all the pilot studies and measurements of LD having been carried out began to think to get a better idea of the number of SNPs that were required the benefits of more SNPs and so SNP generation was actually a first part of the HapMap project as well and it was pretty much being done at the time we published the principles of the HapMap project kind of before it started in earnest but at the same time we were already generating more SNPs in preparation for the HapMap project well I think much of the leadership of the HapMap consortium again came from Francis I think Francis took a very prominent hand in organizing particularly ensuring the involvement of so many people both who had been involved before and those were newcomers to it both large and small this was the first consortium that worked closely I think with Yusuke Nakamura and Japan was really very much part of this the single biggest contributor to the first phase of HapMap that was a very exciting and stimulating entry into the community and I also remember a very large meeting here in Washington I think the Renaissance Hotel or something where actually there are members of every possible community and participant and skill set all gathered in this room to really explore over a day and a half I think it was what this project was what it meant and many different population representatives were present and lots of discussion was had both outlining what the project would be how it affected people how it affected populations how it affected society and the impact it could have on ultimately on population genetics and disease I think pretty early on I don't know what stimulated actually but I do remember early on I think a number of us felt very keen on sampling different ethnic groups certainly to pick from Asia certainly to pick in Africa I also remember a discussion that then went from that to deciding and Eric Lander was on the call at this point as well but a call where we agreed Eric and myself and several others I think that we really needed to go to the indigenous populations to actually collect the samples while it was much more difficult it added a whole level of difficulty to the project compared to utilising an African American group or a European group which was already a research cohort or something but to both indigenous populations for me felt very important from the point of view of going back to the source the Africans are in Africa but of course very much also important it globalised the whole project it engaged communities in a way that was at once very challenging because here were communities who'd never heard of HACMAP didn't necessarily know what the benefit was and so the idea of contributing freely to a consortium they needed to work a lot of that out as part of the engagement it was a fascinating process I wasn't very involved in the engagement I was involved in one engagement process in particular with the tribe of the Maasai in Kenya and that was a tremendous experience and it illustrated to me all the work that must have gone in to the recruitment that was systematically done by more than one team as part of the HACMAP project I was enormously impressed by Charles Rotimi's contributions and thinking about the whole thing there was a simple and very right philosophy and of course he really of all people could do this he understood exactly the cultural differences and what could and could not be done and so I'm delighted Charles's leadership which was also happening at the same time as the African Society of Human Genetics was being set up and Charles was the initial chair or president of the African Society and he invited me out there in fact which is how I came to be in Kenya involved in waiting to engage the Maasai Charles was there and a small team of us were essentially waiting for the call from the local doctor who eventually drove us out to actually meet the chief of the tribe to discuss what it was we wanted and as you described we explained or tried to explain the concepts of what we were doing and of course two things emerge from this discussion from a very wise young tribal chief a remarkable man completely on the ball but we had some trouble in explaining inheritance and we talked about things being passed on from generation to generation and this went off in the direction of what you know cattle and goods and things that get passed on no that's not quite what we meant but we got onto the blood and somehow they understood the concept of things in the blood that get passed on and they weren't talking about infectious disease they were talking about patterns from between generations and they understood then that we wanted to study this idea of things that get passed on and they were very interested and excited they got this because it meant a lot to them the family ancestry was a very strong element for them so suddenly we got off onto a common ground common interest and they absolutely saw why we should be interested in this and they were delighted to help and the other interesting that happened was that actually whether it was Charles or Pat I don't know asked if they'd like something in return for their generous gift of permission to engage their particular community and we asked them whether Charles or Pat asked them did they want anything in return for their generous gift of giving us permission to engage the tribe and he came out with it straight away the chief HIV testing and we asked him to expand a bit on that and he said because we don't have HIV he said yet he said but we know it's coming and when it comes we want to be ready as ready as we can be we want to do what we can and so he was completely in touch with what was happening in other parts of Africa even though it was a relatively isolated tribe it was a fascinating exchange and I asked him afterwards as we walked across for a celebratory soda in the local soda bar I asked him clearly he felt part of his tribe because he was in charge of his tribe did he feel part of all the Maasai the other tribes and he said yes and I said did he feel part of all of Africa and he said yes all of Africa and I said do you feel part of the whole world he said no and that astonished me because he clearly got way beyond his own boundaries of what he saw on a daily, weekly, monthly basis and his responsibilities to Africa as a whole, as a population but he said he did not have any connection with the rest of the world and that of course was exactly what the HATMAP project was actually seeking to define and at that point I recognised we were really coming from rather different backgrounds myself and the Maasai chief I was not involved in the Human Diversity Project at all and I didn't really know much about it but I was aware that as the early discussions about the HATMAP project took off there was this sensitivity there was this past history that it was very important to work differently to fully engage communities and I think that was very much a part of the motivation and the agenda for this very big meeting in this hotel here in Washington DC the Renaissance I think where we did have members of many of these communities present to have a voice to speak out to voice their concerns and their interest and clearly that was a very major part of community engagement and of course community engagement became a big part of the HATMAP and rightly so and I think I'm very glad when it was done on so many levels it was done on the levels of going to get samples with the indigenous populations but using a process of engagement to get them to understand and just explore their interest in that so I think the extent to which that may have been presaged by experience from the Human Diversity Project I think was a very good way of managing the situation as far as I'm aware the process was extremely successful I don't know the details it was another group that was doing it but at the same time it was certainly good and certainly I enjoyed the brief passage of community engagement that I was involved in with the Maasai so I wasn't very directly involved in the real definition of the boundaries of what's HATMAPable and what is not but it was clear the concept was there were regions that were difficult for one reason or another either we weren't finding snips in those regions or there was something intrinsic about the structure of those regions or there simply wasn't any LD there was perhaps more recombination and put two or three of those components together and you suddenly get a region that really defies characterization not to say it isn't mappable but to say that it would involve a disproportionate investment to get across the region perhaps and we didn't necessarily have good approaches at the time to target every region of the HATMAP of the genome to ensure that it could be mapped to the same extent and so as a result we had to come up with a definition of when is the project declared done probably not unlike the human genome in a sense it was just less easy to define the human genome is clear well it's done well it's done when we've done the eukromatic regions because we know we can't do the hetochromatic regions so it's done in one sense it's not done in the sense that a geneticist would say where's the end of that chromosome particularly the the short arms of the acrocentric chromosomes there are ribosomal genes up there but we can't say it's part of a 20 megabase contig or something so clearly the unsequensible regions of the human genome can be defined based on a lot of other evidence about structures being different presumably perhaps base composition being different repetitive sequences we can see the elements that are in the unsequensible regions and of course we can then continue to begin to work on them although they take a lot more investment than the rest of the genome the value of course perhaps considered particularly for supporting genetics and medicine and much of biology of course are in where all the genes are and hence the eukromatic region emerged as being the primary finishing post for the human genome sequence the same is true of HATMAP but we need a different finishing post but the problem was the same there are regions that define characterization for somewhat unknown properties and in this case of course in some cases the properties were less well known to say why was that region different why was it not actually being populated with markers or why was there no LD across the regions perhaps we didn't have the right samples to genotype perhaps more work could have yielded smaller gaps but I think therefore is a rather operational end point to the project that got defined by a number of things including the number of SNPs including the number of samples in the different groups and changing any one of those parameters would make a difference to the unmapped regions at the same time I think we reckon that the first approximations when we sat round a table I think at Colfrey Harbour actually and discussed what the bounds of the project would be we felt that actually to have potentially 85% of the genome of 85% of the sequence to genome 85% of the eukromatic part of the genome essentially captured in haplotype in the box was a tremendous outcome as a good end point to aim for and that we should then direct our strategy to try to cover that rather than saying we should direct all our effort to the remaining 10% or 15% it was important to gather the majority essentially the job would not be finished by one measure this is going right back to the concept of the yeast genome and Maynard but even a product in gaps is a jolly useful product look at the 85% you have and not the 15% that you don't have clearly when you move to applying the results of such a structure to genetic associations to genome-wide association studies or whatever it might be the fact that you only have 85% of the genome means that assuming associations or susceptibility factors are distributed evenly throughout the genome you will find 85% of them based on the SNPs that you have if you have sufficient power in your studies so it was a pretty good starting point look at what you can achieve as opposed to worrying about the 15% that you can't get at the moment well I think there were two ways to go from that point I think one was to continue with developing the concept of the HapMap and addressing some of the original areas that we had to put to rest for now to park which included more SNPs more populations as well more populations question have been there right from the beginning clearly we don't know about the level of similarity or real applicability of one set to another until we actually do another population so I think there was a tremendous opportunity to diversify the populations involved in the study and we're still only scratching the surface as far as the human population is concerned but the other way to go which became more of a focus for me was the unanswered question of how good genome-wide association studies really were could they be better because there was for some time been many antagonists people who didn't believe the GWAS program was really going to either identify the right factors or the the sites identified in the genome wouldn't necessarily provide insights on disease and so I think once this comprehensive HapMap was available with the SNPs to enable it to be applied to case control studies there was a big unanswered question when now we have the opportunity to evaluate once and for all the utility of this approach we're either going to prove it or it's going to stop the garnering funds for further work this is a discussion in the UK certainly John Bell was involved Peter Donnelly was involved and the question was will we really going to mount a program to evaluate for ourselves what the HapMap would bring to powering GWAS studies rather better and that really was an interesting to becoming a national consortium and this was the Wellcome Trust case control consortium started to utilize the HapMap to take advantage of existing case control cohorts in the UK to really start to look for can we now find associations now that we have a HapMap of at least a significant density yeah I wasn't really much involved in the GWAS studies early on I was fairly compelled by the fact association study with deep vein thrombosis and the logic seemed to make sense but clearly as you scaled up yes there were shortcomings of some of the studies and the HapMap of course provided at least reduced the limitations of some of those studies by going truly genome-wide or at least asking the questions of 85% of the genome in a fairly well measured way so that was a positive contribution that the HapMap could make to those studies and I think it did, I think it stimulated a great many more findings findings that were statistically strong developed new ways of actually analyzing the data as a result and clearly a great many targets of the genome have been found in various cohorts it's still a struggle I think for two reasons one is to actually find the variant that is directly associated with the condition the causal variant is still a leap from the association and the other of course is these are common conditions and the multifactorial nature of the program means that even if you found a really strong hit it's only part of the architecture of a particular disease or the cause of the phenotype and there again is another whole complexity to the study of common disease through this kind of approach it's a big challenge I wasn't very much involved in the origination, in the originating it, no by now I was at Selexa and very much the sequencing technology development and Illumina as acquired Selexa as well so in that sense I was less involved in the actual inception of the project but certainly some of the unanswered questions of map and genetic maps and the incompleteness of the coverage which had been posed by these projects were clearly once again being challenged there was the question now we could really overcome at a population scale the gaps between SNPs and to start to in particular I think the idea of being able to capture every variant in a person's genome completely changed the dynamic between indirect and direct association studies and the direct association study you're working with the actual variant that's causing the particular condition the association signal is going to be much stronger than any indirect association that relies on LD between the causal mutation and the actual marker in question so the idea of having every variant in an individual was actually a concept that I was thinking much more about even in a thousand genomes project a thousand genomes project sought to sequence individuals but to accumulate all the variants they could find to make a better resource of variation and that already went a lot of the way towards a much to filling the gaps to really study variation across every part of the genome at least that was covered by sequence and you could really close the gap between the 85% macability and the fact that the reference sequence was covering 98%, 99% of the eukromatic sequence so what is in that difference between 85% and 99% does the thousand genomes project provide those variants and I think that was a very important question for the thousand genomes project to answer


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I'm going to demonstrate the use of the diagnostic A-scan probe. It's important to know that this is not a biometry only probe. This can be used for biometry, but also it's also used for what's called diagnostic A-scan of both the globe and the orbit. This is a separate probe from the B-scan probe. Some units have a combined A and B-scan probe in the same probe, and there's a vector display at the bottom of the screen. This is an independent display of the A-scan only. It's very helpful for quantitation, especially in the orbit, looking at muscles, looking at optic nerve, and in the globe for looking at tumors. So to major things, to analyze internal structure, this is a very useful technique. I will demonstrate the basic probe position. Compared to the B-scan, there is no mark on the A-scan probe, so orientation of the probe doesn't matter. It can be turned any direction, and it's the same display on the screen compared to that of the B-scan probe. The patient has had a drop of anesthetic placed in the eye, and I have the eye open. I'll demonstrate on the left eye, placing the probe at the 6 o'clock limbus, and then I aim superiorly going across the eye to display the superior part of the globe. So even though the probe is at 6 o'clock, I'm displaying the 12 o'clock position in the globe. And as I move the probe, I angle it down towards the inferior fornix, and I watch the display on the screen. And the display, the initial spike, is from the probe itself. I'm going through the vitreous here, which is usually a flat line because there's no reflection within the vitreous cavity unless there's vitreous pathology. And then I see the fundus spike, which is a high-rising spike in the back of the eye. So my goal is, as I move the probe, I try to maintain this in a steeply rising fashion. I want it to be steeply rising, high, and straight, which means I'm perpendicular. And perpendicularity is important for measuring purposes and internal structure analysis. And once I'm behind the initial retina spike, I'm in the orbit, which has many high spikes. So the contrast on the A scan is analogous to the B scan, where the B scan display in the globe is a lighter color grayscale because there's no reflection inside the globe. And correspondingly, the A scan display is a flat line. Once I get into high-reflective tissue on the B scan, which is contrasted to the A scan, I see high reflectivity from the orbital structure. The orbit has many interfaces in it. It has muscles and fat, septa, and these give high reflectivity, so that contrast on the A scan. So as I angle the probe, I'm scanning the globe. I start posteriorly towards the posterior segment. The probe is almost pointed directly posteriorly, and I angle it superiorly more and more as I scan the retina towards the peripheral retina where the signal starts to break down. That means I'm here at the auraserata area and I can't get a good perpendicular spike. So I scan the globe comparable to the B scan in six quadrants. This is the six o'clock position. I then move over here in the left eye. This would be at the four o'clock position, and I do the same thing. I aim the probe almost posteriorly, and I get a spike from the initial signal, and as I angle it, I try to maintain the fundus spike in a perpendicular manner until I break down as I approach the auraserata. I then go to the two o'clock position, do the same thing as I angle from the posterior segment more and more anteriorly to the peripheral retina. So by doing that, I scan the entire inner contents of the globe, and again, watching the vitreous for any spikes in the vitreous, and watching the fundus spike for any low reflectivity indicating a possible lesion, such as a tumor. In this patient, there's no pathology, so that's not demonstrated. I then can go to an orbit expansion, which simply has the same display in a more contracted view, allowing me to see the orbital tissue in a better display. And so as I go on the orbital expansion, I can do the same scanning technique. I place the probe inferiorly at the six o'clock position, and I am going superiorly, scanning the orbit. In this case, this is a superior orbit. So again, here's the initial spike from the probe, here's the vitreous display, which again is flat because of no reflectivity, and here's the orbit reflection with many interfaces because, again, there are many different structures with the orbital tissue to give reflectivity. And I scan the superior orbit, I then place the probe, again, at the four o'clock position, and I'm scanning the superior nasal orbit. Again, going back and forth, trying to maintain perpendicularity of that initial retinal spike. I then can concentrate on specific orbital structures, especially the extracurricular muscles and the optic nerve. And this allows quantitation of these structures, which is very important for following such pathologies as grave disease or myositis or other muscle conditions. And the optic nerve allows me to evaluate the nerve for swelling, as may be found in increased intracranial pressure with optic nerve fluid, or an example of a tumor of the nerve, such as glioma or meningioma with nerve thickening. So to display the muscles, I again place the probe inferiorly to display the superior rectus muscle. I'm going across the globe towards the superior orbit and I watch the display for a little deflection in the reflectivity pattern. Because most of the orbit is low reflective, high reflective, I want to get a low reflective pattern indicating I'm probably in the muscle. So example right here, the muscle would be from here to here. So the muscle sheath, I'm going across the sheath from the inferior muscle sheath to superior muscle sheath, and I would measure that distance. We have electronic calipers and measuring tools to allow us to do that as we measure different structures. On this unit I'm able to move the caliper and the cursor falls on the muscle sheath, and I then measure the other part of the muscle and I display this as a thickness of the muscle. There are various tables indicating muscle thickness and normal patients. I'd refer you to that. Also the textbook addresses that. But we measure the superior rectus muscle in this situation. I then look at the medial rectus muscle by placing the probe on the lateral globe, aiming nasally towards the medial rectus muscle. I move the probe back and forth. I make little microscopic movements side to side up and down, and I watch for a dip in reflectivity and I freeze that. I can see the pattern here of the muscle compared to normal orbit, which is high reflective here, high reflective there, but here you see the dip in the pattern because the muscle is more homogeneous than adjacent orbital tissue. Again, normal orbit is quite high reflective because of many interfaces. The muscles are more homogeneous than surrounding orbit. They tend to be a little bit lower reflective, normally. So I can measure the muscle sheath here on the medial rectus muscle, and the cursor there and there, and I get a measurement of the muscle thickness, 4.42 millimeters. So I can do that for the other muscles. Look slightly down. I place the probes apparently, and I aim towards the inferior orbit to get the inferior rectus muscle, which is usually the smallest muscle of the extracurricular muscles. And I watch the pattern for a slight dip in reflectivity, and I will use that for my measuring purposes. So right here, I put the cursor on this sheath of the muscle, the other cursor on that sheath, and I measure the inferior rectus muscle to be 3.64 millimeters. We then measure the lateral rectus muscle by placing the probe nasally on the globe. And again, we aim towards the lateral rectus muscle on the globe. We watch the orbital pattern for a dip in reflectivity, and use that for our measuring purposes. So there to there would be the muscle sheath. Place the cursor on one side of it, and the other side, and measure the muscle thickness of 3.37 millimeters. So I measure the four rectus muscles. I can also measure the superior oblique muscle by placing the probe inferiorly temporally on the globe, and aiming towards the trochlea in this part. The superior oblique muscle tends to run along the medial wall of the orbit, so it usually is further back on the display on the screen than the other muscles. It is more towards the bone. So right here is the superior oblique muscle. So I place the cursor on one sheath of the muscle, the other cursor here, one oblique muscle, four rectus muscles. The inferior oblique muscle tends to run inferiorly, kind of in a hammock fashion across the inferior globe. It's very hard to display that muscle. You have to get the probe way up here, the brows in the way, and usually I can't display that muscle so I don't usually attempt to unless there is some question about pathology. Then I will attempt to do that. So that's the basic muscle measuring technique with the A-Scan. Again, this probe is not a biometry probe. You couldn't do that kind of examination with a biometry probe. You have to use a dedicated A-Scan probe to be able to do that. And also the size of the probe, as you can see, is much smaller than the B-Scan probe, which is a thicker dimension. And it would be hard to place the probe as I've done here in different parts of the globe for that purpose. Now to measure the optic nerve I usually place the probe on the temporal part of the globe and aim nasally. And I attempt to get a display of the nerve looking right next to the globe display. The muscles again, here's the meteorrectus muscle over here, a nice display showing the dip and reflectivity. But I'm looking here more anterior to that display to visualize the nerve she spikes. Now sometimes they jump right up, sometimes you have to work back and forth. My hand is moving little movements back and forth all the time, side to side to try to maximize that display. And I see two spikes right here. You want to try to get steeply rising spikes. This isn't perfect because of this little artifact here. But I see a spike there, I see a spike there. So in her, I would measure from this part of the nerve sheath, this is the anterior part, the medial part here and the other sheath I would measure here. So my nerve sheath is from there to there, measuring 2.36 millimeters which is in the normal range for optic nerve sheath measurements. You can also to measure the nerve from the medial approach. If you have a hard time temporally sometimes away the nerve kinks in the orbit, it's hard to get a good display. So I will then place the probe medially and aim temporally to try to capture the nerve there. And sometimes you can get a better display as you aim across the nerve going this way. So sometimes I'll go back and forth. I'll do on the temporal part first and then the nasal part attempting to display the nerve. So here it's more difficult, so I had a better view by placing the probe temporally. So this is called the trans-ocular approach. We're going across the globe to visualize orbital structures. You can also do a para-ocular approach where the probe is placed in a position to bypass the globe. Example here, I'm not going through the globe. I'm bypassing the globe to see the lacrimal gland and I'm placing the probe in the area of the lacrimal fossa and looking at the lacrimal gland signal. And here it's a normal gland so you see this kind of a step off in reflectivity as I go through the gland. If the gland is enlarged or reflectivity patterns are different I can pick that up by doing this technique. I'll also go around in the different quadrants, so here at 6 o'clock I will look bypassing the globe. So here's the globe pattern here. I want to bypass that so I'll go more inferiorly and I'll see the orbital display here. I'll go to 2 o'clock correction 4 o'clock and I'll show it here. I'll go to 2 o'clock and bypass the globe showing here. I'm going to 12 o'clock and not showing the globe pattern just the orbital pattern. I'm going to 10 o'clock the orbital pattern here and 8 o'clock the orbital pattern here. So by doing that I've done a para-ocular approach to show the orbit because sometimes orbital lesions are quite quite anterior and they can be displayed unless you show this kind of approach which would be missed on a trans-ocular approach by going further purely in the orbit.


What's your go-to pizza topping? Go-to pizza topping, pepperoni. Would you rather fly or be invisible? I would rather fly, for sure. Saved me a lot of time. What's your most used emoji? My most used emoji is a combo package. Sunglass is on, pound fist. What's your secret party trick? My secret party trick. Making bottles of wine disappear. What's your go-to selfie pose? It's a bit of a wrinkle in the forehead. Kind of confused look, like, sorry, what'd you say? That kind of vibe. What's in your pocket? Just a cell phone. That's it, that's all I got. And an insulin pump on the diabetic, so I gotta keep that in there. If you could be any type of sandwich, what sandwich would you be? Italian hero, turkey, salami, provolone, lettuce, tomatoes, pickles, olives, oil and vinegar, oregano. Do you rather have fingers as long as arms or arms as long as fingers? Fingers as long as arms or arms as long as fingers. Are fingers as long as arms? Yeah, I could do more, but it doesn't. What's your favorite reality TV show? My favorite reality TV show is Life. I'm very present and I live it every moment of my life and I don't need to watch reality on TV to feel like I know what's going on. What was the last text you sent? I'm gonna look, cause I have my phone here. Let's see. Let's hope it's nothing dirty. Oh yeah, I just said to my friends, not sure what my production schedule is this week, I'll be shooting, but let's try to hang out this week if possible. What was the last thing you bought? These jeans, actually, just a little while ago. I had to do a fake hem job, see? Because I just bought them. My legs are shorter than the guy they fit these on. What's your best impression? I'm not very good with impressions, to be honest. I've got a bunch of characters in my head that I like to pull out from time to time, but as far as impressions go, usually they end up being some sort of morph of an Australian and Russian accent, and I can't ever really figure that, so I just sort of steer clear of it. What's the best date you've ever been on? I was rehearsing a tour once, and this girl was very sweet, I felt terrible about this, but I was very tired from 18 hours of tour rehearsal, and I set up this really beautiful date on top of the hotel that I was staying on, and you look over the whole city. And I ordered a pasta, and within two bites, I fell asleep. And I felt terrible about it, and I woke up and said, so sorry, she said, no, it's okay, it's okay, you needed to rest clearly. And I felt like I had to make it up to her, so another time, you know, we went, I think we saw Michael Wobbley or something, and it was great. So that was a long way to get to Michael Wobbley, it was a great day, but. What do you look for in a partner? I look for honesty, I look for the ability to mesh well with my friends and groups of people. I think that's a nice character trait to involve people in the conversation, and someone that likes some of the same TV shows that I like that makes things a little easier, that way we can talk about those things, because you hate that thing on a date when you, okay, you watch the latest episode of Billions, for instance, and then be like, I don't watch that show, and then you're stuck thinking about how great the last episode was, and you can't talk about it. Who's your favorite Disney princess and why? Elsa, right? That's the one from Frozen. I like her because she didn't need a man. That to me is really cool. I think that's a good message. And yeah, Elsa and Jasmine. I love Jasmine, too.


If Ted promises to take his buddy Phil fishing with him and goes without him, that is not a matter where the court will take jurisdiction for resolution. If Phil has promised Jane that he will marry her but makes the same promise to Linda, the courts are not going to accept jurisdiction to resolve the matter. The general rule is the courts will not support a person's promises. If someone makes another person a promise and doesn't keep it, that is not a situation where the courts will intervene. The courts are there for justice services to we the people. It will not take sides with one party or the other in a dispute based on a simple promise and does not yield a justice service to we the people except for some fairly well-defined cases. Most of the promises that are supported are for commercial purposes. They promote the ability of one person to trust another where it yields an effective benefit for commercial efforts involving multiple people. Signature documents are largely supported. It is legal action where someone has affixed a signature to a document in order to have it accepted by others. This would apply to court documents where a pleading is given to a court as a basis for initiating a prosecuting or legal cause. The signature of the person making the pleading or of his lawyer as a legal agent for that person is necessary to get things moving. And the court relies upon the signature as a promise that the documented pleadings contain no lie or misstatement. The courts will act based on that promise, doing what is appropriate to the acceptance and furtherance of the cause in that document. The court will react negatively to any false documents. The oath and affirmation of judges and other public office holders are recognized as supportable promises and judges can take jurisdiction of the situation upon failure to keep that promise. Claims made to the police or other public agents can be considered as supported by promise of accuracy. Such statements can be accepted as legal evidence of the truth of what was said. Telling falsehoods to such officers is often considered a punishable crime. In that sense, every signed document is a promise of appropriateness of the document that is signed. They're signing a writing that says, I owe you $10. As it is a signed note, then the bearer can demand payment of that money from the one who signed it. The courts will accept jurisdiction of the cause if the signatory to the note refuses to pay upon its production. It does not matter who turns it in for payment, as it is not to any specific person nor limited in effect to some time or place where it can be produced for payment. This works only for commercial purposes. The person who promises in writing to take his neighbor's children to a ball game is not going to be legally liable for any failure to perform that promise. Neither will the courts readily accept a written promise that is between close family members unless it is signed by both parties. The assumed relationship is one of trust and the document simply states what the party intends. Tina is a young and pregnant single woman and indicates her attention to give up her baby for adoption and signs a contract with an attorney to complete the action. She signs a promise to surrender her child upon birth for adoption. Peter, Paula and their attorney meet with her and she sees that they will be excellent parents. On the strength of her promise, they enter into a contract with the lawyer and they go out and prepare for the birth as if it was their own child. They buy furniture and prepare a place for the newborn and alert their family physician of the situation. Upon the birth, the mother believes she made a terrible error and refuses to give up her child. The basis for illegal action is expenditure in reliance upon the promise. While the new mother does not have to give up her baby, her promise was an action that caused the other pair to enter into contracts and expend in reliance upon her promised action. If they had not entered into those actions, the promised adoption would not be able to smoothly go forward. The courts can see this as a tort against the parents. They can sue in law for recovery of provable damages and perhaps other damages as well. The proof of action is the written promise. The proof of damage is the receipt from expenditures. The only question remaining for adjudication is proof that her actions were the proximate cause of the damages they claim. In any person's signs of document, there may be consequences. Such actions are never assured of any success. And the attorney can easily refuse to represent them due to the counterclaim that the young lady was not in her very pregnant state, fully aware of the consequences of signing the agreement or her pending role as a new mother nursing her own child. The courts will refuse most promises within the family. If Bobby promises to purchase a tux for his son's use in the high school prom, but only rents one, there is no cause of action that the court would address. There are again promises that have commercial impact that can reach under special circumstances that threshold him official recognition. Arnold Day, wealthy man with a second and much younger wife, is terminally ill.  He immediately instructs his attorney to do the paperwork for the change and have it ready in the morning for the signature. He dies during the night. The family wants to limit her inheritance in a court with the written agreement, but she goes to an attorney based on Arnold's witnessed intent that the will not be accepted as been written, and he had already acted on that intent through his attorney as his agent. The courts would accept the cause as a commercial matter. The outcome of such a suit is not certain. There may be rules of inheritance that the courts are directed to follow. There may be prior cases that weren't somewhat like this. Son matters already settled through precedence. For our purpose, it is enough that the courts will accept the suit based on the promise and work to settle the matter. It is likely that there will be negotiation once the court is involved, and the parties settle their differences out of court. The rule, though, is that the courts will refuse actions based on infamily promises. If Arnold's attorney had not been a witness to the new promise to Nicky, it is likely that the court would refuse to accept the suit. Terry forges $50 bills. He uses a number of these to pay for jewelry in a far city from his home, and promptly disappears with his now valuable gains from the effort. Joanna, owner and operator of the jewelry business, pays the workman who are painting her facility and who insist on cash with some of these bills. When they try to spend them on groceries, the feel is wrong, and the manager refuses to accept them. The bills are soon exposed as forgeries. Can they sue Joanna for passing them? To sue, they must elinch two things, that they suffer damages and that someone's dishonesty was the approximate cause of those damages. The question is, who gets stuck with the loss? Joanna, who probably still has several of the bills, is a loser, too. The question is whether the painters can stick their loss on her. Nobody is alleging that Joanna has done anything wrong, but she knew the fake bills were among those Terry used to scam her. She only discovers the problem when she tries to deposit her cash earnings. She would have paid the painters with a check, drawn on her commercial account, but the painters insisted on cash. The courts might not accept the painters' attempted suit. Joanna is not accused of wronging the painters, but being fooled by the same tokens that initially fooled them. It is likely that the court would not even attempt to take sides on the matter, shifting criminal damage between victims. The same basic logic would apply had it been an excellent forgery of a painting. The one who ends up with the forgery is the victim of the original crime. He or she does not get to sue the one who sold him or her a forgery thinking it genuine. Their sale was as agreed between parties and honestly based on what both accepted is genuine painting. The courts generally support and accept signature documents or works of art as being genuine and will honor them so long as the forgery is not unmasked. The one who accepts an IOU in place of money only to find that it has been forged is probably stuck with the loss. It is a risk that a stranger takes giving commercial effect to a side promise. The risk is much less when they see the other person cited and no one recognize him or her personally. In the negative, we also have promises that the court will not accept as a basis for legal actions, independent of commercial considerations. John, a county construction engineer, promises to build a straight roadway between two towns. The value of land shifts in accord with this promise, raising the price for land along the straight path. He discovers that there is an ancient, even though long forgotten burial ground that cannot illegally move for health reasons. He is forbidden to build the road straight. When he submits the new plans, he finds that several of the owners of land on the straight path have sold out to developers and their land is suddenly reduced in value. Do they have a basis for a suit? The answer is that John cannot promise to do something illegal. If building the road as planned is illegal, John cannot be liable under his promise. The court will not hear it beyond the pleading of its illegality. Even if John was one of those who sold land, the courts would not hold him liable. This is more an issue where the parties would intentionally agree to do something that is knowingly criminal. There's two kind men sharing equally in the proceeds of a scam. If one refused to reimburse the other, the courts would not interfere on behalf of the one who gets stiffed. The court does not honor illegal acts. Also the courts will not give credit to immoral promises, as in payment of a woman for sex outside the marriage or payment of ransom for returning someone's child on harm. A man's promise to help raise a child of his mistress can have commercial impact, but will not be given legal effect by the courts. The courts will get involved in personal problems with commercial impacts, but only deal with the commercial effects, not the promise itself. If there is fraud, the courts may accept an action in tort, or a plea in equity, or someone who is threatened with economic harm. The courts are unlikely to get involved in any distribution or reallocation of harm among victims of criminal misconduct.