Ketamine Research Institute Training Program
"Our program represents the first standardized ketamine infusion training course for clinicians, promoting an effective, safe and uniform infusion protocol for the treatment of mood disorders"...
GW Grass, MD — Ketamine Research Institute
Ketamine Research Institute
Ketamine Infusion Therapy Training Program for Clinicians:
A Practical and Precision Medicine-based "Mini-Fellowship"
Approach to Optimized Ketamine Infusion Therapy for Mood Disorders
The Ketamine Research Institute Training Program
New and Expanded Training Opportunities for 2023
Due to the increasing need for well-qualified and certified ketamine infusion therapy clinicians, the Ketamine Research Institute will be expanding our training program for clinicians in January of 2023 to six sessions per year for a total of 18 available positions.
New for 2023: Improved Ketamine Assisted Psychotherapy with Precision Medicine and a Target-Controlled Infusion Protocol
The Ketamine Research Institute is now offering a specialized training course: Improving Ketamine Assisted Psychotherapy through the use of Precision Medicine and a Target-Controlled Infusion. This advanced course is for clinicians currently using KAP who are not satisfied with the short duration of therapeutic engagement provided by multiple IM injections of ketamine or subpar response rates.
This unique training opportunity provides clinicians with the ability to accurately determine the therapy interval needed, while patient ketamine concentrations are maintained at an optimal steady state for psychotherapy. This protocol also enhances the ED50 pharmacological aspects of ketamine-based therapy to greatly improve patient engagement and overall therapeutic response rates.
RESTORE: A New Methodological Approach to Improve the "Real-World" Effectiveness of Ketamine Infusion Therapy for Treatment-Resistant Depression.
Join Us in New Orleans and Orlando
To learn more about our training programs, please join us at the 2022 Psych Congress Annual Meeting in New Orleans and the International Conference on Neurology and Brain Disorders in Orlando as we present the results of our 5-year outcome study: RESTORE: A New Methodological Approach to Improve "Real World" Effectiveness of Ketamine Infusion Therapy for Treatment-Resistant Depression.
Precision Medicine = More Effective Ketamine Infusion Therapy.
Our training program provides the knowledge, tools, and training necessary for our graduates to achieve the same "remarkable" levels of improvement (70-75% improvement following ketamine infusion treatment), high rates of completion, and few, if any, "adverse effects" as those reported by the most sophisticated, high-level research programs.
As a result of the increased need for well-qualified and certified ketamine infusion therapy clinicians, the Ketamine Research Institute will be expanding our training program to 6 training sessions in 2023. In addition, we will be adding a resource and network directory for patients who contact us seeking more information regarding our Certified ketamine infusion clinicians.
The Ketamine Research Institute Training Program
The Origin of Our Training Course:
Ketamine Infusion Therapy for Mood Disorders - A 3-Day Intensive Training Course for Clinicians presented by the Ketamine Research Institute is the first and only comprehensive Clinical Training Program for practitioners in the United States.
This course is the result of over 35 years of my clinical research and experience, personally administering ketamine-based therapy, to treat a wide variety of complex and challenging medical issues to patients who have come to us from around the world seeking help.
That experience, knowledge, and expertise have formed the basis of our training program. One in which you receive "one-on-one" training in a ketamine infusion center environment, the necessary actual infusion experience to fully understand and appreciate the therapeutic potential of ketamine.
We've learned that this type of immersive and "practical" ketamine training center environment is superior to online video formats or sterile classroom instruction in acquiring useful clinical information and real-world experience with ketamine therapy. Our program may be best characterized as a "mini-fellowship" training program in ketamine infusion therapy that is coupled with ongoing mentorship, clinical support, and direct access to me and our core group of experts long after the initial training period.
It is our opinion that no other ketamine infusion training center or course in the world can provide this level of clinical expertise and experience.
Gerald W. Grass, MD - Course Founder
The Early Days
The ketamine infusion protocol for the treatment of depression was discovered at the Yale University School of Medicine/West Haven Connecticut VA Hospital over 25 years ago. It was my former Department at Yale (Anesthesiology) that formulated and administered the very first ketamine infusion treatment, which has since become known as the "standard" ketamine infusion and is now used by many others around the world, including many prestigious Academic Medical Centers such as Harvard, Yale, Columbia, and the National Institutes of Mental Health (NIMH).
Although I first became acquainted with the clinical use of ketamine in 1985, the early underpinnings of our current training program began in 2002 during my time at the Mount Sinai/NYU Medical Center and later became more formalized in 2007 as part of my teaching responsibilities at Yale University Department of Anesthesiology. As an Assistant Professor in the Department of Anesthesiology, Director of the Pain Medicine Fellowship Program, and Chief of Pain Medicine for the Connecticut VA Healthcare System, in addition to my clinical duties and research, I was responsible for educating Anesthesiology Residents and Fellows in Pain Medicine.
I included didactic lectures, demonstrations, and hands-on training in the administration of high-dose ketamine infusions for chronic neuropathic pain conditions as part of my curriculum. In addition to teaching Residents and Fellows, I also conducted clinical research in the therapeutic basis of ketamine therapy and provided instruction to Attending Physicians, Administrators, and Researchers from the V.A. nationwide and Physicians in the Department of Defense on the remarkable potential of ketamine in treating returning veterans with complex physical and psychological injuries.
Innovation and Evolution of Ketamine Therapy
That early program has evolved significantly over the years, as I have accumulated thousands of hours of direct, "hands-on" ketamine infusion time with patients worldwide who have come to us with widely varied clinical presentations and co-morbid conditions for treatment.
It became very apparent that the simple infusion protocol of 0.5mg ketamine per kilogram given intravenously over 40 minutes, which has become the "de facto" standard ketamine infusion treatment for mood disorders, is not as effective in actual clinical practice as it is in well controlled research studies. Why is that? What other factors and considerations need to be accounted for to improve the therapeutic benefit of ketamine?
Over the years we have been able to find some of those answers and implement them effectively into a more evidence-based approach to ketamine therapy.That knowledge and experience has been condensed and distilled into our current training course. The training that we provide is conducted in our ketamine infusion center in Sarasota, FL. so that you can see and experience the process of ketamine infusion therapy on a firsthand basis.
The program is focused and intended to train a core group of Physicians, Nurse Practitioners, CRNAs, and allied medical clinicians to provide the highest quality, evidence-based, optimized and enhanced ketamine therapy available to patients in their current office or outpatient practice setting.
We believe that our three-day intensive course with personalized, one-on-one training, actual infusion experience, and continuing personal guidance as our student's begin to provide ketamine infusion therapy are unique and invaluable components to this training program and to our student's success utilizing this cutting-edge therapy.
"It is our opinion that no other ketamine infusion training center or course in the world can provide this level of expertise and experience."
During the recent COVID epidemic, depression, anxiety, and post-traumatic stress disorder rates have all risen dramatically. Media outlets have been educating the public about the tremendous therapeutic benefits of ketamine and other psychedelics for the rapid relief of mood disorders and related conditions. Health insurance companies in Canada and the U.S. have taken notice of this new treatment modality and may soon cover such treatments. As this evolution unfolds, many more individuals in need of a new and effective treatment option for mental health issues will be able to benefit from ketamine-based therapy.
Unfortunately, some clinicians who administer ketamine therapy and large business organizations seeking to commercialize ketamine-based therapy today have limited or inadequate clinical knowledge of the intricacies associated with this cutting-edge and non-traditional therapeutic modality, and treatment outcomes are not as good as they might be.
Although ketamine infusion therapy is remarkably rapid and effective in improving symptoms in patients with treatment-resistant depression under research conditions, that is not always the case in actual clinical practice.
Our experience, and that of others, suggest a more realistic number would be only 50-60% of people respond to ketamine infusions when administered in a community setting (1). In fact, according to one recent research study, just 44% of patients with treatment-resistant depression responded favorably after six infusion sessions in a community hospital setting (2).
There are many reasons for the lower response rate, but some typical factors may include a lack of training and experience in administering ketamine, failure to adhere to strict patient selection and treatment standards, and failure to appropriately adjust ketamine dosing based upon the patient's medications, metabolism or genetic profile.
As a result, there is a tremendous need for qualified individuals trained to provide patient-centered, safe, effective ketamine therapy for mood disorders. This 3-day intensive program aims to provide clinicians with the necessary skills, understanding, and knowledge essential to administer a superior and optimized ketamine infusion to their patients in an office or outpatient setting. The program covers all aspects of ketamine therapy that have practical clinical applications today and for the future.
With a focus on clinical efficacy, safety, and patient welfare, the Ketamine Research Institute's program trains participants to safely administer ketamine-based therapy to patients with various mood disorders. This therapeutic approach is now widely recognized to have remarkable effects on treatment-resistant depression, bipolar disorder, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and some forms of chronic pain.
An additional goal of this training program is to train nurses, psychologists, and other medical and mental health clinicians, exploring new treatments options that will be more effective than traditional treatments currently being used.
The course trains participants to safely and effectively administer the ketamine infusion protocol developed at Yale in 1994-2000 and currently used by the National Institute of Mental Health, Academic Centers, and Major University Medical Centers worldwide.
Special Note: This course goes beyond the original limited protocol by training professionals to provide a more sophisticated approach to ketamine infusion therapy. One that we have found to be more effective, versatile, and cost-effective for your patients.
Our course is provided in an actual infusion center setting. Participants will learn while getting to know the equipment, monitoring devices, and layout of an existing ketamine infusion center. Our course is usually limited to only three practitioners at one time to facilitate a small group learning environment, active discussion, and adequate familiarization with an actual ketamine infusion center.
While with us, clinicians have an opportunity to become familiar with and use all of the necessary monitoring equipment, venous access technologies, intravenous delivery systems, and supplies necessary for the safe administration, storage, and handling of ketamine. We have found that this type of immersive and practical training environment is better suited to gaining useful clinical knowledge and actual experience in ketamine therapy than can be provided by online video formats or sterile classroom instruction.
Our intensive training course is a unique educational experience. The course content is comprehensive, extensive, and highly practical; the content of the curriculum is also dictated by the needs of the individuals taking the course.
To the degree possible to maintain our educational objectives, the 3-day intensive training is customized to each practitioner's needs and skill level. It delves deeply into specialized aspects of ketamine pharmacokinetics and pharmacodynamics, including the effects of patient-specific metabolism, medication interactions, and genomic variables on ketamine metabolism and efficacy.
Ketamine Infusion Experience
A unique aspect of the Ketamine Research Institute program is that clinicians who undertake the intensive training are also provided with the opportunity to experience a ketamine infusion first-hand to fully understand this remarkably versatile medication's unique psychological benefits and therapeutic potential.
APA and ASA Training Guidelines and Recommendation
All of our training meets or exceeds the consensus recommendations published by professional organizations such as the American Psychiatric Association and the American Society of Anesthesiologists. Clinicians who complete the course are provided with the comprehensive course manual, which summarizes all of the lecture and presentation concepts and provides the necessary scientific references supporting ketamine therapy.
Also included are examples of required DEA documentation, treatment consents, medical evaluation, and treatment records. In addition, participants are provided with certification of training by the Ketamine Research Institute and personal assistance during the initiation phase of their ketamine infusion practice. They are invited to participate in our ongoing discussion board and chat group.
The course is highly comprehensive and practical in its approach. It includes a detailed didactic component that gives the practitioner a broad overview of the evolution of ketamine therapy and insight into future clinical applications, including neurodegenerative disorders, inflammatory conditions, and substance abuse disorders. Much of our time is devoted to understanding ketamine therapy from pharmacologic, physiologic, and phenomenological perspectives.
We thoroughly cover unique aspects of ketamine pharmacokinetics and pharmacodynamics, including the effects of patient-specific metabolism, medication interactions, and genomic variables, illustrating the effects these variables have on ketamine metabolism and efficacy. These issues directly impact the success or failure a practitioner may encounter in a clinical setting and allow them the understanding and flexibility to modify infusion protocols and treatment regimen to improve outcomes in challenging cases.
Practical considerations include supplying the student with the tools, information, and resources necessary to undertake ketamine-based therapy, including the prerequisite equipment and supply requirements, staffing requirements, drug acquisition, and DEA safe storage and recording procedures. Also, each student is provided with numerous examples of medical documentation necessary for initial patient contact and evaluation, consent forms, procedure notes, infusion records, and follow-up protocols.
After this program, participants will be able to:
— Understand the rationale for using ketamine infusion therapy for mood disorders and the mechanism of action of ketamine as an antidepressant.
— Safely administer ketamine infusion therapy to patients with mood disorders using the National Institute of Mental Health/Yale Protocol
— Identify and manage potential adverse effects associated with ketamine infusion therapy.
— Understand the principles of pharmacokinetics and pharmacodynamics as they relate to ketamine
— Develop a patient care plan for administering and monitoring ketamine infusion therapy in collaboration with a qualified medical professional.
— Optimize treatment outcomes through practical strategies such as dose titration, metabolic optimization, and other psychotherapeutic augmentation techniques.
— Establish and Manage a "State of the Art/Best Practices" Ketamine Infusion Center.
Ketamine Infusion Therapy for Mood Disorders
3-Day Intensive Course
Our course not only covers all of the practical aspects of ketamine therapy but expands into scientific principles allowing optimization of the basic protocol. All course training is conducted “on-site” in an actual infusion center so that you will have an opportunity to become familiar with the environment in which infusions are performed. This includes a demonstration of the necessary monitoring equipment, intravenous delivery systems, and supplies necessary for the safe administration, storage, and handling of ketamine.
How to effectively integrate ketamine therapy into your current practice
Intensive Course Description - Current Content 2022The course content is comprehensive and integrated. It systematically embraces all major aspects of ketamine therapy and emphasizes the incorporation of ketamine-based therapy into contemporary professional practice.
Module 1 - A New Way of Looking at The Treatment of Mood Disorders
- Introduction – Gerald W. Grass, MD
- Are Conventional Antidepressants Obsolete?
- Ketamine - A Master Molecule for Rapid Improvement in Mood Disorders
- The Human Connectome Project and How It Impacts Mood Disorder Treatment
- Ketamine as a form of Multimodal Neuromodulation Therapy
- Why You Should Perform Ketamine Infusions
- Question and Answer Session
Module 2 -The Current Scientific Evidence Supporting Ketamine Therapy
- What is Ketamine – The Strange History of CI 581
- Summary of the Current Scientific Evidence for Ketamine Therapy Part 1
- Summary of the Current Scientific Evidence for Ketamine Therapy Part 2
- Pharmacodynamics and Pharmacokinetics Aspects of Ketamine Therapy.
- Beyond the Pharmacological Effects of Ketamine – Transpersonal Perspectives
- Research into Other Ketamine-like Compounds – Will They Be Effective?
- Should You Consider Incorporating Other Psychedelic Agents in Your Practice?
- Question and Answer Session
Module 3 - Practical Clinical Aspects of Ketamine Therapy
- How to Choose the Right person and Right Condition for Ketamine-Based Therapy - Not Everyone is a Good Candidate.
- Medical Records, labs, and Prior Treatments – What's Important and What is Not.
- Contraindications to Ketamine-Based Therapy - When To Be Very Careful.
- Medicolegal Concerns about Off-Label Use of Ketamine.
- The Best Way To Administer Ketamine: Intravenous vs. Intramuscular vs Oral/Nasal.
- Is Ketamine Abuse and Substance Dependence An Issue?
- Question and Answer Session
Module 4 - The Ketamine Infusion Protocol and Procedure
- Pre-Procedure Assessment and Documentation Requirements
- Equipment Requirements Necessary for Providing Ketamine Safely
- Fundamentals of Anesthesia Monitoring and Intravenous Therapy
- Patient Monitoring Requirements for Infusion Therapy
- Adverse Effects Associated with Ketamine and How to Manage Them Effectively.
- Procedure Observation and Post-Infusion Interview
- Question and Answer Session
Special Section - Participate in an actual Ketamine Infusion/Personal Ketamine Experience.
While other training programs focus solely on the scientific and clinical aspects of ketamine therapy, we go beyond presenting mere technical information to provide the necessary "hands-on" practical experience in administering ketamine infusions that is required to become proficient.
The ketamine infusion experience can be a profound and life-changing event for many people. Most importantly, and unique to our training course, practitioners are also given the opportunity and encouraged to experience a ketamine infusion themselves to fully understand and appreciate the unique psychological environment which their patients will experience.
This one-of-a-kind experience will allow the clinician to personally relate to your patients' pre-infusion anxieties and concerns about ketamine therapy and provide first hand accounts of what the experience is like. More than that, it provides you with invaluable personal insights into the phenomenological environment of ketamine-based therapy and enhances your understanding of the unique therapeutic potential of ketamine.
Module 5 - Optimizing Outcomes and Expanding Indications for Ketamine Therapy
- Optimizing Serum Concentration for Maximal Benefit.
- Special Considerations for Ketamine-Assisted-Psychotherapy (KAP therapy).
- Medications, Metabolism, and Genetics = Make or Break Treatment Outcomes
- Treating Complicated Patients with Mood Disorders
- How to Monitor Treatment Effectiveness and Outcomes.
- Beyond the Recognized Benefits of Ketamine – The Master Molecule
- The Expanding Indications for Ketamine Therapy.
- Is Ketamine really a "Dissociative" Medication - Or is it more "Psychedelic" than Psilocybin or LSD?
- Psilocybin, LSD, DMT, and Ayahuasca – May Not Be That Magical After All..
- Question and Answer Session
Module 6 - Establishing A Ketamine Therapy Program in Your Existing Practice Setting
- Establishing A Ketamine Therapy Program in Your Current Practice Environment.
- Creating A Scalable Infusion Program for New and Existing Patients.
- What are the Start-Up Costs Involved in beginning Ketamine Therapy
- How to Make It More Affordable for Patients?
- Recommendations for Space, Staff, Supplies, Equipment, and Vendors.
- Educating colleagues, patients, and referral sources about ketamine-based therapy.
- Ketamine Institute Mentoring Program
After this program, participants will be able to:— Understand the rationale for using ketamine infusion therapy for mood disorders and the mechanism of action of ketamine as an antidepressant. — Safely administer ketamine infusion therapy to patients with mood disorders using the National Institute of Mental Health/Yale Protocol — Identify and manage potential adverse effects associated with ketamine infusion therapy. — Understand the principles of pharmacokinetics and pharmacodynamics as they relate to ketamine — Develop a patient care plan for administering and monitoring ketamine infusion therapy in collaboration with a qualified medical professional. — Optimize treatment outcomes through practical strategies such as dose titration, metabolic optimization, and other psychotherapeutic augmentation techniques. — Establish and Manage a "State of the Art/Best Practices" Ketamine Infusion Center.
Who Should AttendThe number of organizations and groups offering ketamine training has risen as interest and popularity in ketamine and psychedelic therapy have grown. It's also essential to us that the type and nature of the training be appropriate for a clinician's skill set and unique requirements. Our training course is particularly well suited for clinicians and other medical/mental health professionals interested in ketamine-based therapy as a primary treatment approach for a variety of clinical problems including mood disorders, chronic pain, drug addiction, and neurodegenerative/inflammatory diseases. It emphasizes in-depth and practical approach to ketamine therapy utilizing knowledge of the underlying principles of ketamine therapy. This establishes a firm foundation for knowledge and, when combined with practical clinical experience administering ketamine and ongoing clinical support in administering ketamine therapy, provides the best option for developing clinical proficiency and expertise. For psychiatrists and other medical professionals who wish to utilize ketamine therapy as a supplement to their current therapies such as psychotherapy, rTMS, or ECT - we provide an in-depth approach that will facilitate early implementation of a safe, standardized, and effective treatment modality. For those who do not require a personalized or practice tailored approach, infusion experience, or ongoing clinical support then a training program such as the one provided by IPI/ASKP3 - Ketamine Medical Provider Online Training - may be adequate for their needs. Physicians/Clinicians and other licensed psychotherapists who specialize in neuropharmacology and/or psychotherapy who wish to utilize ketamine as a therapeutic tool during therapy sessions may find the training provided by Phil Wolfson's group, The Ketamine Training Center, to be the most suitable for these situations.
Course Application and Fees:To apply for the course, please download, complete, and return the Training Brochure/Application. In addition, please also submit copies of your current active medical/professional licensure, a resume of formal training, including ketamine infusion therapy, if any; and a brief but thoughtful explanation of your interest in and planned use of ketamine-based therapy. You may send the materials to us by email at email@example.com or by Fax at 850-602-9013. Once all of the documentation has been received and reviewed, we will arrange a convenient time to discuss your application, answer any preliminary questions you may have and provide you with additional details about the program.
Application to the course does not guarantee acceptance. All applications for training are reviewed and the class roster is filled on a rolling basis. The course typically fills early and it is beneficial to submit your application as soon as possible.
2022 Training Program Schedule:
February 17th-19th - Class Full, cancellation/waiting list is available.
May 19th-21st - 2 Clinical Openings available
August 18th-20th - 3 Clinical Openings available
October 13th-15th - 3 Clinical Openings available
Physicians/Clinicians - Usually limited to 3 Clinicians
The registration fee includes all six modules, practical ketamine infusion experience, personal mentoring for one year, and all related course materials:
— The Comprehensive Course Manual and References.
— Examples of Screening Criteria, Office Procedures, Medical Documentation, Infusion Records, DEA Controlled Substances Log, and Administration Record Forms.
— Ketamine Infusion Protocols, Procedures, and Policies.
— Pharmacokinetic Calculator recommendations, Adjusted Body Weight/Composition Calculations, and Drug/Drug Interaction Guides.
— Guidelines for Vendor Selection, Supplies, Equipment, and Monitoring Equipment.
— KRI Standards for a Ketamine Infusion Center. Space, equipment, supplies and staffing recommendations.
— All participants are provided with certification of training by the Ketamine Research Institute.
— Personal Mentoring and advisement during the first year start-up phase of your infusion practice and ongoing life-time participation in private group discussion and advisement sessions.
The registration fee for the 3-Day Intensive for Physicians/Clinicians is $8950.00.
Nurses/Psychologists/Other Clinicians - available by special request only
This course is specifically tailored to each attendee's needs and anticipated role in providing ketamine-based therapy. It is therefore essential that we understand and discuss your specific clinical scenarios, treatment objectives, learning requirements, so that we can ensure you receive the greatest benefit from our program. Please contact us directly by email to arrange a time to discuss your interest in ketamine-based therapy.
Individual, Institutional and Governmental Intensive Training
sessions are available by special arrangement.
Please Note:Accommodations are not included; however, a discounted rate is available for our colleagues with our partner hotels including the Hampton Inn, Ritz-Carlton, and Hilton Art of Ovation hotels. Please be aware that the course does not focus on the RESTORE infusion process which is proprietary to the Ketamine Research Institute. It is also our policy to ask all attendees to sign non-disclosure agreements prior to the start of the course.
For additional information, please contact us at:
Or download the program brochure and fax all required documents to:
What Our Graduates Are Saying
"I am an Austrian psychiatrist. One year ago, I started using ketamine for the treatment of my depressive patients without formal training using the standard protocol published in the literature. I decided to attend the Ketamine Institute’s training program to enhance my skills.
The Ketamine infusion therapy for mood disorders” training course for physicians went above and beyond my expectations. Dr. Grass' brilliance and profound professional expertise made this course an unforgettable and truly eye-opening experience. I can now understand Ketamine from a pharmacological, anesthesiology, psychiatric, medico-legal and therapeutic perspective. I could put the contents I learned immediately into practice and my patients are already profiting from the knowledge I gained."
Since completing the course, Dr. Landauro writes…
"I arrived safely to Salzburg yesterday. Today we are performing our first optimized ketamine infusion. My patients and I are excited about this.
I treated the first wave of my ketamine eligible patients. Last Friday I talked to Ingrid. She couldn’t stop thanking me. To be sincere, I would have never thought any kind of improvement to be possible in her case. Ingrid’s depression is cracked - not in remission - but really cracked. 40 years of treatment from some of the greatest minds in the country couldn’t do the trick; the brilliant new protocol I learnt from you did. She had her first “not very painful 2 weeks” she can remember. She still complains, she still feels bad - but not so bad. I will come back to Ingrid later…
The sheer fact that I have the option to apply the optimized protocol gives my clients strength. It’s a whole new experience for them when I tell them “you don’t have to suffer longer than you want to.” I make them aware that we can “eradicate” 80% of depressions in a week. It gives them confidence and a reason to hope.
I went to Florida to learn how to give infusions properly, I came back with a huge arsenal of psychiatric-psychotherapeutic power-tools.
I wish you would have heard Ingrid saying…
-Dr. Med R Febres Landauro – Saltsburg, Austria
The Ketamine Institute is leading the way in the field of ketamine infusion therapy and physician education with our new ketamine infusion training program. We’re on a mission to accelerate the health care revolution. We have pioneered ketamine infusion therapy to bring the latest breakthrough discoveries about ketamine out of the research lab and into our infusion centers.