The usual practice in evaluating cases for inclusion in statistical calculations is to exclude cases where the patient did not provide all the data needed and with such practice in mind, the number of cases exceeding five years reached 45 percent. I thought I should add, there are 145 cases found so far where the patient had limb onset ALS; of these 61 exceeded five years, with more on the way: hence, the five year survival point for limb onset ALS patients using the pacer currently exceeds 40%, whereas 20% is indicated as the norm. Plausibly, well timed pacer utilization may double patient life expectancy. Possibly more important issue is the dEMG data from the pacer, . . . , Lechtzin observed a chart providing about five data points per patient regarding their respiratory health - the Onders's paper shows one method were thousands of data points could be obtained in one minute, possibly showing in real time the impact of the ALS disease processes on the diaphragm muscle . . . such may be better than a biomarker, so, so long as a patient has good health in their diaphragm they ought to be valuable subjects in clinical studies if they undergo the implant and avail the dEMG data to the researchers. Yet it remains the case clinical studies do not wish to accommodate the pacer . . . more thoughts on same later.