 Okay. Thank you, Mark. Let's move along. The last working group report is Genomic Medicine, and Teri Monoglio is going to give that report. She is the division director of Genomic Medicine at NHGRI. All right. I actually am not the very last thing you have to do today. Rudy still has an item, but I will try to be brief. And many thanks to the Genomic Medicine Working Group members who I will credit here. I wanted to be the next to last thing on the agenda, so I'm doing the report. So these are the members of the group. You can see them here. And then we have five NHGRI staff who also participate in the meetings, and many thanks to them for lots and lots of work. The charge to the group is to assist in advising us through the advisory council, and research needed to evaluate and move genomics into routine medical practice. And so we asked them to review current progress, identify research and education gaps and approaches for filling them, identify and publicize key advances, plan genomic medicine meetings that help us to identify research directions, and facilitate collaborations coordination and availability of genomic resources. Looking specifically at publicizing key advances, we actually spend a monthly conference call reviewing literature that Johnnavi Narula, our program analyst, has skillfully pulled from the literature. And then deciding which of these meet our criteria, which I'll go into in a moment, for significant advances. Many thanks to our communications group and the web team, in particular, Mikul Narukar, who then post this in a searchable database of these various advances. And you can see, you can search it by title author. You can filter it for category and dates, et cetera. The criteria that we use include involving use of patients, genomic variant information and clinical decision making, demonstrating the impact of either direct clinical implementation or the potential for clinical implementation, likely to be generalizable, likely to have implications for healthcare systems or practice guidelines, have important considerations for diversity and health equity in genomic medicine, sufficiently large and rigorous to overcome biases, and are broadly representative of the field beyond NHGRI sponsored or US funded programs. I would note that not every advance has to meet all of these, but we like them to meet at least a few of them. And then we classify them into categories such as a resource, pilot implementation, et cetera. And the criteria for these categories are on the website. We also, at the suggestion of one of our members, Pat Deverka, started doing a genomic medicine year in review that the American Journal of Human Genetics expressed interest in accepting as a commentary. And so we've now done four of these where we basically pick sort of the top 10 of the advances that we've identified. This is totally arbitrary. We do it as a vote among the working group. But you can see we've done these in each of the past four years, the most recent one last December in AJHG. We also take a look at the trends in the types of categories or the types of papers by category that are being published. For instance, you can see if I can find the mouse, it's gone, never mind. You can see that in purple are shown the past three years of number of papers in a given area. In blue is shown the 2022 papers. And you can see that genomic medicine resources are becoming much more common, at least in terms of the things that we identify as being important accomplishments, as is implementation and risk assessment. Sequencing has dropped down, et cetera. So if you have a paper that you feel should be included as a genomic medicine accomplishment, please do send a nomination to us. Sorry that you can't read that very easily. It's gmwg at nih.gov. So it couldn't be simpler. Another thing that the working group does is to plan a series of roughly annual genomic medicine meetings. You can see them here. We began in June of 2011 and have proceeded on a variety of topics, forming collaborations, physician education, global leaders in genomic medicine, genomic medicine clinical decision support, pharmacogenetics, et cetera. Our most recent ones were in February of 2021 in clinical informatics, and then just this past summer, genomic learning healthcare systems. Products of these meetings have been legion. We and we're very proud of the planning that has gone into these. So our very first meeting led actually to another very targeted workshop led by Aaron Ramos that led to the ClinGen consortium, and it has recently also spawned another collaboration or participant in another collaboration, the GenCC, which recently published a paper. It also stimulated our addition of pharmacogenetic testing into emerge back, way in the second phase of emerge. So very early on in the process here. The second meeting on collaborations led to our developing the Ignite Consortium, which I'll talk about in a moment. I have to skip some of these because there are too many of them to count. The Intersociety Coordinating Committee on Practitioner Education in Genomics, you just heard about in the community education group, where both of those members are participating in that group. They're actually having their seventh, I believe, in-person meeting coming up on Wednesday, if you want to stick around for that. Our sixth one led on global leaders in genomic medicine led to the Global Genomic Medicine Consortium and the international 100,000-plus cohorts consortium. Both of these are international collaborations to identify groups around the world that are doing genomic medicine implementation and cohort-based research in genomics and have been quite successful as well. Let's see. The eighth one was sort of an overview of our various programs. We recognized that it would be very helpful to have some educational programs, particularly in modular form. And so that led to that notice. The ninth on bedside dimension back again, yes, and back again led to the variant function disease program announcement back in 2018. The tenth one, which I have been blocking now on what it was on, oh, that was a pharmacogenetics one, sorry. And that led to the AdoptPGX program and Ignite. And the 11th and clinical implementation led to a subsequent meeting on working with employers to incorporate genetic testing into their health care programs, something that they were not quite ready for yet, but we had some very good discussions with them and informed some of our subsequent work. The 12th meeting on predicting risk led to the primed consortium as well as fashioning the fourth phase of the emergent network into genomic risk assessment. And as I mentioned, the most recent one on informatics led to a notice, a request for applications for patient-centered informatics. The 14th one has just happened, and I'll tell you a little bit more about that in a moment. All of these meetings are described on our website. Actually, they're all listed there. And again, many thanks to our colleagues in the web team and the communications group who make very detailed and captioned videos of all of these meetings available, both live-streamed and then archived. Our program analysts prepare both an executive summary and a meeting summary, which are available on the website. And there are often publications that come out of these. And just to remind you of the strategic vision, particularly this figure, so genomic learning health care systems were a major, well, an emphasis within the strategic vision, which had a number of emphases. But this figure really emphasized the importance of the virtuous cycle of taking new genomic knowledge into quality improvement strategies, applying those in practice, collecting data on the outcomes, analyzing those data, and then using that to generate new genomic knowledge and new interventions. So this was something that we recognized we really needed to pursue. And so my colleagues, Pat DeVerca and Renee Ryder, co-chaired with me, our 14th meeting, which was designed to explore real-world examples of how genomic learning health care systems apply cycles of, as I just described, implementation, evaluation, re-implementation across health care delivery systems, look at the barriers and identify potential solutions, and focusing also on trying to increase the potential for transportability to other settings, and then determine ways to develop and share these solutions, form collaborations to facilitate research on this. Key recommendations from that meeting included in one group, sort of building on and extending the interoperability of methods for integrating genomic data into care in health information exchanges that include genomic information and exchanging those data with other systems, and potentially creating a national learning health care system network based in genomics to gather data from collaborating genomic learning health care systems on practice quality improvement and benchmarking. So that was one area. A second area suggested creating some kind of either a consult service or an expert panel and evaluating its impact to help educate clinicians about, for instance, genetic test ordering and interpretation, determining follow-up and management, those sorts of things, and even potentially developing a learning community of practice, like a listserv or some other form of educational opportunity to provide information updates potentially supplemented with a panel of experts. For both of these areas, promoting equity of implementation in low-resourced and under-served settings was recognized as being a priority as well. And it is our hope that we will be bringing you in May two concepts, one for the learning health care system network and another for the consult service and evaluation. To give you an overview of what the current genomic medicine portfolio of research looks like based on fiscal 22 funds, there is the undiagnosed diseases network that's been going on for 10 years. This is a common fund-funded program. It was funded at $16.4 million in fiscal 22 and was slated to end in fiscal 22. A congressional mandate has continued it into this year, unfortunately, without funding. So we're scrambling a bit to figure out how to do that, but that is the plan for that one. The CSER program actually was on a continuation. It's funding ended in fiscal 21, but the investigators have been very enthusiastic and also very efficient in sort of marshalling their resources, and they are continuing to analyze and publish. You saw some of their work in Eric's director's report. The Emerge Network, I mentioned just briefly, is currently looking at risk assessment and management tools for clinical use at about $20 million in fiscal 21. The Ignite Consortium is conducting pragmatic clinical trials, both of April L1 testing for preventing renal disease and pharmacogenetics for pain and depression treatment at about $10 million. The ClinGen Consortium develops and disseminates consensus information on genes and variants relevant to clinical care. You heard a little bit about the added ClinGen curation panel supported by our sister ICs, which establishes expert panels for genes and variants relevant to participating other NIH institutes and centers, and they're contributing nearly half as much as NHGRI is to the ClinGen effort. We have a growing investigator-initiated portfolio, including the Advancing Genomic Medicine Research RFA that you heard about a little bit earlier. There are also emphases on genetic counseling processes and on dissemination and implementation. And in training, we have a portfolio small of training grants, fellowships, and career development. The total Genomic Medicine funding, if we add up all of these programs, is $96 million. The $22 million coming from other institutes leaves $74 million supported by NHGRI. 35% of that is investigator-initiated in fiscal 22. And the total extramural budget of NHGRI in fiscal 22 was $441 million, so this is about 18% Genomic Medicine. And just to show you the growth in NHGRI funding for Genomic Medicine Research, starting from 2015, it actually started before then, but this is where we have good data. And you can see that it's been rising somewhat, you know, a little bit in fits and starts, but that has to do with some programs ending, other programs starting, some loans between different programs, et cetera. Plateauing a little bit currently probably have as much as we can handle at the moment, but hoping to continue to grow it in future years. And then this on a slightly expanded scale is the funding for investigator-initiated Genomic Medicine Research, and you can see a steady growth in that over these past several years, and then if you kind of superimpose that on the research. So that is growing more rapidly than the overall commitment to Genomic Medicine Research, and that's shown here in the percent investigator-initiated, which in 2015 was barely noticeable and now is well above 30%. So with that, I'll be happy to stop and take any questions or comments. Actually, I may note that poor Dr. Jarvik is also on the Genomic Medicine Working Group, and Gail, if you had any comments to add or things that I left out. Yeah, Terry, I'm attending to the time, but I did want to just re-emphasize the incredible impact of the annual meetings, and since I joined rather later, I'm not conflicted by taking credit for some of those, but I think that meetings are particularly strong in saying, where are we, where do we need to go, what are the knowledge gaps, and then how do we address them, and then I applaud Terry's leadership, and then translating those gaps to programs to fill those gaps, and it's been exciting to see that and be part of it, and I really do feel like this is a highly productive group. Thanks. Great. Thank you, Gail, very much. I might also call on Dr. Kalu. You've participated in some of these programs. Did you want to make any comments? No, I think echoing what Gail just said, I think this group has been really extraordinarily, I think, what should I say, the full of foresight for the upcoming initiatives that are needed, and I think in that graph you showed, Terry, it's incredible to see how many initiatives have come out of those deliberations, so I think congratulations to you and the group for really staying on top of things, because I think as we saw from the strategic vision when you were gathering input, I think it was clear that NRGRI has to take the lead in genomic medicine, and I think you really done a wonderful job with that. Thank you. Thank you very much. I see Steve has his hand up. Yeah, just one couple comments. One is that I could think of no other person better than you to help lead this effort because of all the things that you've been through in your past, including the previous institute, I think you've really gathered a lot of skill in bringing people together and hurting cats, so congratulations on that. But I guess the other question is, in your learned opinion, what's next? Great, great question. I think, you know, we are seeing the genomic learning healthcare system as an area that we really need to move into in order to truly evaluate on a large scale the implementation of genomics and clinical care, and that's probably the major effort, which is not going to be a short-term thing. In addition, getting non-geneticist providers to be able to be comfortable with applying genomics in their clinical practice, which is one of the things the consult service is designed to do, but that's another effort that is going to take multiple years, and we need to get this into guidelines with professional societies and other things. So generating that evidence, Cesar was designed to generate evidence as are several of our other programs, and so those we see as major ones, but I would turn to you and say, you know, where do you see gaps and where do you think we should be going? You know, to me, just looking at what's happening with healthcare systems and sort of, I guess, liaisons and then the divorces and then rearrangements, it becomes a little bit of a moving target of how you're going to try to implement genomic medicine in a system where typically is more or less profit-motivated, and it seems like genomic medicine at this stage is viewed as a cost and not something that will help a system differentiate itself from another and gain more patient revenues. Actually, in some places it is considered something that will help them differentiate themselves, but that's not the reason we see that they should be doing it. I guess I might also mention something that we discussed at our most recent in-person meeting, we do meet in-person once a year, is population screening, and so finding ways to do that in a consistent and low-cost but effective way, and that's a big one, so we'll probably have a meeting on that coming up in the fall. If Takar, is that all? Yeah, what Teri just said about population screening, and I think there were maybe, I don't may not have the dates right, but there were these state screening programs maybe three, four decades ago, I think states like Michigan, I think on the west coast, maybe Idaho, I forget, but Roger Williams, for example, had this initiative on family screening, so I think that what you were just describing about population screening downstream of that is cascade testing, and I think we are doing very poorly with that, and I think that's a big need, because if you do population screening, but you don't couple it to cascade screening, you really are not getting the maximum impact, so I think that should be considered as well. Now, thank you, if Takar, that's an excellent point, and one of the things where we've been struggling with, as have many, is how does one increase the uptake among families? It's in the best of hands, it's only about 20%, and an average is much less than that, and that's tough, and you take cost barriers away, and it's still similarly low, so thanks, we'll try and tackle that one. Judy? Yeah, just to echo, this is an impressive array of programs that's been developed, and the progress has been impressive. Just to get back to Steve Birch's point about the profit motive, which I brought up a couple of times at this meeting as well, one of the things that actually may be at least neutral and may be saved money in a health system is pharmacogenetics, and so Sinai is making that bet, and it's something that you can do well by doing good, and I would just throw that out as a potential area where you can really leverage this learning healthcare approach. Super, now thanks for raising that, and actually, I might point out when we did our employer's meeting, one of the things we heard about was a pharmacogenetic management program based in the Kentucky Teacher's Retirement System. They recently published their paper, Jarvis is the first author, I've forgotten where it's, what journal it's in, but at any rate, showing really substantial savings, I think something like $7,000 per participant, and there were thousands of participants, so really impressive, and participants were happy with it and that, so that's an excellent point that PGX probably really is going to be, and plus the recent, just in the last week, the PREPARE trial from the ubiquitous pharmacogenetics program in Europe demonstrating a 30% reduction in adverse drug reactions, 30% is really remarkable. That was remarkable, the absolute values were 28% to 20%, so that was remarkable, I agree. Absolutely, great. Thanks. Okay, any last comments for Terry? If not, thank you very much, Terry.