 So, I apologize in advance if I become incoherent, the combination of red eye and late afternoon presentation may not go so well, but we'll see what happens. Like Ellen, I'm talking about my thesis research, adaptation to living with a BRCA mutation in carriers and their partners, and originally I came at it really interested in kind of the spouse-partner piece of it because it had seemed like kind of a neglected area of study. And then I realized that the pre-vivors, the carriers themselves really were as well in terms of looking at adaptation over time and thinking more about potential positive outcomes and making meaning from living with risk. So I really took the opportunity to study both as individuals and then on a dyadic level as couples. Again, everybody's favorite, Lazarus and Folkman, back one more time today. This is sort of another model that integrates dyadic relationships, in this case couples, Guy Bodinman's, so seeing how each individual progresses sort of on their own path and then together as well. So really kind of the three main aims were one, just sort of looking at adaptation in each of these individuals and then also looking at dyadic adjustment, which is just kind of a general measure of relationship quality and cohesion in the couples, and then kind of seeing what risk-related stressors over time relate to that and then finding any correlations between the measures for one member of the couple and the other. So I decided to cast a super-wide net, collected a ton of information about all of these different variables that I was sure would have huge amounts of significance, particularly in terms of family experience and how that related to adaptation, and well, we'll see. So basically it was a survey online and in print, mostly recruited through support and advocacy organizations. I was really relying on the BRCA carriers to then bring their partners into it, and as a result you can see I got a lot more of the women than their partners to participate on Fortunately, which was a little bit limiting in the data analysis. Those are supposed to be plus or minuses that are instead little empty squares, but just a little kind of basic information, average age around 40, kind of the usual suspects, white, educated, and so on. As far as some of the risk-related stressor information I gathered, about half of them had had risk-reducing mastectomy and half had oophorectomy. And just kind of gathering some more information to see what would come out in the analysis. When I was actually looking at adaptation, and this is on the PAS that was developed by Barb and Lori, among other folks, on a scale of one to five, in general the scores were kind of a little bit above the midpoint. As far as what that means, it's kind of hard to draw too much in the way of conclusions from it. The measure hadn't been used in spouse partner roles before or in this population, but just to kind of see how it spread out, there wasn't much in the way of a normal curve that we saw. It was just kind of across the board for both of them, more about that later. And then also looking at dyadic adjustment, like I said, which was really just a measure kind of a general relationship quality in which anything over 18 is considered a good, well-adjusted relationship, which everyone was well over, regardless of whether or not both members of the couple completed the survey. And we have a nice, much more lovely normal curve. Not really particularly surprising, considering these are couples who are volunteering for research together. So I was not shocked that I didn't capture people with bad relationships. So then kind of moving on, looking to figure out what predictors of all of these millions of variables that I was asking about actually related to adaptation. And there was really just one. And that was whether the woman had had a prophylactic bilateral mastectomy. And the difference in the women themselves was a full point on the five point adaptation scale, which was just massive. And then what I thought was even more interesting was that it was the same thing in their partners. So I wasn't really sure, and I'm still not really sure, what to make of this information. Nothing else really came out in the analysis. I split it up to kind of look and see within each group. Is there anything that stands out? Couple things a little bit, but nothing particularly significant. And did not see this relationship at all in terms of oophorectomy. It was really just related to mastectomy. So then finally, the third part was really looking at these couples on a dyadic level to see how their various scores correlated with each other. And unfortunately, really small sample size for this part of the analysis only have 38 couples to work with. But a few interesting things came out of it. Looking at how strongly correlated some of the pieces were, it was really interesting. I think particularly in terms of the risk perception, the way questions about risk perception were asked seemed to affect how closely correlated their responses were. So for example, asking whether you feel vulnerable to breast ovarian cancer and whether you feel your partner is vulnerable had a higher correlation than rate your level of risk on a scale of one to 10. So that was just sort of something interesting that came out of it, I think, when we're thinking about our conversations with patients and how we ask them about risk and talk to them about risk. The adaptation and dyadic adjustment numbers were all really strongly correlated with each other. Again, probably not terribly surprising. There was really no relationship between dyadic adjustment and adaptation. It seemed like something that there might be a little bit of a weaker correlation between a partner's psychological adaptation and how the carrier scored on dyadic adjustment. Again, it's a pretty small sample size. I don't know if that number actually means anything, but it was something that came out. But really, I think the most interesting thing to me about all this was kind of this question of mastectomy and figuring out what it means. It was a cross-sectional survey, so I can't say cause and effect one way or the other, whether it's having the surgery that improves adaptation, whether more adapted women are more likely to choose that option. And this other idea of whether it's something about not having the surgery that's actually lowering adaptation. When I was looking at the differences between euphorectomy and mastectomy, the women who had not had euphorectomy almost all across the board said, yes, I'm definitely having this someday. Whereas the women who hadn't had mastectomy, there was a lot more. I might have this someday. So I think it may have something to do with kind of a bit of decisional ambivalence around it. But again, I'm not really sure. I think it would be really interesting to do as a longitudinal study and kind of follow women over time to see that adaptation as a process instead of just more a static outcome. Because we know that's what it is anyway. And I think as far as taking into the clinic, really making sure that the psychological, both positive and negative aspects of the surgery are part of the conversation, which is probably not surprising to us as genetic counselors. But obviously, we're not the only health professionals engaging in this conversation. And I think kind of getting that message across to people and really including the partners as well. Obviously, it has a huge impact on their psychological state and their adaptation, which I think makes sense. But it's really to actually see it there in the data, I think, is kind of helpful in terms of pushing that along. And then really including the partner in education. And if they're not there, working with the patient so they can educate their partner. And that's it. So I know that I kind of sped through it because I know it's end of day. And I'm trying to push things along. But thank you, everyone. And if you have questions, I'll take them. Yes, it was only bracket carriers who were unaffected. Can you clarify and forgive me if you went over this in the beginning, but you were using the phrase in the outcome section, dyadic adjustment conceptually, dyadic adjustment versus the couple's adaptation. Is there a distinction or it's just different words, same thing? So there are actually totally different concepts. And I apologize, I had a slide kind of laying it out that I'd taken out. Despite the fact that the words sound nearly the same and like they would be referring to the same concept, dyadic adjustment is really just kind of like, would you call this a well-adjusted couple? Do they have a cohesive relationship that is good in some way? And that's something that really applies to the couple as a unit and how, from the perspective of one individual, how they feel about the couple as a unit? Exactly. It's just kind of a general measure not specific to health or illness or risk in any way. After I pass the boards?