 Good morning, everyone. Welcome to our session on the Global Genetics and Genomics Community, or G3C for short. G3C is an online, unfolding, interactive genetics and genomics case study website that serves as both a learning and education tool. And in this session, we're going to provide a summary of the features of G3C, provide an overview of the different uses of G3C, and both describe and give you a demonstration of some of the cases and the content available in this website. In this session, you can enter questions at any point in the Q&A box and we'll address the questions at the end of the session. And this session is being recorded for future viewing. Speaking today will be Yi Liu, who is a genetic counselor in the genetics branch at the National Cancer Institute. And my name is Taffy Calzone. I'm in the role as a research geneticist and head of the genomic health care section in the genetics branch at the National Cancer Institute. So we will now go ahead and start the session. Hello, everyone. I'm Yi. I'm a genetic counselor from the National Cancer Institute, the Genetics Branch. Today, Cathy and I are going to give you an overview of an interactive online educational tool. It's called Global Genetics and the Genomics Community, short for G3C. As the increasing discovery in genetics and the genomics and is crucial for clinicians and the students are in training, how they integrate in those increased knowledge to practice and how to utilize in clinical care. Then we're thinking about what will be the best way for the learners to learn those information. Then through literature research and our clinical experience, we think learners can learn best when they're utilizing what they learned in the textbook and utilizing in the clinical care. So this is how G3C was born, which is we have a collection of unfolding case study for use with the learners. The learners can be students, can be practicing health providers, and they can learn the basic of genomics concept through interview, simulated patients, and through this process, they can complete a supplemental learning activities, such as practice how to answer those questions and the joint categories. And also, they can hear from the experts who are coming from the topic of this kind of cases to learn how they are addressing the current issues regarding those cases. There are some features, content of G3C. Right now, there are about 18 cases in the G3C website, and the cases can go through from cardiac, from prostate cancer, colon cancer, and the patient selection are ethnically diverse. The reason we're trying to mimic the community of patients we are serving, and also we are focusing on some common public health issues, such as the access to health care and others will be important in the clinical setting. And those cases are portable and web-based, and it's open access to everyone. So it's a free registration and it's flexible for people to use. The cases are interactive and self-paced. You can choose which question to ask the patients, and you can stop at any time. And the questions have different routes, so it's self-directed. And it's an unfolding case study, so it depends on which question you are choosing, and it will lead to different kinds of scenarios, how the story is going to be presented to you. Also, the professional actors and others will be used in the G3C as a simulated patient, so the learners can have similar kinds of experience when they go to a simulating center in an academic setting. In the process, there are incorporated learner education activities and the resources being provided, so that a learner can go into the activity and the resource to enforce what they would love to learn and enforce the knowledge and enforce the knowledge. And faculty support was included as well, and some faculties would love to use this website to integrate it in their curriculum to teach students, and some suggestions are provided by the new website. Once you go into G3C, you will see a login and registration button, and it's free registration, then you follow the username and the password, then you set up a count. In this way, it allows you to track the progress, and it enables you to stop a case and return where it left off. And here to share with you about some unique features of G3C, the first one is the expert commentaries. So those are experts who are familiar with the topic or the case is presented in a specific case, and they can address questions like how realistic the case to be a current practice and how the genomics information is integrated in the case. And or there is any like a conflict or controversies associated with the case, and also they would bring up like ethical, legal, social issues associated with the case. And the commentary are based on their experience and on their clinical practice, and also they will give you recommendations on what will be helpful for the learners to understand the topic. And here I'm going to share with you what's the flavor an expert commentary will apply. So this case is, again, really interesting because there are a number of controversies associated with genetic testing and autism. So the one that I'd like you to keep in mind as a clinician is our best efforts to look at genetic testing. In ASD, again, I mentioned it's a huge, a huge diagnostic category. There's so many different forms of ASD. So on average, when you do genetic testing for ASD, you get a quote-unquote positive answer. You find a genetic variant associated with ASD in that child anywhere between 15 and 30% of the time, 15% being in the lower end if you're using microarrays, and 30% of the time being on the higher end if you're using genome sequencing. So that means that 70 to 85% of the time, their family is going to get a negative result from genetic testing. So it's really important as a clinician to set expectations appropriately that the behavioral test to diagnose ASD is different from any genetic test, which is only looking for specific factors. Because when I talk to years or psychologists with years of experience, and they deal with families all the time, they order genetic testing in this case, the very first question that they get from the parents when the genetic test comes back negative that no linked variant was found is, so that means my child doesn't have ASD, which is not, we can't say that, right? All we can say is that we could not find a specific genetic cause behind the ASD that we've diagnosed behavioral in your child. So that's really important for you to think about as a clinician to be able to set expectations appropriately and be prepared to have that discussion with the family when those results come back. And here is another unique feature for G3C, which is the faculty case guide. So faculty case guide is a PDF that's inputted in each case, and it will have the case objectivity suggestions for users and the supplement student activity. And so the person who wanted to utilizing G3C in the teaching setting, and they can use the faculty guide to help them how to design the study part. And there are additional reading and the resources provided in the faculty guide. Here, I'm going to transition to Cathy and she will continue giving you a discussion regarding G3C. Hi, everyone. My name is Cathy Kelzone. I'm also in the genetics branch at the National Cancer Institute and work with Yi. And I'm going to continue talking about G3C and begin with how learners can benefit by using G3C. And the first is that there's a variety of different cases. So individual learners have the opportunity to be able to select a case that is either relevant to their practice or relevant to what they're learning about and be able to focus on those specific kinds of topics that are of interest to them. It simulates a health care provider experience and encounter. You are actually interviewing patients and you hear a response and you need to begin to integrate that into how you would think about how you would respond to a patient given those circumstances. And that's done in the mechanism of being able to select what question you would pick next, being able to do supplemental learner activities to help you understand some of the things that were brought up in the video itself and being able to actually simulate to the best that we can real-life clinical encounters. All of these cases provide some degree of learning basic genomic concepts and so that varies depending on the case. It's always case specific, but those basic concepts are actually very important as a foundation for utilizing genomics in health care provider practice anyway. And as the case progresses, there's the supplemental learning activities that can be completed and then there's the opportunities that can be completed and the opportunity to hear from experts that are well recognized in the field about their view of the case, how real it is, what kinds of controversies and so forth that are involved with the case. So how is G3C being used in real practice in an academic or continuing education environment? And we've actually learned a lot from users of G3C about how they've been able to use it in a variety of different ways. So let's start with the academic setting and begin with how different faculty have integrated this into lectures and that is to pull out specific case points that they're trying to hone in on and to reinforce some of the content that they've actually taught their students already and didactic content. Some of them have utilized student assignments to explore specific case and that can be an assignment within the classroom environment. It can be an assignment that is a homework assignment or a pre-work assignment prior to class. There can be faculty guided activities where faculty members can actually show a video clip, stop the video, and then have a classroom discussion about the controversies, the ethics of the case, the kinds of issues that were brought up, some of the psychosocial considerations that can be an engaged discussion with the learners or it can be in small group activities where you show a video clip and then break into small groups and the individual groups report on different aspects of a given case. We've had a development of cases that are multi-ethnic and that was very deliberate because that's much more reflective of the kinds of patients that all of us would see in practice. It's a variety of different ages and a variety of different conditions that these people have from common health conditions to more rare genetic kinds of conditions that one might encounter in practice. All of these cases include some degree of assessment and so that's actually important because an assessment provides faculty with an opportunity to examine student's capacity to do these assessments. For example, can they create the pedigree? Are they able to assess family history sufficiently through a case? Are they able to assess risk based on the information that they've collected throughout the case? Can they gather all that information and determine whether or not there is an indication for a genetic test? And if so, what test would that be and how would they proceed in regards to moving forward with the test? And you can engage at any point in discussion with the learners. In group education, you can divide into groups and have groups actually complete a case as a group and go through some of the supplemental activities and discussion points. There can be additional faculty activities. I've never been so surprised by the novel ways that faculty have been able to come up with what kinds of additional activities they could add to these kinds of cases to make them interesting and as real life as possible. We've also had a number of people use D3C in a continuing education capacity. That includes just independent learning that an individual sits down and actually does a case because they're either going to see a patient like this or they know that this is an area where they have a deficit and they need to improve some of their knowledge base. And we provide a lot of faculty support and that includes faculty in the broadest sense of the term, both in academic and continuing education environments. So in addition to what you presented about the faculty guide that is case specific, D3C provides a large number of resources that are very helpful in just understanding, you know, genomics and basic resources. A lot of these are resources that have been developed by the National Human Genome Research Institute, such as the Talking Glossary, the Image Gallery and other kinds of things that faculty could find very useful in sort of planning how to integrate these kinds of tools in practice. We also provide an introduction to D3C, really talking more about this kind of experiential learning methodology as a way to stimulate thinking about how you could use it. There are website overall objectives, so in addition to the case specific objectives that you spoke about, there's overall website objectives, target audience and suggestions and how you could actually use D3C. And each case, like we've mentioned, includes resources and supplemental activities and additional educational activities and the individual case guides. So the latest case that we have developed is on autism spectrum disorder and vaccines. And this particular case, if you look at the picture of the actress here, what you can appreciate is that this actually, if you were looking at some of these slides as they were being presented as somebody that we've utilized before. And that's real life, right? We see patients at a variety of different time points depending on what could be occurring in their life. And so now Dai, who originally was seeking consultation in a prenatal setting, is now at the point of having a four-year-old son. And she is presenting for a discussion because he has what appears to be increasing developmental delays. He has speech and language difficulties. He's very hyperactive. He has a lot of psychosocial issues. He has a lot of difficulty engaging with other children. And she's very concerned about these developmental delays and his behaviors and what may be causing this. And so this particular case delves into the genetics of autism spectrum disorder and fragile X. And the objectives, of course, is how best to respond to Dai's question about these issues, including her suspicion, well, maybe it was associated with vaccines and how genetic information and testing could actually apply to this particular case and that this would not be associated with vaccines. So we're going to actually show you a clip from this case so that you get a real feel for what this actually looks like on the website. Well, Ethan has had a speech delay, for instance, at age two. He couldn't form three to four word sentences. At this point, he can say phrases, but he tends to repeat them a lot. He says, I want that over and over again. He has short bursts of speech with disruption in the flow. So he repeats a lot of sounds and words. So I'm going to conclude here. And I'm just going to mention that, you know, yes, Yi and I are from the National Cancer Institute, but G3C is something that has been a longstanding collaboration between the National Human Genome Research Institute that provided the expertise and funding and platform to continue to develop G3C and bring it to you all. And we're actually very excited to continue that collaboration going forward. And we're happy to answer any of the questions that you may have. Well, we are happy to answer any questions. The link to G3C is in the chat so that you're able to, you know, just, you know, click on it and bookmark it easily enough. I don't see questions right now, but I think one of the things that we'd be happy to do is to actually show you a little bit more of these cases just to give you a better flavor for it. You know, this is all about, you know, the reality that in a learning environment, be it academic or continuing education, you may not have an opportunity to see these kinds of patients. And this is the best, not the best, but the best methodology that we could identify that was feasible to achieve and timely to be able to introduce these kinds of cases on the website methodologies. So I'm going to share my screen. And we're going to start with dye and be able to help you understand when we first encounter dye in the prenatal setting. I just found that I'm pregnant. So I'm coming to start prenatal care. I work as a clinical nurse specialist at my hospital and I'm definitely a planner, so I want to get things as organized as possible. So one of the features that you can see is this is how the question options open up to you. And we're going to pick this question because this was one of the reasons she wanted to start. I'm really concerned that since my husband and I are older, that that might affect the health of the baby. And I know that the California panel is only a small number of tests, whereas the whole genome sequencing has a much larger scope. And I also understand that whole genome sequencing can take a long time to set up. So that's why I'd like to get started so early in the process. Kathy, I saw there is one question showed up. It's Alison asked about which professional or clinical groups are the modules geared towards? Yeah, I think, yeah, go ahead. No, you can answer. Oh, sure. So the professional and the clinical groups and we are focusing, I think, on like two kinds of setting and the one is continued education and who are like, for example, like either physicians or nurses or professional genetics and they are already in the clinical practice. So they can utilizing this to either explore topic and like or updating information they may feel needed at this point of time they do not learn before. And the other section is the students who are in training and like which reflecting the like professionals I talked to before. And yeah, like physicians in any kinds of settings of nursing capacity and from general nursing to professional nursing and also in genetic counselors and training and I think will be it will be useful to using this website. Yeah. And I don't think I have anything additional to add, but I think the the key point that you brought up which I'll just reinforce is that this is for really any kind of health professional or student group who's training in the health professional capacity to be able to use. And that can include faculty, you know, we have found that certainly in, you know, my background is in nursing uses in the genetic counseling profession so it would be different in that setting. But in nursing for sure, we have found that a lot of faculty have difficulty teaching this content because they don't understand it themselves. And so sometimes these cases have been used just for self learning and preparation for teaching about these kinds of issues in the classroom setting. And so it expands across all groups who would be able to use these modules. They are intended to be basic and not highly technical and highly advanced because of the fact that we want to be able to reach any group in any profession across the board. Yeah. And we do have additional reading or resource and so they can explore if they want to advance the knowledge on that. And the experts commentaries and they are all like experts who are familiar with this topic and understanding the current like either research or like standing for this kind of issues in a professional setting. So definitely you can go from basic and to like advance if you wanted to explore some more. Yeah. And thanks, Alison, for the question. Yeah. And I think we have a very interesting question from Mexico. Yeah. And so this question is, is it ethical for companies, banks to have genetic information about people and because it could generate a kind of discrimination? Yeah, definitely. And for example, and giving a health insurance to someone who is likely to suffer from cancer. Yeah, I can comment on the GINA perspective. So there is a non-genetic discrimination act in the U.S. But I do not know like what is the standard in Mexico. And there are a broader like umbrella for protection regarding who are not someone who don't have the symptom showing only carry the genetic change. There are certain like protection for people getting like health insurance. However, like you brought up a great point on like there is no like the standard protection regarding life insurance and also it does not apply to military as well. Definitely, there is a like a very importantly how health providers and in the community, how we providing like the information regarding genetics to people who are interested for genetic testing. Now, Kathy, do you want to comment on that? Yeah, I think one of the important points here is that this is complex. It's very different depending on the country. And even within a country like you said here in the United States, there are people where these laws don't apply and there may not be laws in places like Mexico or other countries. The key thing here is that, you know, this is a changing landscape in many different places. And so what's important in thinking about the use of genetics and genomics and in care is that they're having an encounter with a trained healthcare provider, whether that's a genetic counselor, a geneticist, or a genetic nurse. They need to see someone who has a handle and a knowledge base on what's the landscape in that particular country and that particular environment. I do want to make a comment about like, for example, predisposition to cancer and other kinds of diseases. One of the things that's important in thinking about this is that, you know, that risk is there. And we all have a risk for something, right? And what that is being used for is to inform healthcare decision making to either detect that disease early or intervene early to minimize its effect or be able to modify that risk in some way depending on what the nature of the problem is, you know, it's cardiac condition versus cancer. And so there are many different ways to think about this and not all of it is negative, just knowing that somebody might be at risk for something. It's also informing their healthcare and there's an advantage to that. Not everyone sees it, but there is an advantage and that's why it's so important that people need to see somebody who has an expertise in the environment to be able to explain that to patients so they can make an informed choice based on their environment and the landscape in their country. Yeah, I think Kathy brought up a good point regarding the informed decision making and a professional is able to explore all kinds of either benefit or limitation or risk like about the genetic testing to someone who are thinking about having tests, I think it's very important. And also another thing I think is worse to mention is the people make a decision on genetic testing maybe have a long period of time maybe like a month or two years or three years. I recently had a patient like took about two years that he finally like thinking about his time for him to do genetic testing. So it's as a professional maybe you are not expecting someone giving you an answer immediately. Yeah, it may take a longer time for someone to make a decision. Yeah, I think we have another question. Kathy you want to address? Yeah, so this question is what kind of outreach are you doing to get this to primary physicians and the clinical settings where physicians may not be aware that this resource exists so they can be better planned. They are cared before they send a referral to genetics. So there's a number of outreach activities that are going on both you know that are discipline specific and across all disciplines and I'll highlight the one that we're doing today and this whole week which is the health professional genomic education week that is hosted by the National Human Genome Research Institute to try to engage people as broadly as possible and have these kinds of tools available so that individuals even who participate in this can disseminate this because these these sessions are being taped and are going to be available on Genome TV and other links through the genome institutes for viewing by others who did not attend or didn't hear about it for some reason. We do spend a lot of time both on the side of the genome institute through the ISCC PEG which is the Inter-Society Coordinating Center for Professional Education and Genetics and I probably messed that up and I apologize. ISCC PEG is much easier but that is the platform that in part not in total but in part is being used and is a mechanism for engaging all health professionals pharmacy medicine and others to understand this better to have experts who can begin to develop more resources for education and training who are trying to disseminate within their practice specialty to upskill the capacity and competency of that group and there is a need for more people to engage and participate in ISCC PEG which is a great mechanism to be able to work with others and think about novel ways that could be used to engage these communities because all of us appreciate that there is a deficit in the number of people who could benefit from the use of genetic education and counseling and possibly testing but that they're not getting the information that they need to have a referral and think about what can be done. You know all of us are committed to you know different mechanisms that are being used like through the National Society of Genetic Counselors where they're working on a variety of different outreach efforts. The International Society of Nursing and Genetics and the Global Genomics Nursing Alliance both are international groups with a similar mission of trying to move this out in the nursing community is another mechanism because many of these you know physician providers do not work you know alone in their practice and they have nurses that work with them and so trying to get you know this out from grassroots kind of perspective and increase that capacity. So there's a variety of things that are going on and we are you know always welcome to hear other ideas and strategies that haven't been considered but I'd encourage all of you who are participating to think about joining ISUCPEG as a mechanism to engage in this activity. Yeah Cathy I think last point we brought up about we are interested to everyone contributing in this effort and there is one participant Adriana and if I pronounce your name wrong I'm sorry yeah and then the proposal is would you be open to collaborating on the project to have this program available in other language such as the Spanish yeah I think what we thought about this a long time ago we would love to right Cathy? Yeah we'd love to we we did have one case that actually was done in Spanish it's difficult for us because you know I will say one of the genetic counselors in my group does speak Spanish so that's good but you know it is difficult for us to both maintain that and to have the right resources so we would be very keen about working with people in other countries to you know disseminate a resource like this that could be used and modified for use in other countries so that is something I think that we're very open to being able to do and that's partly some of the work that you know even ISCC PEG might be thinking about because even here in the US we have you know a highly diverse population and different populations that you know do not speak English as their primary language and they have a lot of difficulty understanding some of this so it is the kind of thing that we're quite interested in yeah but you just have to reach out to us yes yeah we yeah go ahead well I was just going to say we'll put our emails in the chat and and then you can always feel free to email us so yeah we'd love to collaborating and bring this platform to be a reach out to more community and to benefit the people who wants to learn those knowledge yeah and the Luis had a question about the on what do you think about the you you genetic genetics yeah so I understand where you're coming from from my perspective and the real we are really focusing on like a disease prevention and how to manage your condition definitely is not to trying to go through the route to limit relating about the variety of genetics of our people yeah and for for the genetics community right now like we are focusing on information now that it's a we are able to approach and there is a management like a own place can tell someone like for example starting screening earlier can detect the either cancer or detect the other kinds of condition to happen and or like is there anything like like for example in pediatrics if we identify the some genetic change we could like predicting like they don't want something while showing up before the child and there are different kinds of interventions that can be utilized in the overall management for the child and for example like the some some are not just showing as a physical like a condition you can see they can be like a mental as well so on the line they will be like interventions about seeing a mental health provider where things like that can be helpful as well so the whole idea is in genetics I think from right now the standpoint it is about to prevent like a medical condition we can manage it to happen and or we can manage it better when it does happen yeah so Kathy do you have any comments now I think it covered it so um I see um yep okay yeah so I think one of the things we also want to do is kind of show you just the scope of these kinds of cases and I'm gonna and it relates to some of what's been brought up here today so I'm going to share the screen again and just give you a flavor of another case just to um help you understand some of what is there but I have too many way too many things open so I'm trying to get to well uh I'm here for my yearly physical and uh I completed the ACT for Health and you know the WebHA and found out that I'm at an increased risk for breast cancer my dad incidentally was um found to have the mutation BRCA2 which I was under the impression that that can only be passed down by the mother side of the family so we found out that's not true right and really I think the reason that we're here today is for me it's primarily because I'm concerned about Jeff's health and I guess I just want to make sure that you know we get this thing squared away Jeff didn't tell me about it until recently um so this is really I guess new to me also I got a genome scan like I don't know a couple months ago so I know a lot about genetics and so I feel like I'm I don't I mean I just found out about this but I'm here to learn more is really why we both are and we're a little nervous about the genetic testing and the implication of the BRCA2 because of what it could mean for our two kids right that's my primary concern I'm over here yes so I wanted to go ahead and show this particular clip um for a clear reason in relationship to what was discussed um and if you go through a case like this we do try to integrate different kinds of concepts throughout the cases including ethical issues in the majority of these cases and in this case the issue of discrimination and concerns about discrimination came up quite a bit because this individual actually the male is in the military the individual who was considering the genetic test and was there with his wife and you can appreciate that there's you know a little bit of tension between the couple because he didn't share this information and she only learned about it recently and so some of those kinds of things come up in the case um and so there's a lot of different avenues for exploration both if one just does the case but also being able to pick out different components of the case and show that video and engage in discussions which can be very country specific um or environment specific about what would be relevant in a particular country on comment yeah sure yeah so as uh as also we know that for BRCA 1 and 2 and the Lynch syndrome and familiar hyperplastroemia as the three condition was on the CDC like the front line trying to for cancer prevention and um expanding the screening for population and I think this also address the comment I had before he's really focusing on something like we are trying to think something we can use through genetic testing we can prevent either to happen or catch it early like we know like the BRCA 2 it is associated with for males prostate cancer pancreatic cancer and melanoma and and so for for those especially for prostate cancer for BRCA 2 is starting at age 40 and for for for PSA screening and the digital record event and which is earlier than the general population starting at age of around like 45 so have this finding have the the finding can help this male regarding the prostate cancer like a screening start early and if you catch it early and it's a really will be much more easier to manageable compared to later and yeah so that's the product a point to regarding that and also the for female the BRCA 2 associating well be like breast ovarian and and that like can help with the management as well yeah so I want to just highlight a couple things from the chat and that is that dana has gone ahead and put in information and the hyperlink to the inter-society coordinating committee for practitioner education and genetics and that they're always welcome to have applications and and there's no fee to participate and so that information is in the chat and you can also just you know follow what's happening in the ISCC peg you know through their website I can share a model case for more like features we can have I'm Kathy I'm showing I'm showing my screen yes okay wonderful yeah so this case it's a lady with potential um um hyper um um with a familiar hypotosteolemia and um from when we go to the case page then we will have have a and some some like the description regarding this uh patients and when you also we will have a link about the uh case note so it's all PDF and able to download and so you can you can see a form like this it's uh showing and for this case first uh usually you begin the case is what brought you to the office today and let's take a look well I was referred here by my gynecologist I went to see her because I got some abnormal cholesterol results from a health fair that I went to so she told me to repeat the test but without eating or drinking anything beforehand so I did and I was told the result of that would be here today um and to be quite honest I don't remember ever having my cholesterol checked before so I was a little concerned with the numbers that came back yeah as you can see here for Larissa we picked uh we choose the Spanish speaking immigrants and also she doesn't see a regular she doesn't have a primary doctor she used the gyne as her like an annual like a check-off and it's very common um like in the community and um the other like points we wanted to show is um sometimes if um in in the in this kind of family and sometimes the information can be family information can be limited so in the in the education um this process we're trying to integrate in those kind of cultural like relevant to um to the the case so um learners can have some idea regarding the cultural components regarding the case not just see the patient as as a disease condition yeah so and there is a another feature I wanted to share with you is and we so when we go to the case this is how you will see in the website and there are different cases showing up so you can you can filter the case through a category and and also like like you can see here there are the heart condition there are our cancer risk assessment child case cystic fibrosis and and the the factor five laden and diabetes and so you can choose from a different variety depends on what a kind of condition you are interested and also there is a menu regarding you wanted to be more advanced the case intermediate so so it's very um it's viewed out to as a learning like a purpose and when you go to go through all the case there is another feature I wanted to show you which is the recommend maker recommendations so that's the way that this website is set to assess your knowledge when you go through the case for a period of time that learned enough doing enough learning activity then you could have some ability able to make recommendations so that is how it's an assessment that the teacher can sign for students to do and and they can so this is how it looks like yeah like a different it's a multiple choice section yeah I'm trying to stop yeah so I don't see any other questions coming in but certainly we've given you the email and you're welcome to go ahead and and contact us with other questions um the link to g3c is in the chat um and we are working on a new case we do you want to describe that case oh sure yeah so um we right currently we are working on the case that is associated with um hyper um it's associated with a cardiac syndrome and we are trying to focusing on the native american population so have cultural elements regarding the some of the elements of the professional encounter with someone with a native american background what kind of information they should keep in mind and and and also with the prevalence regarding the cardiac condition and to think about what kind of genetic testing you can offer and and also how you can refer to a geneticist for or genetic counselor for ordering the test and in this whole route and things so we should be aware how cardiac condition associated with genetics and also with a native american background and and one of the other features associated with this particular case is the issues associated at least here in the us um the native american population has a specific health system which is the indian health service um which is different from other health systems within the us um and there is concern about um the use of genetics and eligibility to continue to be able to get their health care through the indian health service um and so what you can appreciate throughout all of this is that you know our objective is to try to integrate a variety of different kinds of issues into these cases um and and that actually mimics real life because you know patients don't just come in with a particular issue there's a variety of different considerations for every patient um and so we're trying to make sure that what's developed is reflective of the broader population as a whole and the kind of challenges and considerations associated with those things yeah so stay tuned yeah i think we have the last question yeah who is coming from louis i just learned that you are a high schooler thank you for joining me and um the question is like why do you decide to be a researcher yeah um yeah for me i think um i wanted to explore what is um um unknown and it's so much so much like we do not know and we're trying to find the answer so i would love to be the person in the puzzle of um finding what is the reason maybe i can answer some of the question in the end but maybe i will be more confused but in the process it is very like interesting for myself and also i i think very importantly it's a public service like how to serve the community and very importantly it's i love to work for coming from the community and learn what the people are need and how research can meet the can reach the end for what what what is needed in the in the people we're serving yeah and and for me the the motivation to become a researcher was really about trying to identify things that work right i started in oncology i've always worked in oncology and being able to identify things that work treatments that work you know symptom management that works care delivery that works um and the only way to get at that is to study it in a systematic fashion because it's not just he said she said or you know well we did this in our setting and so that's what we do here um and so that's what drove me to wanting to be a researcher now i always worked in a research environment and if you have an interest in research i'd encourage you to look at some of the resources through the national institutes of health at nih.gov um where they also offer opportunities for students to experience the research environment like the summer students and post baccalaureate students so there are many opportunities for people to be exposed to you know a research intensive environment through the national institutes of health and it's nih.gov and then if you put in like summer students or something that is the the link for those kinds of things but nih.gov is the the platform for being able to provide that i can try to um put in the link in the chat or student specifically but all institutes the genome institute which hosts g3c and is hosting this genome education week as well as the cancer institute and all of the many institutes within the nih are very focused on um these kinds of trainings and uh me and dana put in the links um so that you can look it up thank you for all those questions and thank you for joining our session yes yeah feel free to reach out to us um if you are interested in any like topics we addressed today or you have some innovative way how to um expand the g3c we would love to hear thank you thank you