 Well, welcome everyone. My name is Erin Ramos. I'm the Deputy Director of the Division of Genomic Medicine at NHGRI. We're incredibly grateful that all of you agreed to join us today to discuss such an important topic. Before I introduce our wonderful planning committee and workshop co-chairs, I did want to mention that later this afternoon President Biden will sign the Juneteenth National Independence Day Act, which is establishing June 19th as a federal holiday to commemorate the end of slavery in the U.S. Given that June 19th falls on a Saturday, this means that federal employees will observe the holiday tomorrow. This is a very important and momentous event in our history. We had planned to share some information regarding Juneteenth tomorrow before we knew it would be a federal holiday. So as far as the workshop plans for tomorrow go, we're still awaiting additional information from Office of Personnel Management, HHS, and the NIH, and we'll share updates with you later this afternoon. So I just wanted to put that on your radar screen and we'll keep you posted and we'll potentially solicit some additional information from you later today on how to proceed. So I wanted to just briefly introduce our co-chair. So Dr. Howard Chang is the Virginia and DK Ludwig Professor of Cancer Research and a professor of genetics at Stanford University. He's also, which we're grateful for a current member of the NHGRI Advisory Council. Many of you know Howard, his group has made a series of discoveries that introduced the roles of long coding RNAs and biological regulation. And as a physician scientist, his long term goal is to decipher the regulatory information in the human genome for disease diagnosis and therapy. And Dr. Judy Cho is Dean of Translational Genetics and the director of the Charles Bronsman Institute for Personalized Medicine at the ICANN School of Medicine at Mount Sinai. Judy has extensive experience in defining genetic factors underlying susceptibility to inflammatory bowel disease. She's the PI and chair of the Steering Committee of the NIDDK IBD Genetics Consortium and also a member of the NIDDK Advisory Council. So Howard and Judy, thank you and I'll turn it over to you. All right, welcome everybody. I want to thank you all for taking time to participate in this important workshop. And first I just want to mention that this is going to be a two day workshop and hope you will actually participate in both days. And we were looking for active participation from all of you, Judy. Yeah, so beyond active participation. We're also thinking of writing a perspective piece. This is a very tight schedule. So we want folks to the moderators are encouraged to give the speakers the one minute verbal notice that we need to one minute less for their talk for their talk. Perfect. Yeah, we anticipate that at the end of this workshop, we can hopefully give NHGRI some concrete recommendations for the future of this important area of research and multiomics. And that our summary of the state of the field could end up in a perspective piece that can be published in the academic journal. All right, so just some rules for the road. Can we go to slide for please. Okay. Great. So since this is a virtual workshop, please on your zoom profile, write your name and affiliation. And your videos and audio will be turned off by default to reduce noise. But when you want to participate, please turn on your video, especially in your discussion sessions to rate to let people know you want to speak you can use the raise hand feature during the Q&A, or you can post questions using the chat function, and we'll be looking out for that to basically call you out. And when you're called, please turn on your audio and video and speak and by first by saying your name and affiliation. We're going to be recording everything so to just be a record of all the comments. And finally, given the fact that the workshop has a limited number of participants, and it's just really a kind of on without discussing ongoing future work, please no sharing on social media. All right. So, with that, I'm delighted to kick off the first session to kind of set the stage for this workshop to talk about the workshop rationale. And as Judy mentioned, every, we're going to give a little time warning, the moderator will be doing that be a verbal one minute warning. Each participant will a speaker will have a 10 minute presentation time, and the moderators be keeping time. It's my great pleasure to introduce one of our hosts, Dr. Eric Green. Eric is the director of the National Human Genome Research Institute at NIH, of course, prizes appointment as director and he served as the Institute scientific director, chief of the NHGRI genome technology branch and founding director of the NIH intramural sequencing program. And I believe that he'll be this session will be hearing about a lot about NIH NIH vision, but also about the current portfolio and then potential areas for the future. Eric, the screen yours. Hey, thank you, Howard. Can everybody see me and see my slide. Yes. Great. Thank you. So thank you for attending this NHGRI workshop. You will contribute to helping us understand an area that was mentioned and discussed that has been incubated for a while but specifically mentioned in our new strategic vision. And context is everything and while many of you who are participating in this workshop are familiar with our strategic vision and probably been contributed to it directly through various events that led up to it. I thought it was important to provide the context to everybody participating. And so what I'm going to just briefly tell you about us to set up the context of sort of the history and the publication of our latest strategic vision, which really is just part of a history of the field part of the institute, whereby strategic visions have been critically important first during the Human Genome Project, and then the two strategic visions that the institute published since the end of the human genome project that really have provided a blueprint or roadmap, whatever metaphor you want to use for the kind of programmatic priorities that the institute was going to pursue. As an organization, I will tell you that these strategic visions absolutely define errors for the institute, whether it's the Human Genome Project, the years that immediately followed the Human Genome Project, or in our last strategic vision, really setting us on a course in route to the implementation of genomic medicine. But as we entered the new decade, we recognized that it was important to basically update the strategic vision. The previous one was a decade old. And so we sought through a process that we referred to as genomics 2020 to create a 2020 vision, if you will, for the next decade of human genomics research. But we also did so recognizing that genomics has changed completely over the last 20 years or so, where once upon a time it was a very tight discipline of relatively small community of researchers pursuing relatively narrow goals such as those of the Human Genome Project. But of course, now genomics is everywhere, widely disseminated across the biomedical research enterprise, certainly disseminated across all of NIH. And as a result, NHGRI can no longer be about all of genomics, but rather we really are much more about the forefront of genomics, which is our organizational mantra. And so through the two and a half years or so of strategic planning that we conducted that yielded in October of last year, this 10 page paper in nature, everything we talked about was trying to distill the most compelling things that we had to be cognizant about at the forefront of genomics. I hope all of you have read this or if you have not, please do read it. And I give you the URL for the website that has lots of materials about the strategic planning process and actually has the strategic vision document itself. At the end of the day, the community was incredibly helpful to us, our advisory process and workshops and working groups, all contributed tremendous numbers of good ideas and at the end of the day, we had to sort of distill them down to some of the most compelling things that we wanted to describe in the strategic vision. And we found that they actually differed amongst the different types of ideas that bubbled up. And at the end, we found a four component or sort of four classifications that really nicely grouped all the elements of our strategic vision. One of the areas related to rearticulating and amplifying and building upon guiding values and principles that undergird the entire field of genomics. Another set of elements talked about maintaining sustaining and building upon and enhancing the many aspects of the foundation of genomics and the foundation is so used not only by by geneticists and genomicists but increasingly by all biomedical researchers. Some of the elements talked about the barriers that currently exist to make genomics even more powerful and what are the new barriers, like we faced at the end of the genome project the cost of DNA sequencing, while that barrier has been knocked down what are the new barriers and we describe in the strategic vision a number of barriers that we will now try to pursue to knock down and facilitate others from pursuing genomic research activities. And finally of course there's compelling research projects there always are, and we articulate some of the most compelling ones among those. And all of these elements together really represent the most important activities at the forefront of genomics. When you read our strategic vision you will also see we included something new that we've never included before. We came up with 10 bold truly audacious predictions for the coming decade. These 10 really are unlikely to all come true but even if a few of them came true by 2030 it would be truly remarkable. Compared to everything else that was written it was amazing how much press attention that these 10 bold predictions really have received. I was asked to write a commentary and Scientific American when the publication came out, describing these bold predictions and we actually got so much feedback about them that we've actually put together a seminar series and we're literally at halftime right now 10 part series throughout 2021 and 2022. And we've done five of these, we're doing one seminar session for each of the 10 bold predictions like I said we've done the first five. The next one is July 12 for example and you can see the rest of the schedule shown here. Now it's really important to appreciate our strategic vision is about certain things and it's not about other things that is a broad vision for human genomics with an emphasis on health application. This is a reflection of the forefront of genomics the things that NHGRI is going to provide responsible stewardship and leadership and really keep articulating the vision for. And of course we hope that this document will illustrate and illuminate and inspire the same time I want you to make sure you realize what it is not it's not a vision for all of genomics it's really genomics really related to human health and disease. It is not an NHGRI only vision in fact many pursuant genomics will help us achieve the vision we articulate here including other funders around the world. It's also not just five years we sort of view this more in a 10 year time scale. And finally, the 10 pages in nature don't describe how we're going to implement it it just describes the vision for it. And that's where this workshop comes in because the strategic planning process was all about collecting ideas and needs and proposals and possible obstacles and then to still in them down as I described into the 10 pages that we published in nature. But now the real work begins in many ways, because we're going to take a subset of the elements we heard about and implement them. We're going to implement them through projects, in some cases through programs and some cases through new initiatives, or maybe some cases will require policies. We planted seeds in each of those four major areas within our strategic vision, and now a subset of those seeds we're going to more aggressively try to germinate. The purpose of this workshop, which other speakers who will follow me will describe is to take one of the seeds where we talked about multiomic opportunities and health and disease, and try to see if it's time to germinate that seed. And if so, what might that look like and that's the input we want to get from this workshop to feed into some of the things that we might develop into a program. To give you a sense of what another seed might look like, I just want to highlight one seed. It's a very important one. It's one of the ones we decided to germinate very quickly. It came up twice in the strategic vision once in the guiding principles and values where when we described among some of the most important principles and values, one of them was championed a diverse genomics workforce. And we talked about how the promise of genomics really could not be fully achieved if we weren't thinking about the diversity of the workforce involved in genomics and genomic medicine and all aspects of it broadly defined. We thought this was such an important concept and what we heard in strategic planning process was that we even had to consider this notion as part of the foundation for all of genomics. And so sure enough, when we were talking about sustaining and improving a robust foundation for genomics, this notion came up again, where we talked about fostering a diverse genomic workforce and even lay out a little more detail how we're going to achieve that. We are very serious about our commitment to improving an enhanced workforce. So literally when the sun came up on 2021, this new year in New Year's, in fact, we released what we call an action agenda for enhancing the diversity of genomics workforce. And hand in hand with this PDF document, which you can download from this website, Vence Bonham and I, who is now actually the acting deputy director for NHGRI, took that position starting this past Monday, but for over a decade has been my senior advisor for genomics and health disparities. He and I wrote this commentary was the very first article published in the American Journal of Human Genetics in 2021 that reiterates the key elements of this action agenda. I list the goals here. And off we go because now I can tell you we are aggressively pursuing new funding opportunities that will be able to act on the very agenda described under this PDF and that we outlined in this commentary. This is a perfect example of taking a seat of an idea in our strategic vision and then germinating it into real programmatic action. It's not the only seed that's being germinated. That's just the one I happen to illustrate here. Here is representative others that either we started to germinate already or were in the process of germinating at various stages. One minute. It gives you a great illustration of how we go from elements in a strategic vision to actually executing them. We're doing it in multiple different ways, and we are asking you to help us study this element where we to talk about multi omics and health and disease and help us decide is the timing right to germinate it. So what might that look like. And in doing so, I think it will help us take the elements of this 2020 strategic vision and have many of them bloom into something that will really be make us proud 10 years in the future when we look back and see how this strategic vision guided advances in human genomics throughout the 2020s. I will stop there and turn this over to the other speakers. And then there's going to be a Q&A session I think after several speakers and I'm happy to answer any of your questions then. Thank you very much. Great. Thank you, Dr. Green. Our next speaker is Dr. Joannella Morales. Dr. Morales joined the division of genomic medicine as a program director in January 2021. She's a project scientist for the clinical genome resource, also known as ClinGen, a consortium that aims to define the clinical relevance of genes and variants for using position medicine and research. Dr. Morales is also focused on development of initiatives related to multi-omics of health and disease. And the title of her talk is Purpose of the Workshop and Agenda Overview. Dr. Morales, please take it away. Thank you very much. Can you, can everybody see my screen? Great. Well, good afternoon everyone. Thank you so much for joining us on this first day of the workshop. And my goal for the next few minutes or so is to provide a bit of context on the purpose of the workshop and our specific objectives. And then I'm going to briefly go over the agenda to give you a sense of what we will cover today and tomorrow. Before I get to that, I would like to first recognize the members of our workshop planning committee for their guidance and support as we plan this workshop. You have already met our two co-chairs, Howard Chang and Judy Cho, and you will meet the rest of the members during the course of this event. Dave Bodine and Jonathan Haines will help moderate some of the sessions. And Tulile Palainen and Tess Mercia will be speakers. I would also like to recognize my colleagues at the NHGRI for the many hours of hard work, Marie Brennan, Laurie Finley, Ajay Palai, and Aaron Ramos. And last but not least, I would like to thank our colleagues in the communications and AV support teams who have given us a tremendous amount of support. So thank you, everyone. So how should we start? Usually a good place to start is by defining the topic of interest. Advances in technology over the years have led to an increasing number of studies that focus on distinct types of cellular molecules. And all of these molecules represent layers of a complex biological system. Usually all of you are very familiar with all the terms listed here, genomics, transcriptomics, proteomics, epigenomics, metabolomics. The prefix makes very clear the type of molecule that's under analysis. But when we talk about multi-omics, what do we actually mean? And for our purposes, multi-omics is by nature a systems biology approach where the focus is not so much on the individual layers but on the biological system as a whole. The data sets of interest, therefore, are the multiple owns or the layers. And the hope is that the integration of all those layers provide insights that do go beyond what each layer alone can provide. Now the systems biology approach also implies that there's a comprehensive assessment of the actual biological system, be that an individual, a tissue or a cell. This does require the use of high throughput technologies which in turn does generate a vast amount of data or big data. And to properly interpret and make sense of this data, one does need interdisciplinary expertise. So as you can see multi-omics as a field is very complex. However, it holds a lot of promise. It can provide a more detailed molecular understanding of the biological processes that are affected by disease, helping elucidate cause and effect relationships. And in recognition of this, the NIH has made significant investments in the field over the years. And as my colleague Marie will discuss in more detail shortly, if one does a simple review of funded grants or the literature, it will be clear that multi-omics technologies have been used for a number of purposes. For example, to define biomarkers of both the healthy and the disease state to track and model disease progression to develop drug targets and to define therapeutic interventions to consider environmental influence and then to separate those out from the components and actually even to solve on diagnosed cases as a complement to whole genome and whole exome sequencing. However, that same review would also reveal that there are gaps and limitations. This is the case with respect to technology both experimental and computational with respect to data integration, especially when one considers how challenging multi-omics is given the multi-dimensional and often longitudinal nature of these studies. There are also study design considerations, for example, the sample size, the source of data, the diversity of the samples and whether or not harmonization standards are being followed. And then there are limitations with respect to the application into clinical settings. So the hope and promise of multi-omics was articulated in our 2020 strategic vision. It was highlighted as one of the compelling genomics research projects and just to say a word about those, those are by nature ambitious and they do aim to address questions that at the moment seem out of reach. And as Dr. Green said, these are at the forefront of genomics. And a number of projects were flagged and I'm showing box four in that in the strategic vision and a number of projects were highlighted as being compelling. But where multi-omics is concerned, one ambitious aim is to extend multi-omics studies of human disease and health into clinical settings. The strategic vision then goes on to expand on areas of focus that can lead towards achieving this big goal. In the research arena, we want to extend genomics beyond DNA sequence to include other multi-omics data and to combine those data with clinical variables and outcomes. This will require us to dig deeper into the tissue and cell level. It will likely require new tools and technologies. We need to think of new approaches for data integration and we will need to uphold values and principles that are articulated, for example, ensuring sample diversity. The focus of multi-omics research will increase our understanding of biological processes and will help us get a better understanding of disease triggers, onset and progression. This will build into better strategies to both prevent and to treat facilitating drug discovery efforts. In terms of clinical application, for successful adoption in the clinic, multi-omics data will need to be integrated with clinical decision support tools and with electronic health records. While this is a bit further down the road, it is important to start considering the steps that we might take in order to do this. The hope, of course, is that multi-omics integration will facilitate transition from a view of medicine that is focusing on diagnosing and treating disease to one that is focused on maintaining health and wellness. As described earlier, the strategic vision is very much focused on defining what's at the forefront of genomics. So the question for us to consider as we participate in this workshop is where is the forefront of genomics in the multi-omics space. And our goal is that this two-day workshop will help us by getting feedback from all of you, will help us answer this question. Specifically for the workshop, our objectives are to gain insight in terms of how multi-omics data can improve our understanding of health and disease, to identify study design, data integration and technological gaps and challenges, to consider steps that will be required for future clinical application, and obviously to define opportunities, opportunities that are relevant to NHGRI's mission and therefore at the forefront of genomics. So hopefully that has provided some context on the rationale for this particular workshop. And now what I would like to do is just to briefly go over the agenda to give you a sense of what to expect today and tomorrow. So as you know, this workshop will span two days, two afternoons. And we have divided the workshop into five different sessions. The first session will help set the stage. These are our keynote presentations that will help us think through the state of the science at the moment. The second session will be focused on technology, data integration and study design. We'll have three presentations followed by a panel discussion. The third session will be focused on application of multi-omics to observational studies. Again, four presentations followed by a panel discussion. The fourth session will help us think about the steps that are required for future clinical implementation. And the last session tomorrow afternoon will look at recommendations to the NHGRI. I will leave a bit more detail about today just here for you to review. I won't go into detail since I know all of you have the agenda. Just to say that we will get through sessions one and two today and I encourage you to come back tomorrow for the exciting conclusion of this workshop. And with that, I will say thank you so much for joining us. I will stop sharing my screen and pass it on to the next participant. Thank you. Great. Thank you, Dr. Morales. That was very helpful to set the stage. And our next speaker is Dr. Marie-Louise Brennan. Dr. Brennan is a fellow of the NIH, ACMG, Genomics Medicine Management Program, to receive her research training at UCLA and clinical training at Cleveland Clinic and Stanford University. Her research interests include multi-omics technologies in clinical implementation. She will tell us about a summary of NIH investments in the field of multi-omics. Marie, the screen is yours. Thank you, Howard. Good afternoon, everyone. Today I would like to talk about the NIH's current investment in multi-omics research. And considering this topic, there are two key interrelated questions that we wanted to address. What are the significant investments by the NIH in multi-omics research during the past five years? And second, what information do grant trends provide into what is needed to promote the NHGRI strategic vision? We started our analysis very simply. We queried the NIH iSearch grant database to see how many research program grants over the past five and a half years included the concept of multi-omics in the title abstract or specific game. And as you see on this graph showing the number of awarded grants per fiscal year, about 50 investigators raised the concept of multi-omics in their grants. The next year this number doubled and by 2020 the number showed an almost 10-fold increase. This data is not surprising and shows the field is expanding, making it even more essential to understand the funding trend. The efforts are not duplicated and instead focus on research at the forefront. As Jo and Ella discussed, there are many types of ohms and pairing or combinations in which they can be studied, querying with a list of all possible combinations of ohms, for example genome plus epigenome plus metabolome, or genome plus proteome plus metabolome was uninformative as it identified over 52,000 grants. We therefore focused our search as follows. Inclusion criteria were NIH research program grants that either were awarded during or after 2016. And exclusion criteria were training grants and small business innovation research and small business technology transfer SBIR STTR grants. We identified four main queries that examined one, the types of ohms with clinical intent. Two, types of clinical testing. Three, longitudinal measures and four, multi-omics. Using these targeted queries, the resulting list of about 450 grants was then read, or the specific aims for 450 grants were then read and assessed by two reviewers. I'd like to show you two slides that represent what we observed. This graph is a film tree visualization. This tool groups grants into clusters based on key terms. The bigger the cluster, the more common the term. And this allows users to see at a glance the topic areas that are returned in their search. It also allows narrowing of results focusing subcategories that are shown in gray within each cluster. Majority clusters for multi-omics where first technology including single-cell RNA sequencing and DNA methylation. Second, diseases including Alzheimer's disease, HIV, breast cancer and infectious disease. And third, other concepts such as big data and long-term monitoring. This is a film tree based on the literature of multi-omics. And while the literature lags behind the grant proposal, the clusters were similar with major themes of disease signatures and deep phenotyping, technology, data integration and longitudinal omics. Consistent with the grant and literature review, these topics are each represented in talks that will be presented today and tomorrow. While many institutes have funded some investigator initiated grants on multi-omics, we are most interested in the ICs that have made significant investments. And this list includes the ones that are listed on the right-hand side here. The NIA has funded integrated omics to understand healthy aging. NCI has the long-standing cancer genome atlas and other programs such as analysis of existing genomic sets plus omics and other factors. NIAID has omics for predictive modeling and infectious diseases. And NIMH has a brain initiative with eight different data collection modalities including multi-omics imaging and cellular neurophysiology. NIDDK has rich portfolios of a variety of programs including the IPOP longitudinal multi-omics profiling of prediabetes. And NHLBI, which is represented in the pie chart here, has the trans-omics for precision medicine top med program. Top med has a foundation of about 200,000 whole genome sequences, which represent a cohort with diverse ancestry. Top med 2.0 will continue to build and integrate other omics into this resource. And lastly, the Common Sun hub map, which aims to develop a global platform to map healthy cells in the human body, uses the latest technology including multi-omics. Several of these programs listed here are represented by investigators taught today. So in summary, as we dive into the workshops, we note that the majority of these are focused on specific diseases and conditions. We also know that the NHGRI portfolio includes approaches for data integration at CIR and investigator initiated grant. So two key questions to focus on in the workshop are where can NHGRI have impact and what are the standards and generalizable approaches that are needed. And at this point, I'd like to hand it back to the moderator for the discussion. Thank you. Great. Thank you, Marie. And we now have a, we actually live ahead of schedule. So we actually have about 13 minutes for a Q&A session. And as a reminder again, if you have a question, please raise hand function. And also you can turn on your video and I'll do when you raise the question. So let me ask the first question, which is really to the NHGRI staff. And that is that it's very hard to see the increase in grant funding. These are likely basically investigator initiated in this area of multi-omics. And is that an acceptable kind of strategy to just be like, let's wait and see how the field sort of finds itself, right? And the best ideas will come in. What is the sort of unique sort of or will be the strategy then to actually to do something anticipating or to direct this area if there's already this existing interest? I'm happy to take the first pass at that, but others, I mean, you know, I think that's part of what we want to hear at a workshop like this. You know, what we've learned over the years with very nascent ideas is that there's sort of the science that needs to be done and then there's the style with which the science should be done. And by that, I mean, whether it's time for a big project, whether it's time for some small pilots, whether it's time to try to do this in a cooperative way by getting a collaborative network together, or whether it's just best to let, you know, a handful of flowers bloom through a series of investigator initiated awards. You know, I think going into a workshop like this, I don't think we have a strong bias as to which of those I think it'd be heavily influenced by what we hear in terms of how mature certain areas are, whether it's really time to push the accelerator or whether it's time to just barely tap on a few different accelerators. So that's my take but I would welcome my colleagues from an HRI any of them to weigh in because again this is all things we haven't even discussed yet awaiting this workshop to happen first. I would just echo what Dr. Green said I think we're waiting. This is the whole purpose of this workshop is to hear from the community as to what steps we should we should take. Okay, so Manoli tell us great to see you first and then Nancy Cox Manoli. Thank you so much Howard, great to see you as well. So I think my question is very similar and it's on one hand there's the, I mean it's beautiful to see these workshops come together and it's nice to sort of see this type of analysis of the grant. I'm curious if you comment a little bit on the trend and whether this is going in the direction that you were expecting, whether there's some surprises in the trend or sort of how multi-omics is increasing, decreasing. Is there specific areas that are lacking in sort of this field that you're envisioning and whether the only mechanism is through RFAs or if there's other types of encouragement that you can send to the community based on the vibes that you're feeling. So basically it's a general question about the trend that you see and whether you're happy with these trends, whether that you see sort of some areas of concern or some things that you have not anticipated. I don't know who wants to take that. Marie, do you have any thoughts about that having done the portfolio analysis? Sure, so I can't comment on what the NHGRI happiness level is on that so I'll defer to Dr. Green on that. But what I will say is that the areas where there are gaps, these are all represented in directly in the structure of the workshop and this workshop was put together purposefully based on the trends and the gaps. So we're really hoping to be able to solicit community input in these areas. And will it be clear through the workshop where the trends are and where the gaps are? Well, we hope so. Based on what the speakers will be talking about, we've asked them to give somewhat global talks on where they feel the field is. But obviously those are big talks to ask anyone person to account for so we will be paying attention and certainly chiming in during the recommendation section. I think one thing we're looking forward, sorry, Marie, one thing we're looking to hearing from all of you is what Joe and Ella mentioned earlier how, where are we at sort of the state of the science, how generalizable are the approaches? You know, we have a sense obviously that there's some standards that have been developed just to move some of these projects forward, but are those appropriate if you're looking across all diseases? Are they applicable to sort of health in addition to disease? So kind of trying to figure out the sweet spot for NHGRI. What else do we need with data integration? Obviously, we're seeing some new methods being developed. We're funding some of those, but are they extensive enough to really help us get to where we want to be? Yeah, I would say that while we're on this point, the portfolio analysis may be useful to do a comparison contrast. What's the biggest difference in the concepts between those grants funded by NHGRI versus other institutes? You might see something quite different. I might imagine that there's more technology development, tool development for NHGRI and then the other institutes is more biology specific or disease specific under the purview of their topic areas. When the technology is more mature, for example, that might be a possible sign that that's where NHGRI could have impact. Okay Nancy, you have a question? Yeah, it was extremely interesting to see. So there's been much more investment in the development of biomarkers in the omic space than I think I would have appreciated before the presentation. And yet there's been much less direct movement of these kinds of biomarkers into medicine than we might have expected based on that investment and many of the positive results that we hear at meetings. And I know that there are barriers that relate to how to make omics technologies put them into, you know, clear space. That's a that's a complicating factor. But I also suspect that the, the research level investigation is these things is still far from what we need to get it into clinical practice. And I wonder if whether somebody could speak to some of those barriers I mean I'm certainly going to bring that up in my talk to some degree but but I think, as Judy Cho has sometimes said, we have had hardly any new biomarkers in 40 years of medicine, sort of in my professional lifetime, a few, a few that are widely used but very few new biomarkers over that time. And these are such rich opportunities for biomarker development that I think we could be doing so much better in medicine with some of these kinds of biomarkers that we know provide really rich signals for disease progression disease on set. So we already know that they should be working but somehow they're not getting into enough of the clinical side love to hear more discussion from your perspective on why that hasn't happened and what you think needs to be done to get this at scale into medicine. I mean, I don't know who wants to take that Aaron you want to take that I mean Nancy I think the issues you raise are exactly what we hope to get out of this workshop. I mean so you know I would point out that the notice the strategic vision you know we didn't just say we're interested in multi element stuff he said multi health applications we really leaned in, leaned in for the very reason that you're saying is why is it you know and as someone who's trained as a clinical pathologist. You know when you think about what we're we asked a for a clinic I really hasn't advanced much since I was trained, or when since I was in medical school and you wonder why with so much more data available. You know there I do agree with you I feel like there's something missing. And so that's why, you know it's one of the reasons why we sort of leaned in on this to try to see if there's new multiomic approaches that could give us new clinically relevant biomarkers. Yeah, not not only the approaches but what sort of translational research do we need to do to take that initial knowledge that's generated. You know, think about the implementation science to get that knowledge into the clinic and that's something we're starting to do a bit more in our division of genomic medicine but but clearly there's a heck of a lot more that we need to do there. I'm just sad that that is exactly the point of what's at the forefront right so we can think about whether to go down the path of just doing more and more research or whether we can go down the path of, of trying to do more clinical implementation and so it's asking that is a question we're trying to ask, which way should we go. And we would love to hear from the community is it time now are we ready for that or is there something else that needs to happen. David Craig, you have your hand. Yes. So, in your analysis. How do you, how is it, were you able to really take an account public private partnerships and I asked thinking to myself some of the biggest things I think of like answer a ls amp PD, their places where really the agency is helping facilitate with a public partner. And so, do you, is that perhaps being underestimated, where, in fact, there is a bigger resource because sometimes I see these private partnership facilitated by the public sector are really leading. Marie, you can. Sorry, I was going to point to you Marie but I would say my first guess is yes that likely is underestimated, and also not only the public private partnerships but either you know the work that's just being done in the private industry as well that's not captured in our analysis Yeah, it might depend on I mean what David mentioned as example some of those are executed through the foundation for NIH and I'm not sure that data would have been captured by the databases that Marie was looking at so I think it probably isn't underestimated. I was focused on the, the institutions in my searches so it would not be included. Yeah, so I definitely agree with David's point I think this is definitely an opportunity I think a lot of exciting actually, including biomarkers and actually multi oh make technologies are being implemented actually in the end through our, through companies. Okay, any other comments. For questions. I'm looking at my chat here. Okay, well, seeing no further comments at this point. Let me turn then this session over to Judy, who will introduce our first session setting this stage for multi oh make studies.