 All right, hi everyone. So I'm going to present some preliminary data and analyses from the MedSeq project, specifically looking at data from our post-disclosure surveys and interviews primarily with study participating physicians. So I'll just begin by making an argument, which I don't think is going to be a hard sell here, which is that family communication obviously matters very much when we are trying to use genomic testing in the clinic. And I know the focus of this session is cascade screening, but I think it's important to emphasize that more broadly, family communication and information sharing matters with respect to a whole host of issues that come up in genomic sequencing, such as confirming or disproving the pathogenicity of a variant of uncertain significance, or potentially just trying to identify the correct member of a family to test. And so if we're serious about doing this well, I think we need to kind of be serious about best practices for family communication. So in the genetics community, we've been dealing with challenges related to this for a while, but the data that I'm going to present kind of indicates that non-genetics providers may actually view this as kind of a novel challenge and may not be as well prepared to deal with it as people in a genetics clinic. Existing guidelines discourage providers from contacting relatives directly and encourage them to help patients make contact to their families about genetic information, but there's still a little clarity on exactly how to go about this. So the MedSeq study is a randomized trial of whole genome sequencing in cardiology and primary care settings. So participating patients are randomized to have whole genome sequencing in addition to standard of care and family history review, and then the other half of the participants just have the standard of care and family history review. And half of our population is basically primary care population, so in other words, they are ostensibly healthy individuals. And then we're looking at a whole host of medical outcomes. And what I'm going to present now is data from our surveys and our end-of-study interviews. I'll just point out that our study population is mostly white and quite highly educated, and most of the people who participated in our study were past childbearing age. But despite the fact that they were past childbearing age and despite the fact that half of them were ostensibly healthy, it still came up without us even really asking about it that patients in our study were really motivated to participate and to learn information that could help their family members. And so here's one patient at the end of study just telling us that their primary motivation was really to prevent something from happening to their child because they were concerned about their child's future. And this really wasn't an emphasis of our study, again, being in slightly older individuals, but it kind of emerged as a finding regardless that this was very important. I apologize for the messiness of this slide, but its purpose is just to show you that we did surveys immediately after disclosure and then at six months post-disclosure. And participants in our study who received whole genome sequencing were more likely to share certain types of information with their partner and then with other family members. So these analyses are still being run, but I think we see evidence here that the more we use this technology, the more this issue of involving family members is going to come up. And so now I'm just going to walk you through four emerging themes that are coming out of our end of study interviews with physicians who participated in MedSeq. The first theme is that this was a totally unexpected issue for them to have to deal with. And so one participating physician is here saying that he just hadn't been thinking about when he needed to worry about this and hadn't been thinking about somebody having an autosomal recessive trait. You know, what about the rest of their family? It wasn't even on my radar. And this came up over and over that it was just a kind of a surprise to be confronted with this. Most doctors seem to view family communication as the patient's responsibility and likened it to other situations in which they have to balance the duties of care to with their obligations of confidentiality. And so here this physician is saying it's like knowing your patient is using drugs and you'd like to tell their spouse that you can't unless they're going to hurt somebody. And I think it's interesting that many of them kind of echoed the sentiment that it would be nice if we could because it could be actually very useful but we can't. And again, I think we're starting to see in our data a lot more ambivalence on the part of the physician about the limitations in their ability to convey this information to relatives. They acknowledge that there are some situations where it might actually be beneficial to do this. And so here's a physician saying that it's just hard to know where that line is. If it's some life-threatening situation or a condition where early intervention makes a difference, it's hard for the physician not to be able to directly approach family members. Physicians also thought that special circumstances might necessitate a kind of a breach of their presumed confidentiality with the patient that they're seeing. For example, in the event of a patient death where there is no prior knowledge of the person's wishes, they felt that they would just reach out to a spouse, even if it hadn't been formally consented, they hadn't formally consented to do so. And so finally, I'll just wrap up by saying that the physicians in our study definitely seem to want tools to help them with this, whether it was a special patient report or some kind of tool that would allow them to disclose information to family members without breaching the privacy of their patient. And we know that in the literature there's certainly evidence that some of these tools are working and there's some web-based approaches out there that I think people are starting to use. But I think that we may want to think about using different approaches for different result types because the stakes involved in disclosing this information is very different. And I'll just finish by saying that, you know, as I mentioned in the start, family information sharing is very important for a whole host of reasons in genomic testing. These physicians focus mainly on sharing results with family members, but I think we might want to think about it a bit more broadly. Thank you.