 Thank you. I appreciate the opportunity to present here. And I think the context is looking for ways for the educational materials group international sort of focus to collaborate with G2MC, which also has an educational working group, which Vajira, Visenayaki, and I co-chair. So by way of introduction, Donna alluded to the fact that I have a day job and it is as chair of the Department of Genetics at University of Alabama at Birmingham and I also co-direct a Center for Genomic Medicine, which is a cooperation between UAB and Hudson Alpha Institute for Biotechnology in Huntsville. I should also say I'm not a stranger to ISCC in the sense that I was there actually at the kickoff meeting of ISCC several years ago and shared the competencies working group at ISCC, which resulted in the genetics and medicine publication on competencies in genomic medicine a few years ago, I guess 2014. That committee then essentially was retired after that paper was published, as it had accomplished its goal. And I was at that time, I think also representing the American College of Medical Genetics and Genomics. But since then, I think David Flannery, who's the medical director of ACMG, has assumed that role. It's been easier for him since they're headquartered in Bethesda. And so I've been less active in ISCC during the last couple of years, but occasionally tune in on a meeting, so I have some idea. And I was at the meeting in January and possibly some of what I'll say today. I did mention some about G2MC then. So anyway, what I would like to do is to introduce what G2MC is to all of you that might not be familiar with it, to look at specifically the education working group and what it has been doing and then to explore how it could collaborate with ISCC. And Donna had asked a set of questions and I will end the presentation trying to address those. So G2MC has been around now. I would guess about five years. Jeff Ginsburg from Duke is the chair of G2MC and really the spearhead of it. And the idea was in very broad terms to advance the mobile implementation of genomic medicine in particular to engage in collaborative initiatives that would both foster research and also actually work with providers and the public to look at ways to integrate genomics into medical practice broadly. So it's premised on the idea that we're all dealing with the same human genome, more or less. And the question is how do you use the power of genomics into the day-to-day practice of medicine, but realizing that although it's fundamentally the same genome, there are big differences culturally and organizationally in the way medicine is practiced across the globe. And therefore things that work in one setting may or may not work the same in another setting. And also things that are important in one setting aren't always the same elsewhere. There are certainly lots of examples in genetics and genomics of particular traits that are more prevalent in one area than another, and as a consequence what might be important in one place is maybe less important somewhere else. The training paths in medicine are different. The kinds of people who comprise the team or any particular model of care might be different. So there are significant similarities, of course, and then potential differences in the hope was to find where the common ground is and do whatever possible to try to enhance the integration of genetics and genomics. So this is a list of goals, and a few of these slides were provided to me by Jeff Ginsburg, but it was to serve in part as a clearinghouse for information, best practices, and just dissemination of information about genomic medicine activities across the world to look for demonstration projects and opportunities for collaboration to disseminate best practices and to facilitate the generation of evidence that supports the sustainability of genomic medicine. So specific goals, it provides a context for convening the leaders of international programs to actually create these communities where there can be dialogue to connect the various experts with one another to make statements of which there is one published, I think comes up in another slide that would provide some guidance and hopefully maybe inspiration to groups looking to integrate genetics and genomics into practice to develop a web presence and tools to identify underserved communities and ultimately to secure funding for sustainability. There have been now two meetings and another is soon to occur. The last of the meetings took place in Singapore in 2015, and by virtue of where it was there was a fairly heavy representation of individuals from Asia, as you might imagine, but it also has at that time, I think there was also substantial representation from the U.S., Europe, and the Middle East, but not so much from South America and from Africa. The third meeting is actually just a month away and it will take place in Athens and we'll focus on models for implementation of genomic medicine in practice. Still possible, there are people that are interested in participating in the meeting. Obviously, the agenda is pretty well set, but there's certainly room if people are interested in. I can send around, if it's helpful, a link to the website where registration is done. But in any case, I know that at this meeting we actually have made some effort to engage individuals from Africa and South America and in addition from Australia, Southeast Asia, and Europe. So it's becoming more and more a true global alliance. The point that's going to come up in a few minutes, but it's worth mentioning here now, you could get the impression, and maybe it's been assumed that this is the case, that the participating countries are largely third world countries that are at an early stage of adoption of genomic medicine. Actually, the reality is that I don't think that's exactly the case right now. We're actually trying to pull in more people from individuals or from countries that are less well served. But this is a list of some of the large scale genomics initiatives that have been described at the various now previous two G2MC meetings, and there'll be more of this at the upcoming one. But many of the countries here on the list are really quite far along in terms of genomic medicine. So this is not a group of largely underserved countries that are interested in learning, but haven't been doing very much. I think we probably need to reach out more to those kinds of environments, but the countries that are represented so far are actually quite sophisticated in terms of major large scale projects. And it's been one of the interesting things about going to the meetings is learning about how some of these projects have been organized and executed and some of the outcomes that they're generating. I mentioned that there is a publication and so there was a paper published in Science Translational Medicine in 2015, which as you can see has a large number of authors. And I think it reflected a lot of the discussion that took place at the original meeting which was in Washington, D.C., I think in probably 2014. So there is this one paper now that describes some of the findings in terms of ways that genomic medicine was being implemented in different areas of the world. Most recently, there's a global alliance for genomic health, I think it's called. There seems to be a great tendency to use letters and numbers in these acronyms for whatever reason. But in any case, this is a group that also is attempting to galvanize activity from multiple countries that are interested in genomic medicine. And they are very focused on some of the things that are listed here, information, technology, data standards and so forth. And there are many areas of overlap in quitting education. And they actually now are collaborating with G2MC and I think are providing some of the sort of staff coordination and website development resources which had been an area of challenge for G2MC since funding for that initiative has been relatively slim. So GA4, GH now, staff are organizing working group meetings on behalf of G2MC. So let me give you a sense of the different working groups that are listed here. I won't go into great detail about each one of them, but these have met at the two previous international meetings and to some extent have maintained an ongoing dialogue. Probably honestly more in some areas than others. Any of you who are involved in working groups know how critical it is to have staff support to keep the ball rolling. And it's only recently that with the Global Alliance that has actually been the case. And so some of these committees have moved farther along than others, I would say. But let me focus now for a moment, since it's probably most relevant to this presentation, on what the actually, education working group goals have been. So as I mentioned, just on the yaki who is a geneticist in Sri Lanka and I co-chair this group, and there have been three things that we've wanted to take on. One is to collect information on what the different training paths in medical genetics are internationally. For example, there are organized and board certified genetics professionals in some countries, maybe not in others. Genetic counseling exists as a discipline in some places and not in others. And so one thing we've wanted to do and frankly haven't gotten very far with productive staff support and we're hoping now that that will change is to collect information, which is not, I suppose you could say the most stimulating past undertake, but a useful one. And so we are hoping at the Athens meeting to get people moving forward on just trying to define the different training paths. Second is a G2MC Grand Rounds and that has moved pretty far and I'll say more about that in just a moment. And then there's been a hope of creating some cases that could be shared and customized in different regions. I'll say more about that in a second. Here's a screenshot of one of the G2MC Grand Rounds presentations and I'll show you in a moment also a list of some of the others that have taken place. This is not an easy thing to do. You'll probably appreciate this. Maybe you already do just from setting up this particular webinar. But when you want to become global, the price you pay of course is that it's at a convenient time only for one small slice of individuals. And this has been hosted by Pajera's group in Sri Lanka and therefore it usually takes place during working hours there, which happened not to be working hours for me, for example, in Alabama. So we've made an effort to make this available both in real time and also to record these and have them available asynchronously. But I've had the pleasure of hosting one of these at 4 or 4.30 in the morning on one occasion or giving talks at 11 p.m. at night. So when you do something global like this, part of the challenge is obviously synchronizing time zones, which is not even possible to do. But anyway, this has been going on now since last May. We took a break from January through May of this year partly to regroup and decide how we want to go forward. And one of the goals of the Athens meeting is to get further discussion about this. But anyway, you can see there have been several sessions. I guess I realize the titles are probably unreadable, but they have included, for example, a really interesting presentation by a group, I believe. I'm not hearing you. That is common there. So there's been, I think, a really excellent group of talks. And they are attended, I would say, on average by about 15 to 20 people with no surprise as concentration of Southeast Asians. Not necessarily because they're more interested, but because the hours are working when that's where it's being hosted. And what we have not really had is a good dissemination of... Bruce, do you cut out? Oh, I'm not sure why. So you were saying you need better dissemination? Yeah, can you hear me now? Yes. Okay, I'm not sure what happened there. I'm sorry. Yeah, so we're really looking to partner with the GIF, the Genomic Alliance group and actually any others to spread the word about these, both in the real time and the recorded. There are far more hits on the recorded than there are live. Another idea we've had is having the hosting take place at different parts of the world at different times so that the live presentations can be... This is a product that actually has been up and running for better part of the past year. And we expect to resume these in May just after the Athens meeting. The third thing are cases. And so we actually have prepared a set of cases. This is one on tuberous chlorosis complex and its treatment. This is one on the use of microarray and diagnosis of a child with autism spectrum disorder. This is one on the diagnosis of cardiomyopathy. And this is one on... Actually, this focuses on incidental findings in the setting of all exome sequencing. And I'll stop to hold these slides for a moment at that point. The premise behind this is that a particular case that you might write, let's... These were all written by me and presented. Actually, I used it as a presentation I gave to a Southeast Asian education group now a couple of years ago. And if you write a case in the U.S., it may or may not work for somebody in another part of the world because, first of all, they may or may not have access to the technology. Secondly, some of the conditions that you may talk about may not be that common in some parts of the world. And thirdly, the kind of context for how genetic medicine is practiced might be different in different places. So you can't assume that the way you do it is the way someone else would do it. What we had in mind was to create cases that would be essentially put into an open source platform and could be modified by local groups. Obviously, they're not going to use them all because some of them just don't make sense in their environment, but many of them would. And they would have the ability to edit them to fit local culture. So if we say, for example, that a genetic counselor gets involved in providing information to the family and this is going to be used in a country that doesn't have genetic counselors, they can change the case so that it uses the staff that are available in that part of the world. So these cases are there. We haven't really posted them in a central place, partly so we didn't have one. There really wasn't an organized website. So at this point in time, you know, there actually are these four cases are pretty well developed. And we've been really kind of on hold waiting to have a place to put them. And again, hopefully that will improve. And maybe with ISCC, it could be an area of shared involvement. Yeah, I absolutely think this is an area where we could collaborate and grow. You're probably familiar with the G2C2 website, Genetic Genomics Competency Center, and we just recently submitted the three cases that the ISCC cases working group created. That might have been why you were still actively involved with ISCC. So they created three cases that are currently posted on the ISCC website. In fact, there's the fourth one now. And those have all been submitted to the G2C2 editorial board for review and inclusion by the five different disciplines that are active in reviewing resources that go into G2C2. So the team is still working on that, but I think just having looked quickly at the reviewers comments, all of those cases have been accepted into the physician discipline category. And so if we get a critical mass of cases, which I think three or four is close to that kind of point, then we're going to adjust the search strategies on G2C2 to have a whole category for cases. So I think if your group has well-developed cases, then I would recommend a submission of those cases to G2C2 to build this body of cases. And we're also working very hard on disseminating G2C2 itself as a repository for resources, but we want to highlight certain aspects of G2C2. So I can see an article kind of evolving that could go on genome.gov, which has a really wide distribution. And we might be able to say, we now have whatever 10 cases that are available through G2C2 and other sources that can be adjusted, as you say, for specific needs of different institutions. So something to keep in mind. Well, you know, we could make that happen pretty quickly, because we do have these four cases that are already written. And although I guess it would help me, since I wrote them all, to see what format you're using so I can synchronize these with those, they don't absolutely have to be exactly the same, I don't suppose, but you get to see how you're approaching it. These have not been reviewed by any peer review system. Certainly I'm glad to let that happen. And then it would be important, I believe, if these are going to be useful to permit some kind of repurposing or editing in different environments, just realizing that to be really helpful, they're going to have to conform to the culture and medicine practice in a given part of the world. But if all that works, certainly as a pilot, we'd be happy to share the cases I've done. That would be great. You and I can connect and I can share some of the templates. But to your second point about revisions here at the Genome Institute, we're also considering an idea of having a library of resources. And there are some mechanisms whereby we could have people check out a case, as you say, and then modify it and then resubmit it to the library. And then that would be a way to allow adjustments, but also make use of the G2C2 platform as a way to disseminate and let people know that the cases are there. That'd be great. And so that would be a pretty low-hanging fruit sort of thing to do. Let me just make a couple of comments in reference to questions you asked as we were setting this up. So what are the unique contributions of ISCC and G2MC? How are they similar and how different? So from my memory of ISCC, and I think it's probably still true, the two things that were, I think, core of it were one, to engage people from different disciplines, not specifically from genetics, and to use that as a vehicle to reach out to physicians. And I think it was mainly physicians in multiple different disciplines. G2MC has not specifically tried to engage professional societies anywhere, and the membership at G2MC, I think, was probably, I wasn't involved when it was set up, mind you, but it was known leaders in genomic medicine in different parts of the world. I don't think there was much more going on than that. So it does not represent professional societies in different countries, and the people who come to the table are mostly individuals who were known for a strong interest in genomic medicine in different regions. So it's not quite the same focus, but I think there's a shared mission, which is if we're going to be successful in integrating genetics and genomics into medicine, we have to engage professionals from a broad sort of platform. It can't only be the aficionados who are familiar with genetics and genomics, but it is a different membership, and I don't think we have any particular reach to G2MC into the professional infrastructure at any of the member countries. So the second point about ISCC would like to invite G2MC to become a member. That was discussed in January, and I have talked with the G2MC Steering Committee about it, and I think what would, my understanding of what's being proposed here is in essence to treat G2MC like another professional society as a member of ISCC. And I think G2MC is happy to be involved that way. Probably what would be helpful, I don't know if this is how things work now, but to have a short formal invitation, which I could then share with the Steering Committee, and then they would presumably agree to accept that, that might be the best way to formalize this. And I don't think too many of the members of the Steering Committee really know much about ISCC other than what I've told them, but if there's any summary of it they could also see would probably be helpful. So the third point about, and by the way it would be really helpful to have that before the Athens meeting in April, because that's where we'll be a face-to-face meeting of the group and be the perfect time to present it. There's a third point about the represented groups needs. I'm not actually sure that, as I mentioned earlier, that that's really the case. Because of the way G2MC was formed, the people who represent different areas are actually quite sophisticated, and the groups that were interested in getting involved largely were those that already had pretty well-developed genomic medicine initiatives, some of which are exceedingly advanced. You're probably somewhat familiar with what's going on in Estonia, for example, which is moved very far towards a major national genomic program. So there's, I wouldn't say that underrepresented groups are as heavily represented as we actually would like them to be. We have now for the Athens meeting specifically reached out to groups in South America and Africa, which were completely unrepresented at previous G2MC meetings, and now there will be some representation. But obviously these are big continents, and we certainly don't have representation across either of those. So there's plenty more to be done. And obviously, although you could argue that other things than genomics are important in the kind of public health environments in many of these areas, there's still, we think, plenty of opportunity in genomic medicine. So we're trying to reach out to them. I don't know that we necessarily have been so far so successful in doing that. So anyway, right now, actually what we've mostly learned is how expert groups in other countries have approached this. And it has been really fascinating to see just how far some groups have gone. We already talked about the sharing of G2MC cases. So that's certainly something we are glad to pursue. And I guess I would add to this disseminating and engaging even ISCC in our Grand Rounds format would be something we'd be quite happy to do. But I think that might be my last slide just wanted to acknowledge Pajera who I don't think has joined because this is probably some crazy hour of the day for him. But in any case, he's worked very closely with me in trying to build this educational working group and really he spearheaded the Grand Rounds. And Jeff Ginsburg is the overall leader of G2MC and provided a lot of the slides that I used to summarize it. So I think that is all I had and hopefully didn't run too far over time. And if there are additional questions, I'd be happy to try to answer them.