 The recording of the session has begun. First off, we want to welcome you to this first webinar of a series of presentations that are building on the genomic special issue, which has just been published online, February 2013. Today's topic is relevance of genomics to healthcare and nursing practice. I want to introduce you to today's presenters. I am Dr. Jean Jenkins. I'm a clinical advisor at the National Human Genome Research Institute at the National Institutes of Health in Bethesda, Maryland. Our second speaker will be Dr. Susan Genaro. Dr. Genaro is the dean and professor at the School of Nursing at Boston College. And she is also, very importantly for us, the editor of the Journal of Nursing Scholarship and has been gracious enough to share her time and expertise with this webinar today as well. So welcome, Dr. Genaro. The third speaker is Dr. Kathleen Calzone. Dr. Calzone is a senior nurse specialist researcher at the National Cancer Institute, also at NIH in Bethesda, Maryland. So the next slide will show you what we plan to cover today. So Kathy, if you can progress the slides. I'm trying. I'm stuck. Today we plan to provide you with an overview of a number of pieces of information. First off, give you some perspectives of the Journal of Nursing Scholarship by the journal editor. Provide you genetics and genomics and relevance to nursing practice, education, and research background information. Give you a summary of the content which is provided in the genomics special issue that we're so excited about. And also then give you a few genomic education resources that you can learn more about genomics should you wish to go to those in the next couple weeks. There will also be an outline of the ongoing webinar series and discussion, questions, and answers towards the end of this presentation. So we hope you'll be able to join us for the whole, say, 45 minutes today so that we can give you this background information. If you can go to the next slide, we'd like to welcome Dr. Susan Genaro, and we appreciate her telling us more about the JNS and their decision as an editor and a board to have actually this genomic special issue. It is the first of its kind, and we're so excited that this is the topic because obviously we feel this is very important for all nurses, and it's a great way for JNS and us to reach out to the international community with this very important topic. So, Dr. Genaro. Thanks so much. It really is, I always say it's a pleasure when I do these things, and it truly is a pleasure because the Journal of Nursing Scholarship is read by more than 130,000 nurses worldwide in more than 103 countries. And so one of the, and you know it is the Journal of Sports, Educated Quality, and the Society of Nursing. So one of the things that the editorial board is most concerned about always is what do nurses need to know around the world? What are the most important things that nurses in each of those 103 countries need to know to improve nursing science and nursing scholarship? And we're very committed to thinking about not only what is globally important, but what's clinically significant. What's really going to help nurses practice better so that we really, our mission is to improve the health of the world. Knowledge helps you to do that. So we've taken a lot of things and making decisions about what we're going to do. Two of those things, of course, are things like how often are articles cited and how often are articles downloaded. And we've had the pleasure in the past of doing a special issue on genetics and genomics in education. And also, a little while ago, doing an article, a special issue on genetics and genomics in practice. We saw how very important the genetics and genomics in education was to see how downloaded it was. And we're very happy to be able to speak with Dr. Jenkins and Dr. Pelzone at NINR in terms of updating the practice issue on where we looked genetics and genomics in practice. And we were very thrilled that they wanted to do that work with us. It wasn't, however, just their interest and the board's sense of this is important. Like every other kind of board in the world, we look at what other thought leaders are thinking and what's important. So when we look at other thought leaders and what's important in nursing practice, we're very aware that the National Institute for Nursing Research, for example, has been funding workshops in the summer for genetics in a long time and for a long time. And they're very concerned about what other science needs to be advanced in terms of metabolomics, et cetera. So we had a real knowledge that this was an important topic that they needed to be there and that we knew people that we could partner with and have a very high quality information republished, which is, of course, it's great to have good ideas, but if you can't bring them to fruition, it doesn't help you. I'm very proud to be able to say that the issue that we have is now out in terms of being online. And so it's all available to you in early view. You can read it and that the print issue will be out in March. So we're online available. And if you're looking for the actual paper copy, you will miss in March. So not only was it a great idea, but it has come to great fruition in terms of actually being available. So that is very important to us. We really think that we have provided absolutely cutting-edge information with this issue that you're seeing around the world that we need and that we're seeing around the world that we need. And we are just thrilled to be able to talk about information in a very interesting way of being able to look at some of the, hear about what some of the articles are today. I'd just like to close by saying that each of those articles also has resources in terms of clinical resources that will be helpful to you in the specialty areas. So it's a very rich issue, not only in terms of specific information, but getting you to other resources that might be helpful to you. And I know that Dr. Jenkins and Dr. Kelzone will also speak about other resources in this webinar series. So thank you very much for Jay and us being able to have this opportunity to bring such important information to the rest of the world. Thank you, Dr. Gennaro. And I'm sorry if some people are having a little difficulty hearing the sound. We are all in different locations, and hopefully you can hear our microphones as we continue to speak. And then I was also typing in response to questions and comments, so I will stop doing that because someone said it was a little loud. So sorry about that. So let's move on to the next portion of the presentation, which is an overview of the relevance of genomics to nursing practice and education by Dr. Kathleen Kelzone. Thank you, Jean. So I want to start out with some basics and related to what we're talking about in the genomic special issue in JNS. And that's the distinction between genetics and genomics because many of us may use these terms interchangeably, but in actual fact, they're a little bit different. Genetics is really the study of single genes. You can think about people who have relatively rare single gene disorders such as cystic fibrosis or people with the BRCA1 or BRCA2 gene mutation that's associated with an inherited susceptibility to breast and other cancers. Whereas genomics is the study of all genes in the genome together and their interaction with each other, the environment, and other psychosocial and cultural factors. It's actually important to understand that our perspective in approaching the genomic special issue is actually genomics. That's what impacts the practice of all registered nurses and in fact, all other healthcare providers. This is not just an issue that nurses are struggling with but all healthcare providers are engaged in this kind of getting up to speed. And genomics is actually the emphasis that we've tried to place on this issue. And so that's the perspective that we're going forward with. So where are we when we begin to think about genomics and what does this have to do with healthcare in general and nursing practice? And you begin to look at sort of what are the major leading causes of death and illness in our country? The majority of those and in fact all of those have some kind of a genomic component be it heart disease, diabetes, vascular disease, Alzheimer's, even things like influenza, what we're dealing with now with the large influenza outbreak in our country and things like suicide. And so there's not to say that there are not other variables that also come into play, not everything is genomic central but in fact genomics plays a role in all of this is in beginning to change the way that we begin to think about these kinds of disorders or diseases or illnesses that people can suffer from that can lead to death. And we're in an interesting era in which we're seeing a lot of emerging science and technology and the output of that input of science and technology is a change in how much it costs to actually do this application of genomics in practice and in research. So Moore's law is sort of that benchmark that has to do with computer technology advancement. How much it costs to get the latest and greatest iPad that you can walk around with in your little bag as opposed to how much it actually costs to go through and sequence someone's entire genome. And what you'll see is that over the past several years there's been this massive reduction in cost and that massive reduction in cost has translated to a substantial increase in the growth of the ability to do genetic tests that have both clinical utility meaning that there would be something that you could do with this and analyticality. That means if you actually had this test that you actually knew it was accurate of use. And so what you'll see is that the growth of laboratories doing this hasn't changed which is in the green bars, but the number of tests and the capacity to do this has increased. And you'll see this is only until 2011, this particular slide. And that sort of correlates with that reduction in cost is our ability to do more and more of this and move it out into clinical practice has sort of grown exponentially over the last few years. We've also seen this increase in sort of understanding our genome as a whole. And some of that has to do with something called single nucleotide polymorphisms. They're the things that sort of make each of us somewhat unique and distinct. And it's not just a gene but sort of this individual letter variation between you and me and all the rest of us who are on this call and everyone else that we interact with. And that genetic variation we're learning over time has significant health implications. So this is from June of 2011 and each of these long bars represents a chromosome and each of the little circles represents an area where they've begun to look at these single nucleotide polymorphisms and correlated them with studies looking at disease associations. If you look at the kinds of disease associations that you begin to see, you can see anything from diabetes type one and type two, tuberculosis to different kinds of cancer to cognitive function to a wide range of different kinds of health conditions. All of which are things that nurses in every setting irrespective of their scope of practice. Are they prepared at an associate degree level, a baccalaureate level, a master's level or a DNP level or a researcher? This applies really to everybody in any health condition that it could be associated with. And this has continued to expand. This is the latest catalog slide published by the Genome Institute in July of this past year and what you'll see is a massive increase in the little circles and they're only focusing now on 18 particular traits. Now, genome-wide association studies are interesting in that these may not be things that have as much clinical significance right now as far as risk identification but are very important in sort of understanding underlying disease etiology and beginning to think in a way that we haven't thought about before about new therapeutic alternatives for dealing with these kinds of conditions. And so these are sort of rapidly moving along. We may not see a lot more genome-wide association studies but more sort of how they're beginning to utilize that information to move forward. But what we have seen is an application of this sort of technology in the consumer arena with the direct to consumer marketing and testing which is that the offering of these kinds of tests for a wide range of SNPs, for many health conditions, for an ever decreasing amount of money and this is just one of many of these kinds of companies that offer different kinds of tests for anything from ancestry to health conditions or to participate in research. And so these are tests where in large part many of these companies but certainly not all do not offer sort of the clinical interpretation of this. They actually recommend that people go on to their health care provider in many circumstances to gain more information if there's something that somebody has a question about in relationship to their health. Sort of a worrying thing if you have a patient who comes in to their primary care provider or their nurse practitioner and says, oh, gee, I had this done and what does this mean for me? And are we prepared to answer those kinds of questions? So it is something to begin to think about as this continues to move out into the marketplace by passing the health care community in general at the time of the decision to be tested because they're going directly to the consumer. We're also at a point of beginning to learn a lot more about epigenetics which is the study of genetic variation that is not caused by actually a genetic change in the genetic code in any way but it's sort of how variation can occur with chemicals that can mark a genome in a way that can influence whether a gene is activated or deactivated. And so a number of those kinds of things can be very important and it's an area in which a lot of development is ongoing. So there is really a scope that is really moving things forward at a rate that's really extraordinary. And we're at this point where they've been talking about the race for the thousand dollar genome. And the thousand dollar genome is an intriguing concept because it's a point at which the cost of being able to apply this technology reaches the threshold in which its application into general health care becomes more realistic because of the fact that you could do this cheaper than say doing a single gene disorder test. So to put that in perspective to do a single gene disorder test for say BRCA1 and BRCA2 is well over $3,000 but you could sequence a person's entire genome for $1,000 and are we close to that? What we can say is that we are close to that and in fact there's been some companies that have announced that they've sort of got this within reach. I'm intrigued that this particular announcement which was actually a year ago in January looks something like a size of a color printer but I have a mutation of my technology gene so goodness knows my interpretation of that. But what is clear is that it's not just our ability to utilize this technology and to get all this information. I think that the comment here, the thousand dollar genome and the $100,000 analysis is very accurate. What do we do with that information and how do we apply it ethically and appropriately in health care and utilize this information for health outcomes is absolutely fundamental and this is what it's all about and that's what our issue is trying to address is sort of preparing the nursing workforce at least to begin to understand some of this information as this kind of thing continues to roll out because this influences the practice of all health care not just in any one specific discipline and nurses are at the bedside and in practice in every health care setting and play a huge role in the application of genomics in health care. So we're at this point where we have genome analysis that it can include whole genome sequencing, it can include a wide variety of other kinds of whole genome analysis and so it's at the point where we're really well beyond the time of saying well this might be something that has relevance down the road, it has relevance now and that the progress is moving so rapidly that we struggle to be able to keep up and where we begin to see the applications of this as it moves out into health care is across the entire health care continuum. We can deal with application of genomics and preconception and prenatal testing long before someone is even at the point of delivering. Newborn screening, one of the large studies now actually being offered through the Genome Institute with a number of different people who have applied for that funding is actually looking at whole genome analysis at the time of newborn screening. Being able to utilize genomics for disease susceptibility to characterize who is and is not at risk and what we should do about it to use genomics to actually screen for specific diseases or to diagnose a disease or to even take it one step further which is if a disease is present can you actually characterize that disease to a point of predicting prognosis and informing therapeutic decision making. And this is probably one of the most expanding areas of application of genomics when one begins to think about pharmacogenomics and the application of therapeutic decisions that are not just informed by say the traditional height and weight and other kinds of variables of disease that may be associated with medication decision making but that you add a degree of genomic information that may inform whether someone would respond to something, may inform dosing, may result in a reduction in adverse drug events if you were able to modify and ameliorate some of the medications you might use because you had additional information at the time of prescription and then monitoring for disease burden and recurrence and things like end of life care including even things like pain control and so forth. So the application expands through the entire healthcare continuum and will continue, I hope you have an appreciation, will continue to expand at a very breath of place of what is moving from the bench actually to the bedside. So we're at this point of really thinking about personalized healthcare. Some people call it personalized medicine. I don't think it's all just about medicine. It is about healthcare in general where we're beginning to look at more individualized care by adding genomic information into what was traditional healthcare decision making. So it's not replacing what we already had. It's really adding that additional element to it so that we can even have a more personalized approach to healthcare decision making than what we've had today. And this is really an opportunity to improve health outcomes and when you think about it strategically, it's an opportunity to reduce overall healthcare costs. So what is it then that this means for nursing and what do nurses actually need to be able to do? There are sort of two documents that can help guide that and the first document is the essentials of genetic and genomic nursing. These are in their second edition, their competencies, curricular guidelines and outcome indicators. Outcome indicators are specific areas of knowledge associated with the competency and suggested performance indicators. These competencies apply to all nurses. They're the core competencies. It doesn't matter your level of academic preparation, specialty or practice setting. They've been endorsed by 50 nursing organizations and we hope to have a third edition published. We've had some difficulty getting funding for that. So actually the 2012 vision is put into 2013 since now or in February. This document is open access just as the entire special issue is and can be accessed at this website where you can download the PDF directly to your computer and utilize it as you see fit. The second document is one that's more recent and this is actually leveled then taking the competencies that were already established that apply to everyone is sort of that core set of information of what do people need to be able to know and understand and do and adding an additional level for those nurses who are practicing at a graduate level. And the graduate level was a strategic decision in terms of the competencies because you have to think about the DNPs versus your clinical nurse specialist versus your educators versus your PhD level researchers. A similar process of consensus was conducted to establish these competencies. So they're both documents are available. This document can also be downloaded as the PDF to your computer at the website listed here. And so both of them can inform people are beginning to think about, well, what is it that everybody actually needs to be able to know and do depending on their level of practice? So how does that inform the Journal of Nursing Scholarship special issue? Genomics is actually relevant to all nursing practice. And so it's clear that this is something that is going to increasingly apply to patient care in any setting at any point in the healthcare continuum. And the genomic special issue we're delighted that those papers are open access so that anybody can access them and that it's a resource for nursing education. And that's nursing education at an individual level in an academic setting, in a continuing education level for those people who are in a practice environment. It could be utilized in any way. And so the purpose was really to provide a state of the evidence review by individuals from the interdisciplinary community. So not just nurses providing those evidence reviews but input from other health practitioners who can contribute to the evidence and to talk about the genomics of common health conditions. So this is not an emphasis on single gene disorders. It's about genomics and it's about common health conditions, all of which have relevance to nursing practice and services. The articles provide an overview of genomic science and technology so that there's a baseline in sort of getting people up to speed. And then an international perspective on nursing care and implications based on genomics. There's a discussion of genomic variation and its association with common diseases. It covers pediatrics and adult conditions. What's essential when one begins to move genomics increasingly into the healthcare arena is beginning to think about the ethical, legal and social issues. And so there's an extensive manuscript specific to that. And then what is clear is all of us, we don't know everything. And what are the nursing research priorities that can inform a pathway for going forward? So what we're gonna do is actually just walk you through some of these papers just so that you understand some of what a special issue will provide and make sure that you can sort of think about the kinds of things that may be of interest to you. And the first is the editorial. And the editorial is framed not dissimilarly to what I provided in the background leading up to this today. There were many authors including Dr. Jenkins, but also Dr. Nick Nickle who's from the Universal College of Learning in New Zealand, Dr. Heather Skirtan who's at the University of Plymouth in the United Kingdom, Dr. Greg Thiro who is a family practice position in Maine but also has had a position at the time here in the Genome Institute. And then probably most importantly is the senior author is Dr. Eric Green who is the director of the National Human Genome Research Institute here at the National Institutes of Health. So a wide range of perspectives providing this editorial to sort of set the platform for moving this forward. And you'll see that within the editorial use the same sort of healthcare continuum and how that influences care throughout the healthcare continuum. The first paper is by Dr. Vett Conley and it's on current and emerging approaches in genomics and the technologies that are covered in this particular paper include genome sequencing, genome-wide association studies, epigenomics and gene expression. So sound familiar to what I presented to you but it gives you a flavor of what's provided. And the author set in this is very skilled and did a very nice job of sort of leveling this so that any nurse could understand it. So it's not so science dense that it's not relevant to nurses and their ability to understand that information. The next paper is about the ethical, legal and social issues that are associated with the translation of genomics into healthcare. And Dr. Lori Badzik who is at West Virginia University and also the director of the Center for Ethics for the American Nurses Association is the primary author as well as several other colleagues who contributed to this paper. This particular paper provides a review of the ethical and legal foundations of the translation, confidentiality and privacy of genomic information, issues to consider and inform consent and issues in genetic testing and big issues because this is a verging area associated with biorepositories. One of the common complex diseases that's covered is the integration of genomics and cancer care and this was written by several people including Dr. Erica Santos who's in Brazil. And this particular topic is especially unique in that cancer is sort of the poster child for application of genomics in the knowledge of and treatment of a given health condition. This particular issue or manuscript within the issue provides an overview of cancer etiology, hereditary cancer syndromes but it is not just specific to hereditary cancer syndromes. A discussion of epigenetics and cancer management considerations including things like tumor profiling and targeted therapies. And they utilize a case studies to be able to illustrate the advances as they go through the continuum of cancer care. Thank you Kathy. So I'd like to continue with the issue. You can see that we've tried to capture a lot of content that is applicable not only across the healthcare continuum but also across the life continuum because all nurses who work in all settings see patients not only in the early childhood and adolescent phase but also through the adult stages. So one of the things we wanted to have available that may be more familiar to nurses is a content about newborn screening for nurses. And Dr. Jane DeLuca along with her colleagues including Dr. Alex Kemper provides an overview of current newborn screening activities but then also discusses controversies and ethical considerations that are emerging as this new technology becomes more available. They also discuss the role of the nurses in the newborn screening process and talk about summary of developments that may be coming to bedside soon which is genome sequencing. The next article, an update of childhood genetic disorders by Cynthia Prouse provides information that helps to increase awareness of new developments in genetic disorders that are commonly seen in practice and taught by faculty. And these include common childhood genetic disorders which encompass infants, children and adolescents. But Cynthia and her crew have also provided a number of resources and information that can facilitate your access to services and resources that these children need in follow up to their care. One of the more adult complex diseases that is discussed in a paper by Xu Feng Wang and her colleagues is cardiovascular genomics. They provide a really nice overview of cardiovascular genomics in using three case exemplars, myocardial infarction and coronary artery disease, stroke and sudden cardiac death. They also talk about the benefits and limitations of genetic testing for each of these case examples describing specific implications for nursing. The next article is one by Diane Cybert, excuse me, by Jacqueline Taylor and her colleagues which builds on the cardiovascular information in talking about a metabolic syndrome that has been identified. This cardiovascular syndrome provides information about the METS contributions that are identified as cardiovascular disease, obesity and diabetes genomic risk factors. And they have a number of overlapping genes and polymorphisms associated with METS are described. They are also providing guidance for nurses of what the heck this information means in practice with some of the ambiguity and complexities of genomic information. The next article by Diane Cybert and Dr. Thomas Darling provides an overview of the physical, psychological and ethical issues in caring for individuals with genetic skin disease. Diane uses wonderful case examples and definitions and illustrations of sometimes the complexity of genomic information in understanding genetic skin disorders and explaining inheritance patterns, genomics and treatments. She also highlights the ethical and legal issues and concerns that are important to caring for patients with genetic skin diseases. So this is a nice article to kind of get an overview of where information that is currently available and using in dermatology practices is currently available. The next topic of great interest to nurses is one on genetics autism spectrum disorder. We are seeing more and more cases identified with autism and this article provides an overview of ASD identification and diagnosis with implications for the family. The authors review the genomic contributions to the risk for ASD and highlight how current research on ASD underscores the complexity and understanding of genetic processes involved. The genomics of autism is not yet well understood so repercussions of this lack of complete information for nursing practice education and research are also discussed in this wonderful article of information for you. Building on that information in the adult conditions, Dr. Deborah Schudy and her colleagues provide an overview of the implication of genomics on the nursing care of adults with neuropsychiatric conditions. They provide an overview of the contributions to these disorders including irreversible dementias, Alzheimer disease and Huntington disease. And they also discuss the implications of understanding this information for nursing practice and research, not only in the individuals but their families of which they live. Lastly has been an article provided by Dr. Kathy Calzone and a wonderful group that got together in terms of reviewing the state of the science recommendations for genomic nursing science blueprint. This information was done in collaboration with the National Institute of Nursing Research and we encourage you who are interested in research and those who want to provide a framework to further their own nursing science program to improve health outcomes, to actually look at this article and the table of recommendations that are provided because we think it may be of great value to you and perhaps even those students who are interested in doing research for the future. This special issue we hope provides a world perspective of the impact of genomic knowledge on clinical nursing practice. Obviously you can't discuss everything even in a whole issue. There's probably more information that you are gaining in your own practice and research and education setting that could be a value to other nurses so make sure you build on that information and share in publications and presentations as well. But if you're interested in these open access articles they are accessible at genome.gov and this issue would not have been possible without the support of the Journal of Nursing Scholarships so we really can't thank Susan Genera and her editorial board enough for this opportunity to be able to publish these content of articles all in one place that was actually requested by deans of nursing when we attended and presented at a session not too long ago. So we appreciate the interest and excitement and a special thanks to J&S. We also would like to thank not only our lead editors, Kathy and I of course are on this call and webinar today but Nick Nicol from the University College of Learning in New Zealand gave us an international perspective as part of the lead editorial group. And our advisory board spent many hours reviewing these articles and providing guidance back to the authors. Cynthia Prouse from Cincinnati Children's Hospital Dr. Diane Cybert from Uniform Services University of Health Sciences in Bethesda, Maryland and Dr. Greg Fero who at the time was working in the National Human Genome Research Institute. So we thank them for their support as well in getting this issue to publication. In the last few minutes I wanna provide you with a few resources. If we've webbed your appetite and when you go to the Journal and you see this information you get so excited that you want to learn more. There are resources available. Many resources are listed on the Genetic Genomics Competency Center for Education or G2C2. This is a educational learning repository that currently houses resources for genetic counselors, nurses and physician assistants. And we'll be uploading materials from the pharmacy discipline as well hopefully in the spring. A second resource that may be exciting to some of you who are interested in case studies or teaching to this content and don't actually have the cases in your own clinical setting. The Global Genetics and Genomics Community or G3C for short has unloading case scenarios that encompass many of these things we've talked about today. But hopefully would be of interest to you as you begin to teach more and more about genomics integration into practice. And there are a few more resources identified on the competency and curricular resource page at genome.gov listed here. Many of you as educators may know that JNS has also supported us previously. Last 2011 we did a Journal of Nursing Scholarship year long series where four articles were published across the year that were of interest to educators called Genetics and Genomics and Nursing Education. Those can also be found through JNS or on genome.gov. So if you've heard some of these terms today and you're like, what the heck are they talking about? It sounds like a different language. There has actually been development of a talking glossary of genetic terms. Not all of the terms that we included in our articles may be in here and you can recommend new terms if you don't understand certain things. But this is a talking glossary that's available at genome.gov but it's also available as an app. For those of you interested in teaching more about family history because that is one of the first genetic tools that healthcare providers can use in their clinical setting. For many years now we've had a Surgeon General Family History tool or My Family Health Portrait that is available to provide to the consumer to go to their families and collect family information that they can then bring into their care provider and share and then hopefully have those red flags identified and be referred appropriately for follow-up should they need that in regards to either a common complex disease that has a genomic contribution or genetic disease if they have that as a history in their family as well. Lastly, I'd like to share with you a competency focus newsletter that Kathy and I provide about three or four times a year. We just have one disseminated in January which talks a lot about the competencies and this special issue and then opportunities for learning more about genetics and genomics. So if you're interested in receiving the copy of the competency focus which of course is free and we distribute it by email or it's also available on that competency curricular page I talked about earlier on genome.gov but you can also send to us and Kathy on the next slide will show you her email. You can send a request to be part of this competency listserv and we try not to overload people or send out extraneous information but send out information that might be of interest to those interested in genomic competency. So we hope you have found this introductory webinar useful. We will have future webinars and as I make sure that this technology work today we will be scheduling those ahead of time and you can go to genome.gov this number here for login information for each of those webinars. The next webinar will occur February 19th and Dr. Conley will be presenting on the current and emerging technology approaches in genomics at 3.30 p.m. Eastern Standard Time. I wanna highlight for you one change. I had an error in the date that I assigned for the March date of March 19th was on our original communication. The March 20th enter date will be for the webinar series presentation by newborn screening and ethical legal and social issues. So if you're interested in attending the March 19th date switch that on your calendar to March 20th and then you can see the March 5th presentations listed here as well and they will continue through May and on the next slide you will see the dates of April 2nd, April 26th and May 7th for discussions about the topics that we will continue on through April and May. Remember if you can't attend them all these sessions will be taped and archived and available on genome.gov and we will now review submitted questions and answer what we can. Kathy will leave this slide on in terms of our contact information if we didn't receive too many slides or you want to send us questions at a later point in time you can always email us. I will go to these questions and see if we've answered some of them. Okay I'm gonna open it up to my other panelists so they can also answer questions as well so hopefully the background noise won't be too noisy. Let me find the questions. Okay so the first question is are there plans for future special issues and publications in JNS or other journals? So I'm assuming that means on other topics. So Dr. Gennaro do you know if there are plans for other future special issues? We do have a call out for a special issue on the evidence underlying basic nursing care that call came out and you can find it in the hard copy and the last issue in 2012. It will also be available when you look at the hard copy issue of 2013, this first genetic issue. We spend a lot of, we don't do so many special issues but when we know something is really important to the community we look for things. So if any of the listeners out there have areas that they're very interested in the board is always very interested in hearing that. Thank you Susan. I know there was a new call for information related to genomics in nursing and research from Dr. Idis Grul. We can add that resource to this listing when I get off and can cut and paste that information so that you will have that available for further information. Next question is will we be able to get a copy of the slides? The slides we use today. Dr. Calzone and I both work for the federal government so our slides are your slides. If it's okay with you Kathy, I'll say that if they wanna email us and request the slides we could provide those. Yeah, I think that's fine. There's no sense in reinventing the wheel. The question is will we receive CNEs today? Unfortunately not. We did not seek out the capability to provide CNEs so those won't be applied for this webinar series unfortunately. We had a comment from Deborah McDonald that we've done a nice overview. I can't see this. Milena from Brazil is on and she said thank you for the opportunity to be part of this amazing initiative and congratulations. And that is the questions that I have on my list of participant attendee submissions. Is there anything else that anybody else would like to know? Okay, I have another one coming in. Where do we get the articles on the website? Right now if you go to genome.gov on the very front page, the home page we are the second story down. There's a small video that you can look at but also it will give you a link to read more and that way you can also link off to either the webinar series listing or also to the articles themselves because they are available online, freely available currently. And as Dr. Gennaro said, the publication or the printed version will be mailed to Sigma Theta Todd members early March. The articles are also available directly from the Journal of Nursing Scholarship website. So people have difficulty accessing them through genome.gov. You can just search and Google for Journal of Nursing Scholarship and they come right up using that method as well. There was a question that says, how do you view the nurses role versus the genetic counselor role and how do you see us working together in a practical healthcare setting? Do they also view genetics regarding the slides? I just want it to the list of resources and websites. Okay, that just ran into another one together. So the discussion about how we work with genetic counselors in particular, but I would also broaden that to be other healthcare providers. There is so much need for genomics to be integrated into practice. And many nurses as well as physicians and pharmacists and our physician assistant colleagues are at the same level of knowledge deficit. We weren't trained in this information and come to it with not a very strong foundation. So we often rely on our specialists like genetic counselors or geneticists to assist us in being able to interpret this information and to be our referral base for patients and families as they need more advanced care than perhaps our expertise allows. We do have some advanced practice nurses who are credentialed in providing counseling and education. So I'll let Dr. Calzone provide that backdrop as well. So I think that the credentialing piece is specific to nurses or genetic counselors who have credentialing in genetics. And those people have extra training in genetics. And again, I'll echo Jeanne's comment that they're really your resource to connect with. But there is certainly not enough genetic counselors or geneticists or credential genetic nurses to go around to deal with the onslaught of genomics into practice, especially when one begins to think about meeting that assistance at the point of care for say pharmacogenomics or therapeutic decision making in diseases such as cancer with targeted therapies or tumor profiling. But they are your resource and there's, you know, everybody should be sort of looking for who is your expert within your own healthcare setting to begin to work closely with as you go forward, depending on what kind of practice you have and what your environment is. That participant also asked if they, nurses take on a genomic versus a genetic view, excuse me, genetic counselors perhaps, did they take on a genomic versus genetic view? And I think we're all at the beginning stages of looking things with a genomic lens. Nurses have been more in specialty care using genetic information in practice in the newborn and early childhood setting, but this genomic perspective is somewhat new, I think not only to nurses, but also to genetic counselors. There's a huge knowledge base emerging, especially around cancer is kind of the poster child of how I think most of these diseases will progress with our knowledge and understanding of the genomic contribution. So I think we're all in a learning stage. Some of their training programs are beginning to incorporate that genomic perspective. And so I think, as Kathy said, we need to seek out our experts. And some of those experts, at least for nursing, are within the International Society of Nurses and Genetics. And they will be having a meeting this October in the Bethesda, Maryland area. And it's a great place that if you get excited about this information and want to learn more, that it's a great place to network with other experts or those of us learning about genetics constantly because it's always changing. There's a question here about how can I register the rest of the webinar for this series. That link is not yet up there. I wanted to make sure that this technology was set up appropriately and it can be recorded and works well. So once we revisit and make sure all this has been done appropriately, I will then have to assign a registration link for each of the upcoming series presentations. So I should be doing that by the end of the week. It won't be there just yet, but I will do it by the end of the week. There is a question, can we put together a group view for future events? Do we need to do individual registration and view? I don't know. I will have to check my book and see if I can find the answer to that and if that's possible, I will put that information up on genome.gov. How do we find out more about genomic education updates? Kathy and I tried to keep up to date on what educational offerings are being provided, whether it's from ISONG or from various facilities across the country. So if you're part of our list serve, we will send out announcements. For instance, the Summer Genetics Institute is coming up and their application process has been opened. So you can go to ninr.gov and look up the Summer Genetics Institute if you want to learn more about that or you could go on genome.gov and pull up our most recent competency focus newsletter or you can send a request to join our list serve and Kathy's put her email up here so you can see that process. Okay, any other fine points that you would like to know more about before we close off this webinar? Well, at our maximum, we had 88 participants in addition to the four panelists that we've had on board. We appreciate your time and hopefully you're getting excited about this opportunity to read more about the implications of genomics for practice education and research and we look forward to hearing from you in the future. Feel free to let us know if you think this was valuable or if there are other things that we should incorporate to make either the technology work better or other information that you'd like to know more about. And so, Kathy, would you like to say anything or Susan before we close out? No, we just thank you for your participation and we hope that you find the special issue valuable and we would welcome any feedback that you have about it so that anything we do in the future could be improved upon. And from the journal, we're very interested in improving the health of the world. People appreciate NIH's working with us and are very interested in hearing any further thoughts any of our participants have.