 We've been sort of giving you the broad view from Francis of what was going on, you know, NIH-wide and beyond. Eric has focused on NHGRI. And I was asked to talk specifically about the series of meetings of which this is the sixth and how they kind of came to be and what's come out of them, what we hope will come out of them. And this was part and outgrowth of our advisory council. Every institute at the NIH and the office of the director have separate advisory councils which are senior members of the scientific community that generally meet about three times per year. And one of the things they do is give us advice on scientific directions. And we have a specific working group of that group that helps us to plan these genomic medicine meetings, which began about two and a half years ago. And we're initially two to three of them per year, so we're having them about every four months. And that has become exhausting for us and our advisors and the genomic medicine community, which is, you know, it's pretty small. So we may be slowing those down a little bit, but the purpose of this working group was to help us to plan these meetings as well as to give us guidance on other areas of implementation, such as, you know, infrastructural needs, ideas for future collaborations, and reviewing the progress overall. He's met many of the members of this group, all but two are here. Howard Jacob is stuck in Wisconsin, and if you know what it's like in Wisconsin, anybody who could have gotten out would have. So he's watching us by a website right now. And Pearl O'Rourke, who had an injury, unfortunately, and so she's also hopefully joining us by a website. But the rest of them are here, and you've met them. If you're interested in the activities that we're carrying on, we have a website. If you just Google NHGRI GMWG, it will take you right to it, which is very nice, or genomic medicine, NHGRI should take you as well. We began this effort in June of 2011, as I mentioned, with a colloquium very much like this one, except it was focused on U.S. mainly academic medical centers and integrated health systems. And we basically had had a debate internally and with our scientific community as to whether there were people that were really ready to implement this, or was it too early? And you know, it was sort of, you know, half the room felt it was too early, and half the room felt it was too late, and so we thought that was a good time to have a meeting. And so we invited people to come, much like we did on this one, on their own dime in their own time to join us at O'Hare for a day. And 20 groups came, many of them are represented here. And we really were quite surprised and gratified to find not only that there was a lot going on, but also a little concern to recognize that it was going on in isolation. And many of the groups were facing the same challenges, dealing with the same issues, coming to many of the same conclusions, but they were all doing it separately. And that didn't seem to make a lot of sense to any of us. So one of the things we did was to a pair of paper that Jeff referred to that has in its sort of a roadmap almost for implementation. So how are the early adopter groups actually going about this? And as I was chatting at coffee before we came in, several people said to me, yes, but you know, how do you really translate this? How do you get it into the clinic? Well, we think this is a start at kind of pointing you in the direction of the way that some of the groups that have been successful so far have done it. And in it, there's a little figure, but obviously there's a lot more to it than this. But Dan Rodin in particular helped us with this, with their Predict project. And you'll hear a little bit more about his related efforts that he's involved in. But there are a couple of key steps, having some local champions, which often in these institutions, the CEOs of the presidents, that always helps. And then engaging the institutional leadership, as I mentioned, and a variety of other steps. So hopefully that will be of some help. After the colloquium, one of the things we recognized was that every one of these groups was trying to figure out what variants should be reported. So what are the things that you find them and you should implement them and make use of them in the clinic? And so each group was going through a process to do that. And we felt that it would be useful to try to harness those efforts rather than duplicating them, say, all right, how about some groups take, you guys take neurology and we'll take GI and this group will take pharmacology and then we can pool those efforts. So we had a meeting then about six months later to figure out how we could identify variants that were clinically relevant and decide what should be acted upon and what that action should be. Just after that meeting, we had a second meeting where we were trying to develop some potential collaborations among groups. And then a third in May of, doesn't wanna click, there we go. In May of 2012 to look at some of those pilot projects and also to look at some of the barriers and implementation with payers, particularly major insurance companies, Etna and Blue Cross Blue Shield and other stakeholders. We then spun off of that a group specifically devoted to the payers to try to determine whether there would be some opportunities for joint funding of research projects and we're still working in that area now. And from these first three meetings, we actually developed, these are requests for application which you probably have similar kinds of processes in your own countries. That came to sort of spun out of these and Eric mentioned several of them. As you can see there was quite a lot of activity in the research realm that we were able to put forward from this. This is actually a self-portrait of Michelangelo when he finished the cysteine ceiling, you can see his little paintbrush here. And this is pretty much the way our staff felt after that year or so of getting all of those projects up and under way. As we were doing this, we recognized that there were also a large number of infrastructural needs that needed to be addressed, one of which was education of clinicians, particularly physicians. So there had been some fairly successful efforts at educating pharmacists, physician's assistants, nurses and those groups through the National Coalition for Health Provider Education in Genomics or NICHPEG that NHGRI had been working with closely. But physicians had been a tougher nut to crack. And one of the things we did was to contact many professional organizations around the country, some of the largest ones that are listed here, plus obviously the College of Medical Genetics and Genomics, which would be central to this effort. And we had them come to Dallas and join us in January of 2013 just a year ago and ask them, how could we go about educating physicians? Is there an interest and are there needs? And what could we share across groups? And perhaps the key lesson from that and one that you may want to take home to your places as well is that we should present this to physicians as a gradual evolution rather than a revolution. So I think in many ways we've kind of scared people that this is going to change everything and probably will change everything but not today. And today what we have is a handful or perhaps a few more variants that are useful and can be applied in clinical practice. But in many ways they're just another lab test. I mean, you test a creatinine before you give an aminoglycoside, you test a, you should perhaps, test a CYP variant before you give a variety of drugs. So that was a real lesson to us as well as a number of other things and I should note that none of us are probably going through our slides in as much detail as you might like to review them in the future. We will post all of these slides on the NHGRI website along with the video cast of this presentation, of this meeting. From that meeting in January of last year, we, all of the professional societies agreed that what we needed was some way for them to interact in ways that could facilitate education of clinicians and kind of multiply their efforts without duplication. So we formed this inter-society coordinating committee. The charge was to facilitate interactions among societies that would enhance that education and actually not just enhance education but the actual application of genomics to clinical care. This is a brief description of the structure. Let's see. And we have a series of working groups that we've set up. Two of the leaders of those, Bruce Korf from Alabama, is leading the competencies group and Mark Williams is leading the use cases group. They're both here today. But one of the things we wanted to do was to identify, well, what is it that physicians should know? And Bruce's group now has a very nice set of what are now called intrustable professional activities or EPAs. And those will be submitted for publication soon. We also have the use cases group has developed a template of case studies that we're hoping then each of the specialty societies will take and customize and say, okay, if you want to apply pharmacogenomics in cardiology, here's a good example of how that might be appropriately done. And that group has grown, you can see here the new groups that have been added on, plus many, many of the 27 NIH institutes and centers are participating actively. So that was the area of physician education. We also recognize that while many countries, particularly Britain, but others have sort of a strategy for a national strategy for implementing genomics, we don't have that in the U.S. And one of the things we thought might be useful would be to engage the many federal agencies that touch on this from a regulatory standpoint or reimbursement standpoint or whatever and try to get, see if there were places that we could collaborate and work together to move this forward. We are hampered somewhat in the U.S. by not having a medical care system, although Rob Koehler from Duke has found a saying, if you don't think we have a healthcare system, just try to change it. So, and actually in the U.S., we do have a couple of sort of direct providers of medical care, which include the military medical systems as well as our veterans administration, which take care of millions of people. And they were quite interested and wanted to attend and did. We also had many of the reimbursement and regulatory groups and other supportive and facilitative groups that are listed here. One of the things we did was to survey them, much as we surveyed you, except we asked them kind of different questions. And one of the questions was what are the major barriers? And it was interesting to see what was listed by the various groups, but in particular, and we've heard this over and over again, is evidence of clinical validity and utility proved to us that this works and we will use it, we will implement it and we'll pay for it. So, we recognized that that was a major issue and we also recognized that we had a significant opportunity in particularly the interest of the military medical services. So we had a lot of them show up, they were quite enthusiastic and really wanted to be part of this because they're hearing from not only their patients, but also various companies and others that are promoting genomic medicine and they don't know what they should be doing, much like I think many of your practitioners. So one of the things we thought was, well, they're receiving a lot of pressure to do this. They are a comprehensive clinical care system. There are, one of the nice things about the military medical system is that there is less of a socioeconomic gradient in care. They are all conceivably getting the same care, although when you get to the very high levels, it does change a little bit as it does in many systems. And there also are other advantages to using that system. So could we possibly develop some kind of an evidence generation project there? And in talking with them further, the area that seemed to be kind of the least controversial and the most ready was in pharmacogenomics. And so we're now exploring the potential for actually doing some kind of a targeted array or other kind of project in the military medical system. We don't know what this is going to look like, but it could be a very large evidence generation project. And one of the neat things about it is that there's a pilot project for this already going on at the NIH Clinical Center, which also is a direct provider of medical care, obviously, in a much different sort of tertiary and specialized format. But there's great interest in the clinical center group in collaborating with the military. They've done this in many other projects to begin with. And so this is one that we think might actually be able to provide some important evidence and something that we may want to think about as a potential collaborative project across the groups represented here. We also identified with them the need and the importance of family history data, perhaps potentially easier thing, at least a little more understandable to physicians and patients than perhaps some of the pharmacogenomics. So we'll be working forward, working with that, trying to move it forward. And then there's a question of what our seventh meeting should be. We generally plan the next meeting at the dinner the night before this meeting. And so we talked about that last night. And while we recognize that there's some importance in trying to interact more with industry, particularly industries that we don't usually think of in the clinical realm, such as some of the benefit providers, the insurance groups, as well as some medical record companies in genomics, some of the sequencing companies or providers of arrays, as well as some of the drug companies. So that might be something that we would do in our future meeting, which would be held sometime in the fall or so. But we also have a number of kind of irons in the fire that we need to follow up on, and maybe we should be doing that. So that's kind of an open question mark. We will continue the open invitations as space allows, and we are very grateful to the IOM for giving us this space here in this lovely venue. It is a little bit more constrained than we usually use, so we apologize to those who we weren't able to include in this meeting. And we will continue the video streaming as long as my colleagues, Alvaro and Maggie, can continue to join us for it. And then we'll kind of see from there. So I think that's all I had. So I will stop there, and then we'll take questions after the next speaker, which is Dan Rodin. So Dr. Rodin, thank you very much. Thank you.