 Thank you Carol, and I am going to just overview some of the things that we've done within UF Health, and you've heard a little bit about our program there from a kind of clinical implementation perspective, and I want to focus on the educational pieces that we've kind of rolled out in conjunction with that and what we've learned over the past few years. And so many of you have seen this slide. This was the start of our personalized medicine program, and Laurie talked earlier about the CYP-2C-19 clopidogrel implementation and outcomes with that. As part of our, we are one of the Ignite sites, and as part of our Ignite-funded activities, one of our aims includes really education of both students, clinicians, and patients. And so I lead the educational aims within the UF Health program. And so kind of every time we think of something from an implementation perspective, my first thought is to think of it from an educational perspective and what's needed to kind of take those clinicians to the next level based on that. And so this is just data from provider surveys that we were, and actually this is one of the surveys that is in the toolbox that we were talking about earlier, and I'll show you the toolbox later on just to give you an idea of some of those resources that I think meet, for example, the implementation gap within pharmacogenomics. These data are very consistent with what we see across a lot of different healthcare professionals and a lot of different surveys, the way you ask the question. Most providers think that pharmacogenetic data will improve their ability to care for patients. It's an important part of patient care, but they don't really know what to do with it and they don't know how to use it. They don't feel prepared to do that. Usually this disparity is actually even greater, usually from a 90% to as low as 10% down at the bottom. And so I just wanted to show that we've kind of seen that consistently within the Ignite network also within pharmacogenomics. And I think this relates to, there was a great metaphor and something that I read recently that really related this to kind of why is it that we have this and talked really about the perfect storm. And so it's important within genomics that we look at kind of what we're doing, but I think so much of education is a part of implementation. And I know I'm biased towards education, but when we think about overcoming a lot of these implementation barriers, I think we have to look at education. And so within this area, we know that providers really aren't well equipped. It's not covered as much as it is in medical school or in pharmacy school as we would like it to be. There's not a lot of experience with the tools and how to do this in practice and kind of these practice-based activities of understanding differences and how to use those. And so within our program, we really kind of said, how do we overcome that hurdle? How do we get over that storm? And the way that I've begun to think of it is really moving from knowledge to application and thinking how do we help our clinicians move for maybe a knowledge-based foundation that they got in pharmacy school or medical school to be able to apply those principles within a complex patient care arena. So within the personalized medicine program, as I mentioned, we've looked at different areas and specifically implemented pharmacogenetic testing. And Larry focused earlier on SIP-2C19 and clopidogrel in that area. And this just lists kind of the different environments. And I think if you add this up, it's about 3,000, 2,000 tests in about over 10 different specialties. And so I think that speaks a lot to the diversity of our implementation, but it also speaks to me to the diversity of the educational needs. And so each one of these kind of areas or implementations have had different needs from an educational perspective. And that education has been essential in helping to kind of get those implementations up and running and make sure that providers are able to order and are willing to order tests that are offered either in a clinical or research environment. So Larry also showed you this timeline earlier. And so there's kind of a parallel educational timeline that I wanted to talk to you about. So you can see here our start in 2012 with SIP-2C19 testing and clopidogrel patients in a specialized population to almost today, where we're looking at SIP-2C19 and PPIs through the years. And so just in the same way that our implementations have grown, our educational efforts have really grown through the years also. And we really learned a tremendous amount in the past five years in this area. Everybody who knows me knows I like to make things easy to remember. And so I was trying to think of what, if I could boil it down, what have we learned during this time? And to me, it kind of boils down to three things, interactivity, implementation, and individualizing. And so what I mean by that is we really learned that just like other adult education principles and just like other areas, we know that interactivity is important in education in pharmacogenomics and genomic medicine. The way that differs a little bit from kind of standard adult education is that we have some opportunities to interact with our audience or our trainees in a way that we don't through the use of their own genetic information. That's something that we've looked at within our program. It really has to be individualized. What we do is very different with cardiology versus gastroenterology versus psychiatry. And it's really because we look to see what the needs of the audience are and what it is that they're wanting to get out of that kind of process. And then we begin to tailor that. And then I really think it has to be implementation focused. And yesterday, Lynn mentioned the question about drug gene-drug interactions. And to me, that's really kind of an implementation-focused issue. We really try to incorporate into our educational aspects the complexity of patients who really do come back and come to you as a clinician with not just a very straightforward pharmacogenetic question, but they're on multiple drugs. They're on CIF2D6 inhibitors. They have a contraindication to ticagrelor or prasigrel. And what do you do in these kind of more gray areas? I think we really focus on trying to help and equip our students and practitioners to know what to do. From a timeline perspective, you can see we really started out with a more traditional grand rounds. We've had clinical decision support as part of our program since the start. In 2013, we began to build in kind of post-implementation evidence analysis in patient cases. What we're doing right now with our site group, I really, really like. And this was the kind of the suggestion of the PI and that Carol Matthews and that implementation. It's P.E.S.C.E.C.E. But she asked us, can you please take patients that have been genotyped and bring them back to the fellows and talk through them? And basically kind of say, why is it that you recommended what you recommended? And so we specifically, and it's worked so well, I think we'll probably do that with every implementation from now. And because I think it really is a part of the sustainability of that implementation is kind of circling back for those practitioners. We've incorporated both student and practitioner genotyping and then also case-based teaching. I think interactivity in this area has two components. One is potentially in using your own genetic information. The other is really interactive adult education principles like active learning in a flipped classroom environment. We also have a pharmacogenetics residency and a clinical pharmacogenetic postdoctoral fellowship. We have students that rotate with us both from our university and others. So we've had a chance to work with those students. And then in 2016, we held the inaugural precision medicine conference. This is a two and a half day conference that focuses on really, it's really focusing on implementation more and more. And I'll show you some of the differences. We offered that for the first time in 2016. We expanded that this last year in 2017 and are going to continue to do so for 2018. So I can talk to you about some of those plans and then how we're also looking at our graduate certificate in precision medicine and that development in conjunction with the College of Medicine. So as far as kind of who we've educated thus far, I estimated it's about 950, about 1,000 participants have gone through an educational program in the last few years within our health system. And I look today, over half of these have been genotyped. And so our precision medicine conference attendees, student electives, our CEs and some of the other group. So I would say definitely over half, but a good percentage of these educational participants have also had genotyping incorporated into their experience. So one of the things that I think was really laying the foundation for genotyping in the literature was really looking at whether or not this improved learning or changed students' knowledge, attitudes and beliefs. And that was kind of the first year that we did this course. We looked at some of those questions and I think this has been well established. This is just a kind of a summary of the different studies that have been published recently to date on using kind of personal genotype evaluation within a classroom setting. And the thing that jumps out at me about this is kind of two-fold. Number one, all of these showed improvement in knowledge. They also showed kind of an improvement no matter how they measured it in attitudes and beliefs. The other thing I thought was interesting is that y'all use different methods and they all use different specific ways to genotype. And so there's not, I think, one right or wrong way to do this. And so I think this is just kind of an interesting comparison of looking at these side by side. So we looked at that within our first year, within our program, but we really wanted to expand on that in the previous year. And I think that we tried to be able to develop a study design that did that. And so within the College of Pharmacy at the University of Florida, we have a required personalized medicine course. And so that's your left side there and this is our control group. In this course, students learn fundamentals. They learn about CPIC guidelines, but it is more of a knowledge-based course. And so we really aren't talking as much about implementation principles as we're talking about fundamentals of pharmacogenomics knowledge and gene drug pairs. The intervention group had the option to kind of have that learning enhanced by taking an additional elective. In that elective, we focused completely on the clinical applications. And this is where I think teaching is really fun and I get really excited because we really got to do some of those things. Like Lynn said earlier, all of our class time and all of our interactivity was just sitting down and talking through patient cases. And was just saying, well, what would you do in this situation? Well, what if they were on a sub-2D6 inhibitor? How would that change? What if there was a contraindication to this? And so really talking through some of these. We also had the students develop cases for implementation. And so we would say, which gene drug pair would you implement at the first and why? I want you to develop a business plan or model a 15-second elevator pitch as to why you would do this and really help them to consider all these different aspects that we've been talking about, both from a reimbursement, a complexity, a buy-in, evidence gap, implementation gap, and having them make a case for what they would do and really think about things in a practical environment. We also have students answer questions that come up commonly in practice. And so we've talked a little bit about different levels of evidence on, say, a panel-based test. And so we really try to say, well, what are you going to do with this information and show them how to quickly, at least in a clinical arena, identify what's the level of evidence that's associated with a specific gene drug pair, and that's part of their active assignments and walking them through that. So it's a lot of fun for me, we get to do a lot of really neat things. A lot of those are listed on here. The other piece that's different is that students do have the option of undergoing personal genotyping, and that's something that is optional. I think we've never had anybody not opt-in to do it, so we have kind of something that's very popular with the students. One of the things that I struggled with was how do we incorporate that from a teaching perspective in an anonymous manner, and I finally kind of hit on that, and we did this at our precision medicine conferences last year to use polling functionality, either in a webinar-based environment or in person, to allow people to anonymously kind of say, this is my genotype, so in this particular patient, this is what I would do, but they can do that in an anonymous fashion, so we can see a kind of a population of genotypes in the room, and that seems to help be able to use that information, but still allow everyone to kind of stay anonymous. So this course was associated with both a pre- and a post-course test, and the knowledge increased for both groups, and so in our control group, there was a baseline knowledge level that wasn't different than the intervention group, and they increased in both courses, they're both excellent courses, they teach a little bit, kind of, they come at a problem from two different directions, and in this case we really focus on the implementation direction within that elective, and so they both had a significant increase in knowledge too. What I think is really interesting, and this is something that we kind of teased out, is that as part of the test, so they had a knowledge test that was aligned or mapped to the objectives of the course, within each question on that knowledge test, we asked them, how confident are you that you're correct? And so we basically said, how much do you think you know what you're talking about? And so you can see on both the pre-course for both the control and the intervention, there was no correlation between knowledge and confidence. In other words, they really had no idea, they would say, A, and I 100% think it's A, and they were 100% wrong, it was B, or something like that, and so it was a nice way to see, do they really know what they think they know? We also asked them how well prepared they were to fulfill the pharmacist role in pharmacogenomics, and so the American Society of Health Systems Pharmacist has laid out a position statement that lists and delineates roles of the pharmacist. So we were also able to kind of ask them how confident they felt about that, and they felt equally confident. So what we found is in the post-course group in that intervention area, we saw that their scores were higher, but they also had a higher correlation, so they had a significant correlation between their confidence and their knowledge. In other words, if you look at this on kind of a spectrum of novice to competency, so there's a learning model, many that look at novice to competency, the first step of that is unconscious incompetence. You really don't know what you don't know, versus, and that's not a bad thing, that's kind of where you start out in medical school, or you start any new topic. The other end of that spectrum is unconscious competence, which we'll say is Julie, which is like, you know it so well, you don't even think about it, or many people in this room. But it's an important thing to kind of think of, because this is part of the learning process for all students. We've seen a similar shift in content and approach to teaching within our precision medicine conference for healthcare professionals. And so you can see in 2016 we had 150 attendees from 30 states, and in this past year we had 32 states and five countries represented, and we've seen this kind of same shift. And so this is just a breakdown of the type of things we were teaching. And you can see over on the left-hand side, for example, we started out in 2016 with about 16% of the content looking at how to implement. By 2017 that increased to almost half of the course content, half of the precision medicine conference, was focused on how do you do this, addressing that implementation gap that we looked at, or kind of came up in the last hour. And we see that kind of progressively we're learning more and more as we go along the importance of incorporating that into our teaching. And then also we've increased significantly the interactivity, and so you can see the first year we had about 38%, 40% of our content was interactive, the second year's up to 65%. So our conference this year was very different, and I think it will continue to grow and change. Our next steps, and then I'm going to just show you real quick some of the resources are how to access the Ignite Spark Toolbox, which has come up a couple of times, because a lot of what we've learned, points to the ability of that type of a resource to meet this implementation gap. Our next steps we're working right now with the Office of CME in the College of Medicine to expand that precision medicine conference to continue to focus on kind of what's new and these developing trends and implementation to look at that for March 2018 is when that will be scheduled. And then we're also working very closely with the College of Medicine to develop a graduate certificate in precision medicine. And so I'm really excited about this. I have great feedback and different faculty involved within the College of Medicine, and I think we'll have this up and running and have this submitted back for revision to the Faculty Graduate Council within the next few months. And so I'm excited to see that become a part of what we can offer from both a curricular and an academic perspective. Last thing I wanted to show you was just to kind of give you an idea. So this Ignite Spark Toolbox has come up a couple of times. This is a mock-up of the homepage that we're currently working on. So this isn't exactly actually if you have feedback on this. I just sent an email out to everyone at Ignite yesterday and said, please send us feedback. But essentially our goal with this was to kind of rearrange the website in a way that you could get right to what you needed on the first page so that if you wanted, for example, a provider survey, you could search directly on that right-hand side Research Tools box for provider surveys and it would take you right where you needed to go versus having to kind of click into there. So we were just looking at usability. Within this toolbox, there's clinicians and researchers area and within this we've tried to really think about what is it that we've needed to know and had to have when we're trying to implement or we're trying to conduct research in this area. So within, for example, the implementation space or the clinical space, that means we've broken it down by specific gene drug implementation. That may not be perfect for everybody if you look at preemptive testing, but it's a way to think about and organize this concept intellectually and from your head. And so within that, for example, to C19 and Clopidogrel implementation, if you click on the resources for patients and providers, it takes you to a list of available patient education handouts, provider resources, slide templates for presentations. And the goal of this is really to fill that implementation gap and to provide individuals with what they need to get from here to there in the easiest manner. So from A to B, kind of in the shortest and easiest manner possible without having to kind of reinvent that wheel. Other tools on the research side, including data dictionaries, we're trying to really increase what's there. So if you have anything that you'd like to contribute, let us know because we would love to also include that here. And I think I'm done. I have my one-minute warning from Teji. And so I just want to acknowledge our very broad group, especially Julie and Laurie, who are here today. Amanda, I'll see. Michael, Claire Salzer, and Dave Nelson are all in that PMP leadership group. And we've had a tremendous support from trainees and faculty who are helping us to do this every day and also a number of NIH grants, including the Ignite Network grant and then, of course, support from UF and UF Health from an institutional perspective. Great. Thanks, Christian. If there's one quick question, we can take that. Yes. Just one compliment first. I didn't mention your newsletter, which I think is really well done and I hope it gets really wide dissemination. I think a lot of us get news feeds now as a way we get information. And I think yours does a great job of that. The one question is you've done a lot of different educational interventions and I imagine a lot of these are done in your provider network. Have you been able to measure, you know, which intervention has the greatest effect on adoption of ordering tests or following guidance? No, we haven't, and probably because, you know, we're still relatively early in the process, but I think that's something that we can begin to look at now. But I think that the educational intervention has, I think there's a lot of different factors that would affect adoption. And so I'm not sure if you could kind of narrow it down to just what that intervention is from an educational standpoint. I'm trying to think of the kind of the different ways that we approach implementation. There's so many things that influence kind of the sustainability of that once that first is initially launched. I'm not sure if you could tease out that one piece, but it is definitely something we're looking at now as far as our individual implementations is the sustainability kind of what is influencing that. Great. And if there are additional comments or questions, we'll take them up during the discussion period. Our next speaker is Bob Wilden from NHGRI, and he's going to talk to us about the Inter-Society Coordinating Committee and training pharmacogenomics practitioners.