9:02
5G
CaseNex
case-001 · BRCA1 c.5266dupC · evidence tier 1A · Caribbean cohort
PVS1
+ PM2_S + PP4_S
2/2
Peer signatures
+5
COIN minted
Case bundle · case-001★ PUBLISHED
VAR
BRCA1 c.5266dupC · ClinVar VCV000055638 ACMG/AMP: PVS1 + PM2_Supporting + PP4_Strong → Pathogenic
1A
SIG
Peer-signed: @adrienne (FACMG) · @anil (ABOPM) Hash-chain locked · COIN minted +5 · CASE_PEER_REVIEW_SIGNED ×2
HASH
PRO
Cascade screening protocol · siblings + daughter Toronto Protocol surveillance flagged · downstream OncoNex tumor-board ref ready · CPIC PARP-i Tier-1A
FED
COH
3 Caribbean + Sephardic carriers in 14 months · case-001 is the 4th case-089 (45F T&T, peer-signed) · case-104 (38F PR, peer-signed) · case-152 (52F Curaçao, peer-signed) · cohort.gap_check returns 0 published
N=4
SURV
Surveillance schedule auto-staged from bundle Breast MRI annual from age 25 (proband + daughter) · mammo + USS alternating Q6mo · TVUS + CA-125 Q6mo · CO from 30 · risk-reducing BSO post-childbearing
SCHED
PUB
Bundle hash-chain: 8d406f0 → b498542 → acaa8ce CASE_PEER_REVIEW_SIGNED ×2 · ANCHOR_CITED ×7 · CASE_PUBLISHED · open-read · 218 reads / 14 days · COIN +5 to @adrienne + @anil
218R
LLAUDE0.1.0(2)
S
Sarah · PGY-2
walk me through the ACMG/AMP call for c.5266dupC
L
LAUDE
PVS1: null variant in BRCA1 (frameshift). PM2_Supporting: absent in gnomAD non-cancer. PP4_Strong: phenotype-genotype match in 3 Caribbean + Sephardic carriers. Combined → Pathogenic.
S
Sarah · PGY-2
order panel and pull cascade protocol?
L
LAUDE
Illumina TruSight Hereditary Cancer queued. Cascade protocol opens at APPS/CASENEX/cases/case-001/protocol. Toronto Protocol surveillance flagged if a daughter cascades into LFS.
Open the cascade protocol for the daughter…
S
Sarah is a PGY-2. She just admitted the 45F bilateral-breast patient and needs precedent.
She asks LAUDE for a Caribbean-cohort match. case-001 surfaces — peer-signed, tier-1A, ACMG criteria fully traced. She orders the panel and pulls the cascade protocol in two taps.
SLIDE ?? / ??
Resident · PGY-2 · 9:02am · MSMC Floor

Sarah finds precedent.
Peer-signed. Hash-chained.

01
Case-bundle is the unit of evidence
Not a paper. Not a chart note. A case-bundle: peer-signed by two ABOPM-credentialed authors, hash-chained, COIN-minted, content-addressable, federated.
02
ACMG/AMP criteria live in the bundle
PVS1 + PM2_Supporting + PP4_Strong → Pathogenic. Every criterion traces to public-database evidence (ClinVar VCV, gnomAD, PharmGKB).
03
CaseNex is the RWE gold standard
2 peer signatures gate CASE_PUBLISHED. HIPAA-deidentified by construction. Caribbean cohort first-class, not afterthought. Open reading · credentialed authoring.
04
Sarah orders the panel; LAUDE federates
One tap orders TruSight; LAUDE simultaneously opens the cascade protocol for the daughter, flags Toronto Protocol surveillance in OncoNex. Cross-NEX handoff is the unfair advantage.
CANONIC Nexus
magic://hadleylab/CASENEX/cases/case-001 · evidence tier 1A
LEDGER · CASE_PEER_REVIEW_SIGNED ×2 · CASE_PUBLISHED · +5 COIN