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Middleton A, Adams A, Aidid H, Atutornu J, Boraschi D, Borra J, Bircan T, Burch C, Costa A, Dickinson A, Enticknap A, Galloway C, Gale F, Garlick E, Haydon E, Henriques S, Mitchell M, Milne R, Monaghan J, Morley KI, Muella Santos M, Olivares Boldu L, Olumogba F, Orviss K, Parry V, Patch C, Robarts L, Shingles S, Smidt C, Tomlin B, Parkinson S. Public engagement with genomics. Wellcome Open Res 2023; 8:310. [PMID: 37928209 PMCID: PMC10624956 DOI: 10.12688/wellcomeopenres.19473.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 11/07/2023] Open
Abstract
As detailed in its flagship report, Genome UK, the UK government recognises the vital role that broad public engagement across whole populations plays in the field of genomics. However, there is limited evidence about how to do this at scale. Most public audiences do not feel actively connected to science, are oftenunsure of the relevance to their lives and rarely talk to their family and friends about; we term this dis-connection a 'disengaged public audience'. We use a narrative review to explore: (i) UK attitudes towards genetics and genomics and what may influence reluctance to engage with these topics; (ii) innovative public engagement approaches that have been used to bring diverse public audiences into conversations about the technology. Whilst we have found some novel engagement methods that have used participatory arts, film, social media and deliberative methods, there is no clear agreement on best practice. We did not find a consistently used, evidence-based strategy for delivering public engagement about genomics across diverse and broad populations, nor a specific method that is known to encourage engagement from groups that have historically felt (in terms of perception) and been (in reality) excluded from genomic research. We argue there is a need for well-defined, tailor-made engagement strategies that clearly articulate the audience, the purpose and the proposed impact of the engagement intervention. This needs to be coupled with robust evaluation frameworks to build the evidence-base for population-level engagement strategies.
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Affiliation(s)
- Anna Middleton
- Wellcome Connecting Science, Hinxton, England, UK
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
| | | | - Hugbaad Aidid
- Wellcome Connecting Science, Hinxton, England, UK
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
| | - Jerome Atutornu
- Wellcome Connecting Science, Hinxton, England, UK
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
- School of Health and Sport Sciences, University of Suffolk, Ipswich, England, UK
| | - Daniela Boraschi
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
| | | | - Tuba Bircan
- Wellcome Connecting Science, Hinxton, England, UK
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
| | - Claudette Burch
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
| | | | | | | | - Catherine Galloway
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
| | | | - Emma Garlick
- Wellcome Connecting Science, Hinxton, England, UK
| | - Em Haydon
- Wellcome Connecting Science, Hinxton, England, UK
| | - Sasha Henriques
- Wellcome Connecting Science, Hinxton, England, UK
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
- Clinical Genetics Department, Guy's and St Thomas' Hospital, London, England, UK
| | - Marion Mitchell
- Wellcome Connecting Science, Hinxton, England, UK
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
| | - Richard Milne
- Wellcome Connecting Science, Hinxton, England, UK
- Kavli Centre for Ethics, Science and the Public, University of Cambridge, Cambridge, England, UK
| | | | - Katherine I Morley
- RAND Europe, Cambridge, England, UK
- Melbourne School of Population Health, The University of Melbourne, Melbourne, Victoria, Australia
| | | | | | | | | | - Vivienne Parry
- Genomics England, Queen Mary University of London, London, England, UK
| | | | | | - Sam Shingles
- Wellcome Connecting Science, Hinxton, England, UK
| | - Cindy Smidt
- Wellcome Connecting Science, Hinxton, England, UK
| | - Ben Tomlin
- Wellcome Connecting Science, Hinxton, England, UK
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2
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Salvatore M, Clark-Boucher D, Fritsche LG, Ortlieb J, Houghtby J, Driscoll A, Caldwell-Larkins B, Smith JA, Brummett CM, Kheterpal S, Lisabeth L, Mukherjee B. Epidemiologic Questionnaire (EPI-Q) - a scalable, app-based health survey linked to electronic health record and genotype data. Epidemiol Health 2023; 45:e2023074. [PMID: 37591787 PMCID: PMC10867525 DOI: 10.4178/epih.e2023074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/03/2023] [Indexed: 08/19/2023] Open
Abstract
The Epidemiologic Questionnaire (EPI-Q) was established to collect broad, uniform, self-reported health data to supplement electronic health record (EHR) and genotype information from participants in the University of Michigan (UM) Precision Health cohorts. Recruitment of EPI-Q participants, who were already enrolled in 1 of 3 ongoing UM Precision Health cohorts-the Michigan Genomics Initiative, Mental Health Biobank, and Metabolism, Endocrinology, and Diabetes cohorts-began in March 2020. Of 54,043 retrospective invitations, 5,577 individuals enrolled, representing a 10.3% response rate. Of these, 3,502 (63.7%) were female, and the average age was 56.1 years (standard deviation, 15.4). The baseline survey comprises 11 modules on topics including personal and family health history, lifestyle, and cancer screening and history. Additionally, 11 optional modules cover topics including financial toxicity, occupational exposure, and life meaning. The questions are based on standardized and validated instruments used in other cohorts, and we share resources to expedite development of similar surveys. Data are collected via the MyDataHelps platform, which enables current and future participants to share non-Michigan Medicine EHR data. Recruitment is ongoing. Cohort data are available to those with institutional review board approval; for details, contact the Data Office for Clinical and Translational Research (DataOffice@umich.edu).
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Affiliation(s)
- Maxwell Salvatore
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
- Center for Precision Health Data Science, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Dylan Clark-Boucher
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
- Center for Precision Health Data Science, University of Michigan, Ann Arbor, MI, USA
| | - Lars G. Fritsche
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
- Center for Precision Health Data Science, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Jacob Ortlieb
- Precision Health, University of Michigan, Ann Arbor, MI, USA
| | - Janet Houghtby
- Precision Health, University of Michigan, Ann Arbor, MI, USA
| | - Anisa Driscoll
- Precision Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Jennifer A. Smith
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
- Survey Research Center, Institute for Social Research, Ann Arbor, MI, USA
| | | | - Sachin Kheterpal
- Precision Health, University of Michigan, Ann Arbor, MI, USA
- Anesthesiology, Michigan Medicine, Ann Arbor, MI, USA
| | - Lynda Lisabeth
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
- Center for Precision Health Data Science, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
- Precision Health, University of Michigan, Ann Arbor, MI, USA
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3
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Prom-Wormley EC, Wells JL, Landes L, Edmondson AN, Sankoh M, Jamieson B, Delk KJ, Surya S, Bhati S, Clifford J. A scoping review of smoking cessation pharmacogenetic studies to advance future research across racial, ethnic, and ancestral populations. Front Genet 2023; 14:1103966. [PMID: 37359362 PMCID: PMC10285878 DOI: 10.3389/fgene.2023.1103966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/25/2023] [Indexed: 06/28/2023] Open
Abstract
Abstinence rates among smokers attempting to quit remain low despite the wide availability and accessibility of pharmacological smoking cessation treatments. In addition, the prevalence of cessation attempts and abstinence differs by individual-level social factors such as race and ethnicity. Clinical treatment of nicotine dependence also continues to be challenged by individual-level variability in effectiveness to promote abstinence. The use of tailored smoking cessation strategies that incorporate information on individual-level social and genetic factors hold promise, although additional pharmacogenomic knowledge is still needed. In particular, genetic variants associated with pharmacological responses to smoking cessation treatment have generally been conducted in populations with participants that self-identify as White race or who are determined to be of European genetic ancestry. These results may not adequately capture the variability across all smokers as a result of understudied differences in allele frequencies across genetic ancestry populations. This suggests that much of the current pharmacogenetic study results for smoking cessation may not apply to all populations. Therefore, clinical application of pharmacogenetic results may exacerbate health inequities by racial and ethnic groups. This scoping review examines the extent to which racial, ethnic, and ancestral groups that experience differences in smoking rates and smoking cessation are represented in the existing body of published pharmacogenetic studies of smoking cessation. We will summarize results by race, ethnicity, and ancestry across pharmacological treatments and study designs. We will also explore current opportunities and challenges in conducting pharmacogenomic research on smoking cessation that encourages greater participant diversity, including practical barriers to clinical utilization of pharmacological smoking cessation treatment and clinical implementation of pharmacogenetic knowledge.
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Affiliation(s)
- Elizabeth C. Prom-Wormley
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Jonathan L. Wells
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Lori Landes
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Amy N. Edmondson
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Mariam Sankoh
- Department of Integrative Life Sciences, Virginia Commonwealth University, Richmond, VA, United States
| | - Brendan Jamieson
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Kayla J. Delk
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Sanya Surya
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - Shambhavi Bhati
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States
| | - James Clifford
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, United States
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4
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Dupras C, Bunnik EM. Toward a Framework for Assessing Privacy Risks in Multi-Omic Research and Databases. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:46-64. [PMID: 33433298 DOI: 10.1080/15265161.2020.1863516] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
While the accumulation and increased circulation of genomic data have captured much attention over the past decade, privacy risks raised by the diversification and integration of omics have been largely overlooked. In this paper, we propose the outline of a framework for assessing privacy risks in multi-omic research and databases. Following a comparison of privacy risks associated with genomic and epigenomic data, we dissect ten privacy risk-impacting omic data properties that affect either the risk of re-identification of research participants, or the sensitivity of the information potentially conveyed by biological data. We then propose a three-step approach for the assessment of privacy risks in the multi-omic era. Thus, we lay grounds for a data property-based, 'pan-omic' approach that moves away from genetic exceptionalism. We conclude by inviting our peers to refine these theoretical foundations, put them to the test in their respective fields, and translate our approach into practical guidance.
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5
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Lu C, Greshake Tzovaras B, Gough J. A survey of direct-to-consumer genotype data, and quality control tool ( GenomePrep) for research. Comput Struct Biotechnol J 2021; 19:3747-3754. [PMID: 34285776 PMCID: PMC8267563 DOI: 10.1016/j.csbj.2021.06.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 01/07/2023] Open
Abstract
Review of the offerings from commercial genotyping companies. Analysis of consumer genotype data SNP arrays. Quality control analysis of over 7000 open genomes. Open source tools and web service providing quality control report of genotype arrays.
Two major forces have contributed to the fast growth of human genetic data. One from medical research supported by governments and academic institutes; the other from direct-to-consumer (DTC) sequencing companies. While the former benefits from meticulously designed sequencing standards and quality control procedures, the latter comes in various formats and sequencing methods which are subject to changes over time and the particular needs of different companies. Thanks to the general public who shared their DNA data without constraint, here we provide a review for over 7000 genomes made public between 2011 and 2020, and produced by over six DTC sequencing companies. An open source tool-kit to systematically parse, quality check and filter genome files and statistically problematic alleles is provided to prepare consumer DNA datasets for research. The GenomePrep output is available in two common DNA datafile formats to enable further analysis with other tools. We also provide for download the combined output for all OpenSNP array genomes processed in this paper in a single data freeze file.
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Affiliation(s)
- Chang Lu
- MRC Laboratory of Molecular Biology, Francis Crick Avenue, Cambridge Biomedical Campus, Cambridge, UK
| | | | - Julian Gough
- MRC Laboratory of Molecular Biology, Francis Crick Avenue, Cambridge Biomedical Campus, Cambridge, UK
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6
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Carress H, Lawson DJ, Elhaik E. Population genetic considerations for using biobanks as international resources in the pandemic era and beyond. BMC Genomics 2021; 22:351. [PMID: 34001009 PMCID: PMC8127217 DOI: 10.1186/s12864-021-07618-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/14/2021] [Indexed: 12/11/2022] Open
Abstract
The past years have seen the rise of genomic biobanks and mega-scale meta-analysis of genomic data, which promises to reveal the genetic underpinnings of health and disease. However, the over-representation of Europeans in genomic studies not only limits the global understanding of disease risk but also inhibits viable research into the genomic differences between carriers and patients. Whilst the community has agreed that more diverse samples are required, it is not enough to blindly increase diversity; the diversity must be quantified, compared and annotated to lead to insight. Genetic annotations from separate biobanks need to be comparable and computable and to operate without access to raw data due to privacy concerns. Comparability is key both for regular research and to allow international comparison in response to pandemics. Here, we evaluate the appropriateness of the most common genomic tools used to depict population structure in a standardized and comparable manner. The end goal is to reduce the effects of confounding and learn from genuine variation in genetic effects on phenotypes across populations, which will improve the value of biobanks (locally and internationally), increase the accuracy of association analyses and inform developmental efforts.
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Affiliation(s)
- Hannah Carress
- Department of Animal and Plant Sciences, University of Sheffield, Sheffield, UK
| | - Daniel John Lawson
- School of Mathematics and Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Eran Elhaik
- Department of Animal and Plant Sciences, University of Sheffield, Sheffield, UK. .,Department of Biology, Lund University, Lund, Sweden.
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7
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Herzig AF, Velo-Suárez L, Le Folgoc G, Boland A, Blanché H, Olaso R, Le Roux L, Delmas C, Goldberg M, Zins M, Lethimonnier F, Deleuze JF, Génin E. Evaluation of saliva as a source of accurate whole-genome and microbiome sequencing data. Genet Epidemiol 2021; 45:537-548. [PMID: 33998042 DOI: 10.1002/gepi.22386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 11/08/2022]
Abstract
This study sets out to establish the suitability of saliva-based whole-genome sequencing (WGS) through a comparison against blood-based WGS. To fully appraise the observed differences, we developed a novel technique of pseudo-replication. We also investigated the potential of characterizing individual salivary microbiomes from non-human DNA fragments found in saliva. We observed that the majority of discordant genotype calls between blood and saliva fell into known regions of the human genome that are typically sequenced with low confidence; and could be identified by quality control measures. Pseudo-replication demonstrated that the levels of discordance between blood- and saliva-derived WGS data were entirely similar to what one would expect between technical replicates if an individual's blood or saliva had been sequenced twice. Finally, we successfully sequenced salivary microbiomes in parallel to human genomes as demonstrated by a comparison against the Human Microbiome Project.
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Affiliation(s)
| | - Lourdes Velo-Suárez
- Univ Brest, EFS, UMR 1078, GGB, Inserm, Brest, France.,Brest Center for Microbiota Analysis (CBAM), CHU Brest, Brest, France
| | | | - Anne Boland
- National Center for Research in Human Genomics (CNRGH), François Jacob Institute of Biology, CEA, Paris-Saclay University, Evry, France.,Laboratory of Excellence GENMED (Medical Genomics), Paris, France
| | - Hélène Blanché
- Laboratory of Excellence GENMED (Medical Genomics), Paris, France.,Fondation Jean Dausset-CEPH, Paris, France
| | - Robert Olaso
- National Center for Research in Human Genomics (CNRGH), François Jacob Institute of Biology, CEA, Paris-Saclay University, Evry, France.,Laboratory of Excellence GENMED (Medical Genomics), Paris, France
| | - Liana Le Roux
- Clinical Investigation Center 1412, Inserm, CHU Brest, Brest, France
| | | | - Marcel Goldberg
- Inserm-Paris Saclay University, University of Paris, Villejuif, France
| | - Marie Zins
- Inserm-Paris Saclay University, University of Paris, Villejuif, France
| | - Franck Lethimonnier
- National Alliance for Life and Health Sciences (Aviesan), Multiorganism thematic institute, Health technologies, INSERM, Paris, France
| | - Jean-François Deleuze
- National Center for Research in Human Genomics (CNRGH), François Jacob Institute of Biology, CEA, Paris-Saclay University, Evry, France.,Laboratory of Excellence GENMED (Medical Genomics), Paris, France.,Fondation Jean Dausset-CEPH, Paris, France.,Center of Reference, Innovation and Expertize (CREFIX), US39, French Atomic Energy and Alternative Energies Commission, Evry, France
| | - Emmanuelle Génin
- Univ Brest, EFS, UMR 1078, GGB, Inserm, Brest, France.,CHU Brest, Brest, France
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8
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Beesley LJ, Salvatore M, Fritsche LG, Pandit A, Rao A, Brummett C, Willer CJ, Lisabeth LD, Mukherjee B. The emerging landscape of health research based on biobanks linked to electronic health records: Existing resources, statistical challenges, and potential opportunities. Stat Med 2020; 39:773-800. [PMID: 31859414 PMCID: PMC7983809 DOI: 10.1002/sim.8445] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 09/10/2019] [Accepted: 11/16/2019] [Indexed: 01/03/2023]
Abstract
Biobanks linked to electronic health records provide rich resources for health-related research. With improvements in administrative and informatics infrastructure, the availability and utility of data from biobanks have dramatically increased. In this paper, we first aim to characterize the current landscape of available biobanks and to describe specific biobanks, including their place of origin, size, and data types. The development and accessibility of large-scale biorepositories provide the opportunity to accelerate agnostic searches, expedite discoveries, and conduct hypothesis-generating studies of disease-treatment, disease-exposure, and disease-gene associations. Rather than designing and implementing a single study focused on a few targeted hypotheses, researchers can potentially use biobanks' existing resources to answer an expanded selection of exploratory questions as quickly as they can analyze them. However, there are many obvious and subtle challenges with the design and analysis of biobank-based studies. Our second aim is to discuss statistical issues related to biobank research such as study design, sampling strategy, phenotype identification, and missing data. We focus our discussion on biobanks that are linked to electronic health records. Some of the analytic issues are illustrated using data from the Michigan Genomics Initiative and UK Biobank, two biobanks with two different recruitment mechanisms. We summarize the current body of literature for addressing these challenges and discuss some standing open problems. This work complements and extends recent reviews about biobank-based research and serves as a resource catalog with analytical and practical guidance for statisticians, epidemiologists, and other medical researchers pursuing research using biobanks.
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Affiliation(s)
| | | | | | - Anita Pandit
- University of Michigan, Department of Biostatistics
| | - Arvind Rao
- University of Michigan, Department of Computational Medicine and Bioinformatics
| | - Chad Brummett
- University of Michigan, Department of Anesthesiology
| | - Cristen J. Willer
- University of Michigan, Department of Computational Medicine and Bioinformatics
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9
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Axes of a revolution: challenges and promises of big data in healthcare. Nat Med 2020; 26:29-38. [PMID: 31932803 DOI: 10.1038/s41591-019-0727-5] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/03/2019] [Indexed: 01/08/2023]
Abstract
Health data are increasingly being generated at a massive scale, at various levels of phenotyping and from different types of resources. Concurrent with recent technological advances in both data-generation infrastructure and data-analysis methodologies, there have been many claims that these events will revolutionize healthcare, but such claims are still a matter of debate. Addressing the potential and challenges of big data in healthcare requires an understanding of the characteristics of the data. Here we characterize various properties of medical data, which we refer to as 'axes' of data, describe the considerations and tradeoffs taken when such data are generated, and the types of analyses that may achieve the tasks at hand. We then broadly describe the potential and challenges of using big data in healthcare resources, aiming to contribute to the ongoing discussion of the potential of big data resources to advance the understanding of health and disease.
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10
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Raghuram Pillai P, Prows CA, Martin LJ, Myers MF. Decisional conflict among adolescents and parents making decisions about genomic sequencing results. Clin Genet 2019; 97:312-320. [PMID: 31654527 DOI: 10.1111/cge.13658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/23/2019] [Accepted: 10/18/2019] [Indexed: 01/08/2023]
Abstract
Genomic testing of adolescents is increasing yet engaging them in decision-making is not routine. We assessed decisional conflict in adolescents and a parent making independent decisions about actual genomic testing results and factors that influenced their choices. We enrolled 163 dyads consisting of an adolescent (13-17 years) not selected based on a specific clinical indication and one parent. After independently choosing categories of conditions to learn for the adolescent, participants completed the validated Decisional Conflict Scale and a survey assessing factors influencing their respective choices. Adolescents had higher decisional conflict scores than parents (15.6 [IQR:4.7-25.6] vs 9.4 [IQR:1.6-21.9]; P = .0007). Adolescents with clinically significant decisional conflict were less likely to choose to learn all results than adolescents with lower decisional conflict (19.6% vs 80.4%; P < .0001) and less likely to report their choices were influenced by actionability of results (33.3% vs 18.9%; P = .044) and feeling confident they can deal with the results (71.2% vs 91.9%; P = .0005). Our findings suggest higher decisional conflict in adolescents may influence the type and amount of genomic results they wish to learn. Additional research assessing decisional conflict and factors influencing testing choices among adolescents in clinical settings are required.
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Affiliation(s)
- Preethi Raghuram Pillai
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Cynthia A Prows
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio.,Division of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lisa J Martin
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Melanie F Myers
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
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11
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Changing the mindset for precision medicine: from incentivized biobanking models to genomic data. Genet Res (Camb) 2019; 101:e10. [PMID: 31668154 PMCID: PMC7044998 DOI: 10.1017/s0016672319000077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The emerging paradigm in contemporary healthcare, precision medicine, is widely seen as a revolutionary approach to both clinical treatment and overall health promotion. Precision models are making use of the most up-to-date technological advancements – such as genomics and ‘big data’ processing – in an effort to tailor healthcare to each individual. Yet the list of hurdles to successful implementation of precision medicine is no secret. Among the challenges, it was recently suggested in this journal that we must change the ‘mindset’ of patients, practitioners and the wider public (McGonigle, 2016). And while precision medicine indeed demands a significant shift, we must not understate the extent of the overhaul required. In particular, I argue, against McGonigle's suggestion, that the ethical challenges regarding participant contributions cannot be tackled by relying upon existing models of incentivized blood banking or organ donation. Instead, the success of precision medicine requires a wholescale change in mindset.
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