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Kimani RW. Reexamining the use of race in medical algorithms: the maternal health calculator debate. Front Public Health 2024; 12:1417429. [PMID: 38939564 PMCID: PMC11208672 DOI: 10.3389/fpubh.2024.1417429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 05/27/2024] [Indexed: 06/29/2024] Open
Abstract
The concept of race is prevalent in medical, nursing, and public health literature. Clinicians often incorporate race into diagnostics, prognostic tools, and treatment guidelines. An example is the recently heavily debated use of race and ethnicity in the Vaginal Birth After Cesarean (VBAC) calculator. In this case, the critics argued that the use of race in this calculator implied that race confers immutable characteristics that affect the ability of women to give birth vaginally after a c-section. This debate is co-occurring as research continues to highlight the racial disparities in health outcomes, such as high maternal mortality among Black women compared to other racial groups in the United States. As the healthcare system contemplates the necessity of utilizing race-a social and political construct, to monitor health outcomes, it has sparked more questions about incorporating race into clinical algorithms, including pulmonary tests, kidney function tests, pharmacotherapies, and genetic testing. This paper critically examines the argument against the race-based Vaginal Birth After Cesarean (VBAC) calculator, shedding light on its implications. Moreover, it delves into the detrimental effects of normalizing race as a biological variable, which hinders progress in improving health outcomes and equity.
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Jussim L. Diversity Is Diverse: Social Justice Reparations and Science. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2024; 19:564-575. [PMID: 38652785 DOI: 10.1177/17456916241236171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Because the term "diversity" has two related but different meanings, what authors mean when they use the term is inherently unclear. In its broad form, it refers to vast variety. In its narrow form, it refers to human demographic categories deemed deserving of special attention by social justice-oriented activists. In this article, I review Hommel's critique of Roberts et al. (2020), which, I suggest, essentially constitutes two claims: that Roberts et al.'s (2020) call for diversity in psychological science focuses exclusively on the latter narrow form of diversity and ignores the scientific importance of diversity in the broader sense, and ignoring diversity in the broader sense is scientifically unjustified. Although Hommel's critique is mostly justified, this is not because Roberts et al. (2020) are wrong to call for greater social justice-oriented demographic diversity in psychology but because Hommel's call for the broader form of diversity subsumes that of Roberts et al. (2020) and has other aspects critical to creating a valid, generalizable, rigorous, and inclusive psychological science. In doing so, I also highlight omissions, limitations, and potential downsides to the narrow manner in which psychology and the broader academy are currently implementing diversity, equity, and inclusion.
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Affiliation(s)
- Lee Jussim
- Department of Psychology, Rutgers University
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Kępińska AP, Johnson JS, Huckins LM. Open Science Practices in Psychiatric Genetics: A Primer. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:110-119. [PMID: 38298792 PMCID: PMC10829621 DOI: 10.1016/j.bpsgos.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/04/2023] [Accepted: 08/11/2023] [Indexed: 02/02/2024] Open
Abstract
Open science ensures that research is transparently reported and freely accessible for all to assess and collaboratively build on. Psychiatric genetics has led among the health sciences in implementing some open science practices in common study designs, such as replication as part of genome-wide association studies. However, thorough open science implementation guidelines are limited and largely not specific to data, privacy, and research conduct challenges in psychiatric genetics. Here, we present a primer of open science practices, including selection of a research topic with patients/nonacademic collaborators, equitable authorship and citation practices, design of replicable, reproducible studies, preregistrations, open data, and privacy issues. We provide tips for informative figures and inclusive, precise reporting. We discuss considerations in working with nonacademic collaborators and distributing research through preprints, blogs, social media, and accessible lecture materials. Finally, we provide extra resources to support every step of the research process.
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Affiliation(s)
- Adrianna P. Kępińska
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Jessica S. Johnson
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, New York
- Psychiatry Department, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Laura M. Huckins
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Psychiatry, Yale University, New Haven, Connecticut
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Smith HS, Bonkowski ES, Hickingbotham MR, Pereira S, May T, Guerrini CJ. Clinically Indicated Genomic Sequencing of Children in Foster Care: Legal and Ethical Issues. J Pediatr 2023; 262:113612. [PMID: 37468037 PMCID: PMC10792112 DOI: 10.1016/j.jpeds.2023.113612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 07/03/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023]
Abstract
There are approximately 400 000 children in foster care in the US, approximately one-half of whom have chronic health problems and approximately 10% of whom have complex healthcare needs. Given the increasing relevance of genomic sequencing to guide clinical care for children with rare, chronic, and undiagnosed conditions, it may be an important component of diagnostic evaluation for children in foster care. Clinically indicated genomic sequencing may provide information that has health implications for children in foster care, as well as for their biological parents and other relatives. Whether and how genomic sequencing results impact legal decision making and family court outcomes is not yet well-understood. We describe scenarios that highlight legal, ethical, and policy issues surrounding genomic sequencing for children in foster care using 3 cases adapted from real-world events. Together, these cases highlight important yet underexplored issues that arise when genomic information has legal relevance in family court and ethical implications for child and family well-being. As genomic sequencing becomes more routine for the general pediatric population, additional research is needed to better understand its impacts on children and other stakeholders within the foster care system.
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Affiliation(s)
- Hadley Stevens Smith
- Department of Population Medicine, Precision Medicine Translational Research (PROMoTeR) Center, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.
| | - Emily S Bonkowski
- St. Jude Children's Research Hospital, Memphis, TN; University of Washington Institute for Public Health Genetics, Seattle, WA
| | - Madison R Hickingbotham
- Department of Population Medicine, Precision Medicine Translational Research (PROMoTeR) Center, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Stacey Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX
| | - Thomas May
- Department of Medical Education and Clinical Sciences, Washington State University, Pullman, WA
| | - Christi J Guerrini
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX
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Hanson H, Astiazaran-Symonds E, Amendola LM, Balmaña J, Foulkes WD, James P, Klugman S, Ngeow J, Schmutzler R, Voian N, Wick MJ, Pal T, Tischkowitz M, Stewart DR. Management of individuals with germline pathogenic/likely pathogenic variants in CHEK2: A clinical practice resource of the American College of Medical Genetics and Genomics (ACMG). Genet Med 2023; 25:100870. [PMID: 37490054 PMCID: PMC10623578 DOI: 10.1016/j.gim.2023.100870] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 07/26/2023] Open
Abstract
PURPOSE Although the role of CHEK2 germline pathogenic variants in cancer predisposition is well known, resources for managing CHEK2 heterozygotes in clinical practice are limited. METHODS An international workgroup developed guidance on clinical management of CHEK2 heterozygotes informed by peer-reviewed publications from PubMed. RESULTS Although CHEK2 is considered a moderate penetrance gene, cancer risks may be considered as a continuous variable, which are influenced by family history and other modifiers. Consequently, early cancer detection and prevention for CHEK2 heterozygotes should be guided by personalized risk estimates. Such estimates may result in both downgrading lifetime breast cancer risks to those similar to the general population or upgrading lifetime risk to a level at which CHEK2 heterozygotes are offered high-risk breast surveillance according to country-specific guidelines. Risk-reducing mastectomy should be guided by personalized risk estimates and shared decision making. Colorectal and prostate cancer surveillance should be considered based on assessment of family history. For CHEK2 heterozygotes who develop cancer, no specific targeted medical treatment is recommended at this time. CONCLUSION Systematic prospective data collection is needed to establish the spectrum of CHEK2-associated cancer risks and to determine yet-unanswered questions, such as the outcomes of surveillance, response to cancer treatment, and survival after cancer diagnosis.
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Affiliation(s)
- Helen Hanson
- Southwest Thames Regional Genetics Service, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Esteban Astiazaran-Symonds
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD; Department of Medicine, College of Medicine-Tucson, University of Arizona, Tucson, AZ
| | | | - Judith Balmaña
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Medical Oncology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - William D Foulkes
- Departments of Human Genetics, Oncology and Medicine, McGill University, Montréal, QC, Canada
| | - Paul James
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia; Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Susan Klugman
- Division of Reproductive & Medical Genetics, Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Joanne Ngeow
- Genomic Medicine, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Rita Schmutzler
- Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany; Center for Hereditary Breast and Ovarian Cancer, University Hospital of Cologne, Cologne, Germany
| | - Nicoleta Voian
- Providence Genetic Risk Clinic, Providence Cancer Institute, Portland, OR
| | - Myra J Wick
- Departments of Obstetrics and Gynecology and Clinical Genomics, Mayo Clinic, Rochester, MN
| | - Tuya Pal
- Department of Medicine, Vanderbilt University Medical Center/Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Marc Tischkowitz
- Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - Douglas R Stewart
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
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Hofmeyer M, Haas GJ, Jordan E, Cao J, Kransdorf E, Ewald GA, Morris AA, Owens A, Lowes B, Stoller D, Tang WHW, Garg S, Trachtenberg BH, Shah P, Pamboukian SV, Sweitzer NK, Wheeler MT, Wilcox JE, Katz S, Pan S, Jimenez J, Smart F, Wang J, Gottlieb SS, Judge DP, Moore CK, Huggins GS, Kinnamon DD, Ni H, Hershberger RE. Rare Variant Genetics and Dilated Cardiomyopathy Severity: The DCM Precision Medicine Study. Circulation 2023; 148:872-881. [PMID: 37641966 PMCID: PMC10530109 DOI: 10.1161/circulationaha.123.064847] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/14/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Dilated cardiomyopathy (DCM) can lead to advanced disease, defined herein as necessitating a durable left ventricular assist device or a heart transplant (LVAD/HT). DCM is known to have a genetic basis, but the association of rare variant genetics with advanced DCM has not been studied. METHODS We analyzed clinical and genetic sequence data from patients enrolled between 2016 and 2021 in the US multisite DCM Precision Medicine Study, which was a geographically diverse, multiracial, multiethnic cohort. Clinical evaluation included standardized patient interview and medical record query forms. DCM severity was classified into 3 groups: patients with advanced disease with LVAD/HT; patients with an implantable cardioverter defibrillator (ICD) only; or patients with no ICD or LVAD/HT. Rare variants in 36 DCM genes were classified as pathogenic or likely pathogenic or variants of uncertain significance. Confounding factors we considered included demographic characteristics, lifestyle factors, access to care, DCM duration, and comorbidities. Crude and adjusted associations between DCM severity and rare variant genetic findings were assessed using multinomial models with generalized logit link. RESULTS Patients' mean (SD) age was 51.9 (13.6) years; 42% were of African ancestry, 56% were of European ancestry, and 44% were female. Of 1198 patients, 347 had LVAD/HT, 511 had an ICD, and 340 had no LVAD/HT or ICD. The percentage of patients with pathogenic or likely pathogenic variants was 26.2%, 15.9%, and 15.0% for those with LVAD/HT, ICD only, or neither, respectively. After controlling for sociodemographic characteristics and comorbidities, patients with DCM with LVAD/HT were more likely than those without LVAD/HT or ICD to have DCM-related pathogenic or likely pathogenic rare variants (odds ratio, 2.3 [95% CI, 1.5-3.6]). The association did not differ by ancestry. Rare variant genetic findings were similar between patients with DCM with an ICD and those without LVAD/HT or ICD. CONCLUSIONS Advanced DCM was associated with higher odds of rare variants in DCM genes adjudicated as pathogenic or likely pathogenic, compared with individuals with less severe DCM. This finding may help assess the risk of outcomes in management of patients with DCM and their at-risk family members. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03037632.
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Affiliation(s)
- Mark Hofmeyer
- MedStar Health Research Institute, Medstar Washington Hospital Center, Washington, DC
| | - Garrie J. Haas
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Elizabeth Jordan
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Jinwen Cao
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Evan Kransdorf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | - Anjali Owens
- Center for Inherited Cardiovascular Disease, Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Brian Lowes
- University of Nebraska Medical Center, Omaha, NE
| | | | - W. H. Wilson Tang
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Sonia Garg
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Barry H. Trachtenberg
- Houston Methodist DeBakey Heart and Vascular Center, J.C. Walter Jr. Transplant Center, Houston TX
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, VA
| | - Salpy V. Pamboukian
- University of Alabama, Birmingham, AL during study conduct, current affiliation, University of Washington, Seattle, WA
| | - Nancy K. Sweitzer
- Sarver Heart Center, University of Arizona, Tucson, AZ during study conduct, current affiliation, Washington University, St. Louis, MO
| | - Matthew T. Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA
| | - Jane E. Wilcox
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Stuart Katz
- New York University Langone Medical Center, New York, NY
| | - Stephen Pan
- New York University Langone Medical Center, New York, NY
- current affiliation, Department of Cardiology, Westchester Medical Center & New York Medical College, Valhalla, NY
| | - Javier Jimenez
- Miami Cardiac & Vascular Institute, Baptist Health South, Miami, FL
| | - Frank Smart
- Louisiana State University Health Sciences Center, New Orleans, LA
| | - Jessica Wang
- University of California Los Angeles Medical Center, Los Angeles, CA
| | | | | | | | - Gordon S. Huggins
- Cardiology Division, Tufts Medical Center and Tufts University School of Medicine, Boston, MA
| | - Daniel D. Kinnamon
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Hanyu Ni
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Ray E. Hershberger
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
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Jordan E, Kinnamon DD, Haas GJ, Hofmeyer M, Kransdorf E, Ewald GA, Morris AA, Owens A, Lowes B, Stoller D, Tang WHW, Garg S, Trachtenberg BH, Shah P, Pamboukian SV, Sweitzer NK, Wheeler MT, Wilcox JE, Katz S, Pan S, Jimenez J, Fishbein DP, Smart F, Wang J, Gottlieb SS, Judge DP, Moore CK, Mead JO, Hurst N, Cao J, Huggins GS, Cowan J, Ni H, Rehm HL, Jarvik GP, Vatta M, Burke W, Hershberger RE. Genetic Architecture of Dilated Cardiomyopathy in Individuals of African and European Ancestry. JAMA 2023; 330:432-441. [PMID: 37526719 PMCID: PMC10394581 DOI: 10.1001/jama.2023.11970] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/13/2023] [Indexed: 08/02/2023]
Abstract
Importance Black patients with dilated cardiomyopathy (DCM) have increased familial risk and worse outcomes than White patients, but most DCM genetic data are from White patients. Objective To compare the rare variant genetic architecture of DCM by genomic ancestry within a diverse population of patients with DCM. Design Cross-sectional study enrolling patients with DCM who self-identified as non-Hispanic Black, Hispanic, or non-Hispanic White from June 7, 2016, to March 15, 2020, at 25 US advanced heart failure programs. Variants in 36 DCM genes were adjudicated as pathogenic, likely pathogenic, or of uncertain significance. Exposure Presence of DCM. Main Outcomes and Measures Variants in DCM genes classified as pathogenic/likely pathogenic/uncertain significance and clinically actionable (pathogenic/likely pathogenic). Results A total of 505, 667, and 26 patients with DCM of predominantly African, European, or Native American genomic ancestry, respectively, were included. Compared with patients of European ancestry, a lower percentage of patients of African ancestry had clinically actionable variants (8.2% [95% CI, 5.2%-11.1%] vs 25.5% [95% CI, 21.3%-29.6%]), reflecting the lower odds of a clinically actionable variant for those with any pathogenic variant/likely pathogenic variant/variant of uncertain significance (odds ratio, 0.25 [95% CI, 0.17-0.37]). On average, patients of African ancestry had fewer clinically actionable variants in TTN (difference, -0.09 [95% CI, -0.14 to -0.05]) and other genes with predicted loss of function as a disease-causing mechanism (difference, -0.06 [95% CI, -0.11 to -0.02]). However, the number of pathogenic variants/likely pathogenic variants/variants of uncertain significance was more comparable between ancestry groups (difference, -0.07 [95% CI, -0.22 to 0.09]) due to a larger number of non-TTN non-predicted loss of function variants of uncertain significance, mostly missense, in patients of African ancestry (difference, 0.15 [95% CI, 0.00-0.30]). Published clinical case-based evidence supporting pathogenicity was less available for variants found only in patients of African ancestry (P < .001). Conclusion and Relevance Patients of African ancestry with DCM were less likely to have clinically actionable variants in DCM genes than those of European ancestry due to differences in genetic architecture and a lack of representation of African ancestry in clinical data sets.
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Affiliation(s)
- Elizabeth Jordan
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Daniel D. Kinnamon
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Garrie J. Haas
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus
| | - Mark Hofmeyer
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, DC
| | - Evan Kransdorf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Anjali Owens
- Center for Inherited Cardiovascular Disease, Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Brian Lowes
- University of Nebraska Medical Center, Omaha
| | | | | | - Sonia Garg
- University of Texas Southwestern Medical Center, Dallas
| | - Barry H. Trachtenberg
- Houston Methodist DeBakey Heart and Vascular Center, J. C. Walter Jr Transplant Center, Houston, Texas
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | - Nancy K. Sweitzer
- Sarver Heart Center, University of Arizona, Tucson
- Now with Washington University, St Louis, Missouri
| | - Matthew T. Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Jane E. Wilcox
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stuart Katz
- New York University Langone Medical Center, New York, New York
| | - Stephen Pan
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla
| | - Javier Jimenez
- Miami Cardiac and Vascular Institute, Baptist Health South, Miami, Florida
| | | | - Frank Smart
- Louisiana State University Health Sciences Center, New Orleans
| | - Jessica Wang
- University of California Los Angeles Medical Center, Los Angeles
| | | | | | | | - Jonathan O. Mead
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Natalie Hurst
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Jinwen Cao
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Gordon S. Huggins
- Cardiology Division, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
| | - Jason Cowan
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Hanyu Ni
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
| | - Heidi L. Rehm
- Center for Genomic Medicine, Massachusetts General Hospital, Boston
| | - Gail P. Jarvik
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle
- Department of Genome Sciences, University of Washington, Seattle
| | - Matteo Vatta
- Departments of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle
| | - Ray E. Hershberger
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus
- Davis Heart and Lung Research Institute, The Ohio State University, Columbus
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus
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Kimani RW. Racism, colonialism and the implications for nursing scholarship: A discussion paper. J Adv Nurs 2023; 79:1745-1753. [PMID: 36882970 PMCID: PMC10389119 DOI: 10.1111/jan.15634] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/23/2023] [Accepted: 02/23/2023] [Indexed: 03/09/2023]
Abstract
AIM A critical discussion of the intersections between racism and colonialism as social determinants of health and explore how these discriminatory ideologies shape nursing inquiry. DESIGN Discussion paper. DATA SOURCES A review of pertinent discourse on racism and colonialism in nursing from 2000 to 2022. IMPLICATIONS FOR NURSING The failure to address health inequity plaguing racialized and marginalized populations locally and globally affects all groups, as illustrated in the COVID-19 pandemic. Racism and colonialism are inextricably linked, creating potent forces that influence nursing scholarship and adversely affect the health of a culturally and racially diverse society. Power differentials exist within and between countries creating structural challenges that lead to inequitable distribution of resources and othering. Nursing cannot be abstracted from the sociopolitical context in which it exists. There have been calls to address the social drivers that influence the health of the communities. More still needs to be done to support an antiracist agenda and decolonize nursing. CONCLUSION Nurses, as the largest healthcare workforce, can be critical in addressing health disparities. However, nurses have failed to eliminate racism within their ranks, and essentialism ideology has been normalized. A multidimensional approach that includes interventions aimed at nursing education, direct patient care, community health, nursing organizations and policy is needed to address problematic nursing discourse rooted in colonialism and racism ideologies. Since knowledge generated from scholarship informs nursing education, practice and policy, it is imperative to implement antiracist policies that eliminate racist assumptions and practices from nursing scholarship. NO PATIENT OR PUBLIC CONTRIBUTION The paper is a discursive paper using pertinent nursing literature. IMPACT For nursing to attain its potential as a leader in healthcare, standards of scientific vigour should be embedded within history, culture and politics. Recommendations are provided on possible strategies to identify, confront and abolish racism and colonialism in nursing scholarship.
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Affiliation(s)
- Rachel Wangari Kimani
- Laboratory of the Neurogenetics of Language, Rockefeller University, New York, New York, USA
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Miller EG, Young JL, Rao A, Ward-Lev E, Halley MC. Demographic Characteristics Associated With Perceptions of Personal Utility in Genetic and Genomic Testing: A Systematic Review. JAMA Netw Open 2023; 6:e2310367. [PMID: 37145601 PMCID: PMC10163389 DOI: 10.1001/jamanetworkopen.2023.10367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/14/2023] [Indexed: 05/06/2023] Open
Abstract
Importance The expansion of genetic and genomic testing in health care has led to recognition that these tests provide personal as well as clinical utility to patients and families. However, available systematic reviews on this topic have not reported the demographic backgrounds of participants in studies of personal utility, leaving generalizability unclear. Objective To determine the demographic characteristics of participants in studies examining the personal utility of genetic and genomic testing in health care. Evidence Review For this systematic review, we utilized and updated the results of a highly cited 2017 systematic review on the personal utility of genetics and genomics, which identified relevant articles published between January 1, 2003, and August 4, 2016. We also used the original methods to update this bibliography with literature published subsequently up to January 1, 2022. Studies were screened for eligibility by 2 independent reviewers. Eligible studies reported empirical data on the perspectives of patients, family members, and/or the general public in the US on the personal utility of any type of health-related genetic or genomic test. We utilized a standardized codebook to extract study and participant characteristics. We summarized demographic characteristics descriptively across all studies and by subgroup based on study and participant characteristics. Findings We included 52 studies with 13 251 eligible participants. Sex or gender was the most frequently reported demographic characteristic (48 studies [92.3%]), followed by race and ethnicity (40 studies [76.9%]), education (38 studies [73.1%]), and income (26 studies [50.0%]). Across studies, participants disproportionately were women or female (mean [SD], 70.8% [20.5%]), were White (mean [SD], 76.1% [22.0%]), had a college degree or higher (mean [SD], 64.5% [19.9%]), and reported income above the US median (mean [SD], 67.4% [19.2%]). Examination of subgroups of results by study and participant characteristics evidenced only small shifts in demographic characteristics. Conclusions and Relevance This systematic review examined the demographic characteristics of individual participants in studies of the personal utility of health-related genetic and genomic testing in the US. The results suggest that participants in these studies were disproportionately White, college-educated women with above-average income. Understanding the perspectives of more diverse individuals regarding the personal utility of genetic and genomic testing may inform barriers to research recruitment and uptake of clinical testing in currently underrepresented populations.
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Affiliation(s)
- Emily G. Miller
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California
| | - Jennifer L. Young
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anoushka Rao
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California
| | - Eliana Ward-Lev
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California
| | - Meghan C. Halley
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California
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10
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Kinnamon DD, Jordan E, Haas GJ, Hofmeyer M, Kransdorf E, Ewald GA, Morris AA, Owens A, Lowes B, Stoller D, Tang WHW, Garg S, Trachtenberg BH, Shah P, Pamboukian SV, Sweitzer NK, Wheeler MT, Wilcox JE, Katz S, Pan S, Jimenez J, Aaronson KD, Fishbein DP, Smart F, Wang J, Gottlieb SS, Judge DP, Moore CK, Mead JO, Huggins GS, Ni H, Burke W, Hershberger RE. Effectiveness of the Family Heart Talk Communication Tool in Improving Family Member Screening for Dilated Cardiomyopathy: Results of a Randomized Trial. Circulation 2023; 147:1281-1290. [PMID: 36938756 PMCID: PMC10133091 DOI: 10.1161/circulationaha.122.062507] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/15/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Managing disease risk among first-degree relatives of probands diagnosed with a heritable disease is central to precision medicine. A critical component is often clinical screening, which is particularly important for conditions like dilated cardiomyopathy (DCM) that remain asymptomatic until severe disease develops. Nonetheless, probands are frequently ill-equipped to disseminate genetic risk information that motivates at-risk relatives to complete recommended clinical screening. An easily implemented remedy for this key issue has been elusive. METHODS The DCM Precision Medicine Study developed Family Heart Talk, a booklet designed to help probands with DCM communicate genetic risk and the need for cardiovascular screening to their relatives. The effectiveness of the Family Heart Talk booklet in increasing cardiovascular clinical screening uptake among first-degree relatives was assessed in a multicenter, open-label, cluster-randomized, controlled trial. The primary outcome measured in eligible first-degree relatives was completion of screening initiated within 12 months after proband enrollment. Because probands randomized to the intervention received the booklet at the enrollment visit, eligible first-degree relatives were limited to those who were alive the day after proband enrollment and not enrolled on the same day as the proband. RESULTS Between June 2016 and March 2020, 1241 probands were randomized (1:1) to receive Family Heart Talk (n=621) or not (n=620) within strata defined by site and self-identified race/ethnicity (non-Hispanic Black, non-Hispanic White, or Hispanic). Final analyses included 550 families (n=2230 eligible first-degree relatives) in the Family Heart Talk arm and 561 (n=2416) in the control arm. A higher percentage of eligible first-degree relatives completed screening in the Family Heart Talk arm (19.5% versus 16.0%), and the odds of screening completion among these first-degree relatives were higher in the Family Heart Talk arm after adjustment for proband randomization stratum, sex, and age quartile (odds ratio, 1.30 [1-sided 95% CI, 1.08-∞]). A prespecified subgroup analysis did not find evidence of heterogeneity in the adjusted intervention odds ratio across race/ethnicity strata (P=0.90). CONCLUSIONS Family Heart Talk, a booklet that can be provided to patients with DCM by clinicians with minimal additional time investment, was effective in increasing cardiovascular clinical screening among first-degree relatives of these patients. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03037632.
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Affiliation(s)
- Daniel D. Kinnamon
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
| | - Elizabeth Jordan
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
| | - Garrie J. Haas
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Mark Hofmeyer
- Medstar Research Institute, Washington Hospital Center, Washington, DC
| | - Evan Kransdorf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | - Anjali Owens
- Center for Inherited Cardiovascular Disease, Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Brian Lowes
- University of Nebraska Medical Center, Omaha, NE
| | | | - W. H. Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Sonia Garg
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Barry H. Trachtenberg
- Houston Methodist DeBakey Heart and Vascular Center, J.C. Walter Jr. Transplant Center, Houston TX
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, VA
| | - Salpy V. Pamboukian
- University of Alabama, Birmingham, AL; current address, University of Washington, Seattle, WA
| | - Nancy K. Sweitzer
- Sarver Heart Center, University of Arizona, Tucson, AZ; current address, Division of Cardiology, Washington University, St. Louis, MO
| | - Matthew T. Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA
| | - Jane E. Wilcox
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Stuart Katz
- New York University Langone Medical Center, New York, NY
| | - Stephen Pan
- Department of Cardiology, Westchester Medical Center & New York Medical College, Valhalla, NY
| | - Javier Jimenez
- Miami Cardiac & Vascular Institute, Baptist Health South, Miami, FL
| | | | | | - Frank Smart
- Louisiana State University Health Sciences Center, New Orleans, LA
| | - Jessica Wang
- University of California Los Angeles Medical Center, Los Angeles, CA
| | | | | | | | - Jonathan O. Mead
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
| | - Gordon S. Huggins
- Cardiology Division, Tufts Medical Center and Tufts University School of Medicine, Boston, MA
| | - Hanyu Ni
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle, WA
| | - Ray E. Hershberger
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University, Columbus, OH
- The Davis Heart and Lung Research Institute, The Ohio State University, Columbus, OH
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH
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11
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Cho MK, Duque Lasio ML, Amarillo I, Mintz KT, Bennett RL, Brothers KB. Words matter: The language of difference in human genetics. Genet Med 2023; 25:100343. [PMID: 36524987 PMCID: PMC9991958 DOI: 10.1016/j.gim.2022.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
Diversity, equity, and inclusion efforts in academia are leading publishers and journals to re-examine their use of terminology for commonly used scientific variables. This reassessment of language is particularly important for human genetics, which is focused on identifying and explaining differences between individuals and populations. Recent guidance on the use of terms and symbols in clinical practice, research, and publications is beginning to acknowledge the ways that language and concepts of difference can be not only inaccurate but also harmful. To stop perpetuating historical wrongs, those of us who conduct and publish genetic research and provide genetic health care must understand the context of the terms we use and why some usages should be discontinued. In this article, we summarize critiques of terminology describing disability, sex, gender, race, ethnicity, and ancestry in research publications, laboratory reports, diagnostic codes, and pedigrees. We also highlight recommendations for alternative language that aims to make genetics more inclusive, rigorous, and ethically sound. Even though norms of acceptable language use are ever changing, it is the responsibility of genetics professionals to uncover biases ingrained in professional practice and training and to continually reassess the words we use to describe human difference because they cause harm to patients.
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Affiliation(s)
- Mildred K Cho
- Stanford Center for Biomedical Ethics, Stanford University, Stanford, CA; Departments of Medicine and Pediatrics, Stanford University, Stanford, CA.
| | - Maria Laura Duque Lasio
- Division of Genetics & Genomic Medicine, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO; Division of Laboratory and Genomic Medicine, Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Ina Amarillo
- Department of Pathology and Laboratory Medicine, Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA
| | - Kevin Todd Mintz
- Stanford Center for Biomedical Ethics, Stanford University, Stanford, CA
| | - Robin L Bennett
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA
| | - Kyle B Brothers
- Norton Children's Research Institute Affiliated with the University of Louisville, Louisville, KY
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12
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Trinidad MG, Ryan KA, Krenz CD, Roberts JS, McGuire AL, De Vries R, Zikmund-Fisher BJ, Kardia S, Marsh E, Forman J, Kent M, Wilborn D, Spector-Bagdady K. "Extremely slow and capricious": A qualitative exploration of genetic researcher priorities in selecting shared data resources. Genet Med 2023; 25:115-124. [PMID: 36371759 PMCID: PMC9843821 DOI: 10.1016/j.gim.2022.09.003] [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: 04/14/2022] [Revised: 09/04/2022] [Accepted: 09/06/2022] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Genetic researchers' selection of a database can have scientific, regulatory, and ethical implications. It is important to understand what is driving database selection such that database stewards can be responsive to user needs while balancing the interests of communities in equitably benefiting from advances. METHODS We conducted 23 semistructured interviews with US academic genetic researchers working with private, government, and collaboratory data stewards to explore factors that they consider when selecting a genetic database. RESULTS Interviewees used existing databases to avoid burdens of primary data collection, which was described as expensive and time-consuming. They highlighted ease of access as the most important selection factor, integrating concepts of familiarity and efficiency. Data features, such as size and available phenotype, were also important. Demographic diversity was not originally cited by any interviewee as a pivotal factor; when probed, most stated that the option to consider diversity in database selection was limited. Database features, including integrity, harmonization, and storage were also described as key components of efficient use. CONCLUSION There is a growing market and competition between genetic data stewards. Data need to be accessible, harmonized, and administratively supported for their existence to be translated into use and, in turn, result in scientific advancements across diverse communities.
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Affiliation(s)
- M Grace Trinidad
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Kerry A Ryan
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Chris D Krenz
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - J Scott Roberts
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX
| | - Raymond De Vries
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI; Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI; Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Brian J Zikmund-Fisher
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI
| | - Sharon Kardia
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Erica Marsh
- Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Jane Forman
- VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Madison Kent
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | | | - Kayte Spector-Bagdady
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI; Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, MI.
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13
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Cerdeña JP, Grubbs V, Non AL. Racialising genetic risk: assumptions, realities, and recommendations. Lancet 2022; 400:2147-2154. [PMID: 36502852 DOI: 10.1016/s0140-6736(22)02040-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 09/07/2022] [Accepted: 10/14/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Jessica P Cerdeña
- Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Anthropology, University of Connecticut, Storrs, CT, USA
| | - Vanessa Grubbs
- Department of Ambulatory and Preventive Medicine, Alameda Health System, Oakland, CA, USA
| | - Amy L Non
- Department of Anthropology, University of California, San Diego, CA, USA.
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14
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Nelson SC, Gogarten SM, Fullerton SM, Isasi CR, Mitchell BD, North KE, Rich SS, Taylor MR, Zöllner S, Sofer T. Social and scientific motivations to move beyond groups in allele frequencies: The TOPMed experience. Am J Hum Genet 2022; 109:1582-1590. [PMID: 36055210 PMCID: PMC9502047 DOI: 10.1016/j.ajhg.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/05/2022] [Indexed: 11/29/2022] Open
Abstract
For the genomics community, allele frequencies within defined groups (or "strata") are useful across multiple research and clinical contexts. Benefits include allowing researchers to identify populations for replication or "look up" studies, enabling researchers to compare population-specific frequencies to validate findings, and facilitating assessment of variant pathogenicity in clinical contexts. However, there are potential concerns with stratified allele frequencies. These include potential re-identification (determining whether or not an individual participated in a given research study based on allele frequencies and individual-level genetic data), harm from associating stigmatizing variants with specific groups, potential reification of race as a biological rather than a socio-political category, and whether presenting stratified frequencies-and the downstream applications that this presentation enables-is consistent with participants' informed consents. The NHLBI Trans-Omics for Precision Medicine (TOPMed) program considered the scientific and social implications of different approaches for adding stratified frequencies to the TOPMed BRAVO (Browse All Variants Online) variant server. We recommend a novel approach of presenting ancestry-specific allele frequencies using a statistical method based upon local genetic ancestry inference. Notably, this approach does not require grouping individuals by either predominant global ancestry or race/ethnicity and, therefore, mitigates re-identification and other concerns as the mixture distribution of ancestral allele frequencies varies across the genome. Here we describe our considerations and approach, which can assist other genomics research programs facing similar issues of how to define and present stratified frequencies in publicly available variant databases.
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Affiliation(s)
- Sarah C. Nelson
- Department of Biostatistics, University of Washington, Seattle, WA 98195, USA,Corresponding author
| | | | - Stephanie M. Fullerton
- Department of Bioethics and Humanities, University of Washington, Seattle, WA 98195, USA
| | - Carmen R. Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Braxton D. Mitchell
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Kari E. North
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Stephen S. Rich
- Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - Matthew R.G. Taylor
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Sebastian Zöllner
- Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, USA,Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
| | - Tamar Sofer
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
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15
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Young JL, Halley MC, Anguiano B, Fernandez L, Bernstein JA, Wheeler MT, Tabor HK. Beyond race: Recruitment of diverse participants in clinical genomics research for rare disease. Front Genet 2022; 13:949422. [PMID: 36072659 PMCID: PMC9441547 DOI: 10.3389/fgene.2022.949422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: Despite recent attention to increasing diversity in clinical genomics research, researchers still struggle to recruit participants from varied sociodemographic backgrounds. We examined the experiences of parents from diverse backgrounds with enrolling their children in clinical genomics research on rare diseases. We explored the barriers and facilitators parents encountered and possible impacts of sociodemographic factors on their access to research.Methods: We utilized semi-structured interviews with parents of children participating in the Undiagnosed Diseases Network. Interview data were analyzed using comparative content analysis.Results: We interviewed 13 Hispanic, 11 non-Hispanic White, four Asian, and two biracial parents. Participants discussed different pathways to clinical genomics research for rare disease as well as how sociodemographic factors shaped families’ access. Themes focused on variation in: 1) reliance on providers to access research; 2) cultural norms around health communication; 3) the role of social capital in streamlining access; and 4) the importance of language-concordant research engagement.Conclusion: Our findings suggest that variables beyond race/ethnicity may influence access in clinical genomics research. Future efforts to diversify research participation should consider utilizing varied recruitment strategies to reach participants with diverse sociodemographic characteristics.
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Affiliation(s)
- Jennifer L. Young
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, United States
- Center for Genetic Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, United States
- *Correspondence: Jennifer L. Young,
| | - Meghan C. Halley
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, United States
| | - Beatriz Anguiano
- Human Genetics and Genetic Counseling, Stanford University School of Medicine, Stanford, CA, United States
| | - Liliana Fernandez
- Stanford Center for Undiagnosed Diseases, Stanford University, Stanford, CA, United States
| | - Jonathan A. Bernstein
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Matthew T. Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Holly K. Tabor
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, United States
- Department of Medicine, Stanford University, Stanford, CA, United States
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16
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Khan AT, Gogarten SM, McHugh CP, Stilp AM, Sofer T, Bowers ML, Wong Q, Cupples LA, Hidalgo B, Johnson AD, McDonald MLN, McGarvey ST, Taylor MR, Fullerton SM, Conomos MP, Nelson SC. Recommendations on the use and reporting of race, ethnicity, and ancestry in genetic research: Experiences from the NHLBI TOPMed program. CELL GENOMICS 2022; 2:100155. [PMID: 36119389 PMCID: PMC9481067 DOI: 10.1016/j.xgen.2022.100155] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
How race, ethnicity, and ancestry are used in genomic research has wide-ranging implications for how research is translated into clinical care and incorporated into public understanding. Correlation between race and genetic ancestry contributes to unresolved complexity for the scientific community, as illustrated by heterogeneous definitions and applications of these variables. Here, we offer commentary and recommendations on the use of race, ethnicity, and ancestry across the arc of genetic research, including data harmonization, analysis, and reporting. While informed by our experiences as researchers affiliated with the NHLBI Trans-Omics for Precision Medicine (TOPMed) program, these recommendations are applicable to basic and translational genomic research in diverse populations with genome-wide data. Moving forward, considerable collaborative effort will be required to ensure that race, ethnicity, and ancestry are described and used appropriately to generate scientific knowledge that yields broad and equitable benefit.
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Affiliation(s)
- Alyna T. Khan
- Department of Biostatistics, University of Washington, Seattle, WA, USA
- Institute for Public Health Genetics, University of Washington, Seattle, WA, USA
| | | | - Caitlin P. McHugh
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Adrienne M. Stilp
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Tamar Sofer
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, USA
| | - Michael L. Bowers
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Quenna Wong
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - L. Adrienne Cupples
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Bertha Hidalgo
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew D. Johnson
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, Framingham, MA, USA
- The Framingham Heart Study, Framingham, MA, USA
| | - Merry-Lynn N. McDonald
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephen T. McGarvey
- Department of Epidemiology and International Health Institute, Brown University School of Public Health, Providence, RI, USA
- Department of Anthropology, Brown University, Providence, RI, USA
| | - Matthew R.G. Taylor
- Department of Medicine, Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | | | - Sarah C. Nelson
- Department of Biostatistics, University of Washington, Seattle, WA, USA
- Institute for Public Health Genetics, University of Washington, Seattle, WA, USA
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17
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Kim HAJ, Zeng PYF, Sorgini A, Shaikh MH, Khan H, MacNeil D, Khan MI, Mendez A, Yoo J, Fung K, Lang P, Palma DA, Mymryk JS, Barrett JW, Patel KB, Boutros PC, Nichols AC. Tumor molecular differences associated with outcome disparities of Black patients with head and neck cancer. Head Neck 2022; 44:1124-1135. [PMID: 35187756 PMCID: PMC9047510 DOI: 10.1002/hed.27007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/11/2022] [Accepted: 02/08/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Numerous studies of head and neck squamous cell carcinoma (HNSCC) have demonstrated disparate outcomes by race and ethnicity. Beyond known associations with socioeconomic variables, whether these are also associated with differences in tumor molecular composition has thus far been poorly explored. METHODS We downloaded clinical and multiplatform molecular data from The Cancer Genome Atlas and other published studies. These were compared between non-Hispanic Black (n = 43) and White (n = 354) patients with non-HPV-related tumors, using multivariable models. Publicly available validation cohorts were used. RESULTS Black patients had poorer progression-free survival than White patients. Tumors of Black patients had greater copy number aberrations, and increased SFRP1 methylation and miRNA-mediated PRG4 silencing associated with poor survival. PI3K/AkT/mTOR pathway proteins were differentially expressed. CONCLUSIONS There are molecular differences between tumors of Black and White patients that may partially account for differences in survival. These may inform targeted treatment decisions to achieve equitable outcomes.
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Affiliation(s)
- Hugh A J Kim
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Peter Y F Zeng
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Alana Sorgini
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Mushfiq H Shaikh
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Halema Khan
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
- Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - Mohammed I Khan
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Adrian Mendez
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
- Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
- Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
- Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - Pencilla Lang
- Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - David A Palma
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
- Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - Joe S Mymryk
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
- Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
- Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - John W Barrett
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
- Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - Krupal B Patel
- Department of Otolaryngology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Paul C Boutros
- Department of Human Genetics, University of California, Los Angeles, California, USA
- Department of Urology, University of California, Los Angeles, California, USA
- Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California, Los Angeles, California, USA
- Institute for Precision Health, University of California, Los Angeles, California, USA
- Jonsson Comprehensive Cancer Centre, University of California, Los Angeles, California, USA
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
- Department of Oncology, University of Western Ontario, London, Ontario, Canada
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18
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Wicklund C, Sanghavi K, Coleman B, Johansen Taber K, Taylor JY, Asalone KC, Beachy S. Improving racial diversity in the genomics workforce: An examination of challenges and opportunities. Genet Med 2022; 24:1640-1643. [PMID: 35467533 DOI: 10.1016/j.gim.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Catherine Wicklund
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kunal Sanghavi
- The Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - Bernice Coleman
- Geri and Richard Brawerman Nursing Institute and Nursing Research Department, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Jacquelyn Y Taylor
- Center for Research on People of Color, Columbia University School of Nursing, New York, NY
| | - Kathryn C Asalone
- Health and Medicine Division, The National Academies of Science, Engineering, and Medicine, Washington, DC
| | - Sarah Beachy
- Health and Medicine Division, The National Academies of Science, Engineering, and Medicine, Washington, DC.
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19
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Krishnan N, Ingles J. The Need for Inclusive Genomic Research. Circ Genom Precis Med 2022; 15:e003736. [DOI: 10.1161/circgen.122.003736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Neesha Krishnan
- Centre for Population Genomics, Garvan Institute of Medical Research, Darlinghurst, Australia (N.K., J.I.)
- UNSW Sydney, Australia (N.K., J.I.)
- Centre for Population Genomics, Murdoch Children’s Research Institute, Melbourne, Australia (N.K., J.I.)
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research, Darlinghurst, Australia (N.K., J.I.)
- UNSW Sydney, Australia (N.K., J.I.)
- Centre for Population Genomics, Murdoch Children’s Research Institute, Melbourne, Australia (N.K., J.I.)
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia (J.I.)
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20
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Sanders JJ, Gray TF, Sihlongonyane B, Durieux BN, Graham L. A Framework for Anti-Racist Publication in Palliative Care: Structures, Processes, and Outcomes. J Pain Symptom Manage 2022; 63:e337-e343. [PMID: 34662725 DOI: 10.1016/j.jpainsymman.2021.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/22/2021] [Accepted: 10/02/2021] [Indexed: 11/20/2022]
Abstract
Systemic or structural racism describes an embedded pattern of explicit and implicit racial biases that, through policy and action, systematically confer advantage to white people and disadvantage Black, indigenous, and other people of color. Hospice and palliative care journals participate in this broader system of racial discrimination. Building on palliative care's explicit focus on patients' goals and values, which may in and of itself comprise a form of social justice in healthcare, palliative care journals and their publishers have an opportunity to lead others in cultivating anti-racist practices and explicitly promoting equity. The publication life cycle of submission and solicitation, manuscript peer-review, and publication provide a framework for examining the structures, processes, and outcomes by which palliative care and other journals might address systemic racism. We describe the current academic publishing landscape, which diminishes the voices and experiences of racial and ethnic minority patients and undermines the careers of under-represented scholars. We then propose reforms that we believe will improve publication equity and quality as well as healthcare outcomes. These include an Equity in Publication checklist, solicitation of manuscripts on equity-relevant topics, promotion of scholars through editorial structures and peer review processes, and a standard Equity Rating for publications. Greater efforts to include non-dominant voices in every aspect of publication, through appropriate recognition of their scholarship and remuneration for their efforts, will drive equity in health outcomes. By pursuing an anti-racist and equity-focused publishing agenda, hospice and palliative medicine journals and their publishers have an opportunity to transform healthcare.
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Affiliation(s)
- Justin J Sanders
- Department of Family Medicine (J.J.S.), Palliative Care McGill, McGill University, Montreal, Quebec, Canada.
| | - Tamryn F Gray
- Harvard Medical School (T.F.G.), Boston, MA; Department of Psychosocial Oncology and Palliative Care (T.F.G., B.N.D.), Dana-Farber Cancer Institute, Boston, MA
| | | | - Brigitte N Durieux
- Department of Psychosocial Oncology and Palliative Care (T.F.G., B.N.D.), Dana-Farber Cancer Institute, Boston, MA
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21
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Halley MC, Young JL, Fernandez L, Kohler JN, Bernstein JA, Wheeler MT, Tabor HK. Perceived utility and disutility of genomic sequencing for pediatric patients: Perspectives from parents with diverse sociodemographic characteristics. Am J Med Genet A 2022; 188:1088-1101. [PMID: 34981646 DOI: 10.1002/ajmg.a.62619] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/04/2021] [Accepted: 12/05/2021] [Indexed: 12/30/2022]
Abstract
Given the limited therapeutic options for most rare diseases diagnosed through genomic sequencing (GS) and the proportion of patients who remain undiagnosed even after GS, it is important to characterize a broader range of benefits and potential harms of GS from the perspectives of families with diverse sociodemographic characteristics. We recruited parents of children enrolled in the Undiagnosed Diseases Network. Parents completed an in-depth interview, and we conducted a comparative content analysis of the data. Parents (n = 30) were demographically diverse, with 43.3% identifying as Hispanic, 33.3% primarily Spanish-speaking, and widely variable household income and education. Parents reported minimal changes in their child's health status following GS but did report a range of other forms of perceived utility, including improvements in their child's healthcare management and access, in their own psychological well-being, and in disease-specific social connections and research opportunities. Parents who received a diagnosis more frequently perceived utility across all domains; however, disutility also was reported by both those with and without a diagnosis. Impacts depended on multiple mediating factors, including parents' underlying expectations and beliefs, family sociodemographic characteristics, individual disease characteristics, and prior healthcare access. Our study suggests that the perceived utility of GS varies widely among parents and may depend on multiple individual, sociodemographic, and contextual factors that are relevant for pre- and post-GS counseling, for value assessment of GS, and for policymaking related to access to new genomic technologies.
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Affiliation(s)
- Meghan C Halley
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA
| | - Jennifer L Young
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA
| | - Liliana Fernandez
- Stanford Center for Undiagnosed Diseases, Stanford University, Stanford, California, USA
| | - Jennefer N Kohler
- Stanford Center for Undiagnosed Diseases, Stanford University, Stanford, California, USA
| | | | - Jonathan A Bernstein
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Matthew T Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Holly K Tabor
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA.,Department of Medicine (and by courtesy, Department of Epidemiology), Stanford University, Stanford, California, USA
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22
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Byeon YJJ, Islamaj R, Yeganova L, Wilbur WJ, Lu Z, Brody LC, Bonham VL. Evolving use of ancestry, ethnicity, and race in genetics research-A survey spanning seven decades. Am J Hum Genet 2021; 108:2215-2223. [PMID: 34861173 PMCID: PMC8715140 DOI: 10.1016/j.ajhg.2021.10.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 10/20/2021] [Indexed: 12/11/2022] Open
Abstract
To inform continuous and rigorous reflection about the description of human populations in genomics research, this study investigates the historical and contemporary use of the terms "ancestry," "ethnicity," "race," and other population labels in The American Journal of Human Genetics from 1949 to 2018. We characterize these terms' frequency of use and assess their odds of co-occurrence with a set of social and genetic topical terms. Throughout The Journal's 70-year history, "ancestry" and "ethnicity" have increased in use, appearing in 33% and 26% of articles in 2009-2018, while the use of "race" has decreased, occurring in 4% of articles in 2009-2018. Although its overall use has declined, the odds of "race" appearing in the presence of "ethnicity" has increased relative to the odds of occurring in its absence. Forms of population descriptors "Caucasian" and "Negro" have largely disappeared from The Journal (<1% of articles in 2009-2018). Conversely, the continental labels "African," "Asian," and "European" have increased in use and appear in 18%, 14%, and 42% of articles from 2009-2018, respectively. Decreasing uses of the terms "race," "Caucasian," and "Negro" are indicative of a transition away from the field's history of explicitly biological race science; at the same time, the increasing use of "ancestry," "ethnicity," and continental labels should serve to motivate ongoing reflection as the terminology used to describe genetic variation continues to evolve.
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Affiliation(s)
- Yen Ji Julia Byeon
- Department of Sociology, Princeton University, Princeton, NJ 08544, USA; Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Rezarta Islamaj
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD 20894, USA
| | - Lana Yeganova
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD 20894, USA
| | - W John Wilbur
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD 20894, USA
| | - Zhiyong Lu
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD 20894, USA
| | - Lawrence C Brody
- Division of Genomics and Society, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Vence L Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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23
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Ray M, Heinsberg LW, Conley YP, Roberts JM, Jeyabalan A, Hubel CA, Weeks DE, Schmella MJ. An exploratory study of white blood cell proportions across preeclamptic and normotensive pregnancy by self-identified race in individuals with overweight or obesity. Hypertens Pregnancy 2021; 40:312-321. [PMID: 34697971 DOI: 10.1080/10641955.2021.1987453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective: Examine white blood cell (WBC) proportions across preeclamptic (n = 28 cases) and normotensive (n = 28 controls) pregnancy in individuals with overweight/obesity.Methods: WBC proportions were inferred from genome-wide DNA methylation data and compared by case/control status and self-identified race.Results: In Trimester 1, ean B cell proportions were suggestively lower in cases in the overall sample and significantly lower in White participants but not in Black participants. More significant WBC proportion changes were observed across normotensive than preeclamptic pregnancy.Conclusions: These findings in a small sample demonstrate need for additional studies investigating the relationship between self-identified race and WBCs in pregnancy.
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Affiliation(s)
- Mitali Ray
- Department of Health Promotion and Development, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lacey W Heinsberg
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Division of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yvette P Conley
- Department of Health Promotion and Development, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James M Roberts
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Obstetrics, Gynecology, & Reproductive Sciences, University of Pittsburgh, Pittsburgh, USA.,Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA.,Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Global Pregnancy Collaboration, Pittsburgh, Pennsylvania, USA
| | - Arun Jeyabalan
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Obstetrics, Gynecology, & Reproductive Sciences, University of Pittsburgh, Pittsburgh, USA.,Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA.,Global Pregnancy Collaboration, Pittsburgh, Pennsylvania, USA
| | - Carl A Hubel
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of Pittsburgh, Pittsburgh, USA.,Magee-Womens Research Institute, Pittsburgh, Pennsylvania, USA.,Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel E Weeks
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mandy J Schmella
- Department of Health Promotion and Development, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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24
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Thomas SP, Amini K, Floyd KJ, Willard R, Wossenseged F, Keller M, Scott JB, Abdallah KE, Buscetta A, Bonham VL. Cultivating diversity as an ethos with an anti-racism approach in the scientific enterprise. HGG ADVANCES 2021; 2:100052. [PMID: 35047843 PMCID: PMC8756537 DOI: 10.1016/j.xhgg.2021.100052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The diversity of the U.S. population is currently not reflected in the genomic workforce and across the greater scientific enterprise. Although diversity and inclusion efforts have focused on increasing the number of individuals from underrepresented groups across scientific fields, structural racism remains. Thus, the cultivation and adoption of diversity as an ethos requires shifting our focus to being intentional about an institution’s character, culture, and climate. One way for this ethos to be sustained is by facilitating an intentional anti-racism approach within the field. Adopting a new perspective on diversity utilizing an anti-racism approach will support genomics researchers as we build supportive, collaborative research environments. We seek to expand critical thought in the framing of diversity in the research enterprise and propose an anti-racism approach that informs deliberate actions required to address structural racism.
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Affiliation(s)
- Shameka P Thomas
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Kiana Amini
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - K Jameson Floyd
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Rachele Willard
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Faeben Wossenseged
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Madison Keller
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jamil B Scott
- Office of the Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Khadijah E Abdallah
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ashley Buscetta
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Vence L Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
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25
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Gregg AR, Aarabi M, Klugman S, Leach NT, Bashford MT, Goldwaser T, Chen E, Sparks TN, Reddi HV, Rajkovic A, Dungan JS. Screening for autosomal recessive and X-linked conditions during pregnancy and preconception: a practice resource of the American College of Medical Genetics and Genomics (ACMG). Genet Med 2021; 23:1793-1806. [PMID: 34285390 PMCID: PMC8488021 DOI: 10.1038/s41436-021-01203-z] [Citation(s) in RCA: 122] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 11/09/2022] Open
Abstract
Carrier screening began 50 years ago with screening for conditions that have a high prevalence in defined racial/ethnic groups (e.g., Tay-Sachs disease in the Ashkenazi Jewish population; sickle cell disease in Black individuals). Cystic fibrosis was the first medical condition for which panethnic screening was recommended, followed by spinal muscular atrophy. Next-generation sequencing allows low cost and high throughput identification of sequence variants across many genes simultaneously. Since the phrase "expanded carrier screening" is nonspecific, there is a need to define carrier screening processes in a way that will allow equitable opportunity for patients to learn their reproductive risks using next-generation sequencing technology. An improved understanding of this risk allows patients to make informed reproductive decisions. Reproductive decision making is the established metric for clinical utility of population-based carrier screening. Furthermore, standardization of the screening approach will facilitate testing consistency. This practice resource reviews the current status of carrier screening, provides answers to some of the emerging questions, and recommends a consistent and equitable approach for offering carrier screening to all individuals during pregnancy or preconception.
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Affiliation(s)
- Anthony R Gregg
- Department of Obstetrics and Gynecology, Prisma Health, Columbia, SC, USA
| | - Mahmoud Aarabi
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Genetics Program, North York General Hospital, Toronto, ON, Canada
| | - Susan Klugman
- Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Michael T Bashford
- Department of Obstetrics, Gynecology, and Reproductive Science, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Tamar Goldwaser
- Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, New York, NY, USA
- Mount Sinai Hospital, New York, NY, USA
| | - Emily Chen
- Department of Genetics, Kaiser Permanente Medical Center, San Francisco, CA, USA
| | - Teresa N Sparks
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, CA, USA
- Institute of Human Genetics, University of California, San Francisco, CA, USA
| | - Honey V Reddi
- Department of Pathology and Laboratory Medicine and Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Genomic Sciences and Precision Medicine Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aleksandar Rajkovic
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, CA, USA
- Institute of Human Genetics, University of California, San Francisco, CA, USA
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Jeffrey S Dungan
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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26
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Gutierrez AM, Robinson JO, Outram SM, Smith HS, Kraft SA, Donohue KE, Biesecker BB, Brothers KB, Chen F, Hailu B, Hindorff LA, Hoban H, Hsu RL, Knight SJ, Koenig BA, Lewis KL, Lich KH, O’Daniel JM, Okuyama S, Tomlinson GE, Waltz M, Wilfond BS, Ackerman SL, Majumder MA. Examining access to care in clinical genomic research and medicine: Experiences from the CSER Consortium. J Clin Transl Sci 2021; 5:e193. [PMID: 34888063 PMCID: PMC8634302 DOI: 10.1017/cts.2021.855] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/30/2021] [Accepted: 09/06/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Ensuring equitable access to health care is a widely agreed-upon goal in medicine, yet access to care is a multidimensional concept that is difficult to measure. Although frameworks exist to evaluate access to care generally, the concept of "access to genomic medicine" is largely unexplored and a clear framework for studying and addressing major dimensions is lacking. METHODS Comprised of seven clinical genomic research projects, the Clinical Sequencing Evidence-Generating Research consortium (CSER) presented opportunities to examine access to genomic medicine across diverse contexts. CSER emphasized engaging historically underrepresented and/or underserved populations. We used descriptive analysis of CSER participant survey data and qualitative case studies to explore anticipated and encountered access barriers and interventions to address them. RESULTS CSER's enrolled population was largely lower income and racially and ethnically diverse, with many Spanish-preferring individuals. In surveys, less than a fifth (18.7%) of participants reported experiencing barriers to care. However, CSER project case studies revealed a more nuanced picture that highlighted the blurred boundary between access to genomic research and clinical care. Drawing on insights from CSER, we build on an existing framework to characterize the concept and dimensions of access to genomic medicine along with associated measures and improvement strategies. CONCLUSIONS Our findings support adopting a broad conceptualization of access to care encompassing multiple dimensions, using mixed methods to study access issues, and investing in innovative improvement strategies. This conceptualization may inform clinical translation of other cutting-edge technologies and contribute to the promotion of equitable, effective, and efficient access to genomic medicine.
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Affiliation(s)
- Amanda M. Gutierrez
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Jill O. Robinson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Simon M. Outram
- Program in Bioethics, University of California, San Francisco, San Francisco, CA, USA
| | - Hadley S. Smith
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Stephanie A. Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Katherine E. Donohue
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Barbara B. Biesecker
- RTI International, GenOmics, BiOinformatics and Translational Science, Washington DC, USA
| | - Kyle B. Brothers
- Department of Pediatrics, University of Louisville, Louisville, KY, USA
| | - Flavia Chen
- Program in Bioethics, University of California, San Francisco, San Francisco, CA, USA
- Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA
| | - Benyam Hailu
- National Institute of Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Lucia A. Hindorff
- Division of Genomic Medicine, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Hannah Hoban
- Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA
| | - Rebecca L. Hsu
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Sara J. Knight
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Katie L. Lewis
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Julianne M. O’Daniel
- Department of Genetics, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Sonia Okuyama
- Division of Hematology-Oncology, Denver Health and Hospital Authority, Denver, CO, USA
| | - Gail E. Tomlinson
- Division of Hematology-Oncology, Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
- Greehey Children’s Cancer Research Institute, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Margaret Waltz
- Department of Social Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Benjamin S. Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Sara L. Ackerman
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Mary A. Majumder
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
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27
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Opportunities and pitfalls of social media research in rare genetic diseases: a systematic review. Genet Med 2021; 23:2250-2259. [PMID: 34282302 DOI: 10.1038/s41436-021-01273-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Social media may be particularly valuable in research in rare genetic diseases because of the low numbers of patients and the rare disease community's robust online presence. The goal of this systematic review was to understand how social media is currently used in rare disease research and the characteristics of the participants in these studies. METHODS We conducted a systematic review of six databases to identify studies published in English between January 2004 and November 2020, of which 120 met inclusion criteria. RESULTS Most studies were observational (n = 114, 95.0%) and cross-sectional (n = 107, 89.2%), and more than half (n = 69, 57.5%) utilized only surveys. Only 101 rare diseases were included across all studies. Participant demographics, when reported, were predominantly female (70.1% ± 22.5%) and white (85.0% ± 11.0%) adult patients and caregivers. CONCLUSION Despite its potential benefits in rare disease research, the use of social media is still methodologically limited and the participants reached may not be representative of the rare disease population by gender, race, age, or rare disease type. As scholars explore using social media for rare disease research, careful attention should be paid to representativeness when studying this diverse patient community.
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28
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Vasilopoulou C, Wingfield B, Morris AP, Duddy W. snpQT: flexible, reproducible, and comprehensive quality control and imputation of genomic data. F1000Res 2021; 10:567. [PMID: 34900230 PMCID: PMC8637247 DOI: 10.12688/f1000research.53821.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/20/2022] Open
Abstract
Quality control of genomic data is an essential but complicated multi-step procedure, often requiring separate installation and expert familiarity with a combination of different bioinformatics tools. Software incompatibilities, and inconsistencies across computing environments, are recurrent challenges, leading to poor reproducibility. Existing semi-automated or automated solutions lack comprehensive quality checks, flexible workflow architecture, and user control. To address these challenges, we have developed snpQT: a scalable, stand-alone software pipeline using nextflow and BioContainers, for comprehensive, reproducible and interactive quality control of human genomic data. snpQT offers some 36 discrete quality filters or correction steps in a complete standardised pipeline, producing graphical reports to demonstrate the state of data before and after each quality control procedure. This includes human genome build conversion, population stratification against data from the 1,000 Genomes Project, automated population outlier removal, and built-in imputation with its own pre- and post- quality controls. Common input formats are used, and a synthetic dataset and comprehensive online tutorial are provided for testing, educational purposes, and demonstration. The snpQT pipeline is designed to run with minimal user input and coding experience; quality control steps are implemented with numerous user-modifiable thresholds, and workflows can be flexibly combined in custom combinations. snpQT is open source and freely available at https://github.com/nebfield/snpQT. A comprehensive online tutorial and installation guide is provided through to GWAS (https://snpqt.readthedocs.io/en/latest/), introducing snpQT using a synthetic demonstration dataset and a real-world Amyotrophic Lateral Sclerosis SNP-array dataset.
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Affiliation(s)
- Christina Vasilopoulou
- Northern Ireland Centre for Stratified Medicine, University of Ulster, Derry/Londonderry, BT47 6SB, UK
| | - Benjamin Wingfield
- Centre for Personalised Medicine, University of Ulster, Derry/Londonderry, BT47 6SB, UK
| | - Andrew P. Morris
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - William Duddy
- Northern Ireland Centre for Stratified Medicine, University of Ulster, Derry/Londonderry, BT47 6SB, UK
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DiNucci A, Henrikson NB, Jonas MC, Basra S, Blasi P, Brown J, Esplin ED, Hassen D, Hao J, Hu Y, Klinger T, Ladd I, Leppig K, Lewis M, Meyer M, Ney S, Ramaprasan A, Romagnoli K, Salvati Z, Scrol A, Schwiter R, Sheridan L, Somasundaram B, Suwannarat P, Wagner JK, Rahm AK. Feasibility and Assessment of a Cascade Traceback Screening Program (FACTS): Protocol for a Multisite Study to Implement and Assess an Ovarian Cancer Traceback Cascade Testing Program. J Pers Med 2021; 11:543. [PMID: 34208188 PMCID: PMC8230764 DOI: 10.3390/jpm11060543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/06/2021] [Accepted: 06/08/2021] [Indexed: 12/02/2022] Open
Abstract
Ovarian cancer (OVCA) patients may carry genes conferring cancer risk to biological family; however, fewer than one-quarter of patients receive genetic testing. "Traceback" cascade testing -outreach to potential probands and relatives-is a possible solution. This paper outlines a funded study (U01 CA240747-01A1) seeking to determine a Traceback program's feasibility, acceptability, effectiveness, and costs. This is a multisite prospective observational feasibility study across three integrated health systems. Informed by the Conceptual Model for Implementation Research, we will outline, implement, and evaluate the outcomes of an OVCA Traceback program. We will use standard legal research methodology to review genetic privacy statutes; engage key stakeholders in qualitative interviews to design communication strategies; employ descriptive statistics and regression analyses to evaluate the site differences in genetic testing and the OVCA Traceback testing; and assess program outcomes at the proband, family member, provider, system, and population levels. This study aims to determine a Traceback program's feasibility and acceptability in a real-world context. It will account for the myriad factors affecting implementation, including legal issues, organizational- and individual-level barriers and facilitators, communication issues, and program costs. Project results will inform how health care providers and systems can develop effective, practical, and sustainable Traceback programs.
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Affiliation(s)
- Anna DiNucci
- Mid-Atlantic Permanente Research Institute, 2101 E. Jefferson St, Rockville, MD 20852, USA; (A.D.); (M.C.J.); (S.B.); (J.B.); (B.S.); (P.S.)
| | - Nora B. Henrikson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101, USA; (N.B.H.); (P.B.); (K.L.); (A.R.); (A.S.); (L.S.)
| | - M. Cabell Jonas
- Mid-Atlantic Permanente Research Institute, 2101 E. Jefferson St, Rockville, MD 20852, USA; (A.D.); (M.C.J.); (S.B.); (J.B.); (B.S.); (P.S.)
| | - Sundeep Basra
- Mid-Atlantic Permanente Research Institute, 2101 E. Jefferson St, Rockville, MD 20852, USA; (A.D.); (M.C.J.); (S.B.); (J.B.); (B.S.); (P.S.)
| | - Paula Blasi
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101, USA; (N.B.H.); (P.B.); (K.L.); (A.R.); (A.S.); (L.S.)
| | - Jennifer Brown
- Mid-Atlantic Permanente Research Institute, 2101 E. Jefferson St, Rockville, MD 20852, USA; (A.D.); (M.C.J.); (S.B.); (J.B.); (B.S.); (P.S.)
| | - Edward D. Esplin
- Invitae Corporation, 1400 16th St, San Francisco, CA 94103, USA;
| | - Dina Hassen
- Geisinger Department of Population Health Sciences, 100 N. Academy Ave, Danville, PA 17822, USA; (D.H.); (Y.H.)
| | - Jing Hao
- Geisinger Department of Epidemiology and Health Services Research, 100 N. Academy Ave, Danville, PA 17822, USA;
| | - Yirui Hu
- Geisinger Department of Population Health Sciences, 100 N. Academy Ave, Danville, PA 17822, USA; (D.H.); (Y.H.)
| | - Tracey Klinger
- Geisinger Genomic Medicine Institute, 100 N. Academy Ave, Danville, PA 17822, USA; (T.K.); (I.L.); (M.L.); (S.N.); (K.R.); (Z.S.); (R.S.)
| | - Ilene Ladd
- Geisinger Genomic Medicine Institute, 100 N. Academy Ave, Danville, PA 17822, USA; (T.K.); (I.L.); (M.L.); (S.N.); (K.R.); (Z.S.); (R.S.)
| | - Kathleen Leppig
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101, USA; (N.B.H.); (P.B.); (K.L.); (A.R.); (A.S.); (L.S.)
| | - Meredith Lewis
- Geisinger Genomic Medicine Institute, 100 N. Academy Ave, Danville, PA 17822, USA; (T.K.); (I.L.); (M.L.); (S.N.); (K.R.); (Z.S.); (R.S.)
| | - Michelle Meyer
- Geisinger, Center for Translational Bioethics & Health Care Policy, 100 N. Academy Ave, Danville, PA 17822, USA; (M.M.); (J.K.W.)
| | - Steven Ney
- Geisinger Genomic Medicine Institute, 100 N. Academy Ave, Danville, PA 17822, USA; (T.K.); (I.L.); (M.L.); (S.N.); (K.R.); (Z.S.); (R.S.)
| | - Arvind Ramaprasan
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101, USA; (N.B.H.); (P.B.); (K.L.); (A.R.); (A.S.); (L.S.)
| | - Katrina Romagnoli
- Geisinger Genomic Medicine Institute, 100 N. Academy Ave, Danville, PA 17822, USA; (T.K.); (I.L.); (M.L.); (S.N.); (K.R.); (Z.S.); (R.S.)
| | - Zachary Salvati
- Geisinger Genomic Medicine Institute, 100 N. Academy Ave, Danville, PA 17822, USA; (T.K.); (I.L.); (M.L.); (S.N.); (K.R.); (Z.S.); (R.S.)
| | - Aaron Scrol
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101, USA; (N.B.H.); (P.B.); (K.L.); (A.R.); (A.S.); (L.S.)
| | - Rachel Schwiter
- Geisinger Genomic Medicine Institute, 100 N. Academy Ave, Danville, PA 17822, USA; (T.K.); (I.L.); (M.L.); (S.N.); (K.R.); (Z.S.); (R.S.)
| | - Leigh Sheridan
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101, USA; (N.B.H.); (P.B.); (K.L.); (A.R.); (A.S.); (L.S.)
| | - Brinda Somasundaram
- Mid-Atlantic Permanente Research Institute, 2101 E. Jefferson St, Rockville, MD 20852, USA; (A.D.); (M.C.J.); (S.B.); (J.B.); (B.S.); (P.S.)
| | - Pim Suwannarat
- Mid-Atlantic Permanente Research Institute, 2101 E. Jefferson St, Rockville, MD 20852, USA; (A.D.); (M.C.J.); (S.B.); (J.B.); (B.S.); (P.S.)
| | - Jennifer K. Wagner
- Geisinger, Center for Translational Bioethics & Health Care Policy, 100 N. Academy Ave, Danville, PA 17822, USA; (M.M.); (J.K.W.)
| | - Alanna K. Rahm
- Geisinger Genomic Medicine Institute, 100 N. Academy Ave, Danville, PA 17822, USA; (T.K.); (I.L.); (M.L.); (S.N.); (K.R.); (Z.S.); (R.S.)
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