genomic research

基因组研究
  • 文章类型: Journal Article
    JH和蜕皮激素信号通过主转录因子调节昆虫变态,Krüppel同源物1(kr-h1),广义复合体(BR-C),E93蜕皮激素信号激活连续表达的蜕皮激素反应转录因子(ERTF),ERTF之间的相互作用决定了ERTF本身的表达谱。通过构建家蚕多种组织的表达序列标签(EST)数据库,在游荡开始后3天(W3),在翼盘cDNA文库中鉴定出大量角质蛋白(CP)基因的存在。从基因组分析来看,鉴定了12种类型的CP基因的CP簇。CP基因的DNA序列揭示了CP基因的重复,这表明了昆虫的进化。这些CP基因对蜕皮激素和蜕皮激素脉冲有反应;因此,CP基因用于分析ERTF的转录调控。据报道,在几种昆虫中,ERTF的结合位点存在于CP基因的上游,通过与ERTFs的结合发生CP基因的激活。通过分析,推测如下;ERTF的连续出现和靶基因的激活导致连续产生的CP和角质层。ERTF和CP基因表达的序列在幼虫向p和p向成虫转化时相同。还阐明了几个ERTF在一个CP基因表达中的参与;BmorCPG12属于在W3显示表达峰的组,并受两个ERTF调节;BHR3和βFTZ-F1,BmorCPH2属于在P0显示表达峰的组,并受两个ERTF调节;βFTZ-F1和E74A。发现BHR39作为CP基因表达的负调节因子。幼虫,蛹,和成人的角质层应该是由不同和相似类型的CP组合构成的,通过CP基因的表达时间。
    JH and ecdysone signaling regulate insect metamorphosis through the master transcription factors, Krüppel homolog 1 (kr-h1), Broad-Complex (BR-C), and E93. Ecdysone signaling activates successively expressed ecdysone responsive transcription factors (ERTFs), and the interaction between ERTFs determines the expression profiles of ERTFs themselves. Through the construction of expressed sequence tag (EST) database of Bombyx mori from many tissues, the existence of a large number of cuticular protein (CP) genes was identified in wing disc cDNA library of the 3 days after the start of wandering (W3). From the genomic analysis, 12 types of CP clusters of CP genes were identified. DNA sequences of CP genes revealed the duplication of CP genes, which suggests to reflect the insect evolution. These CP genes responded to ecdysone and ecdysone pulse; therefore, CP genes were applied for the analysis of transcriptional regulation by ERTF. The binding sites of ERTF have been reported to exist upstream of CP genes in several insects, and the activation of CP genes occurred by the binding of ERTFs. Through the analysis, the following were speculated; the successive appearance of ERTFs and the activation of target genes resulted in the successively produced CPs and cuticular layer. The sequence of the ERTF and CP gene expression was the same at larval to pupal and pupal to adult transformation. The involvement of several ERTFs in one CP gene expression was also clarified; BmorCPG12 belongs to group showing expression peak at W3 and was regulated by two ERTFs; BHR3 and ßFTZ-F1, BmorCPH2 belongs to group showing expression peak at P0 and was regulated by two ERTFs; ßFTZ-F1 and E74A. The involvement of BHR39 as a negative regulator of CP gene expression was found. Larval, pupal, and adult cuticular layers were supposed to be constructed by the combination of different and similar types of CPs, through the expressed timing of CP genes.
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  • 文章类型: Journal Article
    收集和共享基因组数据以推进健康研究的举措正在广泛和加速。这些努力中的商业利益,虽然至关重要,可能会侵蚀公众的信任和提供个人基因组数据的意愿,这些举措所依赖的。在商业参与的背景下,了解公众对为健康研究提供基因组数据的态度至关重要。PRISMA对六个在线学术数据库的指导搜索使用与公众对管理层商业行为者的态度有关的主要数据,确定了113项定量和定性研究。收藏,access,以及生物样本库和基因组数据的使用。商业利益的存在产生了围绕同意的相互关联的公众担忧,隐私和数据安全,信任科学和科学家,利益共享,以及健康数据的所有权和控制权。因此,需要仔细考虑监管和数据治理以及访问政策,以保持公众对基因组健康计划的信任和支持。
    Initiatives that collect and share genomic data to advance health research are widespread and accelerating. Commercial interests in these efforts, while vital, may erode public trust and willingness to provide personal genomic data, upon which these initiatives depend. Understanding public attitudes towards providing genomic data for health research in the context of commercial involvement is critical. A PRISMA-guided search of six online academic databases identified 113 quantitative and qualitative studies using primary data pertaining to public attitudes towards commercial actors in the management, collection, access, and use of biobank and genomic data. The presence of commercial interests yields interrelated public concerns around consent, privacy and data security, trust in science and scientists, benefit sharing, and the ownership and control of health data. Carefully considered regulatory and data governance and access policies are therefore required to maintain public trust and support for genomic health initiatives.
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  • 文章类型: Journal Article
    在儿科肿瘤学中尚未很好地描述基因组测序(GS)和由此产生的建议。GS结果可能提供癌症易感性综合征(CPS)诊断,需要进行癌症治疗以外的筛查和专科就诊。包括检测或监测家庭成员。TexasKidsCanSeq(KCS)研究评估了GS在不同儿科肿瘤人群中的应用。我们进行了半结构化访谈(n=20),以探索KCS患者家属在学习CPS诊断和跟进推荐护理方面的经验。我们使用定性内容分析来开发跨家庭的主题和子主题,描述他们获得护理的经历,并了解哪些因素带来了障碍和/或促进者。我们发现参与者很难区分他们的孩子目前的癌症治疗与CPS的后续护理建议。在获得CPS后续护理的家庭中,组织因素至关重要:旅行时间和距离是常见的困难,虽然协调护理以简化与不同提供者的多次预约有助于促进CPS护理。财务因素也影响了家庭获得与CPS相关的后续护理的机会:获得经济援助和保险是家庭的便利,虽然成本和缺乏保险是在从儿科护理过渡到成人护理期间失去保险的患者的障碍,以及没有保险的成年家庭成员。与信仰和观念有关的因素,特别是认为风险对他们来说不那么突出,并且对患者的癌症护理感到不知所措,主要为家庭成员提供后续护理的障碍。关于社会因素,相互竞争的生活重点使家庭难以获得后续护理,虽然有社区的支持缓解了这些障碍。我们建议采取干预措施,以改善癌症治疗和CPS相关护理的协调,并遵守儿童年龄家庭的监测方案。例如护理导航员和将纵向遗传咨询整合到遗传性癌症中心。
    Access to genomic sequencing (GS) and resulting recommendations have not been well described in pediatric oncology. GS results may provide a cancer predisposition syndrome (CPS) diagnosis that warrants screening and specialist visits beyond cancer treatment, including testing or surveillance for family members. The Texas KidsCanSeq (KCS) Study evaluated implementation of GS in a diverse pediatric oncology population. We conducted semi-structured interviews (n = 20) to explore experiences of KCS patients\' families around learning about a CPS diagnosis and following up on recommended care. We used qualitative content analysis to develop themes and subthemes across families\' descriptions of their experiences accessing care and to understand which factors presented barriers and/or facilitators. We found participants had difficulty differentiating which follow-up care recommendations were made for their child\'s current cancer treatment versus the CPS. In families\' access to follow-up care for CPS, organizational factors were crucial: travel time and distance were common hardships, while coordination of care to streamline multiple appointments with different providers helped facilitate CPS care. Financial factors also impacted families\' access to CPS-related follow-up care: having financial assistance and insurance were facilitators for families, while costs and lack of insurance posed as barriers for patients who lost coverage during transitions from pediatric to adult care, and for adult family members who had no coverage. Factors related to beliefs and perceptions, specifically perceiving the risk as less salient to them and feeling overwhelmed with the patient\'s cancer care, presented barriers to follow-up care primarily for family members. Regarding social factors, competing life priorities made it difficult for families to access follow-up care, though having community support alleviated these barriers. We suggest interventions to improve coordination of cancer treatment and CPS-related care and adherence to surveillance protocols for families as children age, such as care navigators and integrating longitudinal genetic counseling into hereditary cancer centers.
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  • 文章类型: Journal Article
    UNASSIGNED: Indigenous Peoples are increasingly exerting governance and oversight over genomic research with citizens of their nations, raising questions about how best to enforce research regulation between American Indian, Alaska Native, and Native Hawaiian peoples and researchers.
    UNASSIGNED: Using a community-engaged research approach, we conducted 42 semi-structured interviews with Tribal leaders, clinicians, researchers, policy makers, and Tribal research review board members about their perspectives on ethical issues related to genetics research with Indigenous Peoples in the US.
    UNASSIGNED: We report findings related to (1) considerations for Indigenous governance, (2) institutional relationships upholding sovereignty, (3) expectations for research approvals, and (4) agreements enacting Indigenous governance. Participants described concerns about different ways of exerting oversight, relationships and agreements between Indigenous Peoples and researchers, and gaps that need to be addressed to strengthen existing governance of genomic data.
    UNASSIGNED: The results will ultimately guide policy-making and development of new strategies for Indigenous Peoples to enforce oversight in research to promote ethically and culturally appropriate research.
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  • 文章类型: Review
    背景:生物库和基因组研究需要从研究参与者收集和储存人体组织。从非洲背景下的参与者的角度来看,由于包括神话和对研究人员的不信任在内的无数因素,这可能与恐惧和疑虑有关。从研究人员的角度来看,道德困境可能会出现,尤其是在存储过程中的同意和样品重复使用。本文的目的是探讨在非洲建立和进行生物样本和基因组研究时的这些伦理考虑。
    方法:在对九(9)个数据库和灰色文献进行全面搜索之后,我们进行了叙述性综合。所有主要研究研究设计都有资格纳入,以及来自同行评审期刊的定量和定性证据。最长为20年(2000-2020年)。它专注于在非洲进行的研究工作,即使数据是在该地区以外存储或分析的。
    结果:筛选的2,663份标题和摘要,检索并审查了94篇全文的资格。我们纳入了12项研究(7项定性;4项定量和1项混合方法)。这些论文中描述的与社区知识以及对生物样本和基因组研究的理解有关的道德问题,regulation,以及研究伦理委员会的治理,参与者的注册,知情同意的类型,数据收集,storage,使用和共享以及材料转移,返回结果和利益共享。CA.生物样本的收集和存储是信任的,参与者希望对生成的数据和结果保密。由于对研究人员的信任,大多数参与者对广泛的同意感到满意,尽管一些人希望在未来的研究中得到联系以进行重新研究,这将取决于新研究是否有正当理由。在某些情况下,与外部合作伙伴共享数据是受欢迎的,但一些研究参与者不信任外国研究人员。
    结论:生物样本和基因组研究在非洲是一个真正的需要。与此相关的是与建立和参与生物库以及数据存储有关的道德考虑,export,使用和分享。关于广泛同意作为适当的同意模式的可接受性,已经形成或预先存在共识,非洲人需要在国际合作研究中发挥带头作用,通过深思熟虑的努力来建立本地存储和分析样本的能力,并采用样本收集和使用流程,以建立社区和潜在研究参与者的信任。研究伦理委员会,研究人员和社区需要共同努力,共同适应和使用明确定义的道德框架,指导方针,和政策文件,以协调非洲生物样本库和基因组研究的建立和运行。
    Biobanking and genomic research requires collection and storage of human tissue from study participants. From participants\' perspectives within the African context, this can be associated with fears and misgivings due to a myriad of factors including myths and mistrust of researchers. From the researchers angle ethical dilemmas may arise especially with consenting and sample reuse during storage. The aim of this paper was to explore these ethical considerations in the establishment and conduct of biobanking and genomic studies in Africa.
    We conducted a narrative synthesis following a comprehensive search of nine (9) databases and grey literature. All primary research study designs were eligible for inclusion as well as both quantitative and qualitative evidence from peer reviewed journals, spanning a maximum of 20 years (2000-2020). It focused on research work conducted in Africa, even if data was stored or analysed outside the region.
    Of 2,663 title and abstracts screened, 94 full texts were retrieved and reviewed for eligibility. We included 12 studies (7 qualitative; 4 quantitative and one mixed methods). Ethical issues described in these papers related to community knowledge and understanding of biobanking and genomic research, regulation, and governance of same by research ethics committees, enrolment of participants, types of informed consents, data collection, storage, usage and sharing as well as material transfer, returning results and benefit sharing. ca. Biospecimen collection and storage is given in trust and participants expect confidentially of data and results generated. Most participants are comfortable with broad consent due to trust in researchers, though a few would like to be contacted for reconsenting in future studies, and this would depend on whether the new research is for good cause. Sharing data with external partners is welcome in some contexts but some research participants did not trust foreign researchers.
    Biobanking and genomic studies are a real need in Africa. Linked to this are ethical considerations related to setting up and participation in biobanks as well as data storage, export, use and sharing. There is emerging or pre-existing consensus around the acceptability of broad consent as a suitable model of consent, the need for Africans to take the lead in international collaborative studies, with deliberate efforts to build capacity in local storage and analysis of samples and employ processes of sample collection and use that build trust of communities and potential study participants. Research ethics committees, researchers and communities need to work together to work together to adapt and use clearly defined ethical frameworks, guidelines, and policy documents to harmonize the establishment and running of biobanking and genomic research in Africa.
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  • 文章类型: Journal Article
    在欧盟和美国,遗传数据被认为是需要加强隐私保护的特殊数据类别。可识别性和敏感性是两个司法管辖区监管框架的核心支柱:隐私问题源于遗传数据能够识别个人并揭示有关他们的敏感信息的假设。但并非所有的基因数据都是可识别和敏感的,遗传数据在这些问题上也不一定与其他类型的大数据不同。本文认为,需要一种更细致的方法来评估使用遗传数据对隐私利益的威胁。所涉及的隐私利益应根据拟议的用途加以区分,有问题的数据量,以及它的独特性和信息内容。当这些因素被分解时,很明显,通过更多地关注遗传数据的使用方式,而不是它们作为特殊数据类别的地位,这两种监管方案都可以更好地实现其目标。
    In both the EU and USA, genetic data are recognized as a special category of data that requires heightened privacy protection. Identifiability and sensitivity are central pillars of the regulatory framework in both jurisdictions: the privacy concerns stem from the assumption that genetic data are capable of identifying the individual and reveals sensitive information about them. But not all genetic data are identifiable and sensitive, nor are genetic data necessarily different from other types of big data in terms of these issues. This article argues that a more nuanced approach is needed to assess the threat to privacy interests posed by uses of genetic data. The privacy interests involved should be distinguished in terms of proposed use, the amount of data in question, and its uniqueness and informational content. When these factors are disaggregated, it is clear that both regulatory schemes could better achieve their goals by focusing more on the ways genetic data can be used rather than on their status as a special category of data.
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  • 文章类型: Journal Article
    在研究的背景下,对群体和第三方的伤害和风险可能是巨大的,特别是在涉及基因组的以数据为中心的研究中,人工智能,和/或机器学习技术。本文探讨了是否以及如何调整美国联邦法规,以更好地与当前的道德思维保持一致并保护群体利益。关于团体利益,共同规则的三个方面值得关注和重新考虑:机构审查委员会(IRB)对研究风险/收益的评估;知情同意过程中的披露要求;以及放弃知情同意的标准。根据对个人和社区的尊重,调查人员和IRB在设计和审查方案时应系统地考虑潜在的群体伤害,分别。研究参与者应被告知同意过程中任何潜在的群体伤害。我们呼吁进行更多的公开讨论,实证研究,并对这些问题进行规范分析,确定正确的监管和政策路径。
    Harms and risks to groups and third-parties can be significant in the context of research, particularly in data-centric studies involving genomic, artificial intelligence, and/or machine learning technologies. This article explores whether and how United States federal regulations should be adapted to better align with current ethical thinking and protect group interests. Three aspects of the Common Rule deserve attention and reconsideration with respect to group interests: institutional review board (IRB) assessment of the risks/benefits of research; disclosure requirements in the informed consent process; and criteria for waivers of informed consent. In accordance with respect for persons and communities, investigators and IRBs should systematically consider potential group harm when designing and reviewing protocols, respectively. Research participants should be informed about any potential group harm in the consent process. We call for additional public discussion, empirical research, and normative analysis on these issues to determine the right regulatory and policy path forward.
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  • 文章类型: Journal Article
    尽管有大量的学术研究研究围绕人类基因组学研究的伦理问题,人们对它在马来西亚的地位知之甚少。这项研究旨在探索当地研究人员和研究伦理委员会(REC)成员在马来西亚开发它的经验。2021年4月至5月进行了深入访谈,并对数据进行了主题分析。在推进这项技术的过程中,基因组学研究人员和REC成员都对这项研究在该国的发展方式感到担忧,尤其是在国家一级缺乏明确的伦理和监管框架作为指导。然而,这项研究认为,这不是一个突出的问题,因为有国际准则存在,研究人员和RECs都将受益于有关准则的培训,以确保基因组学研究能够以伦理方式发展.
    Even though there is a significant amount of scholarly work examining the ethical issues surrounding human genomics research, little is known about its footing in Malaysia. This study aims to explore the experience of local researchers and research ethics committee (REC) members in developing it in Malaysia. In-depth interviews were conducted from April to May 2021, and the data were thematically analysed. In advancing this technology, both genomics researchers and REC members have concerns over how this research is being developed in the country especially the absence of a clear ethical and regulatory framework at the national level as a guidance. However, this study argues that it is not a salient issue as there are international guidelines in existence and both researchers and RECs will benefit from a training on the guidelines to ensure genomics research can be developed in an ethical manner.
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  • 文章类型: Journal Article
    背景:精神病学基因组研究是非洲一个不断发展的研究领域,正在研究精神疾病的表观遗传学;其中一个特别关注的焦点是神经发育障碍,包括智力障碍(ID)。进行此类研究对于确定病因和可能的干预措施或进一步研究的领域很重要。然而,一般来说,基因组研究,和精神病学基因组研究,面对许多社会,伦理,文化,和法律问题;涉及有身份证的人的研究尤其具有挑战性。所有研究利益相关者-研究人员,研究审查机构,监管者,患者群体-通常同意,涉及具有身份证的人需要考虑几个因素,包括额外的保护。人们还认识到,不让有身份证的人参与与他们相关的研究意味着错过了学习包括生活经验在内的特定问题的机会。在这次范围审查中,我们旨在从现有文献中描述与智障人士参与基因组研究有关的伦理和社会文化问题的范围。方法:此范围审查将根据JoannaBriggs研究所的范围审查指南进行,并使用PRISMA-ScR指南进行报告。迭代审查阶段将包括系统搜索六个数据库(Embase,Ovid全球健康,PubMed,Scopus,PsycInfo和WebofScience核心集合),筛选,数据的图表和综合。还将对最终审查中包含的文章进行正向和反向引用筛选。我们将包括同行评审的期刊文章,指导文件和报告。根据资格标准筛选和选择研究将由三名审稿人独立完成;冲突将通过与第三名审稿人和其他专家的讨论来解决。结果:结果将包含在范围审查出版物中。结论:本次范围界定审查将确定伦理紧张的关键领域和可能的解决方案,并为实证伦理研究提供机会。
    Background: Psychiatric genomic research is a growing field of research in Africa that is looking at epigenetics of psychiatric disorders; within which a specific focus is neurodevelopmental disorders including intellectual disability (ID). Conducting this type of research is important to identify etiologies and possible interventions or areas for further research. However, genomic research generally, and psychiatric genomic research, faces many social, ethical, cultural, and legal issues; research involving people with ID is particularly challenging. All research stakeholders - researchers, research review bodies, regulators, patient groups - generally agree that involving people with ID require several considerations, including extra protection. It is also recognized that not involving people with ID in research that is relevant to them means that opportunities to learn on specific issues including lived experiences are missed. In this scoping review, we aim to describe the range of ethical and social-cultural issues concerning involvement of people with intellectual disability in genomic research from existing literature. Methods: This scoping review will be conducted based on the Joanna Briggs Institute guidance for scoping review and reported using the PRISMA-ScR guidelines. Iterative review stages will include systematic search of six databases (Embase, Ovid Global Health, PubMed, Scopus, PsycInfo and Web of Science core collection), screening, charting and synthesis of the data. Forward and backward citation screening will also be done for the articles included in the final review. We will include peer reviewed journal articles, guidance documents and reports. Screening and selection of studies based on the eligibility criteria will be done independently by three reviewers; conflicts will be resolved through discussion with a third reviewer and other experts. Results: The results will be included in the scoping review publication. Conclusions: This scoping review will identify key areas of ethical tensions and possible solutions and inform opportunities for empirical ethics studies.
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  • 文章类型: Journal Article
    由于种族原因,文化,语言边缘化,一些人群在临床和研究环境中经历了不成比例的遗传检测障碍.由于电子健康记录(EHR)中的非包容性自我报告的种族和种族类别,因此很难跟踪这种差异。所有人群的包容和获取对于实现健康公平和捕获所有罕见遗传疾病至关重要。
    我们的目标是创建修订的种族和民族类别。此外,我们确定了三个队列中的种族和族裔代表性不足:(1)一般波士顿儿童医院患者人群(一般BCH),(2)接受临床基因组检测(临床测序)的BCH患者群体,(3)儿童罕见疾病队列(CRDC)研究倡议参与者。
    种族和种族数据是从一般BCH的EHR收集的,临床测序,和CRDC队列。我们构建了一套完整的种族和种族类别。基于EHR的种族和种族变量在每个队列中映射到修订的类别。然后,在队列中比较了每个修订后的种族和种族类别中的患者人数.
    黑人或非裔美国人/非洲人的比例明显较低,CRDC队列中的非西班牙裔/非拉丁裔个体与一般BCH队列相比,但CRDC和临床测序队列之间没有统计学上的显著差异.多种族的比例明显较低,CRDC队列中的西班牙裔/拉丁裔个体比临床测序队列。白色,与其他两组相比,非西班牙裔/非拉丁裔个体在CRDC中的比例过高.
    我们强调,与普通医院人群相比,某些种族和族裔人群在测序队列中的代表性不足。我们提出了一系列措施来解决这些差距,争取公平的未来精准医疗为基础的临床护理和整个罕见疾病社区的利益。
    普通诊所中的种族和种族代表,提供基因检测的诊所,波士顿儿童医院的基因组研究背景:那些被认为属于历史上被排除在主流文化之外的种族或民族的个体,政治,和经济活动(“历史上被边缘化”)经历了临床护理的障碍。对于受到罕见遗传条件影响的家庭来说,这些障碍更加复杂。障碍可以表现为无障碍问题(交通,金融,语言),低质量的医疗服务,或不充分纳入研究。重要的是在罕见疾病研究中具有代表性,以便了解这些疾病的全部范围,为所有人提供更好的病人护理,以及健康公平。目标:我们旨在(1)为电子健康记录(EHR)创建新的和包容性的种族和种族类别,以及(2)确定在波士顿儿童医院(一般BCH)常见的患者之间的种族和种族代表性差异。那些在波士顿儿童医院的诊所接受基因检测(临床测序)的人,以及在波士顿儿童医院(CRDC)参加CRDC研究项目的参与者。设计和方法:我们结合了种族和种族类别,以做出比现有EHR类别更具包容性的选择。在观察三个不同的患者组时,观察到种族和种族代表性的差异(一般BCH,临床测序,和CRDC)。结果:我们观察到自我认同为黑人或非裔美国人/非洲人的比例较低,基因检测组(研究和临床)的非西班牙裔/非拉丁裔比一般BCH组。自我认同为多种族的人,与其他两组相比,西班牙裔/拉丁人在CRDC研究中的代表性也不足。在所有组中看到的最高人口百分比是那些被识别为白人的患者,非西班牙裔/非拉丁裔。与其他两个人相比,该组在CRDC研究组中的人数过多。结论:我们的研究发现,与白人相比,历史上被边缘化的患者在临床基因检测和基因组研究中的代表性不足。为了使所有患有罕见遗传疾病的患者受益,这些差异必须通过改善与专科医师/研究人员的接触并在EHR中纳入包容性语言来解决,诊所,和研究协议。
    UNASSIGNED: Due to racial, cultural, and linguistic marginalization, some populations experience disproportionate barriers to genetic testing in both clinical and research settings. It is difficult to track such disparities due to non-inclusive self-reported race and ethnicity categories within the electronic health record (EHR). Inclusion and access for all populations is critical to achieve health equity and to capture the full spectrum of rare genetic disease.
    UNASSIGNED: We aimed to create revised race and ethnicity categories. Additionally, we identified racial and ethnic under-representation amongst three cohorts: (1) the general Boston Children\'s Hospital patient population (general BCH), (2) the BCH patient population that underwent clinical genomic testing (clinical sequencing), and (3) Children\'s Rare Disease Cohort (CRDC) research initiative participants.
    UNASSIGNED: Race and ethnicity data were collected from the EHRs of the general BCH, clinical sequencing, and CRDC cohorts. We constructed a single comprehensive set of race and ethnicity categories. EHR-based race and ethnicity variables were mapped within each cohort to the revised categories. Then, the numbers of patients within each revised race and ethnicity category were compared across cohorts.
    UNASSIGNED: There was a significantly lower percentage of Black or African American/African, non-Hispanic/non-Latine individuals in the CRDC cohort compared with the general BCH cohort, but there was no statistically significant difference between the CRDC and the clinical sequencing cohorts. There was a significantly lower percentage of multi-racial, Hispanic/Latine individuals in the CRDC cohort than the clinical sequencing cohort. White, non-Hispanic/non-Latine individuals were over-represented in the CRDC compared to the two other groups.
    UNASSIGNED: We highlight underrepresentation of certain racial and ethnic populations in sequencing cohorts compared to the general hospital population. We propose a range of measures to address these disparities, to strive for equitable future precision medicine-based clinical care and for the benefit of the whole rare disease community.
    Racial and ethnic representation amongst general clinics, clinics that provide genetic testing, and genomic-based research at Boston Children’s Hospital Background: Individuals who identify as belonging to a race or ethnicity that has been historically excluded from mainstream cultural, political, and economic activities (‘historically marginalized’) experience barriers to clinical care. These barriers are further complicated for families touched by rare genetic conditions. Obstacles can present as accessibility issues (transportation, financial, linguistic), low-quality medical care, or inadequate inclusion in research. It is important to have representation within rare disease research so that the full scope of these conditions is understood, leading to better patient care for all, and for health equity. Objective: We aimed to (1) to create new and inclusive race and ethnicity categories for the electronic health record (EHR) and (2) identify differences in racial and ethnic representation amongst patients generally seen at Boston Children’s Hospital (general BCH), those who received genetic testing in a clinic at Boston Children’s Hospital (clinical sequencing), and participants who enrolled in the CRDC research project at Boston Children’s Hospital (CRDC). Design and Methods: We combined race and ethnicity categories to make more inclusive options than existing EHR categories. Differences in race and ethnicity representation were observed when looking at the three different patient groups (general BCH, clinical sequencing, and CRDC). Results: We observed a lower percentage of individuals who self-identify as Black or African American/African, non-Hispanic/non-Latine in the genetic testing groups (both research and clinical) than in the general BCH group. Individuals who self-identify as multi-racial, Hispanic/Latine are also under-represented in the CRDC research compared to the two other groups. The highest population percentage seen in all groups was that of patients who identify as White, non-Hispanic/non-Latine. This group was over-represented in the research CRDC group compared to the two others. Conclusion: Our study found that patients who are historically marginalized are underrepresented in clinical genetic testing and genomic research studies compared to their White counterparts. In order to benefit all patients with rare genetic conditions, these differences must be addressed by improving access to specialty physicians/researchers and incorporating inclusive language in the EHR, clinics, and research protocols.
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