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Lynch F, Best S, Gaff C, Downie L, Archibald AD, Gyngell C, Goranitis I, Peters R, Savulescu J, Lunke S, Stark Z, Vears DF. Australian Public Perspectives on Genomic Newborn Screening: Risks, Benefits, and Preferences for Implementation. Int J Neonatal Screen 2024; 10:6. [PMID: 38248635 PMCID: PMC10801595 DOI: 10.3390/ijns10010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/14/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
Recent dramatic reductions in the timeframe in which genomic sequencing can deliver results means its application in time-sensitive screening programs such as newborn screening (NBS) is becoming a reality. As genomic NBS (gNBS) programs are developed around the world, there is an increasing need to address the ethical and social issues that such initiatives raise. This study therefore aimed to explore the Australian public's perspectives and values regarding key gNBS characteristics and preferences for service delivery. We recruited English-speaking members of the Australian public over 18 years of age via social media; 75 people aged 23-72 participated in 1 of 15 focus groups. Participants were generally supportive of introducing genomic sequencing into newborn screening, with several stating that the adoption of such revolutionary and beneficial technology was a moral obligation. Participants consistently highlighted receiving an early diagnosis as the leading benefit, which was frequently linked to the potential for early treatment and intervention, or access to other forms of assistance, such as peer support. Informing parents about the test during pregnancy was considered important. This study provides insights into the Australian public's views and preferences to inform the delivery of a gNBS program in the Australian context.
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Affiliation(s)
- Fiona Lynch
- Biomedical Ethics Research Group, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (F.L.); (C.G.); (J.S.)
- Melbourne Law School, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Stephanie Best
- Sir Peter MacCallum Cancer Centre Department of Oncology, University of Melbourne, Melbourne, VIC 3052, Australia;
- Australian Genomics, Melbourne, VIC 3052, Australia; (I.G.); (Z.S.)
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC 3052, Australia
| | - Clara Gaff
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (C.G.); (L.D.); (A.D.A.)
- Melbourne Genomics, Melbourne, VIC 3052, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Lilian Downie
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (C.G.); (L.D.); (A.D.A.)
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3052, Australia
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia;
| | - Alison D. Archibald
- Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (C.G.); (L.D.); (A.D.A.)
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3052, Australia
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia;
| | - Christopher Gyngell
- Biomedical Ethics Research Group, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (F.L.); (C.G.); (J.S.)
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Ilias Goranitis
- Australian Genomics, Melbourne, VIC 3052, Australia; (I.G.); (Z.S.)
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3052, Australia;
| | - Riccarda Peters
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3052, Australia;
| | - Julian Savulescu
- Biomedical Ethics Research Group, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (F.L.); (C.G.); (J.S.)
- Melbourne Law School, The University of Melbourne, Melbourne, VIC 3052, Australia
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Sebastian Lunke
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia;
- Department of Pathology, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Zornitza Stark
- Australian Genomics, Melbourne, VIC 3052, Australia; (I.G.); (Z.S.)
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3052, Australia
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia;
| | - Danya F. Vears
- Biomedical Ethics Research Group, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (F.L.); (C.G.); (J.S.)
- Melbourne Law School, The University of Melbourne, Melbourne, VIC 3052, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3052, Australia
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium
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Tu SJ, Wei YJ, Chen BT, Zhang XF, Luo C, Dong BQ. Effects of a false-positive result in newborn congenital hypothyroidism screening on parents in Guangxi, China. Front Pediatr 2023; 11:1134923. [PMID: 37252042 PMCID: PMC10213940 DOI: 10.3389/fped.2023.1134923] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Background As more than 500,000 neonates participate in newborn congenital hypothyroidism (CH) screening in Guangxi Zhuang Autonomous Region each year, the overall number of false-positive (FP) cases has increased. We aim to assess the parental stress in parents of neonates with FP CH results in Guangxi, find out the influence factors related to demographics, and provide the basis for personalized health education. Methods The parents of neonates with FP CH results were invited to participate in the FP group, and the parents of neonates with all negative results were invited to participate in the control group. The parents completed a questionnaire on demographics, knowledge of CH, and the parental stress index (PSI) in the hospital for the first time. The follow-up visits for PSI were conducted 3, 6, and 12 months afterward through telephone and online. Results A total of 258 and 1,040 parents participated in the FP and control groups, respectively. The parents in the FP group had better knowledge of CH and higher PSI scores than the parents in the control group. The result of logistic regression showed that the major influence factors related to the knowledge of CH were FP experience and source of knowledge. The parents in the FP group who were well-informed during the recall phone call had lower PSI scores than the other parents. The parents in the FP group showed decreasing PSI scores gradually in follow-up visits. Conclusion The results suggested that FP screening results may affect parental stress and parent-child relationship. FP results increased the stress on the parents and increased their knowledge of CH passively.
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Affiliation(s)
- Si-Jing Tu
- School of Public Health and Management, Guangxi University of Chinese Medicine, Nanning, China
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Yu-Jia Wei
- School of Public Health and Management, Guangxi University of Chinese Medicine, Nanning, China
| | - Bu-Tong Chen
- School of Humanities and Social Sciences, Guangxi Medical University, Nanning, China
| | - Xiao-Fei Zhang
- Department of Pediatrics, The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Chao Luo
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bai-Qing Dong
- School of Public Health and Management, Guangxi University of Chinese Medicine, Nanning, China
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3
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Wang H, Page R, Lopez D, Arkatkar S, Young C, Martinez D, Robbins-Furman P, Montalvo-Liendo N, Chen LS. Pregnant Latinas' views of adopting exome sequencing into newborn screening: A qualitative study. Genet Med 2022; 24:1644-1652. [PMID: 35579624 DOI: 10.1016/j.gim.2022.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE There are, currently, conflicting opinions about the adoption of exome sequencing (ES) into the standard newborn screening program. This study aimed to explore the views of pregnant Latinas, a hard-to-reach, underserved, and understudied population, about pursuing ES for their newborns. METHODS We conducted semistructured interviews with 32 pregnant Latinas who predominately lived in rural areas and had low levels of income and education. An emergent coding approach was used to analyze the qualitative data collected. RESULTS Our entire sample believed that ES should be offered as a part of newborn screening, which could empower pregnant Latinas to better understand their children's health and take early treatment actions. Although some participants were concerned about potentially bad ES results and had questions about the accuracy of ES results, nearly all interviewees reported that they would be willing to have their newborns undergo ES. The main reasons given were to be informed of diseases that the baby may have, and the perception that ES is a procedure that involves minimal risk. CONCLUSION Pregnant Latinas in this study had favorable attitudes toward newborn ES. Their perspectives should be considered when decisions are made about incorporating ES into newborn screening.
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Affiliation(s)
- Haocen Wang
- Department of Health and Kinesiology, Texas A&M University, College Station, TX
| | - Robin Page
- College of Nursing, Texas A&M University, College Station, TX
| | - Daniela Lopez
- Department of Nutrition, Texas A&M University, College Station, TX
| | | | - Christine Young
- Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY
| | - Denise Martinez
- School of Public Health, Texas A&M University, College Station, TX
| | | | | | - Lei-Shih Chen
- Department of Health and Kinesiology, Texas A&M University, College Station, TX.
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Abstract
IMPORTANCE Genomic newborn screening (gNBS) may optimize the health and well-being of children and families. Screening programs are required to be evidence based, acceptable, and beneficial. OBJECTIVES To identify what has been discovered following the reporting of the first gNBS pilot projects and to provide a summary of key points for the design of gNBS. EVIDENCE REVIEW A systematic literature review was performed on April 14, 2021, identifying 36 articles that addressed the following questions: (1) what is the interest in and what would be the uptake of gNBS? (2) what diseases and genes should be included? (3) what is the validity and utility of gNBS? and (4) what are the ethical, legal, and social implications? Articles were only included if they generated new evidence; all opinion pieces were excluded. FINDINGS In the 36 articles included, there was high concordance, except for gene disease inclusion, which was highly variable. Key findings were the need for equitable access, appropriate educational materials, and informed and flexible consent. The process for selecting genes for testing should be transparent and reflect that parents value the certainty of prediction over actionability. Data should be analyzed in a way that minimizes uncertainty and incidental findings. The expansion of traditional newborn screening (tNBS) to identify more life-threatening and treatable diseases needs to be balanced against the complexity of consenting parents of newborns for genomic testing as well as the risk that overall uptake of tNBS may decline. The literature reflected that the right of a child to self-determination should be valued more than the possibility of the whole family benefiting from a newborn genomic test. CONCLUSIONS AND RELEVANCE The findings of this systematic review suggest that implementing gNBS will require a nuanced approach. There are gaps in our knowledge, such as the views of diverse populations, the capabilities of health systems, and health economic implications. It will be essential to rigorously evaluate outcomes and ensure programs can evolve to maximize benefit.
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Affiliation(s)
- Lilian Downie
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Halliday
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Sharon Lewis
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - David J. Amor
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Royal Children’s Hospital, Melbourne, Victoria, Australia
- Victorian Clinical Genetics Services, Melbourne, Victoria, Australia
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5
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Tutty E, Amor DJ, Jarmolowicz A, Paton K, Downie L. Personal utility of genomic sequencing for infants with congenital deafness. Am J Med Genet A 2021; 185:3634-3643. [PMID: 34184819 DOI: 10.1002/ajmg.a.62411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/07/2021] [Accepted: 06/12/2021] [Indexed: 11/08/2022]
Abstract
Decisions about genetic testing have traditionally been based on clinical utility and cost, but personal utility is increasingly recognized when assessing the value of testing. Whole exome sequencing (WES) was offered to a population cohort of 106 infants diagnosed with congenital hearing loss. Parents could choose to receive results relating to hearing loss only or also learn additional information about childhood-onset conditions (medically nonactionable and/or actionable). This study aimed to quantify the personal utility of WES for parents after a diagnosis of hearing loss in their child. Parents completed surveys pretest (63/106), after hearing loss results (52/106) and after receiving additional information (47/72). Open-ended responses from all three surveys (N = 67) were analyzed using inductive content analysis. Answers to questions regarding the value of sequencing to parents were analyzed and collated. Parents placed high value on diagnostic WES for hearing loss but had different perspectives on the personal utility of additional information. Diagnostic results provided certainty while the choice to learn additional information about childhood-onset disorders was associated with empowerment. WES also represented an opportunity to promote their child's best interests. Results provide insights into the utility of WES for the indication of congenital deafness and for genomic newborn screening broadly.
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Affiliation(s)
- Erin Tutty
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - David J Amor
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Royal Children's Hospital, Parkville, Victoria, Australia.,Victorian Clinical Genetics Service, Melbourne, Victoria, Australia
| | - Anna Jarmolowicz
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Melbourne Genomics Health Alliance, Melbourne, Victoria, Australia
| | - Kate Paton
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Lilian Downie
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Christensen KD, Bell M, Zawatsky CLB, Galbraith LN, Green RC, Hutchinson AM, Jamal L, LeBlanc JL, Leonhard JR, Moore M, Mullineaux L, Petry N, Platt DM, Shaaban S, Schultz A, Tucker BD, Van Heukelom J, Wheeler E, Zoltick ES, Hajek C. Precision Population Medicine in Primary Care: The Sanford Chip Experience. Front Genet 2021; 12:626845. [PMID: 33777099 PMCID: PMC7994529 DOI: 10.3389/fgene.2021.626845] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/11/2021] [Indexed: 01/10/2023] Open
Abstract
Genetic testing has the potential to revolutionize primary care, but few health systems have developed the infrastructure to support precision population medicine applications or attempted to evaluate its impact on patient and provider outcomes. In 2018, Sanford Health, the nation's largest rural nonprofit health care system, began offering genetic testing to its primary care patients. To date, more than 11,000 patients have participated in the Sanford Chip Program, over 90% of whom have been identified with at least one informative pharmacogenomic variant, and about 1.5% of whom have been identified with a medically actionable predisposition for disease. This manuscript describes the rationale for offering the Sanford Chip, the programs and infrastructure implemented to support it, and evolving plans for research to evaluate its real-world impact.
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Affiliation(s)
- Kurt D Christensen
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, United States.,Department of Population Medicine, Harvard Medical School, Boston, MA, United States.,Broad Institute of MIT and Harvard, Cambridge, MA, United States
| | - Megan Bell
- Sanford Health Imagenetics, Sioux Falls, SD, United States
| | - Carrie L B Zawatsky
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States.,Ariadne Labs, Boston, MA, United States
| | - Lauren N Galbraith
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - Robert C Green
- Broad Institute of MIT and Harvard, Cambridge, MA, United States.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States.,Ariadne Labs, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
| | | | - Leila Jamal
- National Cancer Institute, Bethesda, MD, United States.,Department of Bioethics, National Institutes of Health, Bethesda, MD, United States
| | - Jessica L LeBlanc
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | | | - Michelle Moore
- Sanford Health Imagenetics, Sioux Falls, SD, United States
| | - Lisa Mullineaux
- Mayo Clinic Genomics Laboratory, Rochester, MN, United States
| | - Natasha Petry
- Sanford Health Imagenetics, Fargo, ND, United States.,Department of Pharmacy Practice, North Dakota State University, Fargo, ND, United States
| | - Dylan M Platt
- Sanford Health Imagenetics, Sioux Falls, SD, United States
| | - Sherin Shaaban
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, United States.,ARUP Laboratories, Salt Lake City, UT, United States
| | - April Schultz
- Sanford Health Imagenetics, Sioux Falls, SD, United States.,Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, United States
| | | | - Joel Van Heukelom
- Sanford Health Imagenetics, Sioux Falls, SD, United States.,Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, United States
| | | | - Emilie S Zoltick
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - Catherine Hajek
- Sanford Health Imagenetics, Sioux Falls, SD, United States.,Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, United States
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Abstract
Children with medical complexity (CMC) are a unique pediatric patient population with increased exposure and interactions with the health care system and reliance on family caregivers. These attributes place CMC at high risk of overmedicalization (OM). This article reviews the risk factors for OM in CMC and presents an algorithm that primary providers can use to recognize and address this issue. Involvement of a broad multidisciplinary team, including child advocacy when needed, is recommended. The article also focuses on challenges and additional considerations that arise when medical child abuse as the cause of OM is suspected in this population. [Pediatr Ann. 2020;49(11):e478-e485.].
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Saastamoinen A, Hyttinen V, Kortelainen M, Aaltio J, Auranen M, Ylikallio E, Lönnqvist T, Sainio M, Suomalainen A, Tyynismaa H, Isohanni P. Attitudes towards genetic testing and information: does parenthood shape the views? J Community Genet 2020; 11:461-473. [PMID: 32248430 PMCID: PMC7475141 DOI: 10.1007/s12687-020-00462-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 03/18/2020] [Indexed: 01/15/2023] Open
Abstract
This study examines how parents of pediatric patients might differ in their views and attitudes towards genetic technology and information when compared to adult patients. There is surprisingly little evidence on how parents compare to other parts of population in their attitudes. Previous empirical studies often relate health-related preferences and attitudes to factors such as age, education, and income instead of parental status, thus evading comparison of parents to others as health-related decision makers. Findings related to the parental status can be useful when implementing genetic technology in clinical practice. We conducted a survey of views on genetic technology and information for groups of adult neurology patients (n = 68) and parents of pediatric neurology patients (n = 31) to shed some light on this issue. In addition to our own survey instrument, we conducted other surveys to gain insight on psychosocial factors that might affect these attitudes. The results suggest that parents are more concerned about their children's genetic risk factors when compared to the attitudes of adult patients about their own risk. For both groups, negative emotional state was associated with more concerns towards genetic information. Our study provides insights on how parental views might affect the acceptance of genetic technology and information.
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Affiliation(s)
| | - Virva Hyttinen
- VATT Institute for Economic Research, PO Box 1279, 00100, Helsinki, Finland.
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland.
| | - Mika Kortelainen
- VATT Institute for Economic Research, PO Box 1279, 00100, Helsinki, Finland
- Turku School of Economics, University of Turku, Turku, Finland
| | - Juho Aaltio
- Research Programs Unit, Stem Cells and Metabolism, University of Helsinki, Helsinki, Finland
| | - Mari Auranen
- Research Programs Unit, Stem Cells and Metabolism, University of Helsinki, Helsinki, Finland
- Clinical Neurosciences, Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Emil Ylikallio
- Research Programs Unit, Stem Cells and Metabolism, University of Helsinki, Helsinki, Finland
- Clinical Neurosciences, Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Tuula Lönnqvist
- Department of Child Neurology, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Markus Sainio
- Research Programs Unit, Stem Cells and Metabolism, University of Helsinki, Helsinki, Finland
| | - Anu Suomalainen
- Research Programs Unit, Stem Cells and Metabolism, University of Helsinki, Helsinki, Finland
- Neuroscience Center, University of Helsinki, Helsinki, Finland
| | - Henna Tyynismaa
- Research Programs Unit, Stem Cells and Metabolism, University of Helsinki, Helsinki, Finland
- Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
| | - Pirjo Isohanni
- Research Programs Unit, Stem Cells and Metabolism, University of Helsinki, Helsinki, Finland
- Department of Child Neurology, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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9
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Downie L, Halliday J, Lewis S, Lunke S, Lynch E, Martyn M, Gaff C, Jarmolowicz A, Amor DJ. Exome sequencing in newborns with congenital deafness as a model for genomic newborn screening: the Baby Beyond Hearing project. Genet Med 2020; 22:937-944. [PMID: 31974413 DOI: 10.1038/s41436-019-0745-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/23/2019] [Accepted: 12/26/2019] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Genomic newborn screening raises practical and ethical issues. Evidence is required to build a framework to introduce this technology safely and effectively. We investigated the choices made by a diverse group of parents with newborns when offered tiered genomic information from exome sequencing. METHODS This population-derived cohort comprised infants with congenital deafness. Parents were offered exome sequencing and choice regarding the scope of analysis. Options were choice A, diagnostic analysis only; choice B, diagnostic analysis plus childhood-onset diseases with medical actionability; or choice C, diagnostic analysis plus childhood-onset diseases with or without medical actionability. RESULTS Of the 106 participants, 72 (68%) consented to receive additional findings with 29 (27.4%) selecting choice B and 43 (40.6%) opting for choice C. Family size, ethnicity, and age of infant at time of recruitment were the significant predictors of choice. Parents who opted to have additional findings analysis demonstrated less anxiety and decisional conflict. CONCLUSIONS These data provide evidence from a culturally diverse population that choice around additional findings is important and the age of the infant when this choice is offered impacts on their decision. We found no evidence that offering different levels of genomic information to parents of newborns has a negative psychological impact.
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Affiliation(s)
- Lilian Downie
- Victorian Clinical Genetics Services, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Jane Halliday
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Sharon Lewis
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Sebastian Lunke
- Victorian Clinical Genetics Services, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Elly Lynch
- Victorian Clinical Genetics Services, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Melbourne Genomics Health Alliance, Melbourne, Australia
| | - Melissa Martyn
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Melbourne Genomics Health Alliance, Melbourne, Australia
| | - Clara Gaff
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Melbourne Genomics Health Alliance, Melbourne, Australia
| | - Anna Jarmolowicz
- Victorian Clinical Genetics Services, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - David J Amor
- Victorian Clinical Genetics Services, Melbourne, Australia. .,Murdoch Children's Research Institute, Melbourne, Australia. .,Royal Children's Hospital, Melbourne, Australia. .,Department of Paediatrics, University of Melbourne, Melbourne, Australia.
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10
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Abstract
Next generation DNA sequencing (NGS) has the potential to improve the diagnostic and prognostic utility of newborn screening programmes. This study assesses the feasibility of automating NGS on dried blood spot (DBS) DNA in a United Kingdom National Health Service (UK NHS) laboratory. An NGS panel targeting the entire coding sequence of five genes relevant to disorders currently screened for in newborns in the UK was validated on DBS DNA. An automated process for DNA extraction, NGS and bioinformatics analysis was developed. The process was tested on DBS to determine feasibility, turnaround time and cost. The analytical sensitivity of the assay was 100% and analytical specificity was 99.96%, with a mean 99.5% concordance of variant calls between DBS and venous blood samples in regions with ≥30× coverage (96.8% across all regions; all variant calls were single nucleotide variants (SNVs), with indel performance not assessed). The pipeline enabled processing of up to 1000 samples a week with a turnaround time of four days from receipt of sample to reporting. This study concluded that it is feasible to automate targeted NGS on routine DBS samples in a UK NHS laboratory setting, but it may not currently be cost effective as a first line test.
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11
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Genetti CA, Schwartz TS, Robinson JO, VanNoy GE, Petersen D, Pereira S, Fayer S, Peoples HA, Agrawal PB, Betting WN, Holm IA, McGuire AL, Waisbren SE, Yu TW, Green RC, Beggs AH, Parad RB. Parental interest in genomic sequencing of newborns: enrollment experience from the BabySeq Project. Genet Med 2019; 21:622-630. [PMID: 30209271 PMCID: PMC6420384 DOI: 10.1038/s41436-018-0105-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/15/2018] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Newborn genomic sequencing (nGS) has great potential to improve pediatric care. Parental interest and concerns about genomics are relatively unexplored. Understanding why parents decline research consent for nGS may reveal implementation barriers. METHODS We evaluated parental interest in a randomized trial of nGS in well-baby and intensive care unit nursery settings. Interested families attended an informational enrollment session (ES) with a genetic counselor prior to consenting. Reason(s) for declining participation and sociodemographic associations were analyzed. RESULTS Of 3860 eligible approached families, 10% attended ES, 67% of whom enrolled. Of 1760 families queried for decline reasons, 58% were uninterested in research. Among 499 families considering research, principal reasons for decline prior to ES included burdensome study logistics (48%), feeling overwhelmed postpartum (17%), and lack of interest/discomfort with genetic testing (17%). Decliners after ES more often cited concerns about privacy/insurability (41%) and uncertain/unfavorable results (23%). CONCLUSION Low interest in research and study logistics were major initial barriers to postpartum enrollment and are likely generic to many postpartum research efforts. Concerns over privacy and result implications were most commonly cited in decliners after ES. Understanding parental concerns around research nGS may inform future integration of nGS into newborn screening, predictive testing, and pediatric diagnostics.
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Affiliation(s)
- Casie A Genetti
- Division of Genetics and Genomics and The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Talia S Schwartz
- Division of Genetics and Genomics and The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jill O Robinson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Grace E VanNoy
- Division of Genetics and Genomics and The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Devan Petersen
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Stacey Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Shawn Fayer
- Department of Medicine, Division of Genetics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Hayley A Peoples
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Pankaj B Agrawal
- Division of Genetics and Genomics and The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Wendi N Betting
- Department of Medicine, Division of Genetics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ingrid A Holm
- Division of Genetics and Genomics and The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Susan E Waisbren
- Division of Genetics and Genomics and The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy W Yu
- Division of Genetics and Genomics and The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Robert C Green
- Department of Medicine, Division of Genetics, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Alan H Beggs
- Division of Genetics and Genomics and The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Richard B Parad
- Department of Medicine, Division of Genetics, Brigham and Women's Hospital, Boston, Massachusetts, USA.
- Harvard Medical School, Boston, Massachusetts, USA.
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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12
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Lewis MA, Stine A, Paquin RS, Mansfield C, Wood D, Rini C, Roche MI, Powell CM, Berg JS, Bailey DB. Parental preferences toward genomic sequencing for non-medically actionable conditions in children: a discrete-choice experiment. Genet Med 2018; 20:181-189. [PMID: 28771249 PMCID: PMC5868968 DOI: 10.1038/gim.2017.93] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 03/16/2017] [Indexed: 01/12/2023] Open
Abstract
PurposeApplication of whole-exome and whole-genome sequencing is likely to increase in clinical practice, public health contexts, and research. We investigated how parental preference for acquiring information from genome-scale testing is influenced by the characteristics of non-medically actionable genetic disorders in children, as well as whether the preferences differed by gender and between African-American and white respondents.MethodsWe conducted a Web-based discrete-choice experiment with 1,289 parents of young children. Participants completed "choice tasks" based on pairs of profiles describing sequencing results for hypothetical genetic disorders, selected the profile in each pair that they believed represented the information that would be more important to know, and answered questions that measured their level of distress.ResultsKnowing the likelihood that the disorder would develop given a true-positive test result was most important to parents. Parents showed greater interest in learning sequencing results for disease profiles with more severe manifestations. This was associated with greater distress. Differences by gender and race reflected small differences in magnitude, but not direction.ConclusionParents preferred to learn results about genetic disorders with more severe manifestations, even when this knowledge was associated with increased distress. These results may help clinicians support parental decision making by revealing which types of sequencing results parents are interested in learning.
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Affiliation(s)
- Megan A Lewis
- RTI International, Research Triangle Park, Durham, North Carolina, USA
| | - Alex Stine
- RTI International, Research Triangle Park, Durham, North Carolina, USA
| | - Ryan S Paquin
- RTI International, Research Triangle Park, Durham, North Carolina, USA
| | - Carol Mansfield
- RTI International, Research Triangle Park, Durham, North Carolina, USA
| | - Dallas Wood
- RTI International, Research Triangle Park, Durham, North Carolina, USA
| | - Christine Rini
- Department of Health Behavior and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Myra I Roche
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Genetics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Cynthia M Powell
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Genetics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Jonathan S Berg
- Department of Genetics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Donald B Bailey
- RTI International, Research Triangle Park, Durham, North Carolina, USA
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13
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Psychosocial impact on mothers receiving expanded newborn screening results. Eur J Hum Genet 2018; 26:477-484. [PMID: 29379194 DOI: 10.1038/s41431-017-0069-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 10/20/2017] [Accepted: 11/18/2017] [Indexed: 01/01/2023] Open
Abstract
Expanded newborn screening (NBS) for genetic disorders has improved diagnosis of numerous treatable diseases, positively impacting children's health outcomes. However, research about the psychological impact of expanded NBS on families, especially mothers, has been mixed. Our study examined associations between maternal experiences of expanded NBS and subsequent psychosocial functioning and parenting stress in mothers whose infants received either true negative (TN), true positive (TP) or false positive (FP) results after a 4- to 6-month period. The Parenting Stress Index and the Depression, Anxiety and Stress Scale were used to assess symptoms of anxiety, stress and depression in 3 sets of mothers, whose infants received TN (n = 31), TP (n = 8) or FP (n = 18) results. Multivariate analyses of variance (MANOVA) results revealed no significant differences among these three groups of mothers regarding overall anxiety, stress and depression. However, FP mothers experienced lower levels of stress related to their own health compared to TN group. Two potential trends were also identified; results suggested TN mothers might experience higher levels of isolation than mothers in the TP group and that FP mothers might report higher stress levels in relation to spousal relationships compared to the TN group. FP mothers seemed to report similar or better levels of psychosocial functioning than TN mothers. Our findings are encouraging with respect to impacts of NBS on maternal well-being. We also identify key areas for improvement (parental education) and research (isolation and spousal relationships).
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15
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Abstract
With the rapid evolution of next-generation DNA sequencing technologies, the cost of sequencing a human genome has plummeted, and genomics has started to pervade health care across all stages of life - from preconception to adult medicine. Challenges to fully embracing genomics in a clinical setting remain, but some approaches are starting to overcome these barriers, such as community-driven data sharing to improve the accuracy and efficiency of applying genomics to patient care.
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Affiliation(s)
- Heidi L Rehm
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA; at the Laboratory for Molecular Medicine, Partners Healthcare Personalized Medicine, Cambridge, Massachusetts 02139, USA; and at The Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142, USA
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16
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Friedman JM, Cornel MC, Goldenberg AJ, Lister KJ, Sénécal K, Vears DF. Genomic newborn screening: public health policy considerations and recommendations. BMC Med Genomics 2017; 10:9. [PMID: 28222731 PMCID: PMC5320805 DOI: 10.1186/s12920-017-0247-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 02/14/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The use of genome-wide (whole genome or exome) sequencing for population-based newborn screening presents an opportunity to detect and treat or prevent many more serious early-onset health conditions than is possible today. METHODS The Paediatric Task Team of the Global Alliance for Genomics and Health's Regulatory and Ethics Working Group reviewed current understanding and concerns regarding the use of genomic technologies for population-based newborn screening and developed, by consensus, eight recommendations for clinicians, clinical laboratory scientists, and policy makers. RESULTS Before genome-wide sequencing can be implemented in newborn screening programs, its clinical utility and cost-effectiveness must be demonstrated, and the ability to distinguish disease-causing and benign variants of all genes screened must be established. In addition, each jurisdiction needs to resolve ethical and policy issues regarding the disclosure of incidental or secondary findings to families and ownership, appropriate storage and sharing of genomic data. CONCLUSION The best interests of children should be the basis for all decisions regarding the implementation of genomic newborn screening.
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Affiliation(s)
- Jan M. Friedman
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
- Child & Family Research Institute, Vancouver, Canada
| | - Martina C. Cornel
- Section Clinical Genetics, Department of Clinical Genetics, VU University Medical Center, Amsterdam, Holland
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Holland
| | - Aaron J. Goldenberg
- The Center for Genetic Research Ethics and Law, Department of Bioethics, Case Western Reserve University, Cleveland, OH USA
| | - Karla J. Lister
- Office of Population Health Genomics, Public Health Division, Department of Health, Government of Western Australia, Perth, Australia
| | - Karine Sénécal
- Centre of Genomics and Policy, Department of Human Genetics, McGill University, Montreal, Canada
| | - Danya F. Vears
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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17
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Berg JS, Agrawal PB, Bailey DB, Beggs AH, Brenner SE, Brower AM, Cakici JA, Ceyhan-Birsoy O, Chan K, Chen F, Currier RJ, Dukhovny D, Green RC, Harris-Wai J, Holm IA, Iglesias B, Joseph G, Kingsmore SF, Koenig BA, Kwok PY, Lantos J, Leeder SJ, Lewis MA, McGuire AL, Milko LV, Mooney SD, Parad RB, Pereira S, Petrikin J, Powell BC, Powell CM, Puck JM, Rehm HL, Risch N, Roche M, Shieh JT, Veeraraghavan N, Watson MS, Willig L, Yu TW, Urv T, Wise AL. Newborn Sequencing in Genomic Medicine and Public Health. Pediatrics 2017; 139:e20162252. [PMID: 28096516 PMCID: PMC5260149 DOI: 10.1542/peds.2016-2252] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 12/20/2022] Open
Abstract
The rapid development of genomic sequencing technologies has decreased the cost of genetic analysis to the extent that it seems plausible that genome-scale sequencing could have widespread availability in pediatric care. Genomic sequencing provides a powerful diagnostic modality for patients who manifest symptoms of monogenic disease and an opportunity to detect health conditions before their development. However, many technical, clinical, ethical, and societal challenges should be addressed before such technology is widely deployed in pediatric practice. This article provides an overview of the Newborn Sequencing in Genomic Medicine and Public Health Consortium, which is investigating the application of genome-scale sequencing in newborns for both diagnosis and screening.
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Affiliation(s)
| | - Pankaj B Agrawal
- Divisions of Newborn Medicine and
- Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Alan H Beggs
- Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Amy M Brower
- American College of Medical Genetics and Genomics, Bethesda, Maryland
| | - Julie A Cakici
- Rady Children's Institute for Genomic Medicine, San Diego, California
| | | | - Kee Chan
- Chicago School of Public Health, University of Illinois, Chicago, Illinois
| | | | - Robert J Currier
- Genetic Disease Screening Program, California Department of Public Health, Sacramento, California
| | - Dmitry Dukhovny
- Department of Pediatrics and Division of Neonatology, Oregon Health & Science University, Portland, Oregon
| | | | | | - Ingrid A Holm
- Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Galen Joseph
- Department of Anthropology, History, and Social Medicine
| | | | | | - Pui-Yan Kwok
- Institute for Human Genetics
- Cardiovascular Research Institute, and Department of Dermatology
| | - John Lantos
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
| | - Steven J Leeder
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
| | - Megan A Lewis
- RTI International, Research Triangle Park, North Carolina
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas; and
| | | | | | - Richard B Parad
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stacey Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas; and
| | - Joshua Petrikin
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
| | | | - Cynthia M Powell
- Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Jennifer M Puck
- Department of Pediatrics, University of California, San Francisco, California
| | | | | | - Myra Roche
- Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Joseph T Shieh
- Institute for Human Genetics
- Department of Pediatrics, Benioff Children's Hospital, and
| | | | - Michael S Watson
- American College of Medical Genetics and Genomics, Bethesda, Maryland
| | - Laurel Willig
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
| | - Timothy W Yu
- Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tiina Urv
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland
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