The Ethical Aspects of Exposome Research: A Systematic Review

In recent years, exposome research has been put forward as the next frontier for the study of human health and disease. Exposome research entails the analysis of the totality of environmental exposures and their corresponding biological responses within the human body. Increasingly, this is operationalized by big-data approaches to map the effects of internal as well as external exposures using smart sensors and multiomics technologies. However, the ethical implications of exposome research are still only rarely discussed in the literature. Therefore, we conducted a systematic review of the academic literature regarding both the exposome and underlying research fields and approaches, to map the ethical aspects that are relevant to exposome research. We identify five ethical themes that are prominent in ethics discussions: the goals of exposome research, its standards, its tools, how it relates to study participants, and the consequences of its products. Furthermore, we provide a number of general principles for how future ethics research can best make use of our comprehensive overview of the ethical aspects of exposome research. Lastly, we highlight three aspects of exposome research that are most in need of ethical reflection: the actionability of its findings, the epidemiological or clinical norms applicable to exposome research, and the meaning and action–implications of bias

The Artificial Intelligence in Digital Pathology and Digital Radiology: Where Are We?

This book is a reprint of the Special Issue entitled "The Artificial Intelligence in Digital Pathology and Digital Radiology: Where Are We?". Artificial intelligence is extending into the world of both digital radiology and digital pathology, and involves many scholars in the areas of biomedicine, technology, and bioethics. There is a particular need for scholars to focus on both the innovations in this field and the problems hampering integration into a robust and effective process in stable health care models in the health domain. Many professionals involved in these fields of digital health were encouraged to contribute with their experiences. This book contains contributions from various experts across different fields. Aspects of the integration in the health domain have been faced. Particular space was dedicated to overviewing the challenges, opportunities, and problems in both radiology and pathology. Clinal deepens are available in cardiology, the hystopathology of breast cancer, and colonoscopy. Dedicated studies were based on surveys which investigated students and insiders, opinions, attitudes, and self-perception on the integration of artificial intelligence in this field

Integration of a personalized health care model into health systems and policies in Europe

Every day, we read about new scientifi¬c discoveries and technological advancements for health and medicine in the newspapers, such as: “Diabetes gene is found!” However, we don’t see this genome-based knowledge used in health services. Somehow, they don’t complete their journey from the laboratory to the society. This PhD dissertation deals with the integration of personalized health care applications into health services. It starts with setting the scene by describing health system and its interrelations with ‘public health’, which is presented in light of the 'Health for All' vision. The second part introduces a preventive personalized health care model called Gentest, within the wider context of the ¬field of personalized medicine and health care. This practice model is used as an example in this dissertation to effectively explore the issues related to integration. The third part investigates how this practice model can be integrated into primary care services within European health systems

Multi-parametric model for the improved diagnosis and stratification of rheumatoid arthritis patients.

Rheumatoid arthritis (RA) is one of the most prevalent autoimmune diseases. Despite several serological markers are known for this disease and two of them, rheumatoid factor (RF) and anticitrullinated protein antibodies (ACPA), are included in the RA classification criteria, there are still many patients that are negative for these two biomarkers. For this reason, there is a need to identify novel biomarkers that can help close this serological gap in RA, as well as to improve patient stratification, prediction of prognosis and response to treatment, and disease monitoring. Objectives The main objective of this thesis was to develop a multi-parametric model that helps to improve RA diagnosis, patient stratification and prediction of prognosis. The specific objectives included, firstly, the assessment of the current practice, the evaluation of several immunoassays for the detection of the RA classification criteria markers, and the analysis of combinatory approaches. Secondly, among the RA novel biomarkers, the anti-protein-arginine deiminase (PAD) antibodies were selected to study their clinical and immunological relevance in RA. We then aimed to characterize the PAD enzymes as antigenic targets, to develop immunoassays for the detection of these antibodies, and to determine their clinical significance and utility in RA in several characterized cohorts. Methods Several methodologies were utilized to achieve the thesis objectives. These included literature screening; feasibility studies, early development and optimization of a range of immunoassays for the detection of autoantibodies in human samples; biochemical characterization of the antigens and the autoantibodies; measurement of biomarkers in different clinical cohorts using the immunoassays; data analysis; and drafting of combinatory approaches for the integration of the different data points. Results Combinatory approaches based on RF and ACPA showed an improved diagnostic performance over the individual markers and can help correctly classify a higher number of patients. During the study of the PAD enzymes and anti-PAD antibodies, several linear epitopes were identified on the five PAD family members, with data suggesting the presence of epitopes unique to PAD3 or to PAD4, in addition of the cross-reactive epitope. The presence of anti-PAD4 antibodies of the IgA isotype in RA was confirmed and an association with erosive disease was identified, a link also confirmed for anti-PAD3 IgG. We identified anti-PAD4 IgM and antibodies to PAD1 and 6 for the first time, and confirmed that anti-PAD4 IgG can help close the serological gap in RA and are associated with a more severe disease phenotype. We confirmed that antibodies to PAD2 are also present in the sera of RA patients, however the reported association with milder disease could not be reproduced. Conclusions A combinatory approach based on ACPA and RF IgM represents a promising tool to improve the diagnosis of RA. Anti-PAD3 and 4 antibodies are useful biomarkers for patient stratification. A multiparametric model for the improvement of RA diagnosis and patient stratification based on these autoantibodies and other features has been proposed.pre-print8999 K

Precision Oncology and Cancer Biomarkers

This open access book reflects on matters of social and ethical concern raised in the daily practices of those working in and around precision oncology. Each chapter addresses the experiences, concerns and issues at stake for people who work in settings where precision oncology is practiced, enacted, imagined or discussed. It subsequently discusses and analyses bioethical dilemmas, scientific challenges and economic trade-offs, the need for new policies, further technological innovation, social work, as well as phenomenological research. This volume takes a broad actor-centred perspective as, whenever cancer is present, the range of actors with issues at stake appears almost unlimited. This perspective and approach opens up the possibility for further in-depth and diverse questions, posed by the actors themselves, such as: How are cancer researchers navigating biological uncertainties? How do clinicians and policy-makers address ethical dilemmas around prioritisation of care? What are the patients’ experiences with, and hopes for, precision oncology? How do policy-makers and entrepreneurs envisage precision oncology? These questions are of great interest to a broad audience, including cancer researchers, oncologists, policy-makers, medical ethicists and philosophers, social scientists, patients and health economists

Precision Oncology and Cancer Biomarkers

This open access book reflects on matters of social and ethical concern raised in the daily practices of those working in and around precision oncology. Each chapter addresses the experiences, concerns and issues at stake for people who work in settings where precision oncology is practiced, enacted, imagined or discussed. It subsequently discusses and analyses bioethical dilemmas, scientific challenges and economic trade-offs, the need for new policies, further technological innovation, social work, as well as phenomenological research. This volume takes a broad actor-centred perspective as, whenever cancer is present, the range of actors with issues at stake appears almost unlimited. This perspective and approach opens up the possibility for further in-depth and diverse questions, posed by the actors themselves, such as: How are cancer researchers navigating biological uncertainties? How do clinicians and policy-makers address ethical dilemmas around prioritisation of care? What are the patients’ experiences with, and hopes for, precision oncology? How do policy-makers and entrepreneurs envisage precision oncology? These questions are of great interest to a broad audience, including cancer researchers, oncologists, policy-makers, medical ethicists and philosophers, social scientists, patients and health economists

Biochemical Testing

Clinical Correlation and Diagnosis highlights the improvements in methodological approaches for the purposes of disease diagnosis and health research. Chapters cover such topics as serum protein electrophoresis, urinary iodine measurement, blood collection tubes, semi-solid phase assay and advancement in analytical and bioanalytical techniques, and serological diagnostic tools for Zika virus, among other subjects. All these will not be possible without a proper laboratory management where this book also includes the Tissue Bank ATMP Production as a model. The chapters are expected to provide a new perspective in health science which may trigger a further exploration into the diagnostic and research field

Precision Medicine in Solid Tumors

In the era of precision medicine, the use of molecularly targeted therapies in selected patients has led to a paradigm change in cancer treatment. Multiple studies have demonstrated the benefits of therapies that are chosen based on the molecular profile of the tumor and also from the liquid biopsy. With genomics' increasing ability, a routine transcriptomics analysis of advanced/metastatic cancers is now feasible in most cancer hospitals, including community cancer centers. This is an unprecedented shift in the management of cancers irrespective of their organ types, which not only improved the outcome but also opened several new avenues in research and practice, such as immune-check-point inhibitors, tumor-TME co-evolution in the development of resistance, longitudinal liquid biopsies, biomarkers screening and the management of electronic medical records.This book brings together these crucial areas of investigation. The research presented here attempts to address the current issues to provoke thoughts for the future. The future of precision medicine will have to embrace a shift from in vitro, in vivo/PDX models for the mechanistic study to a more functional test based on the scientific interrogation of genomic data, in the form of functional precision medicine. We will also have to combat the element of noise in the multitudes of data and impart the regulatory structure to make judicious use of the data. The expectations for functional precision medicine are high. We aspire to witness a tremendous improvement in patient outcomes, from better to best, down the road that will match the clinical guidelines

Faculty Publications and Creative Works 2004

Faculty Publications & Creative Works is an annual compendium of scholarly and creative activities of University of New Mexico faculty during the noted calendar year. Published by the Office of the Vice President for Research and Economic Development, it serves to illustrate the robust and active intellectual pursuits conducted by the faculty in support of teaching and research at UNM