Medicine will move from a reactive to a proactive discipline over the next decade--a discipline that is predictive, personalized, preventive and participatory (P4). P4 medicine will be fueled by ...systems approaches to disease, emerging technologies and analytical tools. There will be two major challenges to achieving P4 medicine--technical and societal barriers--and the societal barriers will prove the most challenging. How do we bring patients, physicians and members of the health-care community into alignment with the enormous opportunities of P4 medicine? In part, this will be done by the creation of new types of strategic partnerships--between patients, large clinical centers, consortia of clinical centers and patient-advocate groups. For some clinical trials it will necessary to recruit very large numbers of patients--and one powerful approach to this challenge is the crowd-sourced recruitment of patients by bringing large clinical centers together with patient-advocate groups.
First, design for data sharing Wilbanks, John; Friend, Stephen H
Nature biotechnology,
04/2016, Letnik:
34, Številka:
4
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The mPower study is notable as one of the first observational assessments of human health to rapidly achieve scale as a result of its design and execution purely through a smartphone interface2. To ...support this unique study design, we developed a novel electronic informed consent process that includes participant-determined data-sharing preferences. It is through these preferences that the new data including self-reported outcomes and quantitative sensor data are shared broadly for secondary analysis. Our hope is that by sharing these data immediately, prior even to our own complete analysis, we will shorten the time to harnessing any utility that this studys data may hold to improve the condition of patients who suffer from this disease.
The generation of large-scale biomedical data is creating unprecedented opportunities for basic and translational science. Typically, the data producers perform initial analyses, but it is very ...likely that the most informative methods may reside with other groups. Crowdsourcing the analysis of complex and massive data has emerged as a framework to find robust methodologies. When the crowdsourcing is done in the form of collaborative scientific competitions, known as Challenges, the validation of the methods is inherently addressed. Challenges also encourage open innovation, create collaborative communities to solve diverse and important biomedical problems, and foster the creation and dissemination of well-curated data repositories.
The Use of Smartphones for Health Research Dorsey, E Ray; “Yvonne Chan, Yu-Feng; McConnell, Michael V ...
Academic medicine,
2017-February, 2017-02-00, 20170201, Letnik:
92, Številka:
2
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Because of their growing popularity and functionality, smartphones are increasingly valuable potential tools for health and medical research. Using ResearchKit, Apple’s open-source platform to build ...applications (“apps”) for smartphone research, collaborators have developed apps for researching asthma, breast cancer, cardiovascular disease, type 2 diabetes, and Parkinson disease. These research apps enhance widespread participation by removing geographical barriers to participation, provide novel ways to motivate healthy behaviors, facilitate high-frequency assessments, and enable more objective data collection. Although the studies have great potential, they also have notable limitations. These include selection bias, identity uncertainty, design limitations, retention, and privacy. As smartphone technology becomes increasingly available, researchers must recognize these factors to ensure that medical research is conducted appropriately. Despite these limitations, the future of smartphones in health research is bright. Their convenience grants unprecedented geographic freedom to researchers and participants alike and transforms the way clinical research can be conducted.
Current measures of health and disease are often insensitive, episodic, and subjective. Further, these measures generally are not designed to provide meaningful feedback to individuals. The impact of ...high-resolution activity data collected from mobile phones is only beginning to be explored. Here we present data from mPower, a clinical observational study about Parkinson disease conducted purely through an iPhone app interface. The study interrogated aspects of this movement disorder through surveys and frequent sensor-based recordings from participants with and without Parkinson disease. Benefitting from large enrollment and repeated measurements on many individuals, these data may help establish baseline variability of real-world activity measurement collected via mobile phones, and ultimately may lead to quantification of the ebbs-and-flows of Parkinson symptoms. App source code for these data collection modules are available through an open source license for use in studies of other conditions. We hope that releasing data contributed by engaged research participants will seed a new community of analysts working collaboratively on understanding mobile health data to advance human health.
A potentially useful approach for drug discovery is to connect gene expression profiles of disease-affected tissues ("disease signatures") to drug signatures, but it remains to be shown whether it ...can be used to identify clinically relevant treatment options. We analyzed coexpression networks and genetic data to identify a disease signature for type 2 diabetes in liver tissue. By interrogating a library of 3800 drug signatures, we identified sulforaphane as a compound that may reverse the disease signature. Sulforaphane suppressed glucose production from hepatic cells by nuclear translocation of nuclear factor erythroid 2-related factor 2 (NRF2) and decreased expression of key enzymes in gluconeogenesis. Moreover, sulforaphane reversed the disease signature in the livers from diabetic animals and attenuated exaggerated glucose production and glucose intolerance by a magnitude similar to that of metformin. Finally, sulforaphane, provided as concentrated broccoli sprout extract, reduced fasting blood glucose and glycated hemoglobin (HbA1c) in obese patients with dysregulated type 2 diabetes.
Wearable Digital Health Technology Friend, Stephen H.; Ginsburg, Geoffrey S.; Picard, Rosalind W.
New England journal of medicine/The New England journal of medicine,
11/2023, Letnik:
389, Številka:
22
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Wearable Digital Health Technology SeriesWearable DHT has reached an inflection point between fanciful descriptions and practical applications. The editors announce a series of articles focusing on ...the clinical applications of wearable DHT.
Colorectal cancer (CRC) is a frequently lethal disease with heterogeneous outcomes and drug responses. To resolve inconsistencies among the reported gene expression-based CRC classifications and ...facilitate clinical translation, we formed an international consortium dedicated to large-scale data sharing and analytics across expert groups. We show marked interconnectivity between six independent classification systems coalescing into four consensus molecular subtypes (CMSs) with distinguishing features: CMS1 (microsatellite instability immune, 14%), hypermutated, microsatellite unstable and strong immune activation; CMS2 (canonical, 37%), epithelial, marked WNT and MYC signaling activation; CMS3 (metabolic, 13%), epithelial and evident metabolic dysregulation; and CMS4 (mesenchymal, 23%), prominent transforming growth factor-β activation, stromal invasion and angiogenesis. Samples with mixed features (13%) possibly represent a transition phenotype or intratumoral heterogeneity. We consider the CMS groups the most robust classification system currently available for CRC-with clear biological interpretability-and the basis for future clinical stratification and subtype-based targeted interventions.
The authors address the issues that must be confronted if we are to integrate the use of wearable digital health technologies into clinical care in a way that provides an enduring benefit to patients.
Clues from the resilient Friend, Stephen H; Schadt, Eric E
Science (American Association for the Advancement of Science),
05/2014, Letnik:
344, Številka:
6187
Journal Article
Recenzirano
Genetic information from individuals who do not succumb to disease may point to new therapies and ideas about wellness
The genetics approach to uncovering the causes of disease has focused mainly on ...finding the underlying primary mutations, with diseased individuals playing the leading role in this discovery. But as health care begins to focus more on preventive therapies, an emphasis on understanding how individuals remain healthy—“resilient” to disease—may provide insights into disease pathogenesis and new treatments. This view underlies “The Resilience Project” (
www.resilienceproject.me
), an effort to search broadly for these apparently healthy people (see the photo). There are, indeed, individuals whose genetics indicate exceptionally high risk of disease, yet they never show any signs of the disorder. What are the genetic and environmental factors that buffer disease for them? How can such information be gathered and harnessed most efficiently and effectively?
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