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PubMed2026

Underrepresented voices in a Colorado Biobank: Perspectives from focus groups on motivations, return of results, and data sharing.

Most participants in large cohorts, such as biobanks, are of European descent. This lack of representation has been an ongoing challenge in genomic research. Understanding the perspectives on genomics research and participation in biobanks of historically underrepresented populations could provide insight into ways to better engage with these groups. We conducted a series of virtual and in-person focus groups with individuals who self-identified as American Indian or Alaska Native (AI/AN), African American/Black (AA/B), or Hispanic/Latino (H/L) and who were enrolled in the Colorado Center for Personalized Medicine (CCPM) biobank. The focus group discussions were centered on participant experiences, including but not limited to their motivations, return of results, and data sharing. There was a total of 23 participants across the six focus groups. The majority of participants identified as AI/AN (60.9%), followed by H/L (39.1%), and AA/B (21.7%); many participants identified with multiple race/ethnicities. The motivations for participating in the biobank included the potential to advance science and health, the potential for return of results, to learn more about one's ancestry, and a few indicated that they were interested in helping the biobank be more representative of all populations. Notably, many expressed positive feedback of the focus groups and felt that their views were valued, illustrating the importance of community-centered work. Our findings can be used to guide recruitment and engagement of biobank participants, especially from diverse backgrounds, contributing to enhanced partnerships advancing knowledge and healthcare.

biobank↗

PubMed2025

Primary care providers' perspectives on receiving opportunistic genomic results from a national study: The Million Veteran Program Return Of Actionable Results (MVP-ROAR) Study.

PURPOSE: Patients are increasingly obtaining genetic health information and integrating it into their care with the help of their primary care provider (PCP). However, PCPs may not be adequately prepared to effectively utilize genetic results. Across the Veterans Health Administration health system, the Million Veteran Program Return Of Actionable Results-Familial Hypercholesterolemia (MVP-ROAR-FH) Study clinically confirms and returns genetic results associated with familial hypercholesterolemia (FH), identified in a national biobank program. METHODS: PCPs who received their patient's genetic results through the MVP-ROAR-FH study were invited to participate in semistructured interviews, which explored PCPs' familiarity with FH, how the results affected medical management, and suggestions for process improvement. Interviews were transcribed and analyzed using directed content analysis and constant comparison methods to identify key themes. RESULTS: Interviews with 9 PCPs revealed varied levels of familiarity with genetic testing and FH. Most PCPs did not distinguish FH from common high cholesterol issues and already used similar treatment approaches. Many PCPs did not recall receiving results from the MVP-ROAR-FH study. Alerts in medical records were deemed effective for communicating results. PCPs valued genetics in informing patient care and identifying at-risk family members but noted several implementation barriers, such as additional workload and unclear medical management benefits. Recommendations for improving results disclosure included simplifying the genetic testing report and associated support documents. CONCLUSION: The study represents the first investigation into PCPs' experiences with receiving genetic test results from a biobank linked to a national healthcare system. Results suggest that PCPs generally view genetic testing as beneficial, although they may not significantly alter medical management. PCPs expressed that integrating genetics into routine care may be burdensome and require additional training, which may not be practical. The study underscores the need for accessible genetic information, which could be aided by specialized support roles or different clinical specialties assisting with incorporating genetic results into patient care.

Humans↗

PubMed2026

PanelAppRex aggregates disease gene panels and facilitates sophisticated search.

MOTIVATION: Gene panel data are essential for variant interpretation and genomic diagnostics, but existing resources are fragmented, inconsistently annotated, and not easily accessible for programmatic use. We developed PanelAppRex, a harmonised dataset and interactive search tool that integrates over 58 000 curated gene-disease panel associations. It supports natural language-style queries by gene, phenotype, disease group, and mode of inheritance, with results returned in machine-readable export formats. RESULTS: The resulting dataset includes standardised gene identifiers, disease annotations, mode of inheritance, and literature support, enabling seamless integration into bioinformatic pipelines. We benchmarked 15 case studies spanning immunology, neurology, and additional disease areas. Under the recommended usage, in which the union of returned panels is considered, the causal gene was recovered in every case. Across all returned panels, the causal gene was present in 85.6% of panels. For manual interface interpretation, the causal gene was present in the user-selected best-fit panel(s) in all 15 benchmarked cases. AVAILABILITY: The platform data is openly available at Zenodo https://doi.org/10.5281/zenodo.15736689, with source code at https://github.com/DylanLawless/PanelAppRex, and demonstration page at https://panelapprex.github.io/landing_page. The dataset is maintained for a minimum of two years following publication.

Journal Article↗

PubMed1976

Total anomalous pulmonary venous return with associated patent ductus arteriosus. Two cases with successful correction.

A large patent ductus arteriosus associated with total anomalous pulmonary venous return results in a unique hemodynamic pattern, and long-term survival has been rare. Two patients, aged five and 18 years, underwent successful surgical repair of supracardiac total anomalous pulmonary venous return and an associated large patent ductus arteriosus. The association of the Noonan syndrome in the 18-year-old woman is of additional interest.

Adolescent↗

PubMed1979

Quantitation of hemoglobin A2. An interlaboratory study.

In the 1976 hemoglobinopathy proficiency testing survey of the Center for Disease Control (CDC), whole-blood samples from hematologically normal adults and from individuals heterozygous for beta-thalassemia were shipped to survey participants. The object of this survey was to determine the state of the art for technics used to quantitate hemoglobin A2 (Hb A2) and to test the ability of laboratories to differentiate between blood samples having normal Hb A2 levels and those having elevated levels (i.e., those from individuals with beta-thalassemia trait). The results of Hb A2 quantitation obtained from 183 volunteer participant laboratories were compared with those obtained from 24 reference laboratories. Individual values varied greatly among laboratories and among methods for both normal and elevated Hb A2 samples. The results returned by many laboratories were not within 2 SD of the reference laboratory mean and also were not sufficiently accurate to differentiate between the normal blood samples and those with beta-thalassemia trait. The results suggest that methods for quantitating Hb A2 need to be standardized and a suitable method for determining laboratory performance found.

Blood Chemical Analysis↗

PubMed1979

Nephrotic syndrome induced by D-penicillamine therapy.

The paper presents a female patient in whom the penicillamine therapy for aggressive hepatitis triggered off the development of nephrotic syndrome. Histological findings revealed membranous glomerulonephritis. After the withdrawal of penicillamine therapy, the laboratory results returned to normal. The authors concluded that penicillamine should only be administered in conditions in which other means of therapy prove inefficient (i.e. Wilson's disease, cystinuria associated with calculi).

Adult↗

PubMed1979

Quantitation of hemoglobin F. An interlaboratory study.

Samples of whole blood from four hematologically normal adults and from two individuals with increased fetal hemoglobin levels were shipped to laboratories participating in the 1976 and 1977 Center for Disease Control (CDC) hemoglobinopathy proficiency testing surveys. The data from these surveys were used to evaluate the interlaboratory variability of current methods used to quantitate hemoglobin F (Hb F). Results of Hb F quantitation obtained from more than 100 laboratories than voluntarily participated in the survey were compared with those obtained from 21 reference laboratories. Individual values for all samples varied greatly among laboratories and among methods. Results returned by most of the laboratories were outside two standard deviations of the reference laboratory mean and were not accurate enough to differentiate between a normal level and an increased, abnormal level.

Fetal Hemoglobin↗

PubMed2026

A tiled amplicon protocol for culture-free whole-genome sequencing of M. tuberculosis from clinical specimens.

Whole-genome sequencing of Mycobacterium tuberculosis can be a valuable tool for TB surveillance and treatment, providing insights into transmission patterns and comprehensive drug susceptibility testing. However, the slow growth of M. tuberculosis means traditional culture-based sequencing methods can take weeks to return results, which has limited the widespread adoption of these techniques and limited their use in clinical decision-making. Tiled amplicon sequencing is a fast, reliable, and cost-effective method of whole-genome sequencing that can be done directly on clinical specimens and has been implemented at scale in academic and public health laboratories across the world; it was the cornerstone of SARS-CoV-2 sequencing and has been adapted for a wide range of viral pathogens. However, similar methods are not yet available for far larger bacterial genomes. Extending this approach to M. tuberculosis would significantly reduce the cost, labor, and turnaround time for whole-genome sequencing. We designed a tiled amplicon panel consisting of 5,128 primers that covers the entire M. tuberculosis genome, the largest tiled amplicon sequencing panel we are aware of to date. Applying our amplicon panels to clinical samples of sputum, we show the ability to recover whole-genome bacterial sequences without the need for culture. The resulting sequence data can be used to determine M. tuberculosis lineage and reliably identify markers of drug resistance. Using this approach in clinical settings could reduce the time needed for comprehensive drug susceptibility testing from weeks to days and enable genomic epidemiology to be performed at scale, even in resource-limited settings.IMPORTANCEWe have developed and tested an amplicon panel, TB-seq, for the priority pathogen Mycobacterium tuberculosis, demonstrating recovery of near-full genomes directly from patient sputum, including mixed and low-concentration samples. This approach significantly reduces the turnaround time for this slow-growing bacterium while maintaining high accuracy in detecting clinically relevant mutations, including those associated with drug resistance. Given the global burden of tuberculosis and the critical need for faster diagnostic solutions, we believe our method has the potential to improve clinical decision-making and public health strategies.

Mycobacterium tuberculosis↗

PubMed2026

PD GENEration: An International Parkinson's Disease Genetic Research Study.

BACKGROUND: PD GENEration (NCT04057794, NCT04994015), sponsored by the Parkinson's Foundation in partnership with Aligning Science Across Parkinson's (ASAP) through the Global Parkinson's Genetics Program (GP2), is an international, observational, clinical research study that offers genetic testing and counseling to people living with Parkinson's disease (PwP) at no financial cost. PD GENEration has aimed to empower PwP and their clinicians with knowledge of their genetic status, to accelerate recruitment into precision medicine trials, and to advance research through data sharing. Since its launch in 2019, the study has expanded to enroll over 32,000 PwP (as of March 31, 2026), from 10 countries across North, Central, and South America, the Caribbean, and Israel. METHODS: Over the course of 6 years, PD GENEration has evolved to accommodate the growing scientific and research needs of the Parkinson's community while also increasing the ability to return genetic test results to PwP at a greater scale. Participants with a diagnosis of Parkinson's disease (PD) may enroll in-person or virtually where informed consent and blood sample collection can occur. Samples are analyzed at a College of American Pathologists/Clinical Laboratory Improvement Amendments (CAP/CLIA)-certified laboratory using whole genome sequencing, with variants curated for a primary panel of seven PD-associated genes. Results are disclosed during a genetic counseling visit, where further testing is offered for two optional additional gene panels. Those who consent undergo analysis of additional genes, and results are returned during a genetic counseling visit for those that test positive for a variant. In addition to returning genetic results to PwP, a central pillar of the study design has been the open sharing of genomic data to advance discovery in PD research in partnership with ASAP and GP2. DISCUSSION: PD GENEration applies a flexible framework, allowing for country specific considerations and the integration of multiple site models, evolving based on participant needs and the prioritization of equity and accessibility. We summarize PD GENEration's implementation and scaling, highlight key accomplishments and lessons learned, and provide guidance for those interested in implementing large-scale clinical genetic testing studies across other diseases and therapeutic domains.

Parkinson’s disease↗

PubMed2024

Opportunistic genomic screening has clinical utility: An interventional cohort study.

PURPOSE: Practice is shifting toward genome-first approaches, such as opportunistic screening for secondary findings (SFs). Analysis of SFs could be extended beyond medically actionable results to include non-medically actionable monogenic disease risks, carrier status, pharmacogenomic variants, and risk variants for common complex disease. However, evidence on the clinical utility of returning these results is lacking. We assessed the outcomes of opportunistic screening for a broad spectrum of SFs by evaluating the yield, impact on clinical management, and consistency between SFs and participants' clinical features and family history. METHODS: Adult cancer patients had exome sequencing with the option to learn multiple categories of SFs. Outcomes data were collected through chart review and participant-reported measures up to one year after return of results. RESULTS: All participants (n = 139, 85.6% female, average 54.6 years old) who elected to learn SFs had ≥1 variant reported (100% [139/139]). The yield of reportable findings was highest for pharmacogenomic variants (97.8% [135/138] of participants), followed by common disease risk variants (89.4% [118/132]), carrier status (89.3% [117/131]), and variants related to Mendelian (27.2% [34/125]), medically actionable (15.2% [21/138]), and early-onset neurodegenerative (2.6% [3/117]) disease risks. SFs from the American College of Medical Genetics and Genomics list (v3.2, noncancer genes) were reported in 1.4% (2/138) of participants. SFs across all categories demonstrated clinical utility by prompting management changes in 28.1% (39/139) of participants. Moreover, a considerable proportion of participants had suggestive clinical features (49.0% (24/49)]) or family history (21.8% (27/124)) potentially related to their SFs. CONCLUSION: Our findings indicate there are potential benefits from opportunistic screening for a broad range of SFs.

Humans↗

PubMed2026

Precision medicine and parental experience: a longitudinal study of psychosocial responses to germline genomic results in pediatric oncology.

INTRODUCTION: Precision medicine has become central to pediatric oncology, with germline genomic sequencing commonly integrated into routine care. Families must interpret complex genomic findings during emotionally vulnerable periods, generating mixed reactions ranging from clarity and relief to anxiety and uncertainty. Palliative care clinicians, genetic counselors, psychologists, social workers, and oncology providers may each contribute to supporting families as they interpret and integrate these findings over the course of a child's cancer care and beyond. Little is known about the trajectory of parental emotional and cognitive responses after receiving germline sequencing results, limiting clinicians' ability to anticipate support needs across the cancer care continuum. This study quantitatively examines parental emotional and cognitive responses across time following disclosure of germline sequencing results in a pediatric oncology setting. METHODS: Parents (n = 218) self-reported sequencing-related distress, positive feelings, intrusive thoughts, certainty, and self-efficacy using validated measures at two longitudinal follow-up points after disclosure of their child's germline test results. Outcomes were compared across germline test result types (pathogenic/likely pathogenic [P/LP], n = 31 [14%]; variants of uncertain significance [VUS], n = 86 [39%]; and negative, n = 101[46%]). RESULTS: Parents of children receiving P/LP or P/LP+VUS results reported significantly higher distress yet greater positive feelings than parents receiving negative results. Notably, certainty and self-efficacy increased from Timepoint 1 (median 254 days following return of results) to Timepoint 2 (median 537 days). Intrusive thoughts did not significantly differ by genetic result type or change over time; however, the factors contributing to intrusive thoughts could not be determined from the current study. DISCUSSION: These findings provide insight into how families adapt to germline genomic information following a pediatric cancer diagnosis. As precision medicine becomes increasingly embedded in pediatric oncology, structured follow-up and communication that address families' evolving informational and psychosocial needs are essential to ensure care that is scientifically precise, emotionally attuned, and centered on the family experience.

family-centered care↗

PubMed1979

Pharmacist management of anticoagulant therapy in ambulant patients.

The development, operation, patient management protocol and teaching activities of a pharmacist-managed anticoagulant clinic for ambulatory patients are described. Pharmaceutical services provided in the ambulatory clinic include (1) contribution to the problem-oriented medical record; (2) patient education; (3) therapeutic response monitoring; (4) drug information; (5) drug distribution; and (6) inservice education. A pharmacist completes a medication history on initial visit; assesses and adjusts anticoagulant therapy based on physical examination, detection of adverse drug reactions and laboratory test results; schedules return clinic visits; provides patient education; and records, in the patient's medical record, the assessment and results of treatment. Treatment adjustments made by the pharmacist are based on an oral anticoagulant protocol and reviewed by the clinic cardiologist. The clinic serves as a teaching site for undergraduate pharmacy students, Doctor of Pharmacy students and hospital pharmacy residents. The anticoagulant clinic gives the pharmacist a unique opportunity to provide comprehensive pharmaceutical services, to establish effective, long-term professional relationships with ambulant patients and their families, and to foster interdisciplinary health team activities.

Anticoagulants↗

PubMed2026

Implementing a Multi-Ancestry Polygenic Risk Score for Coronary Heart Disease in a Diverse Cohort.

PURPOSE: We describe a prospective cohort study (NCT05277116) conducted in phase IV of the electronic MEdical Records and GEnomics (eMERGE) Network to implement a multi-ancestry polygenic risk score for coronary heart disease (PRSCHD: PGS004696) and assess outcomes after return of results (RoR). METHODS: PRSCHD was considered alongside family history (FamHxCHD), monogenic risk from familial hypercholesterolemia (FH), and clinical risk factors, to return CHD risk as part of a Genome Informed Risk Assessment (GIRA) report. Participants with high PRSCHD (top 5th percentile) or FH received their results from study personnel, while participants with FamHxCHD were informed by mail/email. Results were placed in the electronic health record and communicated to the primary care provider. The primary outcome of initiation/intensification of lipid lowering therapy within 12 months after RoR is compared between participants with PRSCHD ≥95th percentile and those with PRSCHD 90th-94th percentile, using a regression discontinuity design. Secondary outcomes include ordering of screening tests, a new CHD diagnosis, and lifestyle changes. RESULTS: By April 2025, 20,421 adults were enrolled: mean age 50±15 years (range 18-75 years), 68% female, 50% belonging to health disparity groups, and 40% non-White by self-report. Prevalence of CHD, FamHxCHD, high PRSCHD and FH was 4.0%, 10.2%, 4.3% and 0.7%, respectively; 14.3% had at least one of the three CHD genetic risk factors and CHD risk estimates were highest in those who self-reported as Black. CONCLUSION: The prevalence of increased genetic risk for CHD was high and at least one of the three genetic risk factors for CHD was present in 14.2% of the cohort. Analyses are underway to assess outcomes after PRSCHD implementation in the context of FamHxCHD, FH, and clinical risk, across the age spectrum in a diverse cohort.

PRS↗

PubMed1976

Pancreatic enzyme response with an elemental diet.

Elemental diets can maintain or slightly improve the nutritional status without a major stimulatory effect on the pancreas. Six dogs were maintained with a regular chow diet, switched to an elemental diet and, subsequently, returned to a chow diet. Cannulation of the pancreatic duct through a duodenal cutaneous fistula revealed the enzyme response to be decreased in a dog maintained with an elemental diet, with no or only a slight weight gain. Return to a regular diet resulted in a return of pancreatic enzyme response.

Amino Acids↗

PubMedDate not supplied

The surgical treatment of extratemporal facial paralysis: an overview.

At present there is no single surgical approach that is ideally suited to rehabilitation of the paralyzed face. Dynamic reconstruction and neural reconstitution are usually preferred to static methods, except under special circumstances. Experience with over 150 autogenous facial-nerve grafts using epineural suture technique has resulted in return of movement in 95% of properly selected patients. When grafting is not feasible, as in the obliterated central facial nerve, hypoglossal-facial-nerve crossover is a simple and powerful source of reinnervation, usually resulting in minimal intraoral crippling and mild mass movement. A newer procedure, the cross-face nerve graft, is an alternative to hypoglossal crossover, although it results in less axonal input and longer regenerative time. In cases of long-standing facial paralysis with muscle atrophy, temporalis and masseter transfers are dependable and may sometimes be combined with a nerve graft.

Cervical Plexus↗

PubMed1978

Plane xanthoma and multiple myeloma with lipoprotein--paraprotein complexing.

Clinicopathologic findings are reported of a woman with generalized plane xanthoma, multiple myeloma (IgG type K), and hyperlipemia with very high levels of serum cholesterol and triglyceride. Complexing of the serum lipoproteins and immunoglobulins had cryoglobulin properties and was separable by ultracentrifugation. Immunofluorescent studies of skin and bone marrow demonstrated deposits of IgG with low density lipoprotein apoprotein and IgG with beta-lipoprotein, respectively. Although immunosuppressive therapy resulted in return of serum IgG, lipid, and lipoprotein levels to normal, the patient died from the myeloma. Serum lipoprotein-paraprotein complexes have been demonstrated in at least 20 other cases of cutaneous xanthomatosis and myeloma. This interaction may result in an autoimmune hyperlipemia.

Adult↗

PubMed1977

B-cell tolerance. III. Effect of papain-mediated cleavage of cell surface IgD on tolerance susceptibility of murine B cells.

Under defined conditions, papain removes IgD from cells while leaving IgM, H-2, Ia, Lyb-2, and complement receptor intact. The effect of such treatment with papain on the induction of tolerance in murine splenic B cells was determined in an in vitro system. Treatment of the cells with papain has no effect on subsequent antibody responsiveness presumably because surface receptors regenerate before and during incubation with immunogen. Removal of increasing amounts of IgD results in increasing susceptibility of thymus-dependent responsive cells to tolerance induction. The tolerance susceptibility of thymus-independent responsive cells, which we have previously suggested are immature cells that bear only IgM, is unaffected by cleavage of IgD. If cells are incubated for 24 h after treatment with papain, cell surface IgD and tolerance resistance return. These results indicate that a surface molecule affects susceptibility of B cells to induction of tolerance and suggest that this molecule may be IgD.

Animals↗

PubMed1977

Haemodynamics during partial extracorporeal circulation in the dog.

Circulatory changes were studied in 9 mongrel dogs during partial extracorporeal circulation from the right atrium to the carotid and/or femoral artery. The bypass circuit consisted of a membrane oxygenator and a roller pump. Cardiac output and arterial pressure decreased during bypass, but changed little when extracorporeal flow (EF) was increased from 1/10 to 3/4 of control cardiac output. Right atrial and pulmonary wedge pressures were lower than control. Total blood flow was equal to control when EF was 1/2 of the control cardiac output, and exceeded control flow at 3/4. Such enhanced venous return presumably resulted from sympathetic stimulation via atrial mechanoreceptors.

Animals↗