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      Big data hurdles in precision medicine and precision public health

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          Abstract

          Background

          Nowadays, trendy research in biomedical sciences juxtaposes the term ‘precision’ to medicine and public health with companion words like big data, data science, and deep learning. Technological advancements permit the collection and merging of large heterogeneous datasets from different sources, from genome sequences to social media posts or from electronic health records to wearables. Additionally, complex algorithms supported by high-performance computing allow one to transform these large datasets into knowledge. Despite such progress, many barriers still exist against achieving precision medicine and precision public health interventions for the benefit of the individual and the population.

          Main body

          The present work focuses on analyzing both the technical and societal hurdles related to the development of prediction models of health risks, diagnoses and outcomes from integrated biomedical databases. Methodological challenges that need to be addressed include improving semantics of study designs: medical record data are inherently biased, and even the most advanced deep learning’s denoising autoencoders cannot overcome the bias if not handled a priori by design. Societal challenges to face include evaluation of ethically actionable risk factors at the individual and population level; for instance, usage of gender, race, or ethnicity as risk modifiers, not as biological variables, could be replaced by modifiable environmental proxies such as lifestyle and dietary habits, household income, or access to educational resources.

          Conclusions

          Data science for precision medicine and public health warrants an informatics-oriented formalization of the study design and interoperability throughout all levels of the knowledge inference process, from the research semantics, to model development, and ultimately to implementation.

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          Most cited references106

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          'Mendelian randomization': can genetic epidemiology contribute to understanding environmental determinants of disease?

          Associations between modifiable exposures and disease seen in observational epidemiology are sometimes confounded and thus misleading, despite our best efforts to improve the design and analysis of studies. Mendelian randomization-the random assortment of genes from parents to offspring that occurs during gamete formation and conception-provides one method for assessing the causal nature of some environmental exposures. The association between a disease and a polymorphism that mimics the biological link between a proposed exposure and disease is not generally susceptible to the reverse causation or confounding that may distort interpretations of conventional observational studies. Several examples where the phenotypic effects of polymorphisms are well documented provide encouraging evidence of the explanatory power of Mendelian randomization and are described. The limitations of the approach include confounding by polymorphisms in linkage disequilibrium with the polymorphism under study, that polymorphisms may have several phenotypic effects associated with disease, the lack of suitable polymorphisms for studying modifiable exposures of interest, and canalization-the buffering of the effects of genetic variation during development. Nevertheless, Mendelian randomization provides new opportunities to test causality and demonstrates how investment in the human genome project may contribute to understanding and preventing the adverse effects on human health of modifiable exposures.
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            ‘Mendelian randomization’: can genetic epidemiology contribute to understanding environmental determinants of disease?*

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              Finding the missing heritability of complex diseases.

              Genome-wide association studies have identified hundreds of genetic variants associated with complex human diseases and traits, and have provided valuable insights into their genetic architecture. Most variants identified so far confer relatively small increments in risk, and explain only a small proportion of familial clustering, leading many to question how the remaining, 'missing' heritability can be explained. Here we examine potential sources of missing heritability and propose research strategies, including and extending beyond current genome-wide association approaches, to illuminate the genetics of complex diseases and enhance its potential to enable effective disease prevention or treatment.
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                Author and article information

                Contributors
                m.prosperi@ufl.edu
                Journal
                BMC Med Inform Decis Mak
                BMC Med Inform Decis Mak
                BMC Medical Informatics and Decision Making
                BioMed Central (London )
                1472-6947
                29 December 2018
                29 December 2018
                2018
                : 18
                : 139
                Affiliations
                [1 ]ISNI 0000 0004 1936 8091, GRID grid.15276.37, Department of Epidemiology, College of Medicine & College of Public Health and Health Professions, , University of Florida, ; Gainesville, FL 32610 USA
                [2 ]ISNI 0000 0004 1936 8091, GRID grid.15276.37, Department of Health Outcomes and Biomedical Informatics, College of Medicine, , University of Florida, ; Gainesville, FL 32610 USA
                [3 ]ISNI 0000 0001 1089 6558, GRID grid.164971.c, Center for Health Outcomes and Informatics Research, , Loyola University Chicago, ; Maywood, IL 60153 USA
                Author information
                http://orcid.org/0000-0002-9021-5595
                Article
                719
                10.1186/s12911-018-0719-2
                6311005
                30594159
                7f50bf8f-c573-40be-989a-907f9b2fbe16
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 15 May 2018
                : 4 December 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100006108, National Center for Advancing Translational Sciences;
                Award ID: UL1TR001427
                Funded by: FundRef http://dx.doi.org/10.13039/100006827, Florida Department of Health;
                Award ID: 4KB16
                Funded by: FundRef http://dx.doi.org/10.13039/100006093, Patient-Centered Outcomes Research Institute;
                Award ID: CDRN-1501- 26692
                Funded by: FundRef http://dx.doi.org/10.13039/100010661, Horizon 2020 Framework Programme;
                Award ID: H2020-PHC-2014 #634650
                Categories
                Debate
                Custom metadata
                © The Author(s) 2018

                Bioinformatics & Computational biology
                Bioinformatics & Computational biology

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