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The expanding use of genomic technologies encompasses all phases of life, from the embryo to the elderly, and even the posthumous phase. In this paper, we present the spectrum of genomic healthcare applications, and describe their scope and challenges at different stages of the life cycle. The integration of genomic technology into healthcare presents unique ethical issues that challenge traditional aspects of healthcare delivery. These challenges include the different definitions of utility as applied to genomic information; the particular characteristics of genetic data that influence how it might be protected, used and shared; and the difficulties applying existing models of informed consent, and how new consent models might be needed.
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This paper examines key considerations for the successful integration of genomic technologies into healthcare systems. All healthcare systems strive to introduce new technologies that are effective and affordable, but genomics offers particular challenges, given the rapid evolution of the technology. In this context we frame internationally relevant discussion points relating to effective and sustainable implementation of genomic testing within the strategic priority areas of the recently endorsed Australian National Health Genomics Policy Framework. The priority areas are services, data, workforce, finances, and person-centred care. In addition, we outline recommendations from a government perspective through the lens of the Australian health system, and argue that resources should be allocated not to just genomic testing alone, but across the five strategic priority areas for full effectiveness.
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Advances in precision medicine have presented challenges to traditional public health decision-making paradigms. Historical methods of allocating healthcare funds based on safety, efficacy, and efficiency, are challenged in a healthcare delivery model that focuses on individualized variations in pathology that form the core of precision medicine. Public health policy and decision-making must adapt to this new frontier of healthcare delivery to ensure that the broad public health goals of reducing healthcare disparities and improving the health of populations are achieved, through effective and equitable allocation of healthcare funds. This paper discusses contemporary applications of precision medicine, and the potential impacts of these on public health policy and decision-making, with particular focus on patients living with rare diseases and rare cancers. The authors then reconcile these, presenting precision public health as the bridge between these seemingly competing fields.
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Public health genomics has evolved to responsibly integrate advancements in genomics into the fields of personalized medicine and public health. Appropriate, effective and sustainable integration of genomics into healthcare requires an organized approach. This paper outlines the history that led to the emergence of public health genomics as a distinguishable field. In addition, a range of activities are described that illustrate how genomics can be incorporated into public health practice. Finally, it presents the evolution of public health genomics into the new era of "precision public health."
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Maturation includes physical, reproductive, and social aspects that develop asynchronously. Intra- and inter-individual variation in the relative timing of each aspect reflects context-dependent plasticity. Plasticity in developmental timing may be important for the family-living small apes (family Hylobatidae), where reproductive opportunities are monopolized by territorial breeding pairs. Data on development in hylobatids are so far limited due to their elusive arboreal niche and long lifespans. Herein, we provide the first quantitative analysis of behavioral development in 14 captive individuals of three species (Hylobates moloch, Nomascus leucogenys, and Symphalangus syndactylus), with some individuals being observed over 8 years. To establish a baseline for behavioral development, we compare the behavior of infants (0-2 years), juveniles (2-4 years), adolescents (4-6 years), and subadults (6-9 years) in their natal groups from data obtained over 250 focal observation hours. We then relate changes in behavior to measures of somatic and physiological development, and to wild populations, to identify the degree of intra- and inter-individual variation in developmental timing. We found greater concordance between behavioral and physiological markers of weaning than between different markers of later development, and the timing of later milestones varied more among individuals. Behavioral estimates from both captive and wild individuals in their natal groups indicate that puberty begins close to age 5, but physiological maturation can occur 0.5-3 years earlier in captive individuals than in wild individuals. Ages at onset of puberty, sexual, and social maturation vary in both captive and wild populations. The available evidence indicates that the social environment during development (e.g., presence of breeding female and appropriate mating partner), as well as nutrition, play a role in the timing of life history transitions in hylobatids. Am. J. Primatol. 78:610-625, 2016. © 2015 Wiley Periodicals, Inc.
Asunto(s)
Conducta Animal , Hylobatidae , Reproducción , Animales , Femenino , Hominidae , Hylobates , Masculino , DesteteRESUMEN
Behavioural development was quantified in one family group of silvery gibbons (Hylobates moloch) and one of white-cheeked gibbons (Nomascus leucogenys) over 11 months during 2005 and 2008 at the Perth Zoo. Levels of locomotion, solo play and play solicitation peaked by 5 years of age but continued solo and social play in older immatures suggested that social development continued until at least 7 years of age. Mature offspring responded to play solicitations from younger siblings. The transition to sub-adulthood was marked by the presence of spatial peripheralisation from the parents, and coincided with aggression from the father to a sub-adult male. After the birth of a new infant, the male sub-adult stayed closer to his mother (and the infant) but not to his father; his juvenile brother was closer to both parents. Within-family observations of behaviour that is difficult to observe in the wild but can be observed in captivity contributes to our understanding of family dynamics in gibbons. Observations of these captive groups suggest that sub-adult peripheralisation may be influenced by family social dynamics as well as by local ecology, and that older offspring are responsive to the development of younger siblings.