Monday, September 15, 2014

From Mayo Clinic: Why brain death is considered death and why there should be no confusion

Neurology. 2014 Sep 12. pii: 10.1212/WNL.0000000000000883. [Epub ahead of print]

Why brain death is considered death and why there should be no confusion.

Author information

  • 1From the Department of Anesthesiology (C.M.B.), the Biomedical Ethics Program, Departments of Health Sciences Research and General Internal Medicine (R.R.S.), and the Department of Neurology (E.F.W.), Mayo Clinic, Rochester, MN.
  • 2From the Department of Anesthesiology (C.M.B.), the Biomedical Ethics Program, Departments of Health Sciences Research and General Internal Medicine (R.R.S.), and the Department of Neurology (E.F.W.), Mayo Clinic, Rochester, MN.


Neurologic determination of brain death is a complex assessment that may be misunderstood by nonspecialists and families. Recent guidelines clarify how to proceed with such an examination and are available to physicians, with the time of death in adults and children being determined by the last defining test-the apnea test. This core principle in neurology has been challenged recently in court and resulted in an unprecedented continuation of care in a 13-year-old child declared dead. This review comments on the medical, legal, and ethical quandaries introduced by this case and highlights the major elements of consensus on matters related to brain death that have been forged over 3 decades of sustained medical and societal debate. A clear appreciation by physicians and the public of the diagnostic determination of death following loss of brain function will help to prevent similar conflicts from occurring in the future.

From Eric Bernicker: Biomarker Testing in Non–Small Cell Lung Cancer: A Clinician's Perspective

Eric BernickerMD
From Thoracic Medical Oncology, Houston Methodist Hospital, Houston, Texas.

"By now, it is no longer an active clinical question: multiple clinical trials have conclusively proven that, in the presence of an activating EGFR mutation, targeted agents are superior to cytotoxic chemotherapy.7–10 For that reason, unless the patient has clinical symptoms necessitating rapid  initiation of therapy, most clinicians will await the results of molecular testing before beginning treatment. It is expected that the turnaround time for such results should be 2 weeks at the most, the upper limit of time that a patient and their family can stand to wait for the information. It is certainly true that these mutation-directed therapies retain their ability to cause responses even if used after initial chemotherapy. However, their generally favorable toxicity proļ¬le leads most clinicians to prefer to select targeted therapy if the correct driver mutations are present, unless disease burden or severity necessitates a more urgent therapeutic start."

Biomarkers and Oncology: The Path Forward to a Learning Health System

Peter P. YuMDMark A. HoffmanPhDDaniel F. HayesMD
From the Department of Hematology-Oncology, Palo Alto Medical Foundation, Palo Alto, California (Dr Yu); the Center for Health Insights, University of Missouri, Kansas City (Dr Hoffman); and the Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor (Dr Hayes).

Next-Generation Companion Diagnostics: Promises, Challenges, and Solutions

Joseph D. KhouryMDDaniel V. T. CatenacciMD
From the Division of Pathology and Laboratory Medicine, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, (Dr Khoury); and the Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, Illinois (Dr Catenacci).

College of American Pathologists' Laboratory Standards for Next-Generation Sequencing Clinical Tests

Nazneen AzizPhDQin ZhaoPhDLynn BryMD, PhDDenise K. DriscollMS, MT(ASCP)SBBBirgit FunkePhDJane S. Gibson,PhDWayne W. GrodyMDMadhuri R. HegdePhDGerald A. HoeltgeMDDebra G. B. LeonardMD, PhDJason D. MerkerMD, PhDRakesh NagarajanMD, PhDLinda A. PalickiMT(ASCP)Ryan S. RobetoryeMDIris SchrijverMDKaren E. WeckMDKarl V. VoelkerdingMD
From Molecular Medicine (Dr Aziz), Laboratory Improvement Programs (Dr Zhao and Ms Palicki), and Laboratory Accreditation and Regulatory Affairs (Ms Driscoll), College of American Pathologists, Northfield, Illinois; the Department Pathology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts (Dr Bry); the Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Dr Funke); the Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando (Dr Gibson); the Divisions of Medical Genetics and Molecular Diagnostics, Department of Pathology & Laboratory Medicine, Pediatrics, and Human Genetics, UCLA School of Medicine, UCLA Institute for Society and Genetics, Molecular Diagnostic Laboratories and Clinical Genomics Center, UCLA Medical Center, Los Angeles, California (Dr Grody); the Department of Human Genetics, Emory University School of Medicine, Decatur, Georgia (Dr Hegde); Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio (Dr Hoeltge); the Department of Pathology, University of Vermont College of Medicine, Burlington (Dr Leonard); the Departments of Pathology (Drs Merker and Schrijver) and Pediarics (Dr Schrijver), Stanford University School of Medicine, Stanford, California; the Department of Pathology & Immunology, Washington University School of Medicine, St Louis, Missouri (Dr Nagarajan); the Department of Laboratory Medicine & Pathology, Mayo Clinic in Arizona, Phoenix (Dr Robetorye); the Departments of Pathology & Laboratory Medicine and Genetics, University of North Carolina at Chapel Hill, Chapel Hill (Dr Weck); and ARUP Laboratories Institute for Clinical and Experimental Pathology, and Department of Pathology, University of Utah School of Medicine, Salt Lake City (Dr Voelkerding). Dr Aziz is now with Phoenix Children's Hospital, Phoenix.
Context.— The higher throughput and lower per-base cost of next-generation sequencing (NGS) as compared to Sanger sequencing has led to its rapid adoption in clinical testing. The number of laboratories offering NGS-based tests has also grown considerably in the past few years, despite the fact that specific Clinical Laboratory Improvement Amendments of 1988/College of American Pathologists (CAP) laboratory standards had not yet been developed to regulate this technology.
Objective.— To develop a checklist for clinical testing using NGS technology that sets standards for the analytic wet bench process and for bioinformatics or “dry bench” analyses. As NGS-based clinical tests are new to diagnostic testing and are of much greater complexity than traditional Sanger sequencing–based tests, there is an urgent need to develop new regulatory standards for laboratories offering these tests.
Design.— To develop the necessary regulatory framework for NGS and to facilitate appropriate adoption of this technology for clinical testing, CAP formed a committee in 2011, the NGS Work Group, to deliberate upon the contents to be included in the checklist.
Results.— A total of 18 laboratory accreditation checklist requirements for the analytic wet bench process and bioinformatics analysis processes have been included within CAP's molecular pathology checklist (MOL).
Conclusions.— This report describes the important issues considered by the CAP committee during the development of the new checklist requirements, which address documentation, validation, quality assurance, confirmatory testing, exception logs, monitoring of upgrades, variant interpretation and reporting, incidental findings, data storage, version traceability, and data transfer confidentiality.

Saturday, September 6, 2014

Idaho Most Obese State In The West, Rate Continues To Climb

Idaho Most Obese State In The West, Rate Continues To Climb

"Idaho was the most obese state west of the Dakotas and one of only six states nationwide where adult obesity rose between 2012 and 2013."

Publicly Financed Healthcare and Income Inequality in Canada


Publicly Financed Healthcare and Income Inequality in Canada.

Author information

  • 1Senior researcher with the Bureau of Health Information, New South Wales, Australia, and was a program consultant with Canadian Institute for Health Information (CIHI) at the time of this writing.
  • 2Senior researcher with CIHI and an assistant professor, status only, with the School of Public Policy and Governance, and the Institute for HealthPolicy, Management and Evaluations at the University of Toronto, in Toronto, Ontario.
  • 3Canada research chair in population health modelling/populomics at the University of Ottawa, in Ottawa, Ontario.
  • 4Director of the Centre for Health Economics and Policy Analysis, and an associate professor in the Department of Health, Aging and Society and the Department of Economics at McMaster University, in Hamilton, Ontario.


Income inequality is currently the focus of considerable public and policy attention. Public services such as healthcare and education play a role in reducing income inequality in the population. This study looks at how healthcare affects the distribution of income across five income groups. Specifically, it estimates the tax contributions and the value of benefits received from physician services, drugs and hospital services over a person's lifetime. We found that benefits received from publicly funded healthcare in Canada reduce the income gap between the highest- and lowest-income groups by 16%. This analysis provides a starting point for future research to explore the distributional effects of different options for financing healthcare.

Social media: pathologists' force multiplier.

Arch Pathol Lab Med. 2014 Aug;138(8):1000-1. doi: 10.5858/arpa.2014-0071-ED.

Social media: pathologists' force multiplier.

Author information

  • From the Department of Pathology, University of Texas Medical Branch, Galveston.
"Doctors make up a small percentage of the population in the United States (about 0.29%, or 1 in 300 people),1 and pathologists make up a small percentage of doctors (about 18 000 of the 885 000 doctors, or about 0.2% of doctors).1,2 Pathologists therefore make up only about 0.006% of the population of the United States. Pathologists cannot sway legislators solely by appealing as a numerically powerful constituency; nor can we sway other policymakers, including administrative leaders and quasi-legal agencies, by force of sheer numbers. Further, pathologists' relatively small number significantly hinders our ability to educate society about the pathologist's professional role and the value we provide to patients. Many people, including policymakers, have little or no idea what pathologists do, perhaps other than perform autopsies like Quincy or Ducky. Lots of people do not even know pathologists are physicians."

Friday, September 5, 2014

Daily pain in adolescents with Cystic Fibrosis

 2014 Sep 3. doi: 10.1002/ppul.23091. [Epub ahead of print]

Daily pain in adolescents with CF: Effects on adherence, psychological symptoms, and health-related quality of life.

Author information

  • 1University of Miami, Coral Gables, Florida.



Cystic fibrosis (CF) is a progressive, life-shortening disease currently treated symptomatically. Among the consequences of daily treatments and long-term progression of the disease is significant discomfort and pain. This study measured pain systematically in adolescents with CF using a pain diary, and evaluated its associations with treatment adherence, psychological symptoms, and health-related quality of life (HRQOL).


This study was part of a larger, multi-center study. Ninety-five adolescents with a mean age of 15.8 were enrolled. A total of 413 online pain diaries were completed for 6 days following a routine clinic visit. Diaries measured pain intensity, location, duration, affective ratings, and coping responses. Adherence to pulmonary medications was measured using prescription refill data; other measures included ratings of depression, anxiety and HRQOL.


Pain was reported by 74.5% of participants, generally in the mild range, averaging 2.1 on a 10-point scale. Daily pain ratings were highly variable both within and between participants. Pain was significantly associated with worse adherence, more psychological distress, and worse HRQOL.


Results indicated that pain is a common problem for adolescents with CF and negatively affects their disease management, psychological symptoms and health outcomes. Routine assessment of pain and systematic studies of interventions to treat pain are recommended. 

Teasing, taunting, and the politics of politeness: high sociometric status is associated with expectation-consistent behavior

 2014 Aug 26;9(8):e104737. doi: 10.1371/journal.pone.0104737. eCollection 2014.

Teasing, taunting, and the politics of politeness: high sociometric status is associated with expectation-consistent behavior.

Author information

  • 1Department of Psychology, University of Illinois, Urbana-Champaign, Champaign, Illinois, United States of America.
  • 2Rady School of Management, University of California San Diego, San Diego, California, United States of America.
  • 3Department of Psychology, University of California, Berkeley, California, United States of America.
  • 4Department of Psychology, Bridgewater College, Bridgewater, Virginia, United States of America.
  • 5Department of Psychology, University of St. Thomas, Saint Paul, Minnesota, United States of America.


Research examining face-to-face status hierarchies suggests that individuals attain respect and admiration by engaging in behavior that influences others' judgments of their value to the group. Building on this research, we expected that high-status individuals would be less likely to engage in behaviors that violate group norms and expectations, relative to low-status individuals. Adolescent participants took part in an interaction in which they teased an opposite-gender friend (Study 1) or an experiment in which taunting or cheering expectations were manipulated (Study 2). Consistent with the hypothesis, high-status boys and girls engaged in teasing behaviors consistent with their gender roles, relative to their low status counterparts (Study 1). In Study 2, high-status boys engaged in more direct provocation and off-record commentary while taunting, and more affiliative behavior while cheering on their partner, relative to low-status boys. Discussion focused on how expectation-consistent actions help individuals maintain elevated status.

Wyoming adult obesity rate jumps 3.2% in new study ("’s a lack of physical activity and poor nutrition...")

“There are a lot of factors, but when it comes right down to it, it’s a lack of physical activity and poor nutrition,” said Joe Grandpre, chronic disease epidemiologist at the Wyoming Department of Health.
Historically, one in five adults in the state does not get leisure-time physical activity, and only 17 percent of adults get the recommended serving of fruits and vegetables, according to Grandpre. 


 2014 Aug;121(2):328-32. doi: 10.3171/2014.4.JNS131886. Epub 2014 May 23.

The skull of Chios: trepanation in Hippocratic medicine.

Author information

  • 1Neurosurgery Department, Queen Elizabeth Hospital, Birmingham, United Kingdom; and.


Cranial trepanation is the oldest neurosurgical operation and its roots date back to prehistory. For many centuries, religion and mysticism were strongly linked to the cause of diseases, and trepanation was associated with superstitions such as releasing evil spirits from inside the skull. The Hippocratic treatise "On injuries of the head" was therefore a revolutionary work, as it presented a systematic approach to the management of cranial trauma, one that was devoid of spiritual elements. Unfortunately, there are only a limited number of skeletal findings that confirm that the practice of trepanation was performed as part of Hippocratic medicine. In this historical vignette, the authors present a trepanned skull that was found in Chios, Greece, as evidence of the procedure having been performed in accordance with the Hippocratic teaching. The skull bears a parietal bur hole in association with a linear fracture, and it is clear that the patient survived the procedure. In this analysis, the authors examine the application of the original Hippocratic teaching to the skull of Chios. The rationalization of trepanation was clearly a significant achievement in the evolution of neurosurgery.

India: "The traditional general practitioner is a dying breed and deficiency of doctors willing to work in community settings is rampant."

 2014 Apr;3(2):91-3. doi: 10.4103/2249-4863.137603.

Helicopter Dropping of 50 Free Allopathic Medicines; Prescribed by Homoeopathic Doctors at Ground: Sorry this is not Universal Health Coverage.

Author information

  • President Academy of Family Physicians of India, Chief Editor, Journal of Family Medicine and Primary Care, New Delhi, India.


The provision of Universal Health Coverage (UHC) is being discussed in India. Crippled by the charges of corruption and unethical practice by media and public at large, medical professionals are largely unaware, disinterested, isolated and edged out from this debate. The traditional general practitioner is a dying breed and deficiency of doctors willing to work in community settings is rampant. Is UHC model proposed in present form good for an ordinary Indian citizen? This editorial looks into the underlying politics of health care in India in the past and how this ongoing debate could impact the future of primary care and health care of people in India.

Near-misses: Time for some mitigation standardization? ("... 400 techniques were used to mitigate the near-misses, nearly one per causative factor identified.")

 2014 July/September;34(3):114-119.

What Causes Near-misses and How Are They Mitigated?

Author information

  • 1At Inova Fair Oaks Hospital in Fairfax, Va., Karen Gabel Speroni is a nursing research scientist, Judith Fisher is the former director of clinical operations, Marie Dennis is the former chief nursing officer, and Marlon Daniel is a biostatistician.



The objectives of this study were to determine the reasons hospital RNs attribute to near-misses and the techniques they used to mitigate these near-misses to prevent serious reportable events.


Our health system developed this definition for the study: A near-miss is a variation in a normal process that, if continued, could have a negative impact on patients.


Study participants were RNs who completed a survey about a self-reported near-miss or another RN's near-miss they'd witnessed. Data collected included participant demographics, near-miss occurrence by day of week and time, near-miss type, and attributed causes.


A total of 144 near-miss types were self-reported or witnessed by 123 respondents; of these, 43 (35%) self-reported a near-miss event and 80 (65%) witnessed a near-miss event. The respondents identified medication administration (19%) and transcription errors (10%) as the most frequent types of near-misses (N = 144). Selecting from 412 factors related to near-misses, more RNs attributed near-misses to personal factors than institutional factors. Top personal factors were not following policy and inappropriate decision making or critical assumptions. Top institutional factors were work-related interruptions and distractions, and poor communication about a patient. A total of 400 techniques were used to mitigate the near-misses, nearly one per causative factor identified. Top techniques used were stop, think, act, review (STAR) and verification of proper procedures or actions.


Hospital administrators should consider both personal and institutional factors when evaluating patient-safety programs. Education about mitigating techniques for near-misses is imperative for RNs.

From Tehran U: "...mothers consider immunizing children important and they have enough trust in the health system."

 2014 Sep 4:1-15. [Epub ahead of print]

Maternal concerns about immunization over 0-24 month children: a qualitative research.

Author information

  • 1Department of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences , Tehran , Iran .


The purpose of this qualitative study was to determine the concerns of mothers referred to health center in south TehranIran about immunizing children aged 0-24 months. Data were collected using individual semi-structured interviews and analyzed using content analysis. The mothers' concerns over immunizing their children fell into 5 main categories: (1) "Factors that cause mothers' concerns," (2) "Factors that influence mothers' concerns," (3) "Information, education, and communication barriers," (4) "Informational/educational needs and sources," and (5) "The necessity of childhood vaccinations." According to study findings, mothers consider immunizing children important and they have enough trust in the health system. A deep understanding of maternal concerns about immunizing their children at 0-24 months allows nurses to reduce mothers' concerns by removing communication barriers and providing appropriate and adequate information.

Thursday, September 4, 2014

NIH-funded study: College student "alcohol consumption and other risk factors were related to pregaming and tailgating."

 2014 Sep 3. [Epub ahead of print]

Tailgating and Pregaming by College Students with Alcohol Offenses: Patterns of Alcohol Use and Beliefs.

Author information

  • 11The Pennsylvania State College of Medicine, Mail Code A210, Hershey, Pennsylvania, USA.


Research indicates that pregaming (drinking before a social event) and tailgating (drinking before a sporting event) are two culturally ingrained alcohol use behaviors by college students. We examined the prevalence of these two activities in a sample of college students (N = 354) who violated campus alcohol policy and were mandated to receive an alcohol intervention in fall 2010. Results indicated that alcohol consumption and other risk factors were related to pregaming and tailgating. These findings are discussed in the context of clinical implications and future directions for research. This study was funded in part by the National Institutes of Health.

US to provide $75M to expand Ebola care centers

US to provide $75M to expand Ebola care centers

A court-packing payoff for Obamacare

EDITORIAL: A court-packing payoff for Obamacare

A U.S. appeals court saves health care law again
 - - Thursday, September 4, 2014

"Whoever said cheaters never win never met a president with an unrestrained ambition to make big government bigger, and damn the Constitution. Three new judges of the U.S. Circuit Court of Appeals for the District of Columbia rode to the rescue of Obamacare on Thursday. The judges newly appointed by President Obama and confirmed by Democrats are in the new 7 to 4 majority, which reversed last month’s well-reasoned decision of a three-judge panel that said the administration can’t rewrite provisions of the Obamacare law, however inconvenient to the president, without going through the proper legislative process."

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Digital health care: Cementing centralization?

Health Informatics J. 2014 Sep;20(3):168-75. doi: 10.1177/1460458213494033.

Digital health care: Cementing centralisation?

Author information

  • University of Leeds, UK


This article reviews large-scale digital developments in the National Health Service in England in recent years and argues that there is a mismatch between digital and organisational thinking and practice. The arguments are based on new institutional thinking, where the digital infrastructure is taken to be an institution, which has been shaped over a long period, and which in turn shapes the behaviour of health professionals, managers and others. Many digital services are still being designed in line with a bureaucratic data processing model. Yet health services are increasingly based on a network model, where health professionals and service managers require information systems that allow them to manage risks proactively and to coordinate multiple services on behalf of patients. This article further argues that the data processing model is being reinforced by Open Data policies and by related developments in the acquisition of genomic and telehealth data, suggesting that the mismatch will persist. There is, therefore, an ongoing tension between frontline and central objectives for digital services. It may be that the tension can only be resolved when - or if - there is trust between the interested parties.

Sarcopenia: "From our 30s, we can lose up to about a half pound of muscle per year if we do not take action to sustain it."

"Although we cannot prevent aging, there are steps we can take to slow its progression. One of the key factors related to our quality of life, as well as our risk of many medical issues, is the amount of muscle we have. A common trend as we get older is a shift in body composition — less muscle mass and increased body fat. The good news is that, in many cases, there are steps we can take to counter this trend.
Sarcopenia is a term that refers to progressive muscle loss due to the aging process. It is estimated that about 30 percent of people over 60 and 50 percent of those over 80 years of age have some level of sarcopenia. From our 30s, we can lose up to about a half pound of muscle per year if we do not take action to sustain it."

Childhood Obesity On The Rise

Childhood Obesity On The Rise
It's Hunger Action Month, but another problem to be aware of with children is childhood obesity.

According to experts, one in five kids between the ages of 2 and 5 are already overweight. And 8 percent are already obese. As kids get older, those numbers increase.

"...people profit from a religious affiliation if they also actively practice their religion."

 2014 Aug 14;5:876. doi: 10.3389/fpsyg.2014.00876. eCollection 2014.

Satisfaction with life and character strengths of non-religious and religious people: it's practicing one's religion that makes the difference.

Author information

  • Department of Psychology - Personality and Assessment, University of Zurich Zurich, Switzerland.


According to systematic reviews, religious beliefs and practices are related to higher life satisfaction, happiness, and positive affect (Koenig and Larson, 2001). The present research extends previous findings by comparing satisfaction with life and character strengths of non-religious people,religious people, who practice their religion and people that have a religious affiliation but do not practice their religion. We assessed life satisfaction (SWLS), character strengths (VIA-IS) and the orientations to happiness (OTH) in a sample of N = 20538 participants. People with a religious affiliation that also practice their religion were found to be more satisfied with their life and scored higher on life of meaning than those who do not practice their religion and than non-religious people. Also religious people who practice their religion differed significantly from those who do not practice their religion and non-religious people regarding several character strengths; they scored higher on kindness, love, gratitude, hope, forgiveness, and on spirituality. There were no substantial differences between people who had no religious affiliation and those with a religious affiliation that do not practice their religion (all [Formula: see text]s < 0.009). Altogether, the present findings suggest that people profit from a religious affiliation if they also actively practice their religion.

Sensory Reinforcement-Enhancing Effects of Nicotine Via Smoking

 2014 Sep 1. [Epub ahead of print]

Sensory Reinforcement-Enhancing Effects of Nicotine Via Smoking.


As has been found in nicotine research on animals, research on humans has shown that acute nicotine enhances reinforcement from rewards unrelated to nicotine intake, but this effect may be specific to rewards from stimuli that are "sensory" in nature. We assessed acute effects of nicotine via smoking on responding for music or video rewards (sensory), for monetary reward (nonsensory), or for no reward (control), to gauge the generalizability of nicotine's reinforcement-enhancing effects. Using a fully within-subjects design, dependent smokers (N = 20) participated in 3 similar experimental sessions, each following overnight abstinence (verified by carbon monoxide <10 ppm) and varying only in the smoking condition. Sessions involved no smoking or smoking "denicotinized" ("denic;" 0.05 mg) or nicotine (0.6 mg) Quest brand cigarettes in controlled fashion prior to responding on a simple operant computer task for each reward separately using a progressive ratio schedule. The reinforcing effects of music and video rewards, but not money, were significantly greater due to the nicotine versus denic cigarette (i.e., nicotine per se), whereas there were no differences between denic cigarette smoking and no smoking (i.e., smoking behavior per se), except for no reward. These effects were not influenced by withdrawal relief from either cigarette. Results that generalize from an auditory to a visual reward confirm that acute nicotine intake per se enhances the reinforcing value of sensory rewards, but its effects on the value of other (perhaps nonsensory) types of rewards may be more modest. 

Emerging Issues in Public Health Genomics

Annu Rev Genomics Hum Genet. 2014 Aug 31;15:461-480.

Emerging Issues in Public Health Genomics.

Author information

  • 1Department of Health Behavior and Health Education and.


This review highlights emerging areas of interest in public health genomics. First, we describe recent advances in newborn screening (NBS), with a focus on the practice and policy implications of current and future efforts to expand NBS programs (e.g., via next-generation sequencing). Next, we detail research findings from the rapidly progressing field of epigenetics and epigenomics, highlighting ways in which our emerging understanding in these areas could guide future intervention and research efforts in public health. We close by considering various ethical, legal, and social issues posed by recent developments in public health genomics; these include policies to regulate access to personal genomic information, the need to enhance genetic literacy in both health professionals and the public, and challenges in ensuring that the benefits (and burdens) of genomic discoveries and applications are equitably distributed. We also note needs for future genomic research that integrates across basic and social sciences.