Conserving plants within and beyond protected areas - still problematic and future uncertain

Against a background of continuing loss of biodiversity, it is argued that for the successful conservation of threatened plant species we need to ensure the more effective integration of the various conservation actions employed, clarify the wording of the CBD targets and provide clearer operational guidance as to how they are to be implemented and their implementation monitored. The role and effectiveness of protected areas in conserving biodiversity and in particular plant species are discussed as are recent proposals for a massive increase of their extent. The need for much greater effort and investment in the conservation or protection of threatened species outside protected areas where most plant diversity occurs is highlighted. The difficulties involved in implementing effective conservation of plant diversity both at an area- and species/population-based level are discussed. The widespread neglect of species recovery for plants is noted and the desirability of making a clearer distinction between species recovery and reintroduction is emphasized. Key messages from a global overview of species recovery are outlined and recommendations made, including the desirability of each country preparing a national species recovery strategy. The projected impacts of global change on protected areas and on species conservation and recovery, and ways of addressing them are discussed

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Two Outbreaks of Foodborne Gastrointestinal Infection Linked to Consumption of Imported Melons, United Kingdom, March to August 2021

The aim of this study was to describe two foodborne outbreaks caused by contaminated imported melon and make recommendations for future practice. Between March and July 2021, there was an outbreak of 113 cases of Salmonella Braenderup in the UK (62% female, median age 61 years, 33% hospitalized). Analytical epidemiological studies identified Galia melons as the vehicle of infection (OR 671.9, 95% CI 39.0–58,074.0, p < 0.001). Subsequently, the outbreak strain was isolated from two samples of Galia melon imported from Latin America. In July and August 2021, there was an outbreak of 17 cases of Shiga toxin-producing Escherichia coli (STEC) O157:H7 in the UK (53% female, median age 21 years, 35% were hospitalized). Review of the STEC surveillance questionnaire data, followed by the analysis of responses from a modified hypothesis-generating questionnaire, implicated eating precut watermelon from retailer B sourced from Europe as the vehicle of infection. Outbreaks of gastrointestinal pathogens caused by contaminated food of nonanimal origin are a global public health concern. Given the difficulty in removing pathogens from the flesh of ready-to-eat fruit and vegetables, public health interventions should target all steps of the food chain prior to consumption, from cultivation on the farm to processing/packing and distribution

Perspectives and preferences regarding genomic secondary findings in underrepresented prenatal and pediatric populations: A mixed-methods approach

PurposePatients undergoing clinical exome sequencing (ES) are routinely offered the option to receive secondary findings (SF). However, little is known about the views of individuals from underrepresented minority pediatric or prenatal populations regarding SF.MethodsWe explored the preferences for receiving hypothetical categories of SF (H-SF) and reasons for accepting or declining actual SF through surveying (n&nbsp;= 149) and/or interviewing (n&nbsp;= 47) 190 families undergoing pediatric or prenatal ES.ResultsUnderrepresented minorities made up 75% of the probands. In total, 150 families (79%) accepted SF as part of their child/fetus's ES. Most families (63%) wanted all categories of H-SF. Those who declined SF as part of ES were less likely to want H-SF across all categories. Interview findings indicate that some families did not recall their SF decision. Preparing for the future was a major motivator for accepting SF, and concerns about privacy, discrimination, and psychological effect drove decliners.ConclusionA notable subset of families (37%) did not want at least 1 category of H-SF, suggesting more hesitancy about receiving all available results than previously reported. The lack of recollection of SF decisions suggests a need for alternative communication approaches. Results highlight the importance of the inclusion of diverse populations in genomic research

The motivation and process for developing a consortium‐wide time and motion study to estimate resource implications of innovations in the use of genome sequencing to inform patient care

Abstract Costs of implementing genomic testing innovations extend beyond the cost of sequencing, affecting personnel and infrastructure for which little data are available. We developed a time and motion (T&M) study within the Clinical Sequencing Evidence‐Generating Research (CSER) consortium to address this gap, and herein describe challenges of conducting T&M studies within a research consortium and the approaches we developed to overcome them. CSER investigators created a subgroup to carry out the T&M study (authors). We describe logistical and administrative challenges associated with resource use data collection across heterogeneous projects conducted in real‐world clinical settings, and our solutions for completing this study and harmonizing data across projects. We delineate processes for feasible data collection on workflow, personnel, and resources required to deliver genetic testing innovations in each CSER project. A critical early step involved developing detailed project‐specific process flow diagrams of innovation implementation in projects' clinical settings. Analyzing diagrams across sites, we identified common process‐step themes, used to organize project‐specific data collection and cross‐project analysis. Given the heterogeneity of innovations, study design, and workflows, which affect resources required to deliver genetic testing innovations, flexibility was necessary to harmonize data collection. Despite its challenges, this heterogeneity provides rich insights about variation in clinical processes and resource implications for implementing genetic testing innovations

Diagnostic yield of pediatric and prenatal exome sequencing in a diverse population

The diagnostic yield of exome sequencing (ES) has primarily been evaluated in individuals of European ancestry, with less focus on underrepresented minority (URM) and underserved (US) patients. We evaluated the diagnostic yield of ES in a cohort of predominantly US and URM pediatric and prenatal patients suspected to have a genetic disorder. Eligible pediatric patients had multiple congenital anomalies and/or neurocognitive disabilities and prenatal patients had one or more structural anomalies, disorders of fetal growth, or fetal effusions. URM and US patients were prioritized for enrollment and underwent ES at a single academic center. We identified definitive positive or probable positive results in 201/845 (23.8%) patients, with a significantly higher diagnostic rate in pediatric (26.7%) compared to prenatal patients (19.0%) (P = 0.01). For both pediatric and prenatal patients, the diagnostic yield and frequency of inconclusive findings did not differ significantly between URM and non-URM patients or between patients with US status and those without US status. Our results demonstrate a similar diagnostic yield of ES between prenatal and pediatric URM/US patients and non-URM/US patients for positive and inconclusive results. These data support the use of ES to identify clinically relevant variants in patients from diverse populations

Examining access to care in clinical genomic research and medicine: Experiences from the CSER Consortium.

IntroductionEnsuring equitable access to health care is a widely agreed-upon goal in medicine, yet access to care is a multidimensional concept that is difficult to measure. Although frameworks exist to evaluate access to care generally, the concept of "access to genomic medicine" is largely unexplored and a clear framework for studying and addressing major dimensions is lacking.MethodsComprised of seven clinical genomic research projects, the Clinical Sequencing Evidence-Generating Research consortium (CSER) presented opportunities to examine access to genomic medicine across diverse contexts. CSER emphasized engaging historically underrepresented and/or underserved populations. We used descriptive analysis of CSER participant survey data and qualitative case studies to explore anticipated and encountered access barriers and interventions to address them.ResultsCSER's enrolled population was largely lower income and racially and ethnically diverse, with many Spanish-preferring individuals. In surveys, less than a fifth (18.7%) of participants reported experiencing barriers to care. However, CSER project case studies revealed a more nuanced picture that highlighted the blurred boundary between access to genomic research and clinical care. Drawing on insights from CSER, we build on an existing framework to characterize the concept and dimensions of access to genomic medicine along with associated measures and improvement strategies.ConclusionsOur findings support adopting a broad conceptualization of access to care encompassing multiple dimensions, using mixed methods to study access issues, and investing in innovative improvement strategies. This conceptualization may inform clinical translation of other cutting-edge technologies and contribute to the promotion of equitable, effective, and efficient access to genomic medicine

Genetic evidence of Quaternary demographic changes in four rainforest tree species sampled across the Isthmus of Panama

Aim We examined and compared population genetic structure in a suite of four co-occurring Panamanian tree species and performed coalescent-based analyses of demographic history to evaluate hypotheses of tropical vegetation change during the Last Glacial Maximum (LGM). Location Isthmus of Panama. Methods Nuclear microsatellite variation was assayed in multiple populations (1179 trees, 21 locations, 6–13 locations per species) in Jacaranda copaia (Bignoniaceae), Luehea seemannii (Malvaceae), Simarouba amara (Simaroubaceae) and Symphonia globulifera (Clusiaceae). Population structure was analysed using FST-based statistics and a Bayesian clustering approach (baps). Bayesian coalescent methods (msvar) were used to infer demographic histories. Results High levels of genetic diversity were found in all of the species (HE range, 0.56–0.79). Jacaranda copaia and L. seemannii showed lower FST and fewer Bayesian clusters across similar spatial scales than did S. globulifera and Simarouba amara. For each species examined, the current effective population sizes (Ne) are much lower than ancient Ne, within all inferred baps demes. In light-demanding pioneer species J. copaia, L. seemannii and S. amara, estimates of the number of generations since the bottleneck events overlap with the end of the LGM (median site posterior estimates ranged from 16 to 19 ka) while Symphonia globulifera estimates are consistent with earlier population declines (median 202 ka) in the early Pleistocene and late Pliocene. Main conclusions The wind-dispersed deciduous species J. copaia and L. seemannii showed lower FST and spatially extensive demes, while the animal- dispersed evergreen Symphonia globulifera and Simarouba amara showed spatially restrictive demes and higher FST. Each deme examined shows evidence of historical bottlenecks. For three of the four species which are also light- demanding pioneer species, the mean estimated time and 95% highest poster- ior density of the bottleneck events coincides with the end of the LGM. These results suggest that these species have undergone historical bottlenecks as a result of reduced forest cover during the Pleistocene and provide evidence of shared demographic histories among co-occurring tropical forest trees.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99571/1/Jones2013.pdf8