Saving the Last Unicorns: The Genetic Rescue of Florida’s Pillar Corals

As stony coral tissue loss disease (SCTLD) swept through the Florida Reef Tract, one of the most severely impacted species was the iconic pillar coral, Dendrogyra cylindrus. As the species’ population experienced a precipitous decline, a collaborative rescue project collected colony fragments for safekeeping at onshore and offshore nursery facilities. Between 2015 and 2019, a total of 574 fragments representing 128 genotypes were collected. These are currently dispersed among five facilities where they continue to provide opportunities to (1) refine best husbandry practices for D. cylindrus, (2) develop treatment options for SCTLD that have been adapted for use on other species, (3) maximize growth and fragmentation to provide the live tissue needed for eventual restoration, and (4) provide a source of parent colonies for assisted sexual reproduction and new genetic diversity. With the wild pillar coral population in Florida at the end of 2020 at less than 6% of its known 2014 population and continuing to decline, the rescued ex situ colonies represent the entirety of the restoration potential for this species in Florida

Benchmarking the strategies for assessing clinical reasoning in osteopathic curricula

Background Benchmarking between educational institutions is a vital component of quality assurance and contributes to greater consistency and quality in teaching and learning practices. The investigation of clinical reasoning in osteopathy has only recently begun to be explored in depth. Benchmarking builds confidence in our education practices and processes and demonstrates a maturing of the osteopathic academic profession. Objective The aim of this project was to benchmark the assessment strategy used for clinical reasoning across the final two years of the clinical components of four osteopathic programs. Methods Learning objectives and clinical assessments from the final two years in each of the four programs were analysed to identify the types and frequency of assessments and the degree of alignment between learning objectives and Bloom's taxonomy and Miller's heirarchy. Participants Representatives from Southern Cross University, Australia, Victoria University, Australia, Unitec, New Zealand and the British School of Osteopathy, UK. Results All institutions assess clinical reasoning in a variety of ways such as the assessment of student's actual performance during real-time, in-situ clinical consultations; the assessment of simulated performance; the clinical supervisors' report and; oral or written reports - on simulated case study. The results show that the osteopathy teaching institutions in the present study do not scaffold the expected learning objectives to reflect an increase in difficulty as the student's progress; the learning objectives tend to be clustered and relatively stable. However, this may be a reflection of only investigating the final years of an osteopathy teaching program. This opens the field for future research. Conclusions It would be worthwhile if future studies benchmarked the criteria used in clinical assessments and made explicit the key professional values related to assessing clinical competencies in line with the Core Competencies outlined in the World Health Organization's Benchmarks for Training in Osteopathy

Life-Expectancy Disparities Among Adults With HIV in the United States and Canada: The Impact of a Reduction in Drug- and Alcohol-Related Deaths Using the Lives Saved Simulation Model.

Improvements in life expectancy among people living with human immunodeficiency virus (PLWH) receiving antiretroviral treatment in the United States and Canada might differ among key populations. Given the difference in substance use among key populations and the current opioid epidemic, drug- and alcohol-related deaths might be contributing to the disparities in life expectancy. We sought to estimate life expectancy at age 20 years in key populations (and their comparison groups) in 3 time periods (2004-2007, 2008-2011, and 2012-2015) and the potential increase in expected life expectancy with a simulated 20% reduction in drug- and alcohol-related deaths using the novel Lives Saved Simulation model. Among 92,289 PLWH, life expectancy increased in all key populations and comparison groups from 2004-2007 to 2012-2015. Disparities in survival of approximately a decade persisted among black versus white men who have sex with men and people with (vs. without) a history of injection drug use. A 20% reduction in drug- and alcohol-related mortality would have the greatest life-expectancy benefit for black men who have sex with men, white women, and people with a history of injection drug use. Our findings suggest that preventing drug- and alcohol-related deaths among PLWH could narrow disparities in life expectancy among some key populations, but other causes of death must be addressed to further narrow the disparities

Weight gain among treatment-naïve persons with HIV starting integrase inhibitors compared to non-nucleoside reverse transcriptase inhibitors or protease inhibitors in a large observational cohort in the United States and Canada.

IntroductionWeight gain following antiretroviral therapy (ART) initiation is common, potentially predisposing some persons with HIV (PWH) to cardio-metabolic disease. We assessed relationships between ART drug class and weight change among treatment-naïve PWH initiating ART in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD).MethodsAdult, treatment-naïve PWH in NA-ACCORD initiating integrase strand transfer inhibitor (INSTI), protease inhibitor (PI) or non-nucleoside reverse-transcriptase inhibitor (NNRTI)-based ART on/after 1 January 2007 were followed through 31 December 2016. Multivariate linear mixed effects models estimated weight up to five years after ART initiation, adjusting for age, sex, race, cohort site, HIV acquisition mode, treatment year, and baseline weight, plasma HIV-1 RNA level and CD4+ cell count. Due to shorter follow-up for PWH receiving newer INSTI drugs, weights for specific INSTIs were estimated at two years. Secondary analyses using logistic regression and all covariates from primary analyses assessed factors associated with >10% weight gain at two and five years.ResultsAmong 22,972 participants, 87% were male, and 41% were white. 49% started NNRTI-, 31% started PI- and 20% started INSTI-based regimens (1624 raltegravir (RAL), 2085 elvitegravir (EVG) and 929 dolutegravir (DTG)). PWH starting INSTI-based regimens had mean estimated five-year weight change of +5.9kg, compared to +3.7kg for NNRTI and +5.5kg for PI. Among PWH starting INSTI drugs, mean estimated two-year weight change was +7.2kg for DTG, +5.8kg for RAL and +4.1kg for EVG. Women, persons with lower baseline CD4+ cell counts, and those initiating INSTI-based regimens had higher odds of >10% body weight increase at two years (adjusted odds ratio = 1.37, 95% confidence interval: 1.20 to 1.56 vs. NNRTI).ConclusionsPWH initiating INSTI-based regimens gained, on average, more weight compared to NNRTI-based regimens. This phenomenon may reflect heterogeneous effects of ART agents on body weight regulation that require further exploration

Categorizing Patterns and Processes in Retail Grocery Internationalisation

The last two decades have been characterised by an increasing internationalisation of retail activity and a considerable number of academic attempts to classify or categorise this activity. A number of different classifications have been proposed based mainly on interactions amongst geographical spread, market entry, managerial outlook and managerial flexibility. However, an examination of three leading international grocery chains on such criteria reveals little communality in pattern or process. Instead internationalisation is marked by different, perhaps serendipitous, patterns and by periods of retrenchment and reconsideration of activities, within a generic strategy of front of store adaptation and back of store standardisation. Previous classifications are therefore partial, time-bound semi-descriptions which need to be supplemented by detailed long-term examination of the internationalisation activities and processes of individual companies

Midwest vision for sustainable fuel production

This article charts the progress of CenUSA Bioenergy, a USDA-NIFA-AFRI coordinated agricultural project focused on the North Central region of the US. CenUSA’s vision is to develop a regional system for producing fuels and other products from perennial grass crops grown on marginally productive land or land that is otherwise unsuitable for annual cropping. This article focuses on contributions CenUSA has made to nine primary systems needed to make this vision a reality: feedstock improvement; feedstock production on marginal land; feedstock logistics; modeling system performance; feedstock conversion into biofuels and other products; marketing; health and safety; education, and outreach. The final section, Future Perspectives, sets forth a roadmap of additional research, technology development and education required to realize commercialization

Congenital myasthenic syndrome caused by a frameshift insertion mutation in

Objective: Description of a new variant of the glutamine-fructose-6-phosphate transaminase 1 (GFPT1) gene causing congenital myasthenic syndrome (CMS) in 3 children from 2 unrelated families. Methods: Muscle biopsies, EMG, and whole-exome sequencing were performed. Results: All 3 patients presented with congenital hypotonia, muscle weakness, respiratory insufficiency, head lag, areflexia, and gastrointestinal dysfunction. Genetic analysis identified a homozygous frameshift insertion in the GFPT1 gene (NM_001244710.1: c.686dupC; p.Arg230Ter) that was shared by all 3 patients. In one of the patients, inheritance of the variant was through uniparental disomy (UPD) with maternal origin. Repetitive nerve stimulation and single-fiber EMG was consistent with the clinical diagnosis of CMS with a postjunctional defect. Ultrastructural evaluation of the muscle biopsy from one of the patients showed extremely attenuated postsynaptic folds at neuromuscular junctions and extensive autophagic vacuolar pathology. Conclusions: These results expand on the spectrum of known loss-of-function GFPT1 mutations in CMS12 and in one family demonstrate a novel mode of inheritance due to UPD

First occurrence of diabetes, chronic kidney disease, and hypertension among North American HIV-infected adults, 2000-2013

Background: There remains concern regarding the occurrence of noncommunicable diseases (NCDs) among individuals aging with human immunodeficiency virus (HIV), but few studies have described whether disparities between demographic subgroups are present among individuals on antiretroviral therapy (ART) with access to care. Methods: We assessed the first documented occurrence of type 2 diabetes mellitus (DM), chronic kidney disease (CKD), and treated hypertension (HTN) by age, sex, and race within the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). HIV-infected adults (≥18 years) who initiated ART were observed for first NCD occurrence between 1 January 2000 and 31 December 2013. Cumulative incidences as of age 70 were estimated accounting for the competing risk of death; Poisson regression was used to compare rates of NCD occurrence by demographic subgroup. Results: We included >50000 persons with >250000 person-years of follow-up. Median follow-up was 4.7 (interquartile range, 2.4–8.1) years. Rates of first occurrence (per 100 person-years) were 1.2 for DM, 0.6 for CKD, and 2.6 for HTN. Relative to non-black women, the cumulative incidences were increased in black women (68% vs 51% for HTN, 52% vs 41% for DM, and 38% vs 35% for CKD; all P < .001); this disparity was also found among men (73% vs 60% for HTN, 44% vs 34% for DM, and 30% vs 25% for CKD; all P < .001). Conclusions: Racial disparities in the occurrence of DM, CKD, and HTN emphasize the need for prevention and treatment options for these HIV populations receiving care in North America