Crummer SunTrust Portfolio Recommendations: Crummer Investment Management [2019]

SunTrust endowed this portfolio to provide scholarships for future Crummer students and to give current students a practical, hands on learning opportunity. This year we are pleased to be able to award $50,000 in scholarships. We are extremely grateful for SunTrust’s generosity and investment in higher education. We have all learned a great deal from this experience and the responsibility of managing real money. Our first challenge is to establish a portfolio position that takes advantage of economic opportunities while avoiding unnecessary risk and conforming to the Crummer SunTrust Investment Policy Statement (IPS). We are also tasked by the IPS to operate at two levels simultaneously tactical for the near term, and strategic for the long run. Additionally, this portfolio presents some unusual portfolio management challenges by trading only once a year, in early May. Our tactical approach began with a top down sector analysis. We established an economic forecast based on research and consultation with economists, including Professor William Seyfried of the Crummer School. That forecast then drove our allocation among the eleven S&P sectors: Communication Services, Consumer Discretionary, Consumer Staples, Energy, Financials, Healthcare, Industrials, Information Technology, Materials, Telecommunications, and Utilities. This year we have forecast slowing economic growth and tilted the allocation towards defensive sectors that are less sensitive to the business cycle. Our asset class allocation embodies the long run strategy of our portfolio. The IPS sets asset class ranges from low to moderate risk to keep the portfolio from being whipsawed by transitory market cycles. Our equity allocations entail a moderate level of risk, consistent with our view that the stock market will continue a modest upward trend between now and April 2020 . We maintain an allocation to a sector ETF in each sector to ensure diversification. Additionally, as a practical matter, we are limiting each sector to a maximum of two individual stocks. Fixed income is our anchor sector, providing a hedge against the risk of an economic slowdown adversely impacting our equity holdings We are at the middle of our IPS range for fixed income at 15 %, which is a n increase from the decision of 10% last year. Furthermore, we have incorporated a new theme in to our portfolio selection process related t o the rise of the global middle class. Inspired by Hans Roslings’ Factfulness, we believe there are systematic misunderstandings about the state of the world. The biases and ignorance of rich nations obfuscate the tremendous human progress that has taken p lace across the globe, record low poverty levels providing one noteworthy example. Our investment team is committed to capitalize on opportunities hidden in plain sight. Regardless of a security’s consistency with our theme, all recommendations must be undervalued after rigorous quantitative and qualitative analysis. Lastly, we believe that the economic merits of capitalism will prevail against the negative sentiments unfortunately gaining support in the United States. The innovative capacity of the free market will avail itself and continue to raise living standards across the globe

Tracing oncogene-driven remodelling of the intestinal stem cell niche.

Interactions between tumour cells and the surrounding microenvironment contribute to tumour progression, metastasis and recurrence1-3. Although mosaic analyses in Drosophila have advanced our understanding of such interactions4,5, it has been difficult to engineer parallel approaches in vertebrates. Here we present an oncogene-associated, multicolour reporter mouse model-the Red2Onco system-that allows differential tracing of mutant and wild-type cells in the same tissue. By applying this system to the small intestine, we show that oncogene-expressing mutant crypts alter the cellular organization of neighbouring wild-type crypts, thereby driving accelerated clonal drift. Crypts that express oncogenic KRAS or PI3K secrete BMP ligands that suppress local stem cell activity, while changes in PDGFRloCD81+ stromal cells induced by crypts with oncogenic PI3K alter the WNT signalling environment. Together, these results show how oncogene-driven paracrine remodelling creates a niche environment that is detrimental to the maintenance of wild-type tissue, promoting field transformation dominated by oncogenic clones.Royal Societ

Paediatric tonsillectomy in england a cohort study of clinical practice and outcomes using Hospital Episode Statistics data (2008‐2019)

Objectives: To assess the safety of paediatric tonsillectomy procedures conducted in NHS hospitals in England between 2008 and 2019. Design: Retrospective observational cohort study using Hospital Episode Statistics (HES) data. Setting: Acute NHS trusts in England conducting paediatric tonsillectomy procedures Participants: Children (≤16 years old) undergoing bilateral tonsillectomy Main outcome measures: Number of tonsillectomies performed per year by procedural method. In‐hospital complications including return to theatre for arrest of haemorrhage. Readmission within 28 days, including those for pain, haemorrhage and surgical arrest of haemorrhage. Long‐term outcomes: all‐cause mortality, revision tonsillectomy. Results: A total of 318,453 paediatric tonsillectomies were performed from 2008 to 2019: 278,772 dissection (87.5%), 39,681 coblation (12.5%). The proportion of tonsillectomy performed using coblation increased from 7% in 2008/9 to 27% in 2018/9. Five patients died in hospital (including 4 due to respiratory complications). In‐hospital complications occurred in 4,202 children (1.3%), with the most frequent being haemorrhage. Within 28 days of tonsillectomy, 28,170 patients (8.8%) were readmitted and 7 deaths occurred. Readmission rates for haemorrhage and pain have increased since 2008. The proportion of children undergoing revision tonsillectomy procedures within 5 years following coblation tonsillectomy (1.4%) was approximately double that of dissection (0.6%). Conclusions: Clinical practice of paediatric tonsillectomy has changed in England over the past 11 years. The overall mortality rate associated with the procedure is 0.0037%. Differences in outcomes have been identified for different procedural methods. However, routine administrative data is limited in differentiating procedural detail (e.g. we are unable to differentiate intra or extra‐capsular techniques from current clinical coding of tonsillectomy procedures). Therefore prospective national data collection or more granular clinical coding is essential to capture relative outcomes of the different tonsillectomy methods and techniques being used in the NHS

Frequent intra-subtype recombination among HIV-1 circulating in Tanzania.

The study estimated the prevalence of HIV-1 intra-subtype recombinant variants among female bar and hotel workers in Tanzania. While intra-subtype recombination occurs in HIV-1, it is generally underestimated. HIV-1 env gp120 V1-C5 quasispecies from 45 subjects were generated by single-genome amplification and sequencing (median (IQR) of 38 (28-50) sequences per subject). Recombination analysis was performed using seven methods implemented within the recombination detection program version 3, RDP3. HIV-1 sequences were considered recombinant if recombination signals were detected by at least three methods with p-values of ≤0.05 after Bonferroni correction for multiple comparisons. HIV-1 in 38 (84%) subjects showed evidence for intra-subtype recombination including 22 with HIV-1 subtype A1, 13 with HIV-1 subtype C, and 3 with HIV-1 subtype D. The distribution of intra-patient recombination breakpoints suggested ongoing recombination and showed selective enrichment of recombinant variants in 23 (60%) subjects. The number of subjects with evidence of intra-subtype recombination increased from 29 (69%) to 36 (82%) over one year of follow-up, although the increase did not reach statistical significance. Adjustment for intra-subtype recombination is important for the analysis of multiplicity of HIV infection. This is the first report of high prevalence of intra-subtype recombination in the HIV/AIDS epidemic in Tanzania, a region where multiple HIV-1 subtypes co-circulate. HIV-1 intra-subtype recombination increases viral diversity and presents additional challenges for HIV-1 vaccine design