Identification of cyclin D1 as a major modulator of 3-nitropropionic acid-induced striatal neurodegeneration.

Mitochondria dysfunction occurs in the aging brain as well as in several neurodegenerative disorders and predisposes neuronal cells to enhanced sensitivity to neurotoxins. 3-nitropropionic acid (3-NP) is a naturally occurring plant and fungal neurotoxin that causes neurodegeneration predominantly in the striatum by irreversibly inhibiting the tricarboxylic acid respiratory chain enzyme, succinate dehydrogenase (SDH), the main constituent of the mitochondria respiratory chain complex II. Significantly, although 3-NP-induced inhibition of SDH occurs in all brain regions, neurodegeneration occurs primarily and almost exclusively in the striatum for reasons still not understood. In rodents, 3-NP-induced striatal neurodegeneration depends on the strain background suggesting that genetic differences among genotypes modulate toxicant variability and mechanisms that underlie 3-NP-induced neuronal cell death. Using the large BXD family of recombinant inbred (RI) strains we demonstrate that variants in Ccnd1 - the gene encoding cyclin D1 - of the DBA/2 J parent underlie the resistance to 3-NP-induced striatal neurodegeneration. In contrast, the Ccnd1 variant inherited from the widely used C57BL/6 J parental strain confers sensitivity. Given that cellular stress triggers induction of cyclin D1 expression followed by cell-cycle re-entry and consequent neuronal cell death, we sought to determine if the C57BL/6 J and DBA/2 J Ccnd1 variants are differentially modulated in response to 3-NP. We confirm that 3-NP induces cyclin D1 expression in striatal neuronal cells of C57BL/6 J, but this response is blunted in the DBA/2 J. We further show that striatal-specific alternative processing of a highly conserved 3'UTR negative regulatory region of Ccnd1 co-segregates with the C57BL/6 J parental Ccnd1 allele in BXD strains and that its differential processing accounts for sensitivity or resistance to 3-NP. Our results indicate that naturally occurring Ccnd1 variants may play a role in the variability observed in neurodegenerative disorders involving mitochondria complex II dysfunction and point to cyclin D1 as a possible therapeutic target.

Raloxifene, a cannabinoid type-2 receptor inverse agonist, mitigates visual deficits and pathology and modulates microglia after ocular blast.

Visual deficits after ocular blast injury (OBI) are common, but pharmacological approaches to improve long-term outcomes have not been identified. Blast forces frequently damage the retina and optic nerves, and work on experimental animals has shown the pro-inflammatory actions of microglia can further exacerbate such injuries. Cannabinoid type-2 receptor (CB2) inverse agonists specifically target activated microglia, biasing them away from the harmful pro-inflammatory M1 state toward the helpful reparative M2 state. We previously found that treating mice with CB2 inverse agonists after traumatic brain injury, produced by either focal cranial air blast or dorsal cranial impact, greatly attenuated the visual deficits and pathology that otherwise resulted. Here we examined the consequences of single and repeat OBI and the benefit provided by raloxifene, an FDA-approved estrogen receptor drug that possesses noteworthy CB2 inverse agonism. After single OBI, although the amplitudes of the A- and B-waves of the electroretinogram and pupil light response appeared to be normal, the mice showed hints of deficits in contrast sensitivity and visual acuity, a trend toward optic nerve axon loss, and significantly increased light aversion, which were reversed by 2 weeks of daily treatment with raloxifene. Mice subjected to repeat OBI (5 blasts spaced 1 min apart), exhibited more severe visual deficits, including decreases in contrast sensitivity, visual acuity, the amplitudes of the A- and B-waves of the electroretinogram, light aversion, and resting pupil diameter (i.e. hyperconstriction), accompanied by the loss of photoreceptor cells and optic nerve axons, nearly all of which were mitigated by raloxifene. Interestingly, optic nerve axon abundance was strongly correlated with contrast sensitivity and visual acuity across all groups of experimental mice in the repeat OBI study, suggesting optic nerve axon loss with repeat OBI and its attenuation with raloxifene are associated with the extent of these two deficits while photoreceptor abundance was highly correlated with A-wave amplitude and resting pupil size, suggesting a prominent role for photoreceptors in these two deficits. Quantitative PCR (qPCR) showed levels of M1-type microglial markers (e.g. iNOS, IL1ß, TNFα, and CD32) in retina, optic nerve, and thalamus were increased 3 days after repeat OBI. With raloxifene treatment, the overall expression of M1 markers was more similar to that in sham mice. Raloxifene treatment was also associated with the elevation of IL10 transcripts in all three tissues compared to repeat OBI alone, but the results for the three other M2 microglial markers we examined were more varied. Taken together, the qPCR results suggest that raloxifene benefit for visual function and pathology was associated with a lessening of the pro-inflammatory actions of microglia. The benefit we find for raloxifene following OBI provides a strong basis for phase-2 efficacy testing in human clinical trials for treating ocular injury.

Stable isotope and fatty acid analysis reveal the ability of sea cucumbers to use fish farm waste in integrated multi-trophic aquaculture.

Stable isotope ratios, carbon (δ13C) and nitrogen (δ15N), and fatty acids validated the trophic connection between farmed fish in a commercial nearshore fish farm and sea cucumbers in the Mediterranean Sea. This dual tracer approach evaluated organic matter transfer in integrated multi-trophic aquaculture (IMTA) and the ability of sea cucumbers to incorporate fish farm waste (fish faeces and uneaten artificial fish feed) into their tissue. Between October 2018 and September 2019, Holothuria (Roweothuria) poli Delle Chiaje, 1824, co-cultured at IMTA sites directly below one of the commercial fish cage , at 10 m and 25 m from the selected fish cage, and at two reference sites over 800 m from the fish farm. Sea cucumbers were sampled from each site in February, May and September, except at 0 m due to mass mortalities recorded here in the first month of study. Isotopic mixing models revealed that fish farm organic waste was the dominant dietary source for H. poli in IMTA at 10 m and 25 m from the cage. The contribution of marine plant-derived organic matter, Posidonia oceanica leaves and rhizomes, was least important. The isotopic signatures of sea cucumber tissues at reference sites were not explained by the sampled food resources. Importantly, fatty acid profiling revealed a high abundance of individual terrestrial plant fatty acids, such as oleic (18:1n-9), linoleic (18:2n-6) and eicosenoic (20:1n-9) acids in sea cucumber tissue at 10 m and 25 m from the fish cage, presumably linked to the terrestrial plant oil content of the fish feeds. At the reference sites, sea cucumber tissues were characterised by higher relative abundance of arachidonic acid (20:4n-6) acid, and the natural marine-based eicosapentaenoic (20:5n-3) and docosahexaenoic (22:6n-3) acids. These analyses revealed important differences in the composition of H. poli between the IMTA and reference locations, driven by aquaculture-derived waste near fish cages. Moreover, this study revealed temporal variation in food availability and quality, and possible differences in the physiological responses of H. poli. Stable isotope analysis and fatty acid profiling provided complementary evidence for the important dietary preferences of H. poli and validated the potential of sea cucumbers to uptake aquaculture organic waste as part of inshore fish-sea cucumber IMTA. It reveals the important implications that an established trophic link has on the viability of using sea cucumbers for the development of IMTA and the sustainable expansion of aquaculture.

Loss of Individual Mitochondrial Ribonuclease P Complex Proteins Differentially Affects Mitochondrial tRNA Processing In Vivo.

Over a thousand nucleus-encoded mitochondrial proteins are imported from the cytoplasm; however, mitochondrial (mt) DNA encodes for a small number of critical proteins and the entire suite of mt:tRNAs responsible for translating these proteins. Mitochondrial RNase P (mtRNase P) is a three-protein complex responsible for cleaving and processing the 5'-end of mt:tRNAs. Mutations in any of the three proteins can cause mitochondrial disease, as well as mutations in mitochondrial DNA. Great strides have been made in understanding the enzymology of mtRNase P; however, how the loss of each protein causes mitochondrial dysfunction and abnormal mt:tRNA processing in vivo has not been examined in detail. Here, we used Drosophila genetics to selectively remove each member of the complex in order to assess their specific contributions to mt:tRNA cleavage. Using this powerful model, we find differential effects on cleavage depending on which complex member is lost and which mt:tRNA is being processed. These data revealed in vivo subtleties of mtRNase P function that could improve understanding of human diseases.

Practice Patterns of Family Physicians With and Without Sports Medicine Certification.

OBJECTIVE: To update information regarding practice patterns of family physicians with a certificate of added qualifications (CAQ) in Sports Medicine (SM), because it has been over 10 years since the last comprehensive study. DESIGN: Cross-sectional analysis of 2017 and 2018 American Board of Family Medicine (ABFM) Family Medicine Certification and SM CAQ examination registration practice demographic questionnaire data. SETTING: N/A. PARTICIPANTS: Family physicians with a CAQ in SM [sports medicine family physicians (SM-FPs)] and family physicians without a CAQ registering for the ABFM Family Medicine Certification or SM CAQ examinations. INTERVENTION: N/A. MAIN OUTCOMES: Self-reported time spent practicing SM, activities in SM, scope of practice, and practice setting. RESULTS: Sports medicine family physicians are predominately men (78.7%) and below 49 years (65.8%). Most SM-FPs spend 60% of their time or less practicing SM and the scope of practice of SM-FPs is only slightly narrower than that of their family physician counterparts without a CAQ. In addition, 92.8% of SM-FPs are practicing in an urban setting. CONCLUSIONS: The similarity of scope of practice for SM-FPs and family physicians without a CAQ and the time spent practicing SM by SM-FPs suggests that most SM-FPs are spending a significant amount of time continuing to practice their primary specialty. Sports medicine family physicians are largely attracted to urban practice settings, most likely because of the higher likelihood of employment opportunities. Finally, factors that may be dissuading women from entering the field of SM deserve further investigation.

Achieving a timely diagnosis for teenagers and young adults with cancer: the ACE "too young to get cancer?" study.

BACKGROUND: Time to diagnosis (TTD) concerns teenagers and young adults (TYA) with cancer and may affect outcome. METHODS: Healthcare records from 105 TYA in a regional cancer service were assessed to document events from 1st symptom to treatment start. Detailed pathway construction was possible for 104 patients and allowed a multidisciplinary panel review of each pathway with assessment of good practice and lessons for the future. RESULTS: 1st presentation was to primary care in 86, and 93% consulted in primary care before diagnosis. Routes to Diagnosis were 45% via urgent 2 Week Wait pathways and 38% as emergency referrals. Total Interval (time from 1st presentation to treatment start) was median 63 (range 1-559) days, varying within/between diagnoses. Patient interval (time from 1st symptom to 1st presentation) was longest for lymphoma, carcinoma and bone tumour (medians: 9, 12, 20 days). Overall, time in primary care was short (median 3, range 0-537 days) compared to secondary care (median 29, range 0-195 days) and longest for lymphoma, carcinoma, brain/CNS (medians: 10, 15, 16 days). Specialist Care interval (time from 1st specialist visit to treatment start) was longest for bone, brain/CNS, lymphoma, carcinoma (medians: 30, 33, 36, 48 days). 40% pathways were rated as showing good/best practice but 16% were less than satisfactory. Continued safety-netting/support was identified from primary care but analysis suggested opportunities for improvement in transition through secondary care. CONCLUSIONS: Previous reports of prolonged TTD have focused on delay in referral from primary care but this study suggests that this might be reduced by optimising management in secondary care.

Loss of the mitochondrial protein-only ribonuclease P complex causes aberrant tRNA processing and lethality in Drosophila.

Proteins encoded by mitochondrial DNA are translated using mitochondrially encoded tRNAs and rRNAs. As with nuclear encoded tRNAs, mitochondrial tRNAs must be processed to become fully functional. The mitochondrial form of ribonuclease P (mt:RNase P) is responsible for 5'-end maturation and is comprised of three proteins; mitochondrial RNase P protein (MRPP) 1 and 2 together with proteinaceous RNase P (PRORP). However, its mechanism and impact on development is not yet known. Using homology searches, we have identified the three proteins composing Drosophila mt:RNase P: Mulder (PRORP), Scully (MRPP2) and Roswell (MRPP1). Here, we show that each protein is essential and localizes with mitochondria. Furthermore, reducing levels of each causes mitochondrial deficits, which appear to be due at least in part to defective mitochondrial tRNA processing. Overexpressing two members of the complex, Mulder and Roswell, is also lethal, and in the case of Mulder, causes abnormal mitochondrial morphology. These data are the first evidence that defective mt:RNase P causes mitochondrial dysfunction, lethality and aberrant mitochondrial tRNA processing in vivo, underscoring its physiological importance. This in vivo mt:RNase P model will advance our understanding of how loss of mitochondrial tRNA processing causes tissue failure, an important aspect of human mitochondrial disease.

Bronchiectasis following treatment for high-risk neuroblastoma: A case series.

High-risk (HR) neuroblastoma remains a very challenging disease to treat and long-term cure is only possible with intensive, multimodal treatment including chemotherapy, high-dose therapy, radiotherapy, surgery, and immunotherapy. As a result, treatment-related morbidity and late effects are common in survivors. This report outlines a case series of six patients who developed a chronic productive cough following treatment for HR neuroblastoma. High-resolution computed tomography scanning confirmed the diagnosis of bronchiectasis. Two of the patients who have undergone immunological testing demonstrate hypogammaglobulinaemia and impaired vaccine response. Persistent cough in patients treated for neuroblastoma warrants investigation and consideration of immunological referral.

Quantification of heat shock protein 70 and acetylcholinesterase over a time course suggests environmental adaptation in a foundational molluscan species.

Waterways in urban areas often act as repositories for sewage, industrial waste, and environmental contaminants. In response, inhabitants of these watersheds undergo physiological adaptations specific to their respective environments. Effects of these stressors can be assayed by quantification of various well-documented biomarkers in sentinel species such as the Atlantic Ribbed mussel, Geukensia demissa, a native to the Bronx River Estuary, Bronx, NY, USA. Heat shock protein 70 (Hsp70) is a universally expressed biomarker for an array of environmental stressors including toxins and low dissolved oxygen. To better understand the mechanisms by which organisms tolerate their contaminated environments, we monitored the constitutive and heat shock-induced levels of two proteins: Hsp70 and acetylcholinesterase (AChE) in natural populations of G. demissa from differentially impacted sites: the Bronx River and Greenwich Cove estuaries. We show that G. demissa from the Bronx River exhibits a higher level of constitutive Hsp70, and launches a more rapid and robust heat shock response than does its Greenwich Cove counterpart. In addition, AChE levels are recovered more quickly in Bronx River mussels. Based on response pattern investigations from heat stress as well as constitutive expression, we suggest that the Hsp70/AChE chaperone/client relationship exemplifies the unique adaptive mechanisms utilized by organisms in order to tolerate environmentally impacted habitats. Results from this study offer important insights from an ecological perspective into the molecular and cellular basis of stress response and provide valuable information regarding adaptation to the increased demands of challenging environments.

Impaired Health-Related Quality of Life in Children and Families Affected by Methylmalonic Acidemia.

An understanding of health related quality of life (HRQoL) in children and families affected by methylmalonic acidemia (MMA) is important in planning counseling and therapeutic intervention. Liver transplantation (LT) is used as a treatment for MMA; however, its risks and benefits continue to be investigated. The purpose of this study was twofold: (1) to measure HRQoL in children and families affected by MMA using the Pediatric Quality of Life Inventory (PedsQL™) parent version, and (2) to assess the impact of LT on HRQoL by comparing LT and non-LT patient scores and free responses. Parents/caregivers reported lower scores on the majority of the PedsQL™ scales as compared to samples of healthy children, children with solid organ transplants for indications other than MMA, and families affected by chronic conditions. Scores for children with MMA were lowest in school and social functioning and scores for families were lowest in worry and activity impairment. There were no significant differences in LT and non-LT patient scores on the PedsQL™ scales. Our results document the negative impact of MMA on HRQoL.

How Do Women with an Intellectual Disability Experience the Support of a Doula During Their Pregnancy, Childbirth and After the Birth of Their Child?

BACKGROUND: With increasing numbers of people with an intellectual disability choosing to become parents, the right support is imperative for effective parenting (Macintyre & Stewart ). The aim of this study was to gain insight into the experiences of parents who received support from Doulas during pregnancy, birth and following the birth of their child. In addition, the experiences of the Doulas who provided the support were investigated. MATERIALS AND METHODS: Four women with an intellectual disability who received Doula support were interviewed before and after the birth of their child. Three Doulas were interviewed after the birth about their experiences of supporting women with an intellectual disability. RESULTS: Interview transcripts were analysed using Interpretive Phenomenological Analysis (IPA). Themes were identified from each interview, before an overall analysis of themes from each support phase was undertaken. CONCLUSIONS: Pre-natally, the Doula was considered helpful and a reliable source of information about pregnancy. Each mother perceived Doula support as a means of keeping her child in her care. Post-natally, mothers described a trusting relationship with their Doula, who enabled them to make informed choices. Doulas described how they adapted their work to meet the needs of parents with intellectual disability. Being involved in Child Protection procedures was perceived as stressful and challenging.

Reduced beta-cell reserve and pancreatic volume in survivors of childhood acute lymphoblastic leukaemia treated with bone marrow transplantation and total body irradiation.

BACKGROUND: Impaired glucose tolerance (IGT) and diabetes mellitus (DM) occur more frequently after bone marrow transplantation and total body irradiation (BMT/TBI), but the mechanism is unclear. This study investigates insulin sensitivity, ß-cell reserve and pancreatic volume in adult survivors of childhood acute lymphoblastic leukaemia (ALL). METHOD: Survivors (aged 16-26 years) of ALL treated with BMT/TBI (10-14·4 Gy) Group 1 (n = 20, 10 m) were compared with a chemotherapy-only Group 2 (n = 28, 11 m). Participants underwent assessments of insulin sensitivity by whole body composite-insulin-sensitivity-index (ISIcomp ) from oral glucose tolerance tests (OGTTs); first (AIRarg , AIRg , AUCin10 ) and second (AUC in second phase ) phase insulin responses from arginine-intravenous glucose tolerance tests; and pancreatic volume by abdominal magnetic resonance imaging (MRI). Data were analysed by odds ratio, Chi-square or Fisher's exact tests, Student's t-tests, analysis of covariance (ancova) and Pearson's or partial correlations (5% significance). RESULTS: Abnormal OGTTs were documented in Group 1 (DM = 2, IGT = 7). Insulin secretion adjusted for insulin sensitivity was lower in Group 1 than Group 2 as a whole [LogAIRarg (P = 0·008), logAIRg (P = 0·013) and logAUCin10 (P = 0·014)] and after exclusion of those with abnormal glucose tolerance [logAIRarg (P = 0·011), logAIRg (P = 0·007) and logAUCin10 (P = 0·006)]. Group 1 had lower pancreatic volume than Group 2 [52·0 (14·2) vs 72·8 (23·5), P = 0·001] cm(3) , and results were consistent after adjustment for size by body surface area (P = 0·019). Pancreatic volume correlated with logAIRarg adjusted log ISIcomp (partial correlation = 0·34, P = 0·025). CONCLUSIONS: Adult survivors of childhood BMT/TBI for ALL demonstrated reduced ß-cell reserve and smaller pancreatic volume, both likely additional aetiological factors, with reduced insulin sensitivity, in their increased risk of diabetes.

Women's experiences of participation in a feminist group for women with complex mental health issues.

A sample of women (n = 5) participated in a qualitative service evaluation concerning an open-ended, therapeutic group for women only. Data analysis followed suggestions by Halcomb and Davidson (2006). Main themes derived from the evaluation included: 'Groups are different from individual work', 'Belonging/ not being alone', 'Performance in the group', 'The group as a safety net', 'Life improvements and hope for the future' and 'The extent of emotional despair felt'. In this paper, several sub-themes within the main themes and relevant theories and implications for theory and service provision are discussed.

Clinical whole-exome sequencing: are we there yet?

BACKGROUND: Clinical laboratories began offering whole-exome sequencing in 2011 at a cost between $4,500 and $9,000. Reported detection rates for deleterious mutations range from 25 to 50%. Based on the experience of our clinical genetics service, actual success rates may be lower than estimated rates. We report results from our own experience along with a survey of clinical geneticists to ascertain (i) current success rates for causal gene detection in a clinical setting; (ii) if there are insurance authorization issues; and (iii) if turnaround times quoted by the clinical laboratories are accurate; we also gauge provider opinions toward clinical whole-exome sequencing. METHODS: We reviewed our results and the results of a survey that was electronically distributed to 47 clinical genetics centers. RESULTS: A total of 35 exome reports were available. If all positive results are collated, we observe a success rate of 22.8%. One result incorrectly identified a known benign variant as pathogenic. Some insurers covered all testing, whereas others denied any insurance coverage. Only three (23.1%) of our reports were available within the laboratory's quoted turnaround times. More than 50% of clinicians queried in our survey had not ordered whole-exome sequencing at the current time, many stating concerns regarding interpretation, insurance coverage, and cost. CONCLUSION: Clinical whole-exome sequencing has proven diagnostic utility; however, currently many clinicians have concerns regarding interpretation of results, insurance coverage, and cost.

Mutations in NGLY1 cause an inherited disorder of the endoplasmic reticulum-associated degradation pathway.

PURPOSE: The endoplasmic reticulum-associated degradation pathway is responsible for the translocation of misfolded proteins across the endoplasmic reticulum membrane into the cytosol for subsequent degradation by the proteasome. To define the phenotype associated with a novel inherited disorder of cytosolic endoplasmic reticulum-associated degradation pathway dysfunction, we studied a series of eight patients with deficiency of N-glycanase 1. METHODS: Whole-genome, whole-exome, or standard Sanger sequencing techniques were employed. Retrospective chart reviews were performed in order to obtain clinical data. RESULTS: All patients had global developmental delay, a movement disorder, and hypotonia. Other common findings included hypolacrima or alacrima (7/8), elevated liver transaminases (6/7), microcephaly (6/8), diminished reflexes (6/8), hepatocyte cytoplasmic storage material or vacuolization (5/6), and seizures (4/8). The nonsense mutation c.1201A>T (p.R401X) was the most common deleterious allele. CONCLUSION: NGLY1 deficiency is a novel autosomal recessive disorder of the endoplasmic reticulum-associated degradation pathway associated with neurological dysfunction, abnormal tear production, and liver disease. The majority of patients detected to date carry a specific nonsense mutation that appears to be associated with severe disease. The phenotypic spectrum is likely to enlarge as cases with a broader range of mutations are detected.

Acetate transiently inhibits myocardial contraction by increasing mitochondrial calcium uptake.

BACKGROUND: There is a close relationship between cardiovascular disease and cardiac energy metabolism, and we have previously demonstrated that palmitate inhibits myocyte contraction by increasing Kv channel activity and decreasing the action potential duration. Glucose and long chain fatty acids are the major fuel sources supporting cardiac function; however, cardiac myocytes can utilize a variety of substrates for energy generation, and previous studies demonstrate the acetate is rapidly taken up and oxidized by the heart. In this study, we tested the effects of acetate on contractile function of isolated mouse ventricular myocytes. RESULTS: Acute exposure of myocytes to 10 mM sodium acetate caused a marked, but transient, decrease in systolic sarcomere shortening (1.49 ± 0.20% vs. 5.58 ± 0.49% in control), accompanied by a significant increase in diastolic sarcomere length (1.81 ± 0.01 µm vs. 1.77 ± 0.01 µm in control), with a near linear dose response in the 1-10 mM range. Unlike palmitate, acetate caused no change in action potential duration; however, acetate markedly increased mitochondrial Ca(2+) uptake. Moreover, pretreatment of cells with the mitochondrial Ca(2+) uptake blocker, Ru-360 (10 µM), markedly suppressed the effect of acetate on contraction. CONCLUSIONS: Lehninger and others have previously demonstrated that the anions of weak aliphatic acids such as acetate stimulate Ca(2+) uptake in isolated mitochondria. Here we show that this effect of acetate appears to extend to isolated cardiac myocytes where it transiently modulates cell contraction.

Points to consider in the clinical use of NGS panels for mitochondrial disease: an analysis of gene inclusion and consent forms.

Mitochondrial next generation sequencing (NGS) panels offer single-step analysis of the numerous nuclear genes involved in the structure, function, and maintenance of mitochondria. However, the complexities of mitochondrial biology and genetics raise points for consideration in clinical use of these tests. To understand the current status of mitochondrial genetic testing, we assessed the gene offerings and consent forms of mitochondrial NGS panels available from seven US-based clinical laboratories. The NGS panels varied markedly in number of genes (101-1204 genes), and the proportion of genes causing "classic" mitochondrial diseases and their phenocopies ranged widely between labs (18 %-94 % of panel contents). All panels included genes not associated with classic mitochondrial diseases (6 %-28 % of panel contents), including genes causing adult-onset neurodegenerative disorders, cancer predisposition, and other genetic syndromes or inborn errors of metabolism. Five of the panels included genes that are not listed in OMIM to be associated with a disease phenotype (5 %-49 % of panel contents). None of the consent documents reviewed had options for patient preference regarding receipt of incidental findings. These findings raise points of discussion applicable to mitochondrial diagnostics, but also to the larger arenas of exome and genome sequencing, including the need to consider the boundaries between clinical and research testing, the necessity of appropriate informed consent, and the responsibilities of clinical laboratories and clinicians. Based on these findings, we recommend careful evaluation by laboratories of the genes offered on NGS panels, clear communication of the predicted phenotypes, and revised consent forms to allow patients to make choices about receiving incidental findings. We hope that our analysis and recommendations will help to maximize the considerable clinical utility of NGS panels for the diagnosis of mitochondrial disease.

Evidence for intraspecific endocrine disruption of Geukensia demissa (Atlantic ribbed mussel) in an urban watershed.

Populations undergo physiological adaptations in response to environmental stressors. Our 5-year bio-monitoring study of the Bronx River Estuary demonstrates comparatively low dissolved oxygen concentrations in this urbanized watershed. Additionally, our current results establish altered hormonal levels, resulting from endocrine disruption, in Geukensia demissa (Atlantic ribbed mussel) from the Bronx River Estuary. No studies have yet investigated a correlation between low dissolved oxygen and endocrine disruption in field-collected bivalves. Testosterone, estradiol, and progesterone levels were collected from male and female mussels in the oxygen depleted Bronx River and well-oxygenated Greenwich Cove. Bronx River mussels exhibited higher testosterone levels and lower estradiol levels than Greenwich Cove mussels. The resulting abnormal hormonal ratio seems to indicate that environmental conditions in the Bronx River facilitate an allosteric inhibition of the cytochrome P450 aromatase enzyme, which aids conversion of testosterone to estradiol. Low progesterone levels suggest that Bronx River mussels are experiencing a delay in sexual maturation, and morphometric data show a stalling of shell and tissue growth. To confirm that the mussels collected from both sites are the same species, the universal mitochondrial cytochrome c oxidase subunit I gene was analyzed, through DNA barcoding. Minimal sequential heterogeneity confirmed the mussels are the same species. Such findings suggest intraspecific divergence in various endocrine processes, resulting from environmentally induced stress.

Feedback perceptions of first year medical residents: An intervention-based survey study.

BACKGROUND: Feedback in residency is a necessity for progression toward clinical competency and is included in The Accreditation Council for Graduate Medical Education (ACGME) milestones as an essential component for accreditation. PURPOSE: Our study elucidates perceptions of feedback of first-year residents and aims to identify how these perceptions change after education on building expertise through deliberate practice. METHODS: First-year internal medicine and neurology residents of a mid-sized university-affiliated residency program answered a five-question 5-point unipolar response scale questionnaire regarding feedback perceptions before and after attending a workshop about building expertise through effective feedback during residency orientation. Related-Samples Wilcoxon Signed Rank Test was applied for comparing pre- versus post-questionnaire data. RESULTS: Of 31 first-year residents, 29 completed the pre-questionnaire for a completion rate of 93.5%, while 24 of 31 completed the post-questionnaire for a completion rate of 77.4%. Of the five questions, three improved when comparing pre and post responses to, including the questions on confidence in the ability to procure feedback (p = <0.001), the effort put into procuring feedback (p = 0.001), and frequency of seeking feedback (p = 0.002). Interest in receiving feedback and the importance of feedback remained unchanged after workshop attendance. CONCLUSION: Residents should be educated on building expertise through deliberate practice and how to obtain high-quality feedback, given the emphasis and essentiality of feedback within the milestone assessment system and the core competencies of ACGME. In our study, education on these topics led to significant improvement in resident perceptions of confidence in the ability to procure feedback, effort put into procuring feedback, and frequency at which feedback would be sought.