Interprofessional Collaboration Improves Quality of Life of a Young Adult With Rett Syndrome.

Rett syndrome (RTT) is a genetic neurodevelopmental disease characterized by early normal development followed by regression in motor and language skills. Patients with RTT often exhibit seizure disorders, growth failure, heart and lung disorders, bruxism, and dental caries. We report on a female patient in her 20s with Rett syndrome who presented to her primary care clinic with increasing agitation and pain. This case reports describes a collaborative, interprofessional approach between medical and dental providers who work in an integrated outpatient setting. It demonstrates that interprofessional collaboration, goals of care discussions, and attention to social drivers of health can improve quality of life for a medically and socially complex patient.

Otolith chemical fingerprints of skipjack tuna (Katsuwonus pelamis) in the Indian Ocean: First insights into stock structure delineation.

The chemical composition of otoliths (earbones) can provide valuable information about stock structure and connectivity patterns among marine fish. For that, chemical signatures must be sufficiently distinct to allow accurate classification of an unknown fish to their area of origin. Here we have examined the suitability of otolith microchemistry as a tool to better understand the spatial dynamics of skipjack tuna (Katsuwonus pelamis), a highly valuable commercial species for which uncertainties remain regarding its stock structure in the Indian Ocean. For this aim, we have compared the early life otolith chemical composition of young-of-the-year (<6 months) skipjack tuna captured from the three main nursery areas of the equatorial Indian Ocean (West, Central and East). Elemental (Li:Ca, Sr:Ca, Ba:Ca, Mg:Ca and Mn:Ca) and stable isotopic (δ13C, δ18O) signatures were used, from individuals captured in 2018 and 2019. Otolith Sr:Ca, Ba:Ca, Mg:Ca and δ18O significantly differed among fish from different nurseries, but, in general, the chemical signatures of the three nursery areas largely overlapped. Multivariate analyses of otolith chemical signatures revealed low geographic separation among Central and Eastern nurseries, achieving a maximum overall random forest cross validated classification success of 51%. Cohort effect on otolith trace element signatures was also detected, indicating that variations in chemical signatures associated with seasonal changes in oceanographic conditions must be well understood, particularly for species with several reproductive peaks throughout the year. Otolith microchemistry in conjunction with other techniques (e.g., genetics, particle tracking) should be further investigated to resolve skipjack stock structure, which will ultimately contribute to the sustainable management of this stock in the Indian Ocean.

Demographic structure, sex ratio and growth rates of southern bluefin tuna (Thunnus maccoyii) on the spawning ground.

The demographics of the southern bluefin tuna (SBT) Thunnus maccoyii spawning stock were examined through a large-scale monitoring program of the Indonesian longline catch on the spawning ground between 1995 and 2012. The size and age structure of the spawning population has undergone significant changes since monitoring began. There has been a reduction in the relative abundance of larger/older SBT in the catch since the early 2000s, and a corresponding decrease in mean length and age, but there was no evidence of a significant truncation of the age distribution. Pulses of young SBT appear in the catches in the early- and mid-2000s and may be the first evidence of increased recruitment into the spawning stock since 1995. Fish in these two recruitment pulses were spawned around 1991 and 1997. Size-related variations in sex ratio were also observed with female bias for fish less than 170 cm FL and male bias for fish greater than 170 cm FL. This trend of increasing proportion of males with size above 170 cm FL is likely to be related to sexual dimorphism in growth rates as male length-at-age is greater than that for females after age 10 years. Mean length-at-age of fish aged 8-10 years was greater for both males and females on the spawning ground than off the spawning ground, suggesting that size may be the dominant factor determining timing of maturation in SBT. In addition to these direct results, the data and samples from this program have been central to the assessment and management of this internationally harvested stock.