Trends in the Use and Discussion of Race in Pediatrics Articles Over 75 Years.

BACKGROUND AND OBJECTIVES: Race-based medicine, which falsely assumes that race is biological, is common in the published medical literature. We analyzed trends in the use of race in Pediatrics articles over a 75-year period. METHODS: We analyzed a random sample of 50 original research articles published each decade in Pediatrics from 1948 to 2022. RESULTS: Of 375 articles, 39% (n = 147) included race. Among articles, 85% (n = 116) used race only to describe study subjects, 7% (n = 9) described race as a social construct, and 11% (n = 15) described race as a biological construct. Only 7% (n = 10) of studies provided a reason for including race. Statements reflective of racial bias or discrimination were identified in 22% (n = 30) of the articles that mentioned race. Although statements concerning for explicit racial bias were uncommon, with none identified in the most recent decade, statements suggestive of implicit racial bias still occurred (22%, 5 of 23). Race was presented as a dichotomy, such as "white/nonwhite," in 9% of studies (n = 12). Regarding currently nonrecommended terminology, the term "minorities" was used in 13% of studies (n = 18); 25% of studies used the term "others" (n = 34), and among these, 91% (n = 31 of 34) did not provide any definition, an occurrence that increased over time at a rate of 0.9%/year. CONCLUSIONS: Although there has been improvement over the past 75 years in the reporting of race in published studies in Pediatrics, significant opportunities for further improvement remain.

The Haven Clinic: The Planning and Implementation of a Medical Home for Child Trafficking Survivors.

The authors describe the planning and implementation of a survivor-informed medical home for child trafficking survivors. Key partnerships necessary for establishing clinical infrastructure are highlighted. The trauma-informed clinical practices are described in detail. An overview of next steps for evaluation of this clinical program is provided.

Comparative Genomic Analysis of 31 Phytophthora Genomes Reveals Genome Plasticity and Horizontal Gene Transfer.

Phytophthora species are oomycete plant pathogens that cause great economic and ecological impacts. The Phytophthora genus includes over 180 known species, infecting a wide range of plant hosts, including crops, trees, and ornamentals. We sequenced the genomes of 31 individual Phytophthora species and 24 individual transcriptomes to study genetic relationships across the genus. De novo genome assemblies revealed variation in genome sizes, numbers of predicted genes, and in repetitive element content across the Phytophthora genus. A genus-wide comparison evaluated orthologous groups of genes. Predicted effector gene counts varied across Phytophthora species by effector family, genome size, and plant host range. Predicted numbers of apoplastic effectors increased as the host range of Phytophthora species increased. Predicted numbers of cytoplasmic effectors also increased with host range but leveled off or decreased in Phytophthora species that have enormous host ranges. With extensive sequencing across the Phytophthora genus, we now have the genomic resources to evaluate horizontal gene transfer events across the oomycetes. Using a machine-learning approach to identify horizontally transferred genes with bacterial or fungal origin, we identified 44 candidates over 36 Phytophthora species genomes. Phylogenetic reconstruction indicates that the transfers of most of these 44 candidates happened in parallel to major advances in the evolution of the oomycetes and Phytophthora spp. We conclude that the 31 genomes presented here are essential for investigating genus-wide genomic associations in genus Phytophthora. [Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license.

Chromosome-level assembly of the Phytophthora agathidicida genome reveals adaptation in effector gene families.

Phytophthora species are notorious plant pathogens, with some causing devastating tree diseases that threaten the survival of their host species. One such example is Phytophthora agathidicida, the causal agent of kauri dieback - a root and trunk rot disease that kills the ancient, iconic and culturally significant tree species, Agathis australis (New Zealand kauri). A deeper understanding of how Phytophthora pathogens infect their hosts and cause disease is critical for the development of effective treatments. Such an understanding can be gained by interrogating pathogen genomes for effector genes, which are involved in virulence or pathogenicity. Although genome sequencing has become more affordable, the complete assembly of Phytophthora genomes has been problematic, particularly for those with a high abundance of repetitive sequences. Therefore, effector genes located in repetitive regions could be truncated or missed in a fragmented genome assembly. Using a combination of long-read PacBio sequences, chromatin conformation capture (Hi-C) and Illumina short reads, we assembled the P. agathidicida genome into ten complete chromosomes, with a genome size of 57 Mb including 34% repeats. This is the first Phytophthora genome assembled to chromosome level and it reveals a high level of syntenic conservation with the complete genome of Peronospora effusa, the only other completely assembled genome sequence of an oomycete. All P. agathidicida chromosomes have clearly defined centromeres and contain candidate effector genes such as RXLRs and CRNs, but in different proportions, reflecting the presence of gene family clusters. Candidate effector genes are predominantly found in gene-poor, repeat-rich regions of the genome, and in some cases showed a high degree of duplication. Analysis of candidate RXLR effector genes that occur in multicopy gene families indicated half of them were not expressed in planta. Candidate CRN effector gene families showed evidence of transposon-mediated recombination leading to new combinations of protein domains, both within and between chromosomes. Further analysis of this complete genome assembly will help inform new methods of disease control against P. agathidicida and other Phytophthora species, ultimately helping decipher how Phytophthora pathogens have evolved to shape their effector repertoires and how they might adapt in the future.

DNA metabarcoding reveals high relative abundance of trunk disease fungi in grapevines from Marlborough, New Zealand.

Grapevine trunk diseases (GTDs) are a threat to grape production worldwide, with a diverse collection of fungal species implicated in disease onset. Due to the long-term and complex nature of GTDs, simultaneous detection of multiple microbial species can enhance understanding of disease development. We used DNA metabarcoding of ribosomal internal transcribed spacer 1 (ITS1) sequences, supported by specific PCR and microbial isolation, to establish the presence of trunk pathogens across 11 vineyards (11-26 years old) over three years in Marlborough, the largest wine producing region in New Zealand. Using a reference database of trunk pathogen sequences, species previously associated with GTD, such as Cadophora luteo-olivacea, Diplodia seriata, Diplodia mutila, Neofusicoccum australe, and Seimatosporium vitis, were identified as highly represented across the vineyard region. The well-known pathogens Phaeomoniella chlamydospora and Eutypa lata had especially high relative abundance across the dataset, with P. chlamydospora reads present between 22 and 84% (average 52%) across the vineyards. Screening of sequences against broader, publicly available databases revealed further fungal species within families and orders known to contain pathogens, many of which appeared to be endemic to New Zealand. The presence of several wood-rotting basidiomycetes (mostly Hymenochaetales) was detected for the first time in the Marlborough vineyard region, notably, the native Inonotus nothofagii which was present at 1-2% relative abundance in two vineyards.

Human Trafficking ICD-10 Code Utilization in Pediatric Tertiary Care Centers Within the United States.

BACKGROUND: Human trafficking is a global public health issue that affects pediatric patients widely. The International Labor Organization estimates children comprise approximately 25% of the identified trafficked persons globally, with domestic estimates including over 2000 children a year. Trafficked children experience a broad range of health consequences leading to interface with healthcare systems during their exploitation. In June 2018, International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) released diagnostic codes for human trafficking. OBJECTIVE: To use a large, multicenter database of US pediatric hospitalizations to describe the utilization of the ICD-10-CM codes related to child trafficking, as well as the demographic and clinical characteristics of these children. METHODS: This study was descriptive in nature. Encounters using data from the Pediatric Health Information System database (PHIS) with ICD-10-CM codes indicating trafficking from June 1, 2018 to March 1st, 2020 were included in the study cohort, with data collection continuing for 30 days after first hospital encounter, until March 31st, 2020. Patients 19 years old and younger were included. Condition-specific prevalence as well as demographic and clinical characteristics for patient encounters were analyzed. Study subjects were followed for 30 days after first hospital encounter to describe healthcare utilization patterns. RESULTS: During the study period, 0.005% (n = 293) of patient encounters in the PHIS database were identified as trafficked children. The children of our cohort were mostly female (90%), non-Hispanic Black (38%), and had public insurance (59%). Nearly two-thirds of patients (n = 190) had a documented mental health disorder at the initial encounter, with 32.1% classified as the principal diagnosis. Our cohort had a 30-day hospital inpatient, overnight observation, or emergency department readmission rate of 16% (n = 48). DISCUSSION: Our study demonstrates a low utilization of human trafficking ICD-10-CM codes in academic children's health centers, with code usage predominantly assigned to Non-Hispanic Black teenage girls. As comparison, in 2019 the National Human Trafficking Hotline identified 2,582 trafficked US children in a single year. These results suggest widespread under-recognition of child trafficking in health care settings, including the intensive care unit, in addition to racial and socioeconomic disparities amongst trafficked children.

A Human Trafficking Educational Program and Point-of-Care Reference Tool for Pediatric Residents.

Introduction: Trafficked youth experience complex health issues such as substance abuse, severe physical trauma, and sexual health problems, with many entering trafficking between 15 and 17 years old. There is increasing awareness of the need to educate pediatric health care providers on identifying and aiding trafficked children; however, critical gaps in the literature exist regarding educational sessions specific to the human trafficking of pediatric patients. Our objective was to implement and evaluate a survivor-informed educational session for pediatric resident physicians to improve identification of and assistance to trafficked youth in the clinical setting. Methods: We designed an educational session on human trafficking, which included a 60-minute interactive didactic presentation and distribution of a point-of-care reference tool, in collaboration with a survivor of human trafficking, for 59 pediatric trainees in 2019. We utilized pre/post knowledge assessments. Data analysis included descriptive statistics and Fisher exact analysis. Results: Of 99 total eligible residents, 59 (59%) participated. Statistically significant increases in correct identification of hypothetical trafficked youth and next steps for intervention were observed. Over 80% of participants reported comfort with defining, recognizing, referring to, and understanding health consequences of human trafficking on the postassessment, compared to 25% on the preassessment (p < .001). Discussion: Our educational session resulted in statistically significant increased comfort in identification of human trafficking victims and can be replicated at other institutions. The point-of-care reference tool-which can be adapted for use in different settings-can guide pediatric residents in managing suspected trafficked youth in the clinical setting.

Barriers to the access and utilization of healthcare for trafficked youth in the United States.

BACKGROUND: Child trafficking is a pervasive public health problem in the United States, with significant health consequences for survivors. Previous studies demonstrated that survivors face barriers to healthcare, though much of the literature has not solely focused on domestic child trafficking. OBJECTIVE: To identify barriers to healthcare faced by survivors of child trafficking in the United States, and to characterize the landscape of available trauma-informed medical services. PARTICIPANTS: 62 adult survivors of child trafficking (83% female, 10% male, 7% transgender; 90% sex trafficking, 25% labor trafficking; median age of entry 16) and 37 community agency professionals who work with trafficked children. SETTING: The United States of America. METHODS: The Barriers to Care Questionnaire (BCQ) was adapted, piloted with a focus group, and disseminated to participants. RESULTS: A statistically significant increase in survivors seeking healthcare after compared to before trafficking was demonstrated (p < 0.05). Eighteen consequential barriers to healthcare were identified. The marginalization domain, representing the individual's perception of negative experiences with the healthcare system, had the highest number of consequential barriers. The majority of survivor and agency participants felt the physical and mental health needs of survivors are not being met, but would seek out trauma-informed healthcare if it were available in their community. CONCLUSIONS: Survivors of child trafficking in the U.S. experience a wide range of barriers to healthcare, and a lack of available trauma-informed healthcare. This study identified barriers to healthcare that can be considered by providers hoping to provide accessible and truama-informed services to trafficked children.

Comparison of two commercial recirculated aquacultural systems and their microbial potential in plant disease suppression.

BACKGROUND: Aquaponics are food production systems advocated for food security and health. Their sustainability from a nutritional and plant health perspective is, however, a significant challenge. Recirculated aquaculture systems (RAS) form a major part of aquaponic systems, but knowledge about their microbial potential to benefit plant growth and plant health is limited. The current study tested if the diversity and function of microbial communities in two commercial RAS were specific to the fish species used (Tilapia or Clarias) and sampling site (fish tanks and wastewaters), and whether they confer benefits to plants and have in vitro antagonistic potential towards plant pathogens. RESULTS: Microbial diversity and composition was found to be dependent on fish species and sample site. The Tilapia RAS hosted higher bacterial diversity than the Clarias RAS; but the later hosted higher fungal diversity. Both Tilapia and Clarias RAS hosted bacterial and fungal communities that promoted plant growth, inhibited plant pathogens and encouraged biodegradation. The production of extracellular enzymes, related to nutrient availability and pathogen control, by bacterial strains isolated from the Tilapia and Clarias systems, makes them a promising tool in aquaponics and in their system design. CONCLUSIONS: This study explored the microbial diversity and potential of the commercial RAS with either Tilapia or Clarias as a tool to benefit the aquaponic system with respect to plant growth promotion and control of plant diseases.

Molecular Phylogenomics and Population Structure of Phytophthora pluvialis.

Phytophthora pluvialis is an oomycete that was first isolated from soil, water, and tree foliage in mixed Douglas-fir-tanoak forests of the U.S. Pacific Northwest (PNW). It was then identified as the causal agent of red needle cast of radiata pine (Pinus radiata) in New Zealand (NZ). Genotyping-by-sequencing was used to obtain 1,543 single nucleotide polymorphisms across 145 P. pluvialis isolates to characterize the population structure in the PNW and NZ. We tested the hypothesis that P. pluvialis was introduced to NZ from the PNW using genetic distance measurements and population structure analyses among locations between countries. The low genetic distance, population heterozygosity, and lack of geographic structure in NZ suggest a single colonization event from the United States followed by clonal expansion in NZ. The PNW Coast Range was proposed as a presumptive center of origin of the currently known distribution of P. pluvialis based on its geographic range and position as the central cluster in a minimum spanning network. The Coastal cluster of isolates were located at the root of every U.S. cluster and emerged earlier than all NZ clusters. The Coastal cluster had the highest degree of heterozygosity (Hs = 0.254) and median pairwise genetic distance (0.093) relative to any other cluster. Finally, the rapid host diversification between closely related isolates of P. pluvialis in NZ indicate that this pathogen has the potential to infect a broader range of hosts than is currently recognized.

Functional analysis of RXLR effectors from the New Zealand kauri dieback pathogen Phytophthora agathidicida.

New Zealand kauri is an ancient, iconic, gymnosperm tree species that is under threat from a lethal dieback disease caused by the oomycete Phytophthora agathidicida. To gain insight into this pathogen, we determined whether proteinaceous effectors of P. agathidicida interact with the immune system of a model angiosperm, Nicotiana, as previously shown for Phytophthora pathogens of angiosperms. From the P. agathidicida genome, we defined and analysed a set of RXLR effectors, a class of proteins that typically have important roles in suppressing or activating the plant immune system. RXLRs were screened for their ability to activate or suppress the Nicotiana plant immune system using Agrobacterium tumefaciens transient transformation assays. Nine P. agathidicida RXLRs triggered cell death or suppressed plant immunity in Nicotiana, of which three were expressed in kauri. For the most highly expressed, P. agathidicida (Pa) RXLR24, candidate cognate immune receptors associated with cell death were identified in Nicotiana benthamiana using RNA silencing-based approaches. Our results show that RXLRs of a pathogen of gymnosperms can interact with the immune system of an angiosperm species. This study provides an important foundation for studying the molecular basis of plant-pathogen interactions in gymnosperm forest trees, including kauri.

Barriers to the access and utilization of healthcare for trafficked youth: A systematic review.

BACKGROUND: Healthcare has been identified as an important target for training on identification of trafficked youth. Survivors of human trafficking experience challenges in accessing healthcare, both during enslavement and in survivorship. OBJECTIVE: To examine the current evidence in the literature regarding barriers to healthcare faced by trafficked youth. METHODS: A systematic review of the literature was conducted using the PRISMA guidelines. Through an electronic database search, articles were screened and included if they primarily addressed victims or survivors of child trafficking and focused on barriers to healthcare or problems accessing healthcare. Articles were assessed for overall quality. Data from the articles selected for review were organized into major themes using a framework analysis. RESULTS: Of 3,274 articles resulting from the search, 8 were included in the review. Three sub-themes were coded and classified as extrinsic, intrinsic, and systemic barriers. Extrinsic barriers included trafficker control, physical confinement, and influence of peers. Intrinsic barriers included discrimination, confidentiality, trust in healthcare providers, knowledge of the healthcare system, and emotional reluctance. Systemic issues inherent to the healthcare system included healthcare provider knowledge, complex registration process, language barriers, appointment times, and service coordination. CONCLUSION: The combination of extrinsic, intrinsic, and systemic barriers leads to reduced utilization and access to medical services for trafficked youth. While extrinsic and intrinsic factors are difficult to eliminate given the clandestine nature of human trafficking, systemic barriers can be eliminated through improving effective training for healthcare providers on identification of victims and implementing trauma sensitive care.

Modern-day Slavery in our Health Care System: An Advocacy Journey.

The following is the winning submission from the third annual Section on Pediatric Trainees essay competition. This year's competition was informed by the 2018-2019 Section on Pediatric Trainees Advocacy Campaign: Advocacy Adventure, which empowered trainees to find their areas of passion, acquire and polish new skills, and organize advocacy efforts collaboratively. We asked writers to share experiences as physician advocates and were impressed with the broad variety of important topics submitted by trainees from around the country. This essay by Drs Panda and Garg highlights a critical issue facing children, human trafficking, and shares their innovative and sustainable survivor-informed training for pediatric trainees. Along with the runner-up submission by Dr Ju, which also appears in this issue, this piece is a wonderfully inspiring reminder that we are all well positioned to advocate for children in our roles as trainees and pediatricians.

Genome sequencing of oomycete isolates from Chile supports the New Zealand origin of Phytophthora kernoviae and makes available the first Nothophytophthora sp. genome.

Genome sequences were generated for six oomycete isolates collected from forests in Valdivia, Chile. Three of the isolates were identified morphologically as Phytophthora kernoviae, whereas two were similar to other clade 10 Phytophthora species. One isolate was tentatively identified as Nothophytophthora valdiviana based on nucleotide sequence similarity in the cytochrome oxidase 1 gene. This is the first genome sequence for this recently described genus. The genome assembly was more fragmented and contained many duplicated genes when compared with the other Phytophthora sequences. Comparative analyses were performed with genomic sequences of the P. kernoviae isolates from the UK and New Zealand. Although the potential New Zealand origin of P. kernoviae has been suggested, new isolations from Chile had cast doubt on this hypothesis. We present evidence supporting P. kernoviae as having originated in New Zealand. However, investigation of the diversity of oomycete species in Chile has been limited and warrants further exploration. We demonstrate the expediency of genomic analyses in determining phylogenetic relationships between isolates within new and often scantly represented taxonomic groups, such as Phytophthora clade 10 and Nothophytophthora. Data are available on GenBank via BioProject accession number PRJNA352331.