cro

Temperature and Nutrient Levels Correspond with Lineage-Specific Microdiversification in the Ubiquitous and Abundant Freshwater Genus Limnohabitans [Environmental Microbiology]

Most freshwater bacterial communities are characterized by a few dominant taxa that are often ubiquitous across freshwater biomes worldwide. Our understanding of the genomic diversity within these taxonomic groups is limited to a subset of taxa. Here, we investigated the genomic diversity that enables Limnohabitans, a freshwater genus key in funneling carbon from primary producers to higher trophic levels, to achieve abundance and ubiquity. We reconstructed eight putative Limnohabitans metagenome-assembled genomes (MAGs) from stations located along broad environmental gradients existing in Lake Michigan, part of Earth’s largest surface freshwater system. De novo strain inference analysis resolved a total of 23 strains from these MAGs, which strongly partitioned into two habitat-specific clusters with cooccurring strains from different lineages. The largest number of strains belonged to the abundant LimB lineage, for which robust in situ strain delineation had not previously been achieved. Our data show that temperature and nutrient levels may be important environmental parameters associated with microdiversification within the Limnohabitans genus. In addition, strains predominant in low- and high-phosphorus conditions had larger genomic divergence than strains abundant under different temperatures. Comparative genomics and gene expression analysis yielded evidence for the ability of LimB populations to exhibit cellular motility and chemotaxis, a phenotype not yet associated with available Limnohabitans isolates. Our findings broaden historical marker gene-based surveys of Limnohabitans microdiversification and provide in situ evidence of genome diversity and its functional implications across freshwater gradients.

IMPORTANCE Limnohabitans is an important bacterial taxonomic group for cycling carbon in freshwater ecosystems worldwide. Here, we examined the genomic diversity of different Limnohabitans lineages. We focused on the LimB lineage of this genus, which is globally distributed and often abundant, and its abundance has shown to be largely invariant to environmental change. Our data show that the LimB lineage is actually comprised of multiple cooccurring populations for which the composition and genomic characteristics are associated with variations in temperature and nutrient levels. The gene expression profiles of this lineage suggest the importance of chemotaxis and motility, traits that had not yet been associated with the Limnohabitans genus, in adapting to environmental conditions.




cro

Applicant gender and matching to first-choice discipline: a cross-sectional analysis of data from the Canadian Resident Matching Service (2013-2019)

Background:

Previous studies examining potential sex and gender bias in the Canadian Resident Matching Service (CaRMS) match have had conflicting results. We examined the results of the CaRMS match over the period 2013–2019 to determine the potential association between applicants’ gender and the outcome of matching to their first-choice discipline.

Methods:

In this cross-sectional analysis, we determined the risk of matching to one’s first-choice discipline in CaRMS by applicant gender and year, for all Canadian medical students who participated in the first iteration of the R-1 match for the years 2013 to 2019. We analyzed data in 3 categories of disciplines according to CaRMS classifications: family medicine, nonsurgical disciplines and surgical disciplines. We excluded disciplines with fewer than 10 applicants.

Results:

Match results were available for 20 033 participants, of whom 11 078 (55.3%) were female. Overall, female applicants were significantly more likely to match to their first-choice discipline (relative risk [RR] 1.03, 95% confidence interval [CI] 1.02–1.04). After adjustment for match year and stratification by discipline categories, we found that female applicants were more likely to match to family medicine as their first choice (RR 1.04, 95% CI 1.03–1.05) and less likely to match to a first-choice surgical discipline (RR 0.95, 95% CI 0.91–1.00) than their male peers. There was no significant difference between the genders in matching to one’s first-choice nonsurgical discipline (RR 1.01, 95% CI 0.99–1.03).

Interpretation:

These results suggest an association between an applicant’s gender and the probability of matching to one’s first-choice discipline. The possibility of gender bias in the application process for residency programs should be further evaluated and monitored.




cro

Association of physician payment model and team-based care with timely access in primary care: a population-based cross-sectional study

Background:

It is unclear how patient-reported access to primary care differs by physician payment model and participation in team-based care. We examined the association between timely and after-hours access to primary care and physician payment model and participation in team-based care, and sought to assess how access varied by patient characteristics.

Methods:

We conducted a cross-sectional analysis of adult (age ≥ 16 yr) Ontarians who responded to the Ontario Health Care Experience Survey between January 2013 and September 2015, reported having a primary care provider and agreed to have their responses linked to health administrative data. Access measures included the proportion of respondents who reported same-day or next-day access when sick, satisfaction with time to appointment when sick, telephone access and knowledge of an after-hours clinic. We tested the association between practice model and measures of access using logistic regression after stratifying for rurality.

Results:

A total of 33 665 respondents met our inclusion criteria. In big cities, respondents in team and nonteam capitation models were less likely to report same-day or next-day access when sick than respondents in enhanced fee-for-service models (team capitation 43%, adjusted odds ratio [OR] 0.88, 95% confidence interval [CI] 0.79–0.98; nonteam capitation 39%, adjusted OR 0.78, 95% CI 0.70–0.87; enhanced fee-for-service 46% [reference]). Respondents in team and nonteam capitation models were more likely than those in enhanced fee-for-service models to report that their provider had an after-hours clinic (team capitation 59%, adjusted OR 2.59, 95% CI 2.39–2.81; nonteam capitation 51%, adjusted OR 1.90, 95% CI 1.76–2.04; enhanced fee-for service 34% [reference]). Patterns were similar for respondents in small towns. There was minimal to no difference by model for satisfaction with time to appointment or telephone access.

Interpretation:

In our setting, there was an association between some types of access to primary care and physician payment model and team-based care, but the direction was not consistent. Different measures of timely access are needed to understand health care system performance.




cro

Characteristics of high-drug-cost beneficiaries of public drug plans in 9 Canadian provinces: a cross-sectional analysis

Background:

Drugs are the fastest growing cost in the Canadian health care system, owing to the increasing number of high-cost drugs. The objective of this study was to examine the characteristics of high–drug-cost beneficiaries of public drug plans across Canada relative to other beneficiaries.

Methods:

We conducted a cross-sectional study among public drug plan beneficiaries residing in all provinces except Quebec. We used the Canadian Institute for Health Information’s National Prescription Drug Utilization Information System to identify all drugs dispensed to beneficiaries of public drug programs in 2016/17. We stratified the cohort into 2 groups: high–drug-cost beneficiaries (top 5% of beneficiaries based on annual costs) and other beneficiaries (remaining 95%). For each group, we reported total drug costs, prevalence of high-cost claims (> $1000), median number of drugs, proportion of beneficiaries aged 65 or more, the 10 most costly reimbursed medications and the 10 medications most commonly reimbursed. We reported estimates overall and by province.

Results:

High–drug-cost beneficiaries accounted for nearly half (46.5%) of annual spending, with an average annual spend of $14 610 per beneficiary, compared to $1570 among other beneficiaries. The median number of drugs dispensed was higher among high–drug-cost beneficiaries than among other beneficiaries (13 [interquartile range (IQR) 7–19] v. 8 [IQR 4–13]), and a much larger proportion of high–drug-cost beneficiaries than other beneficiaries received at least 1 high-cost claim (40.9% v. 0.6%). Long-term medications were the most commonly used medications for both groups, whereas biologics and antivirals were the most costly medications for high–drug-cost beneficiaries.

Interpretation:

High–drug-cost beneficiaries were characterized by the use of expensive medications and polypharmacy relative to other beneficiaries. Interventions and policies to help reduce spending need to consider both of these factors.




cro

Proportion of female recipients of resident-selected awards across Canada from 2000 to 2018: a retrospective observational study

Background:

Female physicians have been shown to receive fewer awards from medical societies than their male colleagues. We examined the sex distribution of recipients of Canadian residency association awards.

Methods:

We conducted a retrospective observational study of the sex of staff and resident physician recipients of resident-selected awards from provincial and national residency associations using data from 2000–2018. We classified awards into professionalism, advocacy and wellness awards, and education and teaching awards based on award names and descriptions, and compared the proportion of male and female recipients in these categories.

Results:

We identified 314 recipients of staff physician awards and 129 recipients of resident physician awards. Male staff and resident physicians had higher odds of receiving awards than their female counterparts (odds ratio [OR] 1.45, 95% confidence interval [CI] 1.13–1.89 and OR 1.70, 95% CI 1.18–2.46, respectively). There was a reduction in the odds of male residents’ receiving an award over the study period (OR 0.94, 95% CI 0.90–0.98). Male physicians had higher odds of receiving education and teaching awards than female physicians as staff but not as residents (OR 3.21, 95% CI 1.72–5.95 and OR 1.96, 95% CI 0.84–4.60, respectively).

Interpretation:

Male staff and resident physicians in Canada had higher odds of receiving awards from provincial and national residency associations between 2000 and 2018 than their female counterparts. Given this disparity, it would be prudent for organizations that distribute awards to physicians, residents and medical students to examine their nomination criteria and processes for potential bias.




cro

Digging Deep in the Microbiome to Diagnose Clostridioides difficile Infection

Clostridioides difficileDiagnosticsMetabolomicsMicrobiome




cro

Efficacy and Safety of Duvelisib Following Disease Progression on Ofatumumab in Patients with Relapsed/Refractory CLL or SLL in the DUO Crossover Extension Study

Purpose:

In the phase III DUO trial, duvelisib, an oral dual PI3K-, inhibitor, demonstrated significantly improved efficacy versus ofatumumab [median (m) progression-free survival (PFS), 13.3 vs. 9.9 months (HR, 0.52; P < 0.0001); overall response rate [ORR], 74% vs. 45% (P < 0.0001)], with a manageable safety profile in patients with relapsed/refractory (R/R) chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). We report results from patients with progressive disease (PD) after ofatumumab who crossed over to duvelisib in the DUO trial.

Patients and Methods:

Patients with radiographically confirmed PD after ofatumumab received duvelisib 25 mg twice daily in 28-day cycles until PD, intolerance, death, or study withdrawal. The primary endpoint was ORR per investigator. Secondary endpoints included duration of response (DOR), PFS, and safety.

Results:

As of December 14, 2018, 90 ofatumumab-treated patients in the DUO trial prior to crossover had an ORR of 29%, mDOR of 10.4 months, and mPFS of 9.4 months. After crossover, 77% of patients (69/90) achieved a response, with an mDOR of 14.9 months and mPFS of 15.7 months. Patients with del(17p) and/or TP53 mutations had similar outcomes [ORR, 77% (20/26); mPFS, 14.7 months]. Notably, 73% of patients (47/64) with disease previously refractory to ofatumumab achieved a response. The most frequent any-grade/grade 3/4 treatment-emergent adverse events were diarrhea (47%/23%), neutropenia (26%/23%), pyrexia (24%/4%), cutaneous reactions (23%/4%), and thrombocytopenia (10%/6%).

Conclusions:

Duvelisib demonstrated high response rates with good durability and a manageable safety profile in patients with R/R CLL/SLL who progressed on ofatumumab, including patients with high-risk disease and disease previously refractory to ofatumumab.




cro

Surveillance of Omadacycline Activity Tested against Clinical Isolates from the United States and Europe: Report from the SENTRY Antimicrobial Surveillance Program, 2016 to 2018 [Epidemiology and Surveillance]

Omadacycline is a broad-spectrum aminomethylcycline approved in October 2018 by the U.S. Food and Drug Administration for treating acute bacterial skin and skin structure infections and community-acquired pneumonia as both an oral and intravenous once-daily formulation. In this report, the activities of omadacycline and comparators were tested against 49,000 nonduplicate bacterial isolates collected prospectively during 2016 to 2018 from medical centers in Europe (24,500 isolates, 40 medical centers [19 countries]) and the United States (24,500 isolates, 33 medical centers [23 states and all 9 U.S. census divisions]). Omadacycline was tested by broth microdilution following the methods in Clinical and Laboratory Standards Institute document M07 (Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically; Approved Standard, 11th ed., 2018). Omadacycline (MIC50/90, 0.12/0.25 mg/liter) inhibited 98.6% of Staphylococcus aureus isolates at ≤0.5 mg/liter, including 96.3% of methicillin-resistant S. aureus isolates and 99.8% of methicillin-susceptible S. aureus isolates. Omadacycline potency was comparable for Streptococcus pneumoniae (MIC50/90, 0.06/0.12 mg/liter), viridans group streptococci (MIC50/90, 0.06/0.12 mg/liter), and beta-hemolytic streptococci (MIC50/90, 0.12/0.25 mg/liter), regardless of species and susceptibility to penicillin, macrolides, or tetracycline. Omadacycline was active against all Enterobacterales tested (MIC50/90, 1/8 mg/liter; 87.5% of isolates were inhibited at ≤4 mg/liter) except Proteus mirabilis (MIC50/90, 16/>32 mg/liter) and indole-positive Proteus spp. (MIC50/90, 8/32 mg/liter) and was most active against Escherichia coli (MIC50/90, 0.5/2 mg/liter), Klebsiella oxytoca (MIC50/90, 1/2 mg/liter), and Citrobacter spp. (MIC50/90, 1/4 mg/liter). Omadacycline inhibited 92.4% of Enterobacter cloacae species complex and 88.5% of Klebsiella pneumoniae isolates at ≤4 mg/liter. Omadacycline was active against Haemophilus influenzae (MIC50/90, 0.5/1 mg/liter), regardless of β-lactamase status, and against Moraxella catarrhalis (MIC50/90, ≤0.12/0.25 mg/liter). The potent activity of omadacycline against Gram-positive and -negative bacteria indicates that omadacycline merits further study in serious infections in which multidrug resistance and mixed Gram-positive and Gram-negative bacterial infections may be a concern.




cro

Antibacterial Monoclonal Antibodies Do Not Disrupt the Intestinal Microbiome or Its Function [Experimental Therapeutics]

Antibiotics revolutionized the treatment of infectious diseases; however, it is now clear that broad-spectrum antibiotics alter the composition and function of the host’s microbiome. The microbiome plays a key role in human health, and its perturbation is increasingly recognized as contributing to many human diseases. Widespread broad-spectrum antibiotic use has also resulted in the emergence of multidrug-resistant pathogens, spurring the development of pathogen-specific strategies such as monoclonal antibodies (MAbs) to combat bacterial infection. Not only are pathogen-specific approaches not expected to induce resistance in nontargeted bacteria, but they are hypothesized to have minimal impact on the gut microbiome. Here, we compare the effects of antibiotics, pathogen-specific MAbs, and their controls (saline or control IgG [c-IgG]) on the gut microbiome of 7-week-old, female, C57BL/6 mice. The magnitude of change in taxonomic abundance, bacterial diversity, and bacterial metabolites, including short-chain fatty acids (SCFA) and bile acids in the fecal pellets from mice treated with pathogen-specific MAbs, was no different from that with animals treated with saline or an IgG control. Conversely, dramatic changes were observed in the relative abundance, as well as alpha and beta diversity, of the fecal microbiome and bacterial metabolites in the feces of all antibiotic-treated mice. Taken together, these results indicate that pathogen-specific MAbs do not alter the fecal microbiome like broad-spectrum antibiotics and may represent a safer, more-targeted approach to antibacterial therapy.




cro

Antimicrobial Activity of the Quinoline Derivative HT61 against Staphylococcus aureus Biofilms [Susceptibility]

Staphylococcus aureus biofilms are a significant problem in health care settings, partly due to the presence of a nondividing, antibiotic-tolerant subpopulation. Here we evaluated treatment of S. aureus UAMS-1 biofilms with HT61, a quinoline derivative shown to be effective against nondividing Staphylococcus spp. HT61 was effective at reducing biofilm viability and was associated with increased expression of cell wall stress and division proteins, confirming its potential as a treatment for S. aureus biofilm infections.




cro

Antimicrobial Activity of Ceftolozane-Tazobactam and Comparators against Clinical Isolates of Haemophilus influenzae from the United States and Europe [Susceptibility]

Nine hundred Haemophilus influenzae clinical isolates from 83 U.S. and European medical centers were tested for susceptibility by reference broth microdilution methods against ceftolozane-tazobactam and comparators. Results were stratified by β-lactamase production and infection type. Overall, ceftolozane-tazobactam MIC50/90 values were 0.12/0.25 mg/liter, and 99.0% of isolates were inhibited at the susceptible breakpoint of ≤0.5 mg/liter; the highest MIC value was only 2 mg/liter. Our results support using ceftolozane-tazobactam to treat H. influenzae infections.




cro

Unorthodox Parenteral {beta}-Lactam and {beta}-Lactamase Inhibitor Combinations: Flouting Antimicrobial Stewardship and Compromising Patient Care [Commentary]

In India and China, indigenous drug manufacturers market arbitrarily combined parenteral β-lactam and β-lactamase inhibitors (BL-BLIs). In these fixed-dose combinations, sulbactam or tazobactam is indiscriminately combined with parenteral cephalosporins, with BLI doses kept in ratios similar to those for the approved BL-BLIs. Such combinations have been introduced into clinical practice without mandatory drug development studies involving pharmacokinetic/pharmacodynamic, safety, and efficacy assessments being undertaken. Such unorthodox combinations compromise clinical outcomes and also potentially contribute to resistance development.




cro

The Novel Macrolide Resistance Genes mef(D), msr(F), and msr(H) Are Present on Resistance Islands in Macrococcus canis, Macrococcus caseolyticus, and Staphylococcus aureus [Mechanisms of Resistance]

Chromosomal resistance islands containing the methicillin resistance gene mecD (McRImecD) have been reported in Macrococcus caseolyticus. Here, we identified novel macrolide resistance genes in Macrococcus canis on similar elements, called McRImsr. These elements were also integrated into the 3' end of the 30S ribosomal protein S9 gene (rpsI), delimited by characteristic attachment (att) sites, and carried a related site-specific integrase gene (int) at the 5' end. They carried novel macrolide resistance genes belonging to the msr family of ABC subfamily F (ABC-F)-type ribosomal protection protein [msr(F) and msr(H)] and the macrolide efflux mef family [mef(D)]. Highly related mef(D)-msr(F) fragments were found on diverse McRImsr elements in M. canis, M. caseolyticus, and Staphylococcus aureus. Another McRImsr-like element identified in an M. canis strain lacked the classical att site at the 3' end and carried the msr(H) gene but no neighboring mef gene. The expression of the novel resistance genes in S. aureus resulted in a low-to-moderate increase in the MIC of erythromycin but not streptogramin B. In the mef(D)-msr(F) operon, the msr(F) gene was shown to be the crucial determinant for macrolide resistance. The detection of circular forms of McRImsr and the mef(D)-msr(F) fragment suggested mobility of both the island and the resistance gene subunit. The discovery of McRImsr in different Macrococcus species and S. aureus indicates that these islands have a potential for dissemination of antibiotic resistance within the Staphylococcaceae family.




cro

Fibroblast Heterogeneity in the Pancreatic Tumor Microenvironment [Mini Review]

The poor prognosis for patients with pancreatic ductal adenocarcinoma (PDAC) impels an improved understanding of disease biology to facilitate the development of better therapies. PDAC typically features a remarkably dense stromal reaction, featuring and established by a prominent population of cancer-associated fibroblasts (CAF). Genetically engineered mouse models and increasingly sophisticated cell culture techniques have demonstrated important roles for fibroblasts in PDAC progression and therapy response, but these roles are complex, with strong evidence for both tumor-supportive and tumor-suppressive or homeostatic functions. Here, we review the recent literature that has improved our understanding of heterogeneity in fibroblast fate and function in this disease including the existence of distinct fibroblast populations, and highlight important avenues for future study.

Significance:

Although the abundant stromal reaction associated with pancreatic cancer has long been appreciated, the functions of the CAF cells that establish this stromal reaction remain unclear. An improved understanding of the transcriptional and functional heterogeneity of pancreatic CAFs, as well as their tumor-supportive versus tumor-suppressive capacity, may facilitate the development of effective therapies for this disease.




cro

Colibactin Causes Colorectal Cancer-Associated Mutational Signature [Microbiome]

The pks+ E. coli metabolite colibactin caused a unique mutational signature in intestinal organoids.




cro

Microbiome Predicts Blood-Cell Transplant Success [News in Brief]

A large international study found that the composition of the intestinal microbiome can predict clinical outcomes in patients undergoing allogenic hematopoietic-cell transplant (HCT) for blood cancers. The findings may help assess patients' transplantation-related mortality risk and aid in developing interventions to prevent or mitigate microbiome changes that affect HCT outcomes.




cro

CAR Engineering Comes to Macrophages [News in Brief]

Human macrophages equipped with chimeric antigen receptor constructs infiltrate solid tumors, ingest malignant tissue, and stimulate adaptive immunity in mouse models. Several new biotech companies are racing to bring the technology into clinical trials.




cro

Oral Microbiome Profiling in Smokers with and without Head and Neck Cancer Reveals Variations Between Health and Disease

While smoking is inextricably linked to oral/head and neck cancer (HNSCC), only a small fraction of smokers develop HNSCC. Thus, we have sought to identify other factors, which may influence the development of HNSCC in smokers including microbiology. To determine microbial associations with HNSCC among tobacco users, we characterized oral microbiome composition in smokers with and without HNSCC. 16S rRNA MiSeq sequencing was used to examine the oral mucosa microbiome of 27 smokers with (cases) and 24 without HNSCC (controls). In addition, we correlated previously reported levels of DNA damage with the microbiome data. Smokers with HNSCC showed lower microbiome richness compared with controls (q = 0.012). Beta-diversity analyses, assessed as UniFrac (weighted and unweighted) and Bray–Curtis distances, showed significant differences in oral mucosal microbiome signatures between cases and controls (r2 = 0.03; P = 0.03) and higher interindividual microbiome heterogeneity in the former (q ≤ 0.01). Higher relative abundance of Stenotrophomonas and Comamonadaceae and predicted bacterial pathways mainly involved in xenobiotic and amine degradation were found in cases compared with controls. The latter, in contrast, exhibited higher abundance of common oral commensals and predicted sugar degradation pathways. Finally, levels of DNA damage in the oral cavity were correlated with the microbiome profiles above. Oral microbiome traits differ in smokers with and without HNSCC, potentially informing the risk of eventual HNSCC and shedding light into possible microbially mediated mechanisms of disease. These findings present data that may be useful in screening efforts for HNSCC among smokers who are unable to quit.




cro

Glial TIM-3 Modulates Immune Responses in the Brain Tumor Microenvironment

T-cell immunoglobulin and mucin domain–containing molecule 3 (TIM-3), a potential immunotherapeutic target for cancer, has been shown to display diverse characteristics in a context-dependent manner. Thus, it would be useful to delineate the precise functional features of TIM-3 in a given situation. Here, we report that glial TIM-3 shows distinctive properties in the brain tumor microenvironment. TIM-3 was expressed on both growing tumor cells and their surrounding cells including glia and T cells in an orthotopic mouse glioma model. The expression pattern of TIM-3 was distinct from those of other immune checkpoint molecules in tumor-exposed and tumor-infiltrating glia. Comparison of cells from tumor-bearing and contralateral hemispheres of a glioma model showed that TIM-3 expression was lower in tumor-infiltrating CD11b+CD45mid glial cells but higher in tumor-infiltrating CD8+ T cells. In TIM-3 mutant mice with intracellular signaling defects and Cre-inducible TIM-3 mice, TIM-3 affected the expression of several immune-associated molecules including iNOS and PD-L1 in primary glia-exposed conditioned media (CM) from brain tumors. Further, TIM-3 was cross-regulated by TLR2, but not by TLR4, in brain tumor CM- or Pam3CSK4-exposed glia. In addition, following exposure to tumor CM, IFNγ production was lower in T cells cocultured with TIM-3–defective glia than with normal glia. Collectively, these findings suggest that glial TIM-3 actively and distinctively responds to brain tumor, and plays specific intracellular and intercellular immunoregulatory roles that might be different from TIM-3 on T cells in the brain tumor microenvironment.Significance:TIM-3 is typically thought of as a T-cell checkpoint receptor. This study demonstrates a role for TIM-3 in mediating myeloid cell responses in glioblastoma.




cro

Immunotherapeutic Response in Tumors Is Affected by Microenvironmental ROS

Carcinoma-associated fibroblasts (CAF) are a potential therapeutic target for both direct and indirect regulation of cancer progression and therapy response. In this issue of Cancer Research, Ford and colleagues investigate the influence of CAF on the immune environment of tumors, specifically focusing on the regulation of CD8+ T cells, required for immune therapy response. Their work suggests a role for stromally expressed NADPH oxidase 4 (NOX4) as a modulator of reactive oxygen species that in turn can reduce the number of CD8+ T cells locally. Inhibition of NOX4 increased CD8+ T cells and restored responsiveness to immune therapy, suggesting an indirect stromally targeted avenue for therapy resensitization.See related article by Ford et al., p. 1846




cro

[PERSPECTIVES] Regulating Preimplantation Genetic Testing across the World: A Comparison of International Policy and Ethical Perspectives

Preimplantation genetic testing (PGT) is a reproductive technology that, in the course of in vitro fertilization (IVF), allows prospective parents to select their future offspring based on genetic characteristics. PGT could be seen as an exercise of reproductive liberty, thus potentially raising significant socioethical and legal controversy. In this review, we examine—from a comparative perspective—variations in policy approaches to the regulation of PGT. We draw on a sample of 19 countries (Australia, Austria, Belgium, Brazil, Canada, China, France, Germany, India, Israel, Italy, Japan, Mexico, Netherlands, Singapore, South Korea, Switzerland, United Kingdom, and the United States) to provide a global landscape of the spectrum of policy and legislative approaches (e.g., restrictive to permissive, public vs. private models). We also explore central socioethical and policy issues and contentious applications, including permissibility criteria (e.g., medical necessity), nonmedical sex selection, and reproductive tourism. Finally, we further outline genetic counseling requirements across policy approaches.




cro

Intermixed Dimethyl-Sulfoxide-Based Nonadhesive Liquid Embolic Agents Delivered Serially via the Same Microcatheter for Cerebral AVM Treatment [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Conventional nonadhesive liquid embolic agents currently are the criterion standard for endovascular embolization of cerebral AVMs. However, inadequate distal penetration into the nidus and unstable proximal plug formation are the major limitations of this approach and of the currently available embolic materials. The aim of this study was to evaluate the hypothetic efficacy of combining liquid embolic agents with different properties and viscosities for use in endovascular embolization of cerebral AVMs.

MATERIALS AND METHODS:

From March 2018 to March 2019, sixteen patients with cerebral AVMs (12 women, 4 men; age range, 33–61 years) underwent endovascular embolization with combined liquid embolic agents delivered serially via a single microcatheter. The procedure consists of initial embolization with PHIL 30%, followed by Menox 18 through the same microcatheter. According to the Spetzler-Martin scale, 11 (68.75%) AVMs were grades I–II, 4 (25%) were grade III, and 1 (6.25%) was grade IV. Angiographic, technical, and clinical outcomes were analyzed independently.

RESULTS:

Combined PHIL and Menox embolization through the same microcatheter via 21 pedicles was performed in these 16 patients. Once the length of the reflux reached approximately 2 cm, PHIL 30% was switched to Menox 18. Antegrade flow and distal penetration of the serially applied liquid embolic agents were observed in all 16 cases. The ability to completely control the flow of the materials and avoid any dangerous proximal reflux was noted in all performed embolizations. The estimated average size reduction of the treated AVMs was 85%, ranging from 50% to 100%. Complete embolization was achieved in 10/16 or 62.5% of the cases. There was no procedure-related complication during or after the embolization. No mortality or postprocedural clinical worsening was seen. Clinical success and complete obliteration were confirmed with at least 1 follow-up angiography in 10/16 patients.

CONCLUSIONS:

Serial delivery of nonadhesive liquid embolic agents via the same microcatheter was safe and effective in our study and may be a potential technique for routine AVM treatment. However, further investigations are required to validate the safety and the efficacy of the method.




cro

Leasing townhouse with 2 frontages, 1 ground floor, 2 floors, near crossroads; suitable for office

+ townhouse with 2 frontages, 1 ground floor, 2 floors, near crossroads; convenient traffic and parking + Crowded residential area, surrounded by many offices, schools, apartments, mini supermarkets, cafes ... + Convenient for trading in cafes, mini supermarkets, transaction offi...




cro

Flamingo Crown Bay

Flamingo Crown Bay (Flamingo Hải Tiến Thanh Hóa) tọa lạc trên khu đất quy hoạch rộng 19.3901m2 tại 4 xã thuộc huyện Hoằng Hóa, tỉnh Thanh Hóa.




cro

How to make your listing stand out from the crowd?

Every home seller wants to sell it fast and reach as many buyers as possible. Here are some tips to make your listing stand out to potential buyers from the crowd.




cro

Biệt thự hàng chục triệu USD của đồng sáng lập Microsoft

Căn biệt thự ở Atherton, California (Mỹ) của tỷ phú quá cố Paul Allen, nhà đồng sáng lập Microsoft, đang được rao bán với giá 41,48 triệu USD (khoảng 960 tỷ đồng).




cro

World Red Cross Day: क्यों मनाया जाता है रेड क्रॉस दिवस, कोरोना महामारी काल में क्या है इसकी भूमिका

इसकी स्थापना हेनरी ड्यूडेंट ने की थी, जिनका जन्म आठ मई को ही हुआ था। इसलिए हर साल आठ मई को रेड क्रॉस दिवस मनाया जाता है। यह संस्था युद्ध और शांति के समय दुनियाभर के देशों की सरकारों के बीच समन्वय का काम करती है। इसका मुख्य कार्य मानव सेवा है। 




cro

Switch Shipments Reach 55.77 Million Units as of March 31, Animal Crossing: New Horizons Sells 12 Million

Nintendo has released its latest hardware and software figures for the Nintendo Switch and Nintendo 3DS through March 31, 2020. Shipments figures for the Nintendo Switch reached 55.77 million units, while the Nintendo 3DS hit 75.77 million units shipped. As for lifetime software 356.24 million Switch games have been shipped and 383.11 million 3DS games. 

For the quarter Nintendo shipped 3.28 million Switch units and 45.59 million Switch games, as well as 0.07 million 3DS units and 0.89 million 3DS games. 

Nintendo forecasts it will ship 19 million Switch units in the fiscal year ending March 31, 2021.

Here are the top 10 best-selling Switch first-party titles:

  1. Mario Kart 8 Deluxe – 24.77 million
  2. Super Smash Bros. Ultimate – 18.84 million
  3. The Legend of Zelda: Breath of the Wild – 17.41 million
  4. Super Mario Odyssey – 17.41 million
  5. Pokemon Sword / Pokemon Shield – 17.37 million
  6. Pokemon: Let’s Go, Pikachu! / Pokemon: Let’s Go, Eevee! – 11.97 million
  7. Animal Crossing: New Horizons – 11.77 million (first 11 days) / 13.41 million (first six weeks)
  8. Splatoon 2 – 10.13 million
  9. Super Mario Party – 10.10 million
  10. New Super Mario Bros. U Deluxe – 6.60 million
Nintendo also shared the sales figures of more games:
  • Luigi’s Mansion 3 – 6.33 million
  • Super Mario Maker 2 – 5.48 million
  • The Legend of Zelda: Link’s Awakening – 4.38 million
  • Fire Emblem: Three Houses – 2.87 million
  • Ring Fit Adventure – 2.73 million
  • Pokemon Mystery Dungeon: Rescue Team DX – 1.26 million
  • Astral Chain – 1.08 million
  • Marvel Ultimate Alliance 3: The Black Order – 1.08 million

Nintendo in a separate report revealed sell-in figures for the Nintendo switch. For the 2020 fiscal year Nintendo sold 21.03 million Switch consoles, which is a 24 percent increase over the 16.95 million sold the previous year. Software sales for the fiscal year jumped 42.3 percent to 168.72 million games sold. 

Nintendo also revealed sell-through sales in three major regions for the 2020 fiscal year. In North America sales for the Switch were 7.67 million units, a 20 percent increase. In Europe, sales increased 19 percent to 5.37 million units, and in Japan sales jumped 33 percent to 5.06 million units.

A life-long and avid gamer, William D'Angelo was first introduced to VGChartz in 2007. After years of supporting the site, he was brought on in 2010 as a junior analyst, working his way up to lead analyst in 2012. He has expanded his involvement in the gaming community by producing content on his own YouTube channel and Twitch channel dedicated to gaming Let's Plays and tutorials. You can contact the author at wdangelo@vgchartz.com or on Twitter @TrunksWD.

Full Article - https://www.vgchartz.com/article/443417/switch-shipments-reach-5577-million-units-as-of-march-31-animal-crossing-new-horizons-sells-12-million/




cro

Colonel Croesus: Turn 8

ZINC, the rough-hewn chamber with the shack in its centre, has already cost the Comment Commanders Robert Duvall (Colonel Croesus) and John Nettles (Corporal Wood). Will it also claim the life of Charles Bronson (Sergeant Nemchik)? (Colonel Croesus is an open-to-all game of Combat Mission: Fortress Italy in which Allied forces are orchestrated by commenters […]



  • PC Game News
  • Colonel Croesus
  • Combat Mission: Fortress Italy
  • communal Combat Mission

cro

Call Of Duty: Modern Warfare's crowded April Fool's Shipment playlist returns

Fancy a 1v1 match on Shipment? Of course not. Duels to the death are played out and boring. Subscribing to the view that bigger is indeed always better, Call Of Duty: Modern Warfare has brought back its 10v10 Shipment playlist. After briefly appearing as an April Fool’s jab, Infinity Ward have decided to make 20-player […]




cro

Microrobots made from pollen help remove toxic mercury from wastewater

Pollen has a natural tendency to adsorb mercury and forms the basis of a new class of tiny robots that speed through toxic water to purify it




cro

Microwaved bamboo could be used to build super-strong skyscrapers

Bamboo is a renewable material that when microwaved becomes stronger by weight than steel or concrete – which could make it ideal for constructing buildings, cars and planes




cro

Robot with pincers can detect and remove weeds without harming crops

A robot that uses artificial intelligence to find and remove weeds could eventually be used as an alternative to chemical insecticides




cro

Animal Crossing Is the Breath of the Wild Postgame I Always Dreamed Of

Strange as it may sound, Animal Crossing: New Horizons feels like where Breath of the Wild should have ended up gameplay-wise.




cro

Google Duo Courts the PG Crowd With Addition of 'Family Mode'

Google has been folding in a score of updates to help delineate Duo from the dozens of other video chat services available.




cro

Bioluminescent Waves Draw Crowds to California Beaches

It’s quite the spectacle, but the light show is leading people to be less than cautious about social distancing.




cro

A giant raft of rock may once have floated across Mars’s ancient ocean

Mars could have had an ancient ocean in its northern hemisphere, and a large raft of volcanic rock may have floated across it to settle into mounds we can see today




cro

I'm a space archaeologist studying junk strewn across the solar system

From vintage satellites to lunar rovers, space archaeologist Alice Gorman is teasing out a unique history of humanity from the objects we've dispatched from Earth




cro

Quantum Computing Gets a Boost From AI and Crowdsourcing

Can an online game that combines human brainpower with AI solve intractable problems?




cro

Microsoft's AI Research Draws Controversy Over Possible Disinformation Use

Microsoft's AI could enable its popular chatbot to comment on news, but critics see a tool for spreading disinformation



  • robotics
  • robotics/artificial-intelligence

cro

In 2016, Microsoft’s Racist Chatbot Revealed the Dangers of Online Conversation

The bot learned language from people on Twitter—but it also learned values



  • robotics
  • robotics/artificial-intelligence

cro

Sure, Why Not?: A Lid For Dripping Melting Butter On Microwave Popcorn As It Pops

This is the Popcorn Popping Lid with Butter Vents available from Uncommon Goods ($11). You just fill a microwave-safe 10-inch bowl with your choice of popping corn, set the lid on top, add a pat of butter to each of the lid's butter vents, and let the microwaving begin! Of course if you're anything like me you'll balance as much butter as you can atop each of those vents because, I don't know if you knew this about me, but I love butter. I don't really like it cold but *microwave beeping* sometimes when I'm really feeling down I'll just melt two sticks and drink it. Keep going for a couple more shots because they exist.




cro

RPGCast – Episode 382: “Alex Fuller Lacrosse”

Take a break from PAX East 2016 for some gentle RPG sound waves. Anna Marie confesses her obsession with rebuilding the moon. Alex confesses his...




cro

RPGCast – Episode 448: “Hannibal Crossing”

Xenosaga Chronicles 2 is here. Did you get a switch just for it? Chris and Alex talk through their experiences. Johnathan, meanwhile, has been delving...




cro

RPGCast – Episode 460: “Ten X Cross: Chi”

While Johnathan defends his pride from Scar, Alex practices being Daduza. Christopher learns that it’s hard work owning a TurboGrafx. Anna Marie, meanwhile, has been...




cro

Obesity is linked to gut microbiota disturbance, but not among statin-treated individuals

Scientists set out to investigate a potential role of the gut microbiota in the development of cardio-metabolic diseases. They ended up identifying the common cholesterol-lowering drug statins as a potential microbiota-modulating therapeutic.




cro

Nintendo sells a lot more Switches, as people stay at home playing Animal Crossing

A couple of weeks ago, we noted some new NPD numbers pointing to a very good March for the Switch. Nintendo’s financials this week bear out the predicted surge in popularity for the three-year-old console. The company has sold 21 million Switch units in the past year, handily beating a 19.5 million forecast; 6.2 million […]




cro

Microsoft showcases 13 new titles for the Xbox Series X

With conferences canceled indefinitely, companies are increasingly reliant on online events to hype product launches. As they prepare to release a next-gen console before the end of the year, expect plenty of live streams and blogs from both Microsoft and Sony in an attempt to flesh out all that their respective systems have to offer. […]




cro

Aviation Sector in India Stares at Rs 25,000 Crore Loss Due to COVID-19 Crisis: Crisil

The report by Crisil also added that the losses will climb if travel restrictions last longer in hubs such as Mumbai, Delhi, Chennai and Kolkata.





cro

Chhattisgarh CM demands Rs 30,000 crore help from PM Modi

New Delhi, May 09: Chhattisgarh Chief Minister Bhupesh Baghel has written a letter to Prime Minister Narendra Modi demanding of a package worth Rs 30,000 crore to help the state battle the economic crisis due to the coronavirus pandemic, ANI reported.