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Introduction: There are established protocols for staged return to physical activity in sport and military settings following concussion. Currently, there is no evidence-based staged return to shooting protocol in use by the U.S. military despite the unique challenges and stresses shooting places on the vestibular-ocular and cognitive systems often disrupted by a concussion. The primary purpose of this scoping review was to summarize available evidence and current practices on return to shooting post-concussion, with the goal of optimizing an evidence-based return to shooting protocol for military service members. Our secondary aim was to identify individuals who may benefit from a return to shooting progression., Materials and Methods: A comprehensive search of PubMed, SPORTDiscus, and Google Scholar was performed from the earliest dates to April 2023. A gray literature (Google) search was also performed. Articles were included if they studied a population with concussion, addressed return to shooting, and were written in English. Articles were excluded if they discussed health conditions other than concussion, focused on non-shooting interventions, did not use human subjects, or were written in a language other than English., Results: Our search strategy yielded 134 articles: 1 article met our inclusion and exclusion criteria, whereas the other 133 articles were rejected. The gray literature search yielded one item., Conclusions: Based on our results, there is insufficient evidence to inform current practices on return to shooting post-concussion. In the absence of a published return to shooting protocol, we offer recommendations for identifying individuals who may benefit from a return to shooting progression and a revised version of a U.S. Army Special Operations Command Return to Range Progression. This protocol follows a conceptual framework for progression for variables such as environment, weapon type/caliber, and shooter position/movement. Further research is needed on identifying individuals who may benefit from a return to shooting protocol and safely and effectively progressing these individuals through a return to shooting protocol post-concussion., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Genetic disorders are a leading contributor to mortality in neonatal and pediatric intensive care units (ICUs). Rapid whole-genome sequencing (rWGS)-based rapid precision medicine (RPM) is an intervention that has demonstrated improved clinical outcomes and reduced costs of care. However, the feasibility of broad clinical deployment has not been established. The objective of this study was to implement RPM based on rWGS and evaluate the clinical and economic impact of this implementation as a first line diagnostic test in the California Medicaid (Medi-Cal) program. Project Baby Bear was a payor funded, prospective, real-world quality improvement project in the regional ICUs of five tertiary care children's hospitals. Participation was limited to acutely ill Medi-Cal beneficiaries who were admitted November 2018 to May 2020, were <1 year old and within one week of hospitalization, or had just developed an abnormal response to therapy. The whole cohort received RPM. There were two prespecified primary outcomes-changes in medical care reported by physicians and changes in the cost of care. The majority of infants were from underserved populations. Of 184 infants enrolled, 74 (40%) received a diagnosis by rWGS that explained their admission in a median time of 3 days. In 58 (32%) affected individuals, rWGS led to changes in medical care. Testing and precision medicine cost $1.7 million and led to $2.2-2.9 million cost savings. rWGS-based RPM had clinical utility and reduced net health care expenditures for infants in regional ICUs. rWGS should be considered early in ICU admission when the underlying etiology is unclear., (Copyright © 2021 American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.)

In D. melanogaster males carrying Segregation Distorter (SD) second chromosomes, sperm receiving sensitive alleles of the Responder (Rsp) locus are subject to high rates of dysfunction. The Rsp region is located in 2R immediately adjacent to the centromere in heterochromatic band 39, and covers roughly 600 kb of material, of which approximately 85 kb is comprised of several hundred copies of a 240-bp satellite DNA sequence. Cytological observations as well as molecular analysis of rearrangements which bisect h39 indicate that sensitivity of the Rsp target to SD action is also subdivisible, and sensitivities of the component pieces appear to be correlated with copy number of the 240 bp repeat. In an attempt to examine possible higher order sequence structure for these blocks, PCR using single primers derived from a canonical repeat was used to identify potential reversals of direction of tandem arrays; that is, head-to-head or tail-to-tail junctions. Surprisingly, for two different Rsp alleles, only a single such reversal product for each was identified, differing in size and sequence between alleles. Sequencing of PCR products identified diverged copies of the canonical repeats that would not have been found using the levels of DNA stringency employed in earlier studies. Examination of Southern digests and slot-blots for DNA quantification indicates that adding the estimated numbers of such diverged copies to the canonical repeat copies discovered earlier is potentially sufficient to account for the entire 600 kb Rsp region. This adds strength to the hypothesis that this extended family of repeats is in fact the target of SD-mediated sperm dysfunction. Implications of these results for understanding the evolution of repetitive DNA are also discussed.

We present the first isolation of the terminal DNA of an intact Drosophila telomere. It differs from those isolated from other eukaryotes by the lack of short tandem repeats at the terminus. The terminal 14.5 kb is composed of four tandem elements derived from two families of non-long terminal repeat retrotransposons and is subject to slow terminal loss. One of these transposon families, TART (telomere-associated retrotransposon), is described for the first time here. The other element, HeT-A, has previously been shown to transpose to broken chromosome ends. Our results provide key evidence that these elements also transpose to natural chromosome ends. We propose that the telomere-associated repetitive DNA is maintained by saltatory expansions, including terminal transpositions of specialized retrotransposons, which serve to balance terminal loss.