Search

Coral reef health is tightly connected to the coral microbiome. Coral bleaching and disease outbreaks have caused an unprecedented loss in coral cover worldwide, particularly correlated to a warming ocean. Coping mechanisms of the coral holobiont under high temperatures are not completely described, but the associated microbial community is a potential source of acquired heat-tolerance. The relationship between stress and stability in the microbiome is key to understanding the role that the coral microbiome plays in thermal tolerance. According to the Anna Karenina Principle (AKP), stress or disease will increase instability and stochasticity among animal microbiomes. Here we investigate whether heat stress results in microbiomes that follow the AKP. We used shotgun metagenomics in an experimental setting to understand the dynamics of microbial taxa and genes in the surface mucous layer (SML) microbiome of the coral Pseudodiploria strigosa under heat treatment. The metagenomes of corals exposed to heat stress showed high similarity, indicating a deterministic and stable response of the coral microbiome to disturbance, in opposition to the AKP. We hypothesize that this stability is the result of a selective pressure towards a coral microbiome that is assisting the holobiont to withstand heat stress. The coral SML microbiome responded to heat stress with an increase in the relative abundance of taxa with probiotic potential, and functional genes for nitrogen and sulfur acquisition. These consistent and specific microbial taxa and gene functions that significantly increased in proportional abundance in corals exposed to heat are potentially beneficial to coral health and thermal resistance.

Microbiomes confer beneficial physiological traits to their host, but microbial diversity is inherently variable, challenging the relationship between microbes and their functional contribution to host health. Here, we compare diversity and architectural complexity of the epidermal microbiome from 74 individual whale sharks (Rhincodon typus) across five aggregations, globally. We hypothesised co-occurrence patterns would occur independently of diversity patterns. Whale shark aggregation was the most important factor discriminating taxonomic diversity patterns. Microbiome network architecture was similar across all aggregations with degree distributions matching Erdos-Renyi graphs. However, networks had greater modularity than expected, indicating definitive microbiome structure. In addition, whale sharks hosted 35 ‘core’ microbiome members supporting the high modularity observed in microbiomes. Therefore, while variability in microbiome diversity is high, network structure and core taxa are inherent characteristics of the microbiome in whale sharks. We suggest host-microbiome and microbe-microbe interactions which drive self-assembly of the microbiome are, in part, the result of emergent functions that support functionally redundant key core microbial members. Teaser Sentence: The skin microbiome of whale sharks has emergent co-occurrences structure despite distinct diversity patterns.

Presentation Video: https://doi.org/10.23641/asha.21235632

Purpose: Approximately 10% of the U.S. adult population has a speech, language, and/or voice disability, collectively referred to as communication disabilities. An increasing number of studies demonstrate that persons with communication disabilities have worse health and health care outcomes as compared to those without communication disabilities. Understanding the state of the science, including potential contributing factors is critical to begin to address the disparities. Method: Applying a historical lens and integrating multiple models of disability provide a comprehensive perspective of the health and health care outcomes of persons with communication disabilities. Results: Three phases for addressing health care disparities exist: detecting, understanding, and reducing. Results from a 2012 National Health Interview Survey provide compelling population-level results of the health and health care disparities experienced by persons with communication disabilities. To understand the disparities, factors within the health care system, such as availability of communication aids and services, as well as provider and staff biases, assumptions, and lack of knowledge need to be considered. To date, few interventions exist to address disparities in care for persons with communication disabilities. Consequently, researchers need to engage with stakeholders in innovative study designs and methods to facilitate the rapid development, implementation, and dissemination of interventions that address the disparities. Conclusion: To ensure equity for the large and growing population of persons with communication disabilities, researchers, policy makers, patients, and health care systems need to collaborate in identifying and addressing the factors contributing to health and health care disparities. Presentation Video: https://doi.org/10.23641/asha.21215804

Bacterial remineralization of algal organic matter is thought to fuel algal growth, but this has not been quantified. Consequently, we cannot currently predict whether some bacterial taxa may provide more remineralized nutrients to algae than others, nor whether this is linked their incorporation. We quantified bacterial incorporation of algal-derived complex dissolved organic C (DOC) and N (DON) and net algal incorporation of remineralized C and N at the single cell level using isotope tracing and NanoSIMS for fifteen bacterial co-cultures growing with the diatom Phaeodactylum tricornutum. We found unexpected variability in the net C and N fluxes between algae and bacteria, including non-ubiquitous complex DON utilization and remineralization. We identified three distinct functional categories of metabolic interactions, which we termed macromolecule remineralizers, macromolecule users, and small-molecule users, the latter exhibiting efficient growth under low carbon availability. The functional categories were not linked to phylogeny and could not be elucidated strictly from metabolic capacity as predicted by comparative genomics. Using comparative proteogenomic analyses, we show that a complex DON incorporating strain expressed proteins related to growth and peptide transport, and a non-incorporator prioritized reactive oxygen species scavenging and inorganic nutrient uptake. Our analysis suggests that phylogeny does not predict the extent of algae-bacteria metabolite exchange, and activity-based measurements are indispensable to classify the high diversity of microbes into functional groups. These categorizations are useful for conceptual understanding and mechanistic numerical modeling to ultimately predict the fate of elemental cycles in response to environmental change.

Background: PAD is often undiagnosed and undertreated. Black American and Hispanic patients experience greater disease severity and worse outcomes compared to white patients. Applying the Kilbourne et al.’s comprehensive framework which identifies multilevel determinants of health disparities, we sought to understand why disparities exist by identifying provider factors that explain gaps in health and health care. Methods: Semi-structured in-depth interviews were conducted with 19 providers across diverse specialties from two clinical sites. Interviews occurred from November 2021 to February 2022. Domains of interest were provider factors that contribute to delays in diagnosis, treatment, and management of PAD, as well as how providers communicate with patients about PAD. Interviews were professionally transcribed and analyzed using a qualitative content analysis methodology. Findings: Specialists noted that the diagnosis of PAD may be delayed due to the lack of consistent early detection of risk factors and screening. PCPs felt that diagnosis of PAD is difficult due to patient under recognition of symptoms, symptoms mimicking other diseases, and asymptomatic patients. Both specialists and PCPs highlighted delayed PAD diagnosis due to a lack of clear guidelines for screening. Broader institutional constraints on screening for and diagnosing PAD related to time, resources, and logistics for both specialists and PCPs. There was general agreement that disease awareness and knowledge was lacking by both providers and patients, and may contribute to gaps in screening, treatment, and management of disease across the health care system. Some providers noted differences across populations in access to care and interventions, which may contribute to health disparities around PAD. Implications for Cardiovascular and Health Disparities Research: Overall, there is a clear sense among providers representing multiple disciplines that diagnosis of PAD is challenging. To address these challenges, more work needs to be to develop clinic team approaches to screen for PAD symptoms in at-risk patients. To close the gap in health disparities, patient perspectives should also be sought to better understand specific needs among different populations.

The coral holobiont is comprised of a highly diverse microbial community that provides key services to corals such as protection against pathogens and nutrient cycling. The coral surface mucus layer (SML) microbiome is very sensitive to external changes, as it constitutes the direct interface between the coral host and the environment. Here we investigate whether the bacterial taxonomic and functional profiles in the coral SML are shaped by the local reef zone and explore their role in coral health and ecosystem functioning. The analysis was conducted using metagenomes and metagenome assemble genomes (MAGs) associated with the coral Pseudodiploria strigosa and the water column from two naturally distinct reef environments in Bermuda: inner patch reefs exposed to a fluctuating thermal regime and the more stable outer reefs. The microbial community structure in the coral SML varied according to the local environment, both at taxonomic and functional levels. The coral SML microbiome from inner reefs provides more gene functions that are involved in nutrient cycling (e.g., photosynthesis, phosphorus metabolism, sulfur assimilation) and those that are related to higher levels of microbial activity, competition, and stress response. In contrast, the coral SML microbiome from outer reefs contained genes indicative of a carbohydrate-rich mucus composition found in corals exposed to less stressful temperatures and showed high proportions of microbial gene functions that play a potential role in coral disease, such as degradation of lignin-derived compounds and sulfur oxidation. The fluctuating environment in the inner patch reefs of Bermuda could be driving a more beneficial coral SML microbiome; potentially increasing holobiont resilience to environmental changes and disease.

Introduction Allergic rhinitis is an immune-mediated response of the nasal mucosa to allergens, which is clinically characterised by paroxysms of sneezing, rhinnorhea, and nasal obstruction which is often accompanied by itching of the eyes, nose and palate. In the most severe cases, patients can still have a reduced quality of life despite optimal treatment with antihistamines, eye drops and nasal sprays. When the symptoms of allergic rhinitis persist, they can have a dramatic impact on the quality of life of the child and their family. Untreated symptoms can have a detrimental effect the child’s sleeping pattern which consequently can impact negatively on their growth potential, cognition and participation in social activities. Sublingual Immunotherapy (SLIT) can alter a patient’s sensitivity to inhaled allergens and improve symptoms which do not respond to the standard therapies. Aim and methods The aims of this study were to assess the effect SLIT had on patients both during the treatment and after. Effects were determined by retrospective chart review. 38 children (age 5–17) completed 3 years of SLIT at Cork University Hospital between 2010 and 2016. 34 patient/guardians were contacted by telephone to provide additional information; the remaining 4 were unreachable by phone. Results In the study population, Immunotherapy was prescribed for house dust mites (24%) and grass pollen (76%). Treatment with SLIT reduced symptoms of allergic rhinitis in 91% of patients during SLIT. 62% had an improvement in symptoms post completion of therapy and 29.4% maintained the level of reduction during treatment. There was a reported drop in the amount of patients using medications such as antihistamines, nasal sprays and eye drops. 50% of the patients had a diagnosis of asthma as well as allergic rhinitis. 76% of these patients had an improvement of their asthma symptoms, resulting in a reduction of inhaler use. Overall, 88% of the patients were satisfied with the SLIT and they would recommend it to others. Discussion The effect of grass pollen and HDM allergen SLIT for allergic rhinitis is substantial and sustained in medium term, patients experienced a reduction in both symptoms and medication use. There is also an effect of SLIT on asthma which must be noted, as these patients also experienced a reduction in symptoms and medication use.

An important limitation to the effectiveness of family mediation in assisting separated parents is parents failing to engage in the mediation process. In 524 parents who presented to a telephone-based mediation service, 113 (22%) initiating parents withdrew from mediation before the other parent was invited to participate, 241 (46%) initiating parents had respondent parents who declined to participate in mediation, and 170 cases (33%) completed mediation. We tested whether socio-demographic variables, psychological distress, coparental acrimony, parenting problems, or children's behavioral difficulties predicted mediation engagement. High interparental acrimony predicted failure to engage in mediation, but none of the other variables predicted mediation engagement. We followed a sample of 131 families that did not mediate and found they showed elevated psychological distress, acrimony, parenting problems and child adjustment difficulties, which remained unchanged 6 months later. Further research is needed to explore strategies to enhance respondent parent engagement with mediation, and to address the negative outcomes for those separated families not proceeding with mediation.

The relationship between parents has a profound effect on children. The current chapter includes a presentation of an ecological framework for understanding the interaction between parents’ relationship and parent–child relationships, and the range of factors that impact each of these family relationships. We then review evidence on the association of negative aspects of parental relationships, like high conflict and violence, with poor adjustment in children, and then examine the association of positive aspects of parental relationships, like intimacy and affection, with positive child adjustment. There is a review of evidence on the effects of psychological interventions to enhance the parents’ relationship and how they affect children. We conclude that attention to the parental relationship, particularly when it is highly conflictual, is important to enhance adjustment of children.

Purpose: In September 2014, the Rapid Access Palliative Clinic [RAPC] was set up in the Radiation Oncology Department in Cork University Hospital [CUH] a Regional Cancer Centre in Ireland. Its purpose is to streamline the pathway and facilitate prompt review and timely delivery of palliative radiotherapy [PRT] for symptom relief of patients with terminal cancer. This study reviews the clinical activity of the RAPC over the initial 3 months and compares it to a second 3 months to evaluate if we are meeting the objectives of the program. Materials/Methods: From the CUH oncology patient information system (Lantis) database, we retrieved the number of patients referred to the RAPC, their demographics, diagnosis and treatment for 1st September to 30th November, 2014 inclusive. We calculated the time interval between referral to consultation, consultation to simulation and the percentage of patients who started PRT on the day of their initial RAPC consultation. We calculated the 30-day mortality of the clinic. We also compared the data from the initial 3 months against a 3 month period from 1st May to 31st July, 2016 inclusive, when there was no clinic due to staffing shortages. Results: During the initial 3 month period, the number of cases seen in consultation was 129. Patient’s ages ranged from 28.4 to 96 years with a mean age of 69.1 years. Most common primary tumour sites were Genitourinary and Lung accounting for 25% and 21% of the patient population respectively. Most common indication for PRT was bone pain accounting for 69% of patients seen in the clinic. The 30-day mortality rate was 13.95%. Of the 122 patients who received PRT, 57 patients (46.7%) received single fraction PRT whilst 65 patients (53.2%) received fractionated PRT. 98% were seen within 2 weeks of referral (87% within 1 week). The median time from consultation to simulation was 0.9 days vs 2.7 days with no RAPC. 74% were simulated on the day of their initial consultation vs 31.4% with no RAPC. 35% started their PRT treatment on the day of their consultation visit vs 23% with no RAPC. Conclusion: The overall median interval from referral to consultation was 4 days. Thirty-five percent were simulated, planned and started treatment on the day of their initial consultation. The 30-day mortality rate suggests appropriate patient selection. The comparison between the initial 3 months of the RAPC vs the 3 months with no RAPC showed the median time from consultation to simulation tripled and only twenty-three percent received same day treatment. Setting up a dedicated clinic decreased waiting times, reduced the number of visits to the Regional Cancer Centre and provided prompt PRT to symptomatic patients in the terminal phase of their illness. The RAPC is therefore meeting our objectives.

Family therapists often see separating parents who need to agree on co-parenting arrangements. This article provides a guide to current research and practice in family mediation. The limited available research suggests mediation is a useful approach for some separated parents and their children, but often is not successful with highly conflicted parents, parents with mental health problems, parents struggling to accept the separation from their partner, or parents with unrealistic co-parenting expectations. We analyse ways in which mediation might be enhanced, and discuss the potential roles of family therapists to support separating families to negotiate positive co-parenting.

Family mediation is a widely used alternative to litigation for separated parents to resolveconflict about parenting arrangements. The current research includes two studies. The firstinvestigated engagement in family mediation, and attempted to predict those families thatwould not engage in or complete the mediation process. In a sample of 524 parents whoinitiated family mediation, 354 (67%) did not complete mediation; 113 (22%) disengagedprior to their former partner being invited and 241 (46%) did not complete mediation becausetheir former partner refused to engage in mediation. I tested whether socio-demographicvariables, psychological distress, co-parental acrimony, parenting problems or children’sbehavioral difficulties predicted mediation engagement. Only high inter-parental acrimonypredicted failure to engage in mediation. A sample of families that did not mediate (n = 131)showed high psychological distress, acrimony, parenting problems and child adjustmentdifficulties, which remained unchanged 6 months later. The second study was a randomisedcontrolled trial, testing if motivational interviewing (MI) improved agreement rate andoutcomes for separated families relative to mediation as usual (MAU). The outcome ofmediation was classified as no agreement, partial agreement, and full agreement. Parentalpsychological distress, child adjustment, and co-parental conflict was assessed before andafter the mediation, and at a three month follow-up. The mediation outcomes for the MIcondition included a reduced rate of no agreement in comparison to the MAU condition (33%versus 42% of all mediations), and double the rate of full agreements (16% versus 33%).There was no significant difference in psychological distress, child adjustment, or acrimonybetween the MI and MAU conditions. While outcomes for the MI condition includedenhanced agreement rates, there was no significant difference in psychological outcomesbetween conditions.This research suggests that the outcomes for separated families seeking mediation may beimproved by enhancing the process of engagement with respondent parents and trainingfamily mediators in motivational interviewing.

Genetic counselling is offered in diverse settings, and patient reactions vary due to differences in personal, family and community beliefs, local healthcare settings, as well as cultural background. Together, these factors influence how individuals experience genetic counselling. This study aimed to describe and document the experiences of thirteen mothers, with children with Down syndrome, oculocutaneous albinism or haemophilia B, who had received genetic counselling at state hospitals in Johannesburg, South Africa. A qualitative research design drawing on principles of Interpretative Phenomenological Analysis was used. Four voice-recorded focus groups were conducted and the resulting data were analysed using thematic content analysis. Five themes were identified in the data: thrown into the unknown; a worthwhile experience; a break in communication; telling the family and the community; and spreading the word. It was seen that genetic counselling cannot be viewed as a singular experience, but rather as one which is influenced by mothers’ lived experiences and their interactions with other healthcare services, family and community members. The results from this study showed that genetic services and conditions were poorly understood, that the experience of genetic counselling varied amongst mothers, and on-going patient support is needed particularly when addressing family and community members. Further research is needed to assess what information is valuable to individuals during genetic counselling and how to deliver this information in a contextually appropriate manner. Greater awareness of genetic conditions is also required amongst communities and healthcare professionals. Valuable insight was gained from this study which can be used to improve local training programmes and genetic counselling services in Johannesburg, and in South Africa.

Photopolymerizable hydrogels have been investigated extensively for biomedical applications, specifically in the area of tissue engineering. While fabrication approaches have shown promise in designing hydrogel scaffolds that guide cell function, the ability to spatially control localization in three-dimensions has been limited. We have developed a method for generating two-dimensional and three-dimensional (3D) patterns within multilayered poly(ethylene glycol) diacrylate (PEG-DA) hydrogels. Covalently attached hydrogel layers are formed using precursor solutions with a 10:1 mole ratio of PEG-DA to PEG-aminoacrylate (Acr-PEG-NH2). Upon illumination of the precursor with visible light (wavelength = 514 nm), a hydrogel layer forms with pendant amine groups induced by the presence of Acr-PEG-NH2 macromer. Pendant amine groups are further functionalized with free carboxyl groups present on the visible light photoinitiator eosin, allowing for the formation of subsequent hydrogel layers. Using noncontact photolithography, the prepolymer solution is polymerized through a photomask, resulting in hydrogel structures with distinct pattern formation in each layer. Unreacted regions immobilized with eosin can be subsequently filled with a different PEG hydrogel. The technique presented shows a great potential for tissue engineering applications, for biosensors, and in the formation of cell and protein patterning for biotechnology.