Publications by authors named "J K Miller"

18,121 Publications

  • Page 1 of 1

Current Management of Age-Related Macular Degeneration.

Adv Exp Med Biol 2021 ;1256:295-314

Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.

Age-related macular degeneration (AMD) remains a leading cause of blindness worldwide. The assessment and management of patients with this condition has evolved in the last decades. In this chapter, current standards for diagnosis, follow-up, and treatment of patients with AMD are reviewed and summarized. Namely, we highlight how current assessment has moved from conventional ophthalmoscopy and fluorescein angiography testing to a multimodal approach, and its important advantages. Alternatives to visual acuity for functional assessment of patients with AMD are also presented. Regarding strategies for follow-up and treatment, we provide specific information for the different stages (i.e., early, intermediate, and late) and forms (for example, choroidal neovascularization and geographic atrophy) of AMD. Specifically, we discuss the relevance and options for self-monitoring and non-pharmacological interventions. Additionally, a summary of the important trials (both on exudative and non-exudative AMD) that have helped inform clinical practice is provided, including data on antiangiogenic agents currently available, and outcomes of the different regimens that have been studied. The influence of advances in imaging on treatment strategies is also discussed.In summary, this chapter is a resource for all clinicians engaged in providing state of the art care for patients with AMD, and can help improve diagnosis, management, and outcomes of individuals with this blinding condition.
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http://dx.doi.org/10.1007/978-3-030-66014-7_12DOI Listing
January 2021

Radiation Oncology Virtual Education Rotation (ROVER) for Medical Students.

Int J Radiat Oncol Biol Phys 2021 Apr 9. Epub 2021 Apr 9.

Department of Radiation Oncology, Stanford School of Medicine, Stanford CA.

Purpose: We describe the implementation of a novel virtual educational program for medical students, Radiation Oncology Virtual Education Rotation (ROVER), and its impact on student interest and knowledge in radiation oncology.

Methods And Materials: ROVER comprised a series of virtual educational panels with case-based discussions across disease sites tailored to medical students. These were moderated by radiation oncology residents and included faculty panelists from academic radiation oncology programs across the country. Student pre- and post-session surveys were collected. Paired t-tests were used to compare the pre- and post-session assessment results.

Results: Six ROVER sessions were held from June 4, 2020 to August 20, 2020 with a total of 427 medical students registering for at least one session. Of these, 231 students attended at least one session, with 140 completing at least one post-session survey (60.6% response rate). Fourth-year medical students were the largest group represented among attendees (32.0%). Most attendees had exposure to radiation oncology (78.8%) prior to the sessions. Majority of students signed up for these sessions for education (90.6%). Some students signed up for the sessions to help with specialty selection (30.9%) and to network (30.4%). Medical students' understanding of the role of radiation oncology in each disease site (breast, sarcoma, central nervous system, pediatrics, gastrointestinal, genitourinary, gynecologic, lymphoma, lung, and head and neck) was improved by attending each session (pre- versus post-session, p <0.0001 for all disease sites). Over three-quarters of respondents stated they were considering applying or were likely to apply into radiation oncology both before and following the sessions.

Conclusions: ROVER improved medical student perceived knowledge of radiation oncology across all disease sites covered. ROVER fulfills a need for a national medical student education platform for radiation oncology. Future work is warranted to augment virtual and open educational platforms to improve access to radiation oncology education.
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http://dx.doi.org/10.1016/j.ijrobp.2021.03.057DOI Listing
April 2021

Evolution of surgical management for phaeochromocytoma over a 17-year period: an Australian perspective.

ANZ J Surg 2021 Apr 12. Epub 2021 Apr 12.

Department of General Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia.

Background: Minimally invasive adrenalectomy and advances in anaesthetic techniques have transformed surgery for phaeochromocytoma. This 17-year review describes the evolution of phaeochromocytoma care in our unit.

Methods: We performed a retrospective cohort review of all patients who underwent adrenalectomy for phaeochromocytoma from 2000 to 2016. Patients were divided into three time periods, early: 2000-2005 (n = 17), middle: 2006-2010 (n = 15) and late: 2011-2016 (n = 24). The posterior retroperitoneoscopic adrenalectomy was introduced in 2011. Demographics and clinicopathological details were extracted. Median values for nominal data were compared using Mann-Whitney U-test. A chi-squared test was used to compare categorical data.

Results: Sixty-one adrenalectomies were performed on 56 patients: 19 open, 17 laparoscopic and 20 posterior retroperitoneoscopic adrenalectomies. The median length of operation decreased from 135 to 90 min from the early to the late time period (P > 0.05). Length of stay decreased from a median of 5 days in the early group to 1 day in the late group (P = 0.01). A total of 94.1% of the early period patients were admitted to the intensive care unit compared to 30.4% of the late group (P = <0.01). Need for post-operative vasopressors and blood transfusions was significantly reduced.

Conclusion: Over the 17-year period, the choice of operative technique has transitioned towards posterior retroperitoneoscopic adrenalectomy. Operative time, rate of intensive care unit admission, and admission length have all decreased without any increase in rates of complications.
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http://dx.doi.org/10.1111/ans.16847DOI Listing
April 2021

Disaster Neurology Update: Focus on the COVID-19 Pandemic.

Neurol Clin Pract 2021 Apr;11(2):175-178

Department of Neurology, New York Medical College, Valhalla.

In 2013, the term disaster neurology was introduced to describe a new practice opportunity for neurologists interested in providing needed, nonsurgical neurologic care in regions affected by natural or human-influenced disasters. Although previously presented as an option for interested neurologists, the coronavirus disease 2019 (COVID-19) pandemic has made it clear that every neurologist should be prepared to take on the unique challenges of disaster neurology. Examining the role of neurologists on the frontlines of the COVID-19 pandemic response represents an opportunity to review and apply key features of disaster neurology, including recognizing the categories of neurologic cases expected to be seen during a disaster, adapting inpatient and outpatient workflows, and accommodating the needs of vulnerable populations. Relating principles of disaster neurology to the response of neurologists to the current pandemic informs best practices for neurologic care as COVID-19 cases continue to surge throughout the United States and abroad.
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http://dx.doi.org/10.1212/CPJ.0000000000001042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032428PMC
April 2021

Removing the Complexity From Wide Complex Tachycardia.

Trends Cardiovasc Med 2021 Apr 7. Epub 2021 Apr 7.

Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine. Electronic address:

Correctly diagnosing the cause of wide QRS tachycardias remain an area of difficulty for many clinicians. The authors provide a concise update to the different ECG algorithms that have been developed as well as caveats in their application.
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http://dx.doi.org/10.1016/j.tcm.2021.04.001DOI Listing
April 2021

Views of health professionals on climate change and health: a multinational survey study.

Lancet Planet Health 2021 Apr 7. Epub 2021 Apr 7.

Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland.

Climate change arguably represents one of the greatest global health threats of our time. Health professionals can advocate for global efforts to reduce emissions and protect people from climate change; however, evidence of their willingness to do so remains scarce. In this Viewpoint, we report findings from a large, multinational survey of health professionals (n=4654) that examined their views of climate change as a human health issue. Consistent with previous research, participants in this survey largely understood that climate change is happening and is caused by humans, viewed climate change as an important and growing cause of health harm in their country, and felt a responsibility to educate the public and policymakers about the problem. Despite their high levels of commitment to engaging in education and advocacy on the issue, many survey participants indicated that a range of personal, professional, and societal barriers impede them from doing so, with time constraints being the most widely reported barrier. However, participants say various resources-continuing professional education, communication training, patient education materials, policy statements, action alerts, and guidance on how to make health-care workplaces sustainable-can help to address those barriers. We offer recommendations on how to strengthen and support health professional education and advocacy activities to address the human health challenges of climate change.
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http://dx.doi.org/10.1016/S2542-5196(21)00053-XDOI Listing
April 2021

Serious Adverse Events in Related Donors: A Report from the Related Donor Safe Study.

Transplant Cell Ther 2021 Apr 15;27(4):352.e1-352.e5. Epub 2021 Jan 15.

Children's Hospital Los Angeles Cancer and Blood Disease Institute, USC Keck School of Medicine, Los Angeles, California.

The incidence and risk factors for severe adverse events (SAEs) in related donors (RD) of hematopoietic cell transplants is unknown. The Related Donor Safe study is a prospective observational cohort of 1680 RDs and represents an opportunity to examine characteristics of SAEs in RDs. In this cohort, we found that SAEs were reported in a total 12 (0.71%) RDs. Of these, 5 SAEs occurred in bone marrow donors (5/404, 1.24%), and 7 (7/1276, 0.55%) were in donors of peripheral blood stem cells. All of the SAEs were considered to be related (definite, probable, or possible) to the donation process. There were no donor fatalities. Of the 12 RDs who experienced an SAE, 10 were either overweight or obese. Five of the 12 RDs had predonation medical conditions that would have resulted in either possible or definite ineligibility for donation were they being assessed as unrelated donors. These SAE data will be useful in the counseling of prospective RDs before planned donation and may be helpful in identifying donors who should be considered medically unsuitable for donation.
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http://dx.doi.org/10.1016/j.jtct.2021.01.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036235PMC
April 2021

Early Adaptive Natural Killer Cell Expansion Is Associated with Decreased Relapse After Autologous Transplantation for Multiple Myeloma.

Transplant Cell Ther 2021 Apr 17;27(4):310.e1-310.e6. Epub 2020 Dec 17.

Department of Medicine, University of Minnesota, Minneapolis, Minnesota.

Adaptive natural killer (NK) cells are long-lived and exhibit properties of immunologic memory against cytomegalovirus (CMV). We previously reported that expansion of adaptive NK cells after CMV reactivation in recipients of allogeneic hematopoietic cell transplantation (HCT) was associated with a lower rate of relapse of acute myelogenous leukemia. In the present study, we examined the impact of adaptive NK cell expansion in a cohort of 110 individuals who underwent autologous HCT (AHCT) for a lymphoid malignancy (lymphoma or multiple myeloma [MM]). In this cohort, higher absolute numbers of adaptive NK cells (>1.58/μL) at day 28 post-AHCT were associated with significantly decreased risk of relapse in patients with MM. No significant association was seen in patients with lymphoma. Further stratification of MM patients by CMV serostatus found a strong protective effect of adaptive NK cells only in CMV-seropositive individuals. These findings suggest that strategies to increase adaptive NK cells after AHCT may be a therapeutic option in patients with MM.
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http://dx.doi.org/10.1016/j.jtct.2020.10.023DOI Listing
April 2021

Trends and Usage Patterns of Minimally Invasive Glaucoma Surgery (MIGS) in the US: IRIS Registry Analysis 2013-2018.

Ophthalmol Glaucoma 2021 Apr 5. Epub 2021 Apr 5.

Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA; Glaucoma Service, Massachusetts Eye and Ear, Boston, MA; Harvard Medical School, Department of Ophthalmology, Boston, MA.

Objective: Understanding trends and patterns in the use of minimally invasive glaucoma surgery (MIGS) and patient profiles undergoing each procedure is important given their relative expense and unknown long-term safety and effectiveness.

Design: Retrospective analysis SUBJECTS: MIGS and standard glaucoma surgeries recorded in the American Academy of Ophthalmology (AAO) Intelligent Research in Sight (IRIS®) Registry.

Methods: We used the data from IRIS® Registry between 2013-2018 (inclusive) to measure annual number of MIGS and standard surgical techniques (trabeculectomy or glaucoma drainage device (GDD)) performed in the US, stratified by demographic characteristics. Secondary analyses of concurrent surgeries and of subsequent surgeries for MIGS and standard surgical technique were also conducted.

Main Outcome Measures: Trends and sociodemographic characteristics of MIGS usage in the US.

Results: 203,332 eyes and 232,537 unique procedures had associated, documented International Statistical Classification of Diseases and Related Health Problems (ICD) 9/10 codes for glaucoma and were included in final analyses. Among eyes with documented glaucoma diagnoses, there was a substantial increase in annual MIGS procedures over the study period (from 7,586 in 2013 to 39,677), and a smaller decrease in standard glaucoma procedures (from 16,215 to 13,701). The proportion of iStent procedures almost tripled during the study period (from 14% to 40%), and by 2017 accounted for almost half (43.7%) of all glaucoma surgeries in the US. 21,025 (10.3%) of all eyes received multiple procedures; 7,638 (36.3%) on the same day and 13,387 (63.7%) on subsequent days. ECP and iStent were the most common concurrent procedures (55.4% of all concurrent procedures). Trabeculectomy and GDD were most commonly followed by another standard glaucoma surgery, but when followed by sequential MIGS, ECP and goniotomy were the most common procedures performed (33.0%, 21.9%, respectively).

Conclusions: There was a significant increase in MIGS use over the recent six-year period despite limited evidence of their long-term safety or effectiveness, highlighting the need for trials comparing safety and outcomes of novel MIGS vs traditional surgical treatments for glaucoma.
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http://dx.doi.org/10.1016/j.ogla.2021.03.012DOI Listing
April 2021

Liver involvement in Children with SARS-COV-2 Infection: Two Distinct Clinical Phenotypes Caused by the Same Virus.

Liver Int 2021 Apr 7. Epub 2021 Apr 7.

Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Irving Medical Center Morgan Stanley Children's Hospital, New York, NY, USA.

Background And Aims: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) associated acute liver injury (ALI) has been linked to poor outcomes in adults. Here we compare characteristics in children with elevated ALT (E-ALT) in two distinct manifestations of the infection, multisystem inflammatory syndrome-children (MIS-C) and coronavirus disease 2019 (COVID-19).

Methods: This is a retrospective study of patients ≤ 21 years of age with positive for SARS-CoV-2 PCR. E-ALT was defined as alanine aminotransferase (ALT) > 40 U/L. Bivariate analysis and multivariable logistic regression were obtained to describe differences in children with and without E-ALT in COVID-19 and MIS-C.

Results: E-ALT was detected in 36% of the 291 patients; 31% with COVID-19, and 51% with MIS-C. E-ALT in COVID-19 was associated with obesity (p <0.001), immunocompromised status (p=0.04), and chronic liver disease (p=0.01). In the regression models, E-ALT in COVID-19 was associated with higher c-reactive protein (OR 1.08, p=0.01) after adjusting for common independent predictors. Children with E-ALT and MIS-C were more often boys (p=0.001), Hispanic (p=0.04), or Black (p<0.001). In MIS-C, male gender (OR 5.3, p=0.02) and Black race (OR 4.4, p=0.04) were associated with increased odds of E-ALT. Children with E-ALT in both cohorts had significantly higher multiorgan dysfunction, longer hospitalization, and ICU stay. Children with MIS-C had 2.3-fold increased risk of E-ALT compared to COVID-19. No association was found between E-ALT and mortality.

Conclusion: E-ALT with SARS-CoV-2 presents as elevated transaminases without hepatic synthetic dysfunction. Patients with either manifestation of SARS-CoV-2 infection and E-ALT experienced more severe disease.
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http://dx.doi.org/10.1111/liv.14887DOI Listing
April 2021

Use of Active Comparator Trials for Topical Medications in Dermatology.

JAMA Dermatol 2021 Apr 7. Epub 2021 Apr 7.

Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia.

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http://dx.doi.org/10.1001/jamadermatol.2021.0356DOI Listing
April 2021

Exploring patient centredness, communication and shared decision-making under a new model of care: Community rehabilitation in canada.

Health Soc Care Community 2021 Apr 6. Epub 2021 Apr 6.

Alberta Health Services, Calgary, Canada.

Patient-centred care and patient engagement in healthcare and health research are widely mandated by funders, health systems and institutions. Increasingly, shared decision-making (SDM) is recognised as promoting patient-centred care. We explore this relationship by studying SDM in the context of integrating novel patient-centred policies in community rehabilitation. There is little research on SDM in rehabilitation, and less so in the critical community context. Patient co-investigators led study co-design. We aimed to describe how patients and providers experience SDM at community rehabilitation sites that adopted a novel, patient-centred Rehabilitation Model of Care (RMoC). Guided by focused ethnography, we conducted focus groups and interviews. Patient and professional participants were recruited from 10 RMoC early-adopter community rehabilitation sites. Sites varied in geography, patient population and provider disciplines. Patient and community engagement researchers used a set-collect-reflect method to document patient perspectives. Researchers captured provider perspectives using a semi-structured question guide. We completed 11 focus groups and 18 interviews (n = 45 providers, n = 17 patients). We found that most early-adopter providers spoke in a shared, patient-first language that focused on patient readiness, barriers and active listening. Congruent patient perceptions reflected inclusion in decision-making, goal setting and positive relationships. Many patients queried how care would become and remain accessible before and after community rehabilitation care respectively. Remaining connected while in the community was described as important to patients. Providers identified barriers like time, team dynamics and lack of clarity on the RMoC aims, which challenged the initiative's long-term sustainability. Policy innovations can promote SDM and communication through multiple strategies and training to facilitate candid, encouraging conversations. Sustainability of SDM gains is paramount. Most providers moved beyond tokenistic engagement, but competing responsibilities and team member resistance could thwart continuity. Further research is needed to empirically assess respectful and compassionate communication and SDM in community rehabilitation long term.
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http://dx.doi.org/10.1111/hsc.13304DOI Listing
April 2021

Commentary: Postoperative Stereotactic Body Radiotherapy for Spinal Metastasis and Predictors of Local Control.

Neurosurgery 2021 Apr 2. Epub 2021 Apr 2.

Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington, USA.

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http://dx.doi.org/10.1093/neuros/nyab093DOI Listing
April 2021

For Mass Eye and Ear Special Issue Quantitative autofluorescence: Review of Current Technical Aspects and Applications in Chorioretinal Disease.

Semin Ophthalmol 2021 Apr 4:1-5. Epub 2021 Apr 4.

Department of Ophthalmology, Retina Service Mass Eye and Ear Harvard Medical School, Boston, MA, United States.

In this review we discuss the broad clinical application of qAF and provide a descriptive summary of the phenotypic findings of different chorioretinal pathologies. Quantitative Fundus autofluorescence (qAF) is a novel developing technology that can aid in diagnosis and longitudinal disease monitoring by measuring and comparing autofluorescence intensities. Fundus autofluorescence (FAF) is a noninvasive imaging method that creates a density map of the fluorophores of the ocular fundus and provides both functional and topographic anatomic information about retinal cells. Fluorophores are molecules that have the ability to temporarily absorb irradiated light, and emit a small amount of light of a different wavelength. Different endogenous fluorophores can be found in the ocular fundus. Changes in accumulation of retinal fluorophores usually indicate retinal pathology and create characteristic patterns of hyper-autofluorescence and hypo-autofluorescence that help establish a diagnosis. qAF allows a safe non-invasive visualization of the retina, enables a standard for AF intensities comparison and aids to the understanding of the genotype-phenotype correlations.
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http://dx.doi.org/10.1080/08820538.2021.1908570DOI Listing
April 2021

Subclinical post-traumatic stress symptomology and brain structure in youth with chronic headaches.

Neuroimage Clin 2021 Mar 13;30:102627. Epub 2021 Mar 13.

Vi Riddell Children's Pain & Rehabilitation Centre, Alberta Children's Hospital, Calgary, AB, Canada; Behaviour & The Developing Brain, Alberta Children's Hospital Research Institute, Calgary, AB, Canada; Psychology, University of Calgary, Calgary, AB, Canada.

Background/aims: Post-traumatic stress symptoms (PTSS) and chronic pain often co-occur at high rates in youth. PTSS may alter brain structure thereby contributing to headache chronicity. This study examined whether PTSS and altered limbic circuitry were associated with headache frequency in youth.

Methods: Thirty youth aged 10-18 years with chronic headaches and 30 age- and sex-matched controls underwent a 3T MRI scan. Volumes of the hippocampus and amygdala were obtained from T1-weighted images. Mean fractional anisotropy (FA, an index of white matter structure) axial and radial diffusivity values of the cingulum and uncinate fasciculus were extracted from diffusion-weighted images. Youth reported on their headaches daily, for one-month, and self-reported pubertal status, emotion regulation, adverse childhood experiences (ACEs) and PTSS using validated measures. Volumes of the hippocampus and amygdala and diffusivity values of the cingulum and uncinate were compared between patients and controls. Hierarchical linear regressions were used to examine the association between PTSS, subcortical volumes and/or diffusivity values and headache frequency.

Results: Mean FA values of the cingulum were higher in patients compared to controls (P = 0.02, Cohen's d = 0.69). Greater PTSS (P = 0.04), smaller amygdala volumes (P = 0.01) and lower FA of the cingulum (P = 0.04) were associated with greater headache frequency, after accounting for age, puberty, pain duration, emotion regulation, and ACEs (Adjusted R ≥ 0.15). Headache frequency was associated with increases in radial diffusivity (P = 0.002, Adjusted R = 0.59), as opposed to axial diffusivity (n.s.).

Conclusions: PTSS, smaller amygdalar volume, and poorer cingulum structural connectivity were associated with headache frequency in youth, and may underlie headache chronicity.
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http://dx.doi.org/10.1016/j.nicl.2021.102627DOI Listing
March 2021

Chemical and thermal ocular burns in the United States: An IRIS registry analysis.

Ocul Surf 2021 Mar 31. Epub 2021 Mar 31.

Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA. Electronic address:

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http://dx.doi.org/10.1016/j.jtos.2021.03.008DOI Listing
March 2021

Molecular signatures of long-distance oceanic dispersal and the colonization of Pacific islands in Lycium carolinianum.

Am J Bot 2021 Apr 2. Epub 2021 Apr 2.

Department of Biology, Amherst College, Amherst, Massachusetts, 01002, USA.

Premise: Long-distance dispersal has been important in explaining the present distributions of many plant species. Despite being infrequent, such dispersal events have considerable evolutionary consequences, because bottlenecks during colonization can result in reduced genetic diversity. We examined the phylogeographic history of Lycium carolinianum, a widespread taxon that ranges from southeastern North America to several Pacific islands, with intraspecific diversity in sexual and mating systems.

Methods: We used Bayesian, likelihood, and coalescent approaches with nuclear and plastid sequence data and genome-wide single nucleotide polymorphisms to reconstruct the dispersal history of this species. We also compared patterns of genetic variation in mainland and island populations using single nucleotide polymorphisms and allelic diversity at the S-RNase mating system gene.

Results: Lycium carolinianum is monophyletic and dispersed once from the North American mainland, colonizing the Pacific islands ca. 40,100 years ago. This dispersal was accompanied by a loss of genetic diversity in SNPs and the S-RNase locus due to a colonization bottleneck and the loss of self-incompatibility. Additionally, we documented at least two independent transitions to gynodioecy: once following the colonization of the Hawaiian Islands and loss of self-incompatibility, and a second time associated with polyploidy in the Yucatán region of Mexico.

Conclusions: Long-distance dispersal via fleshy, bird dispersed fruits best explains the unusually widespread distribution of L. carolinianum. The collapse of diversity at the S-RNase locus in island populations suggests that self-fertilization may have facilitated the subsequent colonization of Pacific islands following a single dispersal from mainland North America.
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http://dx.doi.org/10.1002/ajb2.1626DOI Listing
April 2021

The Impact of Multiple Sclerosis Disease Status and Subtype on Hematological Profile.

Int J Environ Res Public Health 2021 Mar 23;18(6). Epub 2021 Mar 23.

Department of Microbiology and Molecular Biology, Brigham Young University, Provo, UT 84602, USA.

Multiple sclerosis (MS) is an immune-mediated, demyelinating disease of the central nervous system. In this study, an MS cohort and healthy controls were stratified into Caucasian and African American groups. Patient hematological profiles-composed of complete blood count (CBC) and complete metabolic panel (CMP) test values-were analyzed to identify differences between MS cases and controls and between patients with different MS subtypes. Additionally, random forest models were used to determine the aggregate utility of common hematological tests in determining MS disease status and subtype. The most significant and relevant results were increased bilirubin and creatinine in MS cases. The random forest models achieved some success in differentiating between MS cases and controls (AUC values: 0.725 and 0.710, respectively) but were not successful in differentiating between subtypes. However, larger samples that adjust for possible confounding variables, such as treatment status, may reveal the value of these tests in differentiating between MS subtypes.
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http://dx.doi.org/10.3390/ijerph18063318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8004915PMC
March 2021