Publications by authors named "John R Clark"

91 Publications

Rapid Serial Immunoprofiling of the Tumor Immune Microenvironment by Fine Needle Sampling.

Clin Cancer Res 2021 Jul 7. Epub 2021 Jul 7.

Center for Systems Biology, Massachusetts General Hospital, Boston, Massachusetts.

Purpose: There is increasing effort to discover and integrate predictive and/or prognostic biomarkers into treatment algorithms. While tissue-based methods can reveal tumor-immune cell compositions at a single time point, we propose that single-cell sampling via fine needle aspiration (FNA) can facilitate serial assessment of the tumor immune microenvironment (TME) with a favorable risk-benefit profile.

Experimental Design: Primary antibodies directed against 20 murine and 25 human markers of interest were chemically modified via a custom linker-bio-orthogonal quencher (FAST) probe. A FAST-FNA cyclic imaging and analysis pipeline were developed to derive quantitative response scores. Single cells were harvested via FNA and characterized phenotypically and functionally both in preclinical and human samples using the newly developed FAST-FNA assay.

Results: FAST-FNA samples analyzed manually versus the newly developed deep learning-assisted pipeline gave highly concordant results. Subsequently, an agreement analysis showed that FAST and flow cytometry of surgically resected tumors were positively correlated with an R = 0.97 in preclinical samples and an R = 0.86 in human samples with the detection of the relevant tumor and immune biomarkers of interest. Finally, the feasibility of applying this minimally invasive approach to analyze the TME during immunotherapy was assessed in patients with cancer revealing local antitumor immune programs.

Conclusions: The FAST-FNA is an innovative technology that combines bio-orthogonal chemistry coupled with a computational analysis pipeline for the comprehensive profiling of single cells obtained through FNA. This is the first demonstration that the complex and rapidly evolving TME during treatment can be accurately and serially measured by simple FNA.
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http://dx.doi.org/10.1158/1078-0432.CCR-21-1252DOI Listing
July 2021

A phase II trial of all-trans retinoic acid (ATRA) in advanced adenoid cystic carcinoma.

Oral Oncol 2021 Aug 3;119:105366. Epub 2021 Jun 3.

Department of Medical Oncology, Center for Head & Neck Oncology, Center for Salivary and Rare Head and Neck Cancers, Dana-Farber Cancer Institute, Boston, USA.

Background: Effective therapies are lacking for recurrent, metastatic adenoid cystic carcinoma (R/M ACC) and preclinical models suggest retinoic acid agonists inhibit ACC growth. This phase II trial evaluated all-trans retinoic acid (ATRA) as a novel therapy for ACC.

Methods: Patients with R/M ACC (any site) with clinical and/or radiographic progression ≤12 months prior to study entry were eligible. Cohort 1 (CH1) received ATRA 45 mg/m split oral daily dosing on days 1-14 of a 28-day cycle; Cohort 2 (CH2) received the same dosing continuously. Primary endpoint was best overall response rate (CR + PR) (RECIST v1.1). Secondary endpoints: safety and progression-free survival (PFS). Exploratory analyses: ATRA impact on MYB expression and genomic predictors of response.

Results: Eighteen patients enrolled. There were no responses, but 61% (11/18) had stable disease (SD) and 28% (5/18) progression as best response; 11% (2/18) unevaluable. Median duration of stability: 3.7 months (95%CI, 1.9-3.9). One patient (CH1) remains on drug with SD approaching 1 year. Half of those who received prior VEGFR therapy achieved SD (4/8). At median follow up of 7.9 months, median PFS was 3.2 months (95%CI, 1.8-3.9). N = 1 required dose adjustment; N = 1 came off drug for toxicity. There were no grade 3-4 adverse events. NOTCH1 and PI3K pathway alterations were most frequent. Low MYB protein expression was associated with longer duration of stability on ATRA (P < 0.01).

Conclusion(s): While the trial did not meet its prespecified response endpoint, ATRA alone or in combination may be a low toxicity treatment for disease growth stabilization in R/M ACC.
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http://dx.doi.org/10.1016/j.oraloncology.2021.105366DOI Listing
August 2021

The Incidence, Risk Factors, and Outcomes With 5-Fluorouracil-Associated Coronary Vasospasm.

JACC CardioOncol 2021 Mar 16;3(1):101-109. Epub 2021 Mar 16.

Cardiovascular Imaging Research Center (CIRC), Department of Radiology and Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Background: Coronary vasospasm is a recognized side effect of 5-FU (fluorouracil). There are limited and conflicting data on the incidence, risk factors and prognostic effect of 5-FU associated vasospasm.

Objectives: To assess the incidence, risk factors and prognostic implications of 5-FU coronary vasospasm among patients receiving 5-FU regimens at a single tertiary care center.

Methods: We conducted a retrospective analysis of all patients who received 5-FU at a single academic center from January 2009 to July 2019. Vasospasm was defined as the occurrence of a typical chest pain syndrome in the presence of 5-FU. The presence of associated electrocardiogram (ECG) changes and/or elevated biomarkers was used to further confirm the diagnosis. Patients with vasospasm were compared to patients treated with 5-FU without vasospasm in a 1:2 ratio. Data regarding demographics, medical history, and follow-up were collected by manual chart review.

Results: From approximately 4019 individual patients who received 5-FU from 2009 to 2019 at a single center, 87 (2.16%) developed vasospasm. Patients who developed vasospasm were younger (58±13 vs. 64±13 years, P = 0.001), and were less likely to have any cardiovascular risk factors (70.1% vs. 84.5%, P = 0.007). Patients with vasospasm and patients without vasospasm were otherwise similar in terms of types of cancer, stage of cancer, sex, and race. There was no significant difference in progression-free survival, overall mortality or cancer specific mortality between patients who developed vasospasm versus those who did not.

Conclusion: In a large, single-center report of 5-FU associated vasospasm, patients who developed vasospasm were younger, had lower rates of traditional cardiovascular risk factors and had no significant difference in progression-free or overall survival compared to those who did not develop vasospasm.
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http://dx.doi.org/10.1016/j.jaccao.2020.12.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8018593PMC
March 2021

Predictive value of peripheral lymphocyte counts for immune checkpoint inhibitor efficacy in advanced head and neck squamous cell carcinoma.

Mol Clin Oncol 2020 Dec 20;13(6):87. Epub 2020 Oct 20.

Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA 02114, USA.

Anti-programmed death 1 (PD-1) immune checkpoint inhibitors (ICI) have revolutionized the treatment of advanced head and neck squamous cell carcinoma (HNSCC) but benefit only a small subset of patients. Several studies have previously assessed the predictive value of peripheral lymphocyte count for ICI therapy responses; however the optimal lymphocyte measure for the best predictive value in HNSCC is unknown. The present study examined the predictive values of multiple peripheral lymphocyte measures for anti-PD-1 ICI therapy in advanced HNSCC. Clinicopathologic data were retrospectively collected on patients with recurrent or metastatic HNSCC who had received anti-PD-1 therapy. The association between clinical outcomes and various peripheral lymphocyte count measures was analyzed, including absolute lymphocyte count (ALC) and neutrophil-to-lymphocyte ratios (NLR) at baseline, week 6, and change from baseline to week 6. The primary outcome of interest was progression-free survival (PFS). A total of 108 patients with HNSCC who had received anti-PD-1 therapy were identified. The median PFS was 4.1 months. Week 6 high ALC (≥0.77) and low NLR (<6.2) were associated with a longer PFS (5.6 vs. 3.1 months, P=0.002; and 8.7 vs. 2.9 months, P=0.001, respectively). Decreased NLR during treatment was also associated with an improved PFS (6.7 vs. 2.7 months; P=0.015). Baseline lymphocyte counts and absolute lymphocyte changes during treatment did not predict ICI outcome. The present single institution retrospective study suggested that ALC and NLR values at week 6, and on-treatment NLR dynamic change have predictive value for anti-PD-1 therapy response.
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http://dx.doi.org/10.3892/mco.2020.2157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657085PMC
December 2020

Treatment sequence of cetuximab and immune checkpoint inhibitor in head and neck squamous cell carcinoma differentially affects outcomes.

Oral Oncol 2020 12 13;111:105024. Epub 2020 Oct 13.

Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States; Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States; Massachusetts Eye and Ear, 243 Charles St, Boston, MA 02114, United States; Broad Institute of MIT and Harvard, 415 Main St, Cambridge, MA 02142, United States. Electronic address:

Objectives: To examine the impact of treatment sequences of Immune checkpoint inhibitor (ICI) and cetuximab on clinical outcomes in patients with recurrent or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC).

Materials And Methods: Clinicopathologic data were retrospectively collected on patients with R/M HNSCC who received ICI treatment. Association between treatment sequence and clinical outcomes were assessed.

Results: A total of 113 patients with R/M HNSCC were analyzed. Patients who had cetuximab prior to ICI had worse overall (HR, 1.83) and progression-free survival (HR, 1.76) compare to those without prior cetuximab. Among patients who had subsequent therapy after ICI, cetuximab-based therapy was associated with a trend toward higher response rate and longer survival than non-cetuximab regimen.

Conclusion: Our single institution analysis showed that treatment sequence of cetuximab and ICI in R/M HNSCC may affect clinical outcomes. Cetuximab prior to ICI was associated with worse outcomes while the efficacy of cetuximab may be enhanced after ICI therapy.
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http://dx.doi.org/10.1016/j.oraloncology.2020.105024DOI Listing
December 2020

Paramedic Board Certification: The International Board of Specialty Certification Turns 20.

Air Med J 2020 Sep - Oct;39(5):334-339. Epub 2020 Aug 21.

International Board of Specialty Certification, Snellville, GA.

The International Board of Specialty Certification (IBSC) has been offering specialty certification for 20 years. Originally formed as the Board for Critical Care Transport Paramedic Certification (BCCTPC), the first official examination at the Air Medical Transport Conference (AMTC) in October of 2000. Paramedic specialty certification flourished because of the vision and tireless commitment of a small group of paramedic champions. Some of that group from 20 years ago included David O. Bump, John R. Clark, Dr. John Cole, Dr. Robert Donovan, Chris Giller, Lisa Gilmore, Jonathan Gryniuk; Bob Hesse, TJ Kennedy, Brian Schaeffer, and Jackie Stocking. Without their tenacity, paramedic specialty certification would not be celebrating this milestone. The IBSC is a functional specialty board with a mission to support paramedicine specialties anywhere in the world. The Certified Flight Paramedic (FP-C®), Certified Critical Care Paramedic (CCP-C®) Certified Tactical Paramedic (TP-C®), Certified Tactical Responder (TR-C®) and Certified Community Paramedic (CP-C®) examinations are well established and have become a recognized standard for clinical competency by medical providers in the United States, Europe, South Africa and the Middle East. Founded in 2000, the IBSC is a not-for-profit professional certification organization responsible for the administration and development of specialty certification exams for critical care professionals. The mission of the IBSC is to improve quality of care in all aspects of specialty EMS care across a wide variety of settings by providing a portfolio of certification exams that are an objective, fair, and honest validation of specialty knowledge to paramedics and other allied health providers are called upon to perform critical care transport. Exams are developed that are responsive to the needs of the paramedic community. Currently, there are nearly 10,000 board certified providers in one of the five specialty designations.
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http://dx.doi.org/10.1016/j.amj.2020.07.006DOI Listing
August 2020

Discrimination and the Bona Fide Occupational Qualification.

Authors:
John R Clark

Air Med J 2020 Sep - Oct;39(5):324-326. Epub 2020 Aug 4.

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http://dx.doi.org/10.1016/j.amj.2020.07.008DOI Listing
August 2020

A Rosaceae Family-Level Approach To Identify Loci Influencing Soluble Solids Content in Blackberry for DNA-Informed Breeding.

G3 (Bethesda) 2020 10 5;10(10):3729-3740. Epub 2020 Oct 5.

USDA-ARS National Clonal Germplasm Repository, Corvallis, OR

A Rosaceae family-level candidate gene approach was used to identify genes associated with sugar content in blackberry ( subgenus ). Three regions conserved among apple (), peach (), and alpine strawberry () were identified that contained previously detected sweetness-related quantitative trait loci (QTL) in at least two of the crops. Sugar related genes from these conserved regions and 789 sugar-associated apple genes were used to identify 279 candidate transcripts. A Hyb-Seq approach was used in conjunction with PacBio sequencing to generate haplotype level sequence information of sugar-related genes for 40 cultivars with high and low soluble solids content from the University of Arkansas and USDA blackberry breeding programs. Polymorphisms were identified relative to the 'Hillquist' blackberry () and ORUS 4115-3 black raspberry () genomes and tested for their association with soluble solids content (SSC). A total of 173 alleles were identified that were significantly (α = 0.05) associated with SSC. KASP genotyping was conducted for 92 of these alleles on a validation set of blackberries from each breeding program and 48 markers were identified that were significantly associated with SSC. One QTL, qSSC-Ruh-ch1.1, identified in both breeding programs accounted for an increase of 1.5 °Brix and the polymorphisms were detected in the intron space of a sucrose synthase gene. This discovery represents the first environmentally stable sweetness QTL identified in blackberry. The approach demonstrated in this study can be used to develop breeding tools for other crops that have not yet benefited directly from the genomics revolution.
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http://dx.doi.org/10.1534/g3.120.401449DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7534445PMC
October 2020

Can I Get Force Majeure from a Novel Coronavirus?

Authors:
John R Clark

Air Med J 2020 Jul - Aug;39(4):235-236. Epub 2020 May 4.

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http://dx.doi.org/10.1016/j.amj.2020.04.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7198141PMC
September 2020

Should I Stay or Should I Go?

Authors:
John R Clark

Air Med J 2020 Mar - Apr;39(2):82-83. Epub 2020 Feb 18.

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http://dx.doi.org/10.1016/j.amj.2020.01.007DOI Listing
January 2021

Prove It.

Authors:
John R Clark

Air Med J 2019 Sep - Oct;38(5):315-316. Epub 2019 Aug 17.

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http://dx.doi.org/10.1016/j.amj.2019.05.013DOI Listing
July 2020

There Isn't Enough Narcan to Fix This.

Authors:
John R Clark

Air Med J 2019 Jul - Aug;38(4):251-253. Epub 2019 Apr 16.

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http://dx.doi.org/10.1016/j.amj.2019.03.016DOI Listing
July 2020

High-density linkage maps and loci for berry color and flower sex in muscadine grape (Vitis rotundifolia).

Theor Appl Genet 2019 May 12;132(5):1571-1585. Epub 2019 Feb 12.

Department of Horticulture, University of Georgia, 4604 Research Way, Tifton, GA, 31793, USA.

Key Message: Linkage maps of muscadine grape generated using genotyping-by-sequencing (GBS) provide insight into genome collinearity between Muscadinia and Euvitis subgenera and genetic control of flower sex and berry color. The muscadine grape, Vitis rotundifolia, is a specialty crop native to the southeastern USA. Muscadine vines can be male, female, or perfect-flowered, and berry color ranges from bronze to black. Genetic linkage maps were constructed using genotyping-by-sequencing in two F populations segregating for flower sex and berry color. The linkage maps consisted of 1244 and 2069 markers assigned to 20 linkage groups (LG) for the 'Black Beauty' × 'Nesbitt' and 'Supreme' × 'Nesbitt' populations, respectively. Data from both populations were used to generate a consensus map with 2346 markers across 20 LGs. A high degree of collinearity was observed between the genetic maps and the Vitis vinifera physical map. The higher chromosome number in muscadine (2n = 40) compared to V. vinifera (2n = 38) was accounted for by the behavior of V. vinifera chromosome 7 as two independently segregating LGs in muscadine. The muscadine sex locus mapped to an interval that aligned to 4.64-5.09 Mb on V. vinifera chromosome 2, a region which includes the previously described V. vinifera subsp. sylvestris sex locus. While the MYB transcription factor genes controlling fruit color in V. vinifera are located on chromosome 2, the muscadine berry color locus mapped to an interval aligning to 11.09-11.88 Mb on V. vinifera chromosome 4, suggesting that a mutation in a different gene in the anthocyanin biosynthesis pathway determines berry color in muscadine. These linkage maps lay the groundwork for marker-assisted breeding in muscadine and provide insight into the evolution of Vitis species.
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http://dx.doi.org/10.1007/s00122-019-03302-7DOI Listing
May 2019

Association of Estrogen Receptor Alpha Expression With Survival in Oropharyngeal Cancer Following Chemoradiation Therapy.

J Natl Cancer Inst 2019 09;111(9):933-942

Background: Oropharyngeal squamous carcinoma (OPSC) continues to increase in incidence secondary to human papillomavirus (HPV) infection. Despite the good overall prognosis for these patients, treatment with chemoradiation is associated with morbidity and treatment failure. Better predictors for disease outcome are needed to guide de-intensification regimens. We hypothesized that estrogen receptor α (ERα), a prognostic biomarker in oncology with therapeutic implications, might have similar utility in OPSC.

Methods: To investigate associations among ERα and demographics, HPV status, and survival, we analyzed ERα mRNA expression of head and neck squamous carcinomas (HNSC) from The Cancer Genome Atlas (TCGA) and immunohistochemistry (IHC) of pretreatment biopsy specimens from an independent group of 215 OPSC patients subsequently treated with primary chemoradiation (OPSC-CR). Associations among variables were evaluated with Fisher exact tests and logistic regression; associations with survival were evaluated with log-rank tests and Cox proportional hazards regression.

Results: Among 515 patients in TCGA, ERα mRNA expression was highest in HPV-positive OPSC. High ERα mRNA expression was associated with improved survival among those receiving chemoradiation (hazard ratio adjusted for HPV status = 0.44, 95% confidence interval = 0.21 to 0.92). In OPSC-CR, ERα was positive by IHC in 51.6% of tumors and was associated with improved overall, disease-specific, progression-free, and relapse-free survival (log-rank tests: P < .001, P < .001, P = .002, P = .003, respectively); statistically significant associations of ERα positivity with improved survival were maintained after adjusting for clinical risk factors including HPV status.

Conclusion: In two independent cohorts, ERα is a potential biomarker for improved survival that also may represent a therapeutic target in OPSC.
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http://dx.doi.org/10.1093/jnci/djy224DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6748818PMC
September 2019

The Fireman's Rule.

Authors:
John R Clark

Air Med J 2019 Jan - Feb;38(1):10-11

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http://dx.doi.org/10.1016/j.amj.2018.11.015DOI Listing
April 2020

Can You Keep a Secret?

Authors:
John R Clark

Air Med J 2018 09 7;37(5):282-284. Epub 2018 Aug 7.

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http://dx.doi.org/10.1016/j.amj.2018.07.003DOI Listing
September 2018

A Duty to Warn.

Authors:
John R Clark

Air Med J 2018 Jul - Aug;37(4):229-230. Epub 2018 May 31.

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http://dx.doi.org/10.1016/j.amj.2018.03.003DOI Listing
November 2019

Tritrophic phenological match-mismatch in space and time.

Nat Ecol Evol 2018 06 23;2(6):970-975. Epub 2018 Apr 23.

Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, UK.

Increasing temperatures associated with climate change may generate phenological mismatches that disrupt previously synchronous trophic interactions. Most work on mismatch has focused on temporal trends, whereas spatial variation in the degree of trophic synchrony has largely been neglected, even though the degree to which mismatch varies in space has implications for meso-scale population dynamics and evolution. Here we quantify latitudinal trends in phenological mismatch, using phenological data on an oak-caterpillar-bird system from across the UK. Increasing latitude delays phenology of all species, but more so for oak, resulting in a shorter interval between leaf emergence and peak caterpillar biomass at northern locations. Asynchrony found between peak caterpillar biomass and peak nestling demand of blue tits, great tits and pied flycatchers increases in earlier (warm) springs. There is no evidence of spatial variation in the timing of peak nestling demand relative to peak caterpillar biomass for any species. Phenological mismatch alone is thus unlikely to explain spatial variation in population trends. Given projections of continued spring warming, we predict that temperate forest birds will become increasingly mismatched with peak caterpillar timing. Latitudinal invariance in the direction of mismatch may act as a double-edged sword that presents no opportunities for spatial buffering from the effects of mismatch on population size, but generates spatially consistent directional selection on timing, which could facilitate rapid evolutionary change.
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http://dx.doi.org/10.1038/s41559-018-0543-1DOI Listing
June 2018

Will a Screwdriver Work?

Authors:
John R Clark

Air Med J 2018 Jan - Feb;37(1):16-17

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http://dx.doi.org/10.1016/j.amj.2017.11.008DOI Listing
October 2019

Reporting Abuse.

Authors:
John R Clark

Air Med J 2017 Nov - Dec;36(6):287-289

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http://dx.doi.org/10.1016/j.amj.2017.09.001DOI Listing
December 2018

Vehicular Manslaughter.

Authors:
John R Clark

Air Med J 2017 Sep - Oct;36(5):229-230. Epub 2017 Aug 24.

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http://dx.doi.org/10.1016/j.amj.2017.07.006DOI Listing
June 2018

Conflict of Interest.

Authors:
John R Clark

Air Med J 2017 Jul - Aug;36(4):160-161

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http://dx.doi.org/10.1016/j.amj.2017.05.009DOI Listing
May 2018

A molecular phylogeny of the Pacific clade of Cyrtandra (Gesneriaceae) reveals a Fijian origin, recent diversification, and the importance of founder events.

Mol Phylogenet Evol 2017 11 10;116:30-48. Epub 2017 Jul 10.

Rancho Santa Ana Botanic Garden, Claremont Graduate University, 1500 North College Avenue, Claremont, CA 91711, USA.

Cyrtandra (Gesneriaceae) is among the largest genera of flowering plants in the remote oceanic islands of the Pacific, with an estimated 175 species distributed across an area that extends from the Solomon Islands, east to the Marquesas Islands, and north to the Hawaiian Islands. The vast majority of species are single-island endemics that inhabit upland rainforests. Although previous molecular phylogenetic studies greatly advanced our understanding of the diversification of Pacific Cyrtandra, a number of uncertainties remain regarding phylogenetic relationships, divergence times, and biogeographic patterns within this large and widely dispersed group. In the present study, five loci (ITS, ETS, Cyrt1, psbA-trnH, and rpl32-trnL) were amplified and sequenced for phylogenetic reconstruction of 121 Cyrtandra taxa. Maximum likelihood and Bayesian inference confirmed that C. taviunensis from Fiji is sister to the remaining members of the Pacific clade. Dating analyses and ancestral area estimation indicates that the Pacific clade of Cyrtandra originated in Fiji during the Miocene ca. 9mya. All major crown lineages within the Pacific clade appeared < 5mya, coincident with the emergence of numerous Pacific islands and a subsequent increase in available habitat. The biogeographic history of Cyrtandra in the Pacific has been shaped by extinction, dispersal distance, and founder events. Biogeographic stochastic mapping analyses suggest that cladogenesis within Pacific Cyrtandra involved a combination of narrow (within-area) sympatry and founder events. A mean of 24 founder events was recovered between Pacific archipelagos, while a mean of 10 founder events was recovered within the Hawaiian archipelago.
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http://dx.doi.org/10.1016/j.ympev.2017.07.004DOI Listing
November 2017

Good People Don't Smoke Marijuana.

Authors:
John R Clark

Air Med J 2017 May - Jun;36(3):99-100. Epub 2017 Mar 22.

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http://dx.doi.org/10.1016/j.amj.2017.02.002DOI Listing
May 2018

Winner, Winner, Chicken Dinner.

Authors:
John R Clark

Air Med J 2017 Mar - Apr;36(2):52-53. Epub 2017 Feb 28.

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http://dx.doi.org/10.1016/j.amj.2017.01.006DOI Listing
May 2018

The Perfect Resume.

Authors:
John R Clark

Air Med J 2017 Jan - Feb;36(1):13-15. Epub 2016 Dec 24.

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http://dx.doi.org/10.1016/j.amj.2016.10.005DOI Listing
May 2017

Drones Rule!

Authors:
John R Clark

Air Med J 2016 Nov - Dec;35(6):336-338. Epub 2016 Nov 4.

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http://dx.doi.org/10.1016/j.amj.2016.10.003DOI Listing
July 2017

Civilians in a War Zone.

Authors:
John R Clark

Air Med J 2016 Sep-Oct;35(5):268-70. Epub 2016 Aug 24.

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http://dx.doi.org/10.1016/j.amj.2016.07.005DOI Listing
July 2017

Two Girls Falsely Imprisoned After Mother Killed.

Authors:
John R Clark

Air Med J 2016 Jul-Aug;35(4):197-9

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http://dx.doi.org/10.1016/j.amj.2016.04.016DOI Listing
July 2017
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