Philadelphia ZOO

Background The lack of inclusion of Latinos/Hispanics in Alzheimer’s disease and related dementias (ADRD) clinical trials reduces the generalizability of study findings and hinders our understanding of the mechanisms of dementia, further widening cognitive health disparities. To address this growing public health concern, the purpose of this study is to leverage the national infrastructure of a Consortium between the National Association of Hispanic Nurses (NAHN) and the Alzheimer’s Association (ALZ) to increase the representation Latino/Hispanic participants in one clinical trial on dementia. Methods The study used a randomized controlled trial design and mixed‐method evaluation. Recruitment intervention strategies were tested across 4 cities with high Latino/Hispanic populations. Metrics of sites receiving the intervention vs. those using usual recruitment activity in a clinical trial on dementia. Focus groups and semi‐structured interviews captured the experiences and perceptions of recruitment procedures from the research team, officers of NAHN and ALZ and potential participants who chose to enroll in the clinical trial. Results Across the 4 intervention sites, a total of 145 Latino potential participants were referred to the clinical trial; however, none were enrolled. Themes that emerged from focus groups and interviews include: 1) Thirst for information about dementia in Latino communities; 2) A sense of being stronger and bigger together stemming from the partnership between NAHN and ALZ; 3) Importance of logistical support offered by the research team; 4) Importance of timely and thorough follow up with Latino adults who expressed intention to participate in the clinical trial. Conclusion Study findings underline the importance of focusing on structural mechanisms enhancing Latino representation. Findings can inform future recruitment science efforts among researchers, community leaders, and policymakers to capture and promote the beneficial roles of collaborations between academia and national organizations that are embedded within communities historically underrepresented in ADRD clinical trials.

Background Alzheimer’s disease (AD) is pathologically defined by the presence of extracellular Aβ plaque and intracellular tau inclusions. Emerging evidence shows that tau aggregates contain pathogenic bioactivities of templating monomeric tau into filamentous fibrils and propagating through cells. Based on these findings, assays have been developed to detect minute amounts of pathogenic tau in human samples. With great potential, it remains unclear about the sensitivity and fidelity of tau fibrillization due to the presence of pathogenic tau species. Methods To that end, our study focuses on optimizing the Real‐Time Quaking‐Induced Conversion (RT‐QuiC) assay for its potential of detecting and amplifying insoluble tau seeds derived from AD patient. To this end, we utilized recombinant tau monomers t306 and k12, 2R and 3R tau peptide respectively known for their rapid fibrillization and high amplification signals in previous studies. More specifically, we optimized the RT‐QuiC assay using both crude and purified brain lysates from AD and control cases. Results The specificity of the RT‐QuiC assay were successfully reproduced by multiple cases of AD and control brain lysates. Moreover, we tested the RT‐QuiC assay with purified AD tau seeds and assessed the sensitivity of the assays based on the amount of insoluble tau. To further interrogate the system, we also evaluated the impact of reaction buffer on the ThT‐based measurement of tau fibrillization. Our results show that the original RT‐QuiC assay can sensitively detect insoluble AD tau seeds at the nM level in our hands. The optimized RT‐QuiC assay could differentiate better between AD‐seeded reactions and controls with an improved sensitivity up to fM level, with a better separation between AD and control and faster reaction rate. The assay showed a clear dose‐dependent response till pM range. Conclusion Upon optimization, the RT‐QuiC assay is both ultrasensitive and specific to AD tau fibrillization. Our findings offer insights into the fibrillization mechanism of tau aggregates and expand our understanding of pathogenic tau seeds in AD. By optimizing the assay to more accessible patient samples in the future, namely CSF and plasma, the RT‐QuiC can serve as a potent diagnostic tool for AD tau progressions.

Background To evaluate the one-year safety and effectiveness of bio-interventional cyclodialysis and scleral reinforcement in open-angle glaucoma (OAG) patients undergoing cataract surgery. Methods An ab-interno approach was used to create a sectoral cyclodialysis in OAG patients who were prospectively followed in a consecutive case series. Subsequent visco-cycloplasty with scleral reinforcement using homologous minimally modified allograft scaffold was completed to maintain patency of the cyclodialysis reservoir and increase uveoscleral outflow. Outcomes were mean medicated IOP and mean number of IOP-lowering medications. Safety outcomes were adverse events (AEs) and best-corrected visual acuity (BCVA) changes. Results Successful cyclodialysis and allograft bio-scaffold reinforcement was achieved in 117 eyes. There was minimal intraoperatie bleeding and few post-operative adverse events. At baseline, mean BCVA was 0.48 (95% CI: 0.42‒0.54; 20/40 Snellen) and mean ± SD medicated IOP was 20.2 ± 6.0 mmHg on 1.4 ± 1.3 IOP-lowering medications. At 12 months, there was a 27.1% reduction from baseline mean medicated IOP. In eyes with medicated baseline IOP > 21 mmHg (n = 45), there was a 39.7% paired IOP reduction at 12 months with a concurrent reduction in the mean number of IOP lowering medications to 0.8 ± 0.9 which were statistically significant (p < 0.01). For all eyes, 81.9% achieved a medicated IOP ≤ 18 mmHg with no increase in medications at 12 months. To achieve target IOP control, secondary glaucoma surgery was performed in 3.2% of the cases. Conclusion IOP lowering through uveoscleral outflow enhancement can be achieved by means of a bio-interventional cyclodialysis procedure with allograft scleral reinforcement.

Ozark hellbender ( Cryptobranchus alleganiensis bishopi , Grobman 1943) populations in Missouri and Arkansas have been federally listed as endangered since 2011. As part of the comprehensive recovery plan for the subspecies, the Saint Louis Zoo WildCare Institute's Ron and Karen Goellner Center for Hellbender Conservation, in collaboration with the Missouri Department of Conservation, Arkansas Game and Fish Commission, and the U.S. Fish and Wildlife Service, established a conservation breeding and head‐starting program to augment and create self‐sustaining wild populations. We examined how the river of origin and egg origin (i.e., Zoo‐bred or wild‐bred) influenced various growth and mortality responses of Zoo‐reared Ozark hellbenders. River of origin significantly predicted most larval and long‐term Zoo‐reared Ozark hellbender growth responses, with our results concurring with observed differences in wild populations and known genetic relationships between Ozark hellbender populations. Mortality of Zoo‐reared Ozark hellbenders was often predicted by river of origin and egg origin with Zoo‐bred hellbenders having significantly higher proportional mortality responses relative to wild‐bred hellbenders. Further exploration of this egg origin relationship revealed differences between the Zoo breeding group generations with higher proportional mortality rates for hellbenders from the less mature second‐generation breeding group relative to hellbenders from the first‐generation breeding group and wild‐bred hellbenders. Ultimately, our results provide baseline data on Zoo‐bred and wild‐bred Ozark hellbenders in the program, help identify differences in growth and mortality responses between Ozark hellbender populations, and contribute to existing evidence supporting distinct populations of Ozark hellbenders in Missouri to aid in targeted conservation strategies.

Populations of Ozark hellbenders (Cryptobranchus alleganiensis bishopi, Grobman 1943) in Missouri and Arkansas are federally listed as endangered. The Saint Louis Zoo WildCare Institute's Ron and Karen Goellner Center for Hellbender Conservation, in collaboration with the Missouri Department of Conservation and US Fish and Wildlife Service, has developed a sustainable conservation breeding and head-starting program, a priority for species recovery. Using 9 years of program data, we examined various egg production, egg development, and mortality responses of Zoo-bred Ozark hellbenders. Our results identified river of origin and breeding location as important predictors of egg production responses including average breeding female total lengths as well as brooding male clutch size, total egg count, and the estimated number of female clutches, respectively. We found that breeding group generation was a significant predictor of Zoo-bred hellbender egg development responses with hellbenders from the first breeding group generation ovipositing later and producing eggs that hatch later and develop longer than hellbenders from the second-generation breeding group. These responses are consistent with females from the first breeding group generation being larger at the time of reproduction. Breeding group generation was also a significant predictor of proportional egg and total mortality, while the proportion of hatchling mortality was best predicted by breeding location, and the proportion of larval mortality was best predicted by river of origin. Ultimately, our results provide baseline metrics for the program and identify areas for further inquiry to maximize the success of future conservation breeding and head-starting efforts at the Zoo.

Endemic to only three known provinces in South Central Vietnam, Cuora picturata have faced extensive collection pressures for the food, medicinal, and pet trades. Further exacerbating their decline is the lack of protected areas where wild populations exist, with only one known population occurring within a protected area. With threats to wild populations persisting, the development of an assurance colony has been prioritized for C. picturata. The Asian Turtle Program of Indo-Myanmar Conservation has been operating the Turtle Conservation Center (TCC) in Cuc Phuong National Park since 1998. From 2020 to 2022, 24 C. picturata were acquired by the TCC from the illegal trade. With no ideal repatriation plan, these animals provided an opportunity for developing a captive assurance colony at the TCC to safeguard the species from extinction. As semi-aquatic species, box turtles in the genus Cuora are a unique group that shows variations in habitat use and behavior between species. Herein, we documented some specific courtship behaviors not yet described for C. picturata, providing insight into the unique reproductive behaviors of this species.

Invasive meningococcal disease (IMD) is a severe and life-threatening disease. In the United States (US), vaccine coverage with MenACWY and MenB meningococcal vaccines is suboptimal among adolescents/young adults aged 16–23 years. A combined meningococcal vaccine (MenABCWY) could increase convenience (e.g., fewer injections) and improve coverage. The objective was to quantify preferences for hypothetical meningococcal vaccine profiles among adolescents/young adults and parents. An online discrete choice experiment was conducted among 16- to 23-year-olds, and parents of 16- to 18-year-olds. Attributes (3 × 4) and levels (1 × 2) were based on the literature and focus groups. Participants made ten pair-wise forced trade-off choices, systematically varied using a D-optimal design. Random parameter logit quantified the relative importance of vaccination attributes and estimated the trade-offs. Differences in preferences by subgroups were assessed. Totals of 300 adolescents and young adults (median age 20 years) and 300 parents (median age 46 years) completed the survey. Overall, 89.6% of 16- to 23-year-olds and 69.1% of parents preferred a simplified hypothetical meningococcal vaccination profile, e.g., with fewer injections (3 vs. 4) and fewer healthcare provider (HCP) visits (2–3 vs. 4). Having HCP advice and clear Centers for Disease Control and Prevention recommendations impacted vaccination choice, with both groups reporting high trust in HCP information (83.3% among 16- to 23-year-olds; 98.7% among parents). Barriers to vaccination included lack of HCP advice or awareness of meningococcal vaccines, and income level and out-of-pocket costs for parents. Adolescents/young adults and parents demonstrated a significant preference for a meningococcal vaccine that is more convenient (such as combined MenABCWY). Parents’ vaccination preferences differed by income level and out-of-pocket costs, suggesting financial barriers to vaccination may exist which could result in IMD prevention inequalities. Findings from this study provide important information to support patient-facing informed policy discussions. A simplified vaccination schedule and strong recommendation could help improve vaccine uptake, schedule compliance, disease prevention, and reduce inequalities in IMD risk and prevention. A graphical abstract is available with this article.

Objective To investigate the association between workload and pregnancy outcomes among US surgical faculty and trainees. Summary Background Data Despite the increased risk of pregnancy associated complications among surgeons, most US institutions do not have formalized support to help sustain a healthy pregnancy in surgeons. Methods An anonymous self-administered Qualtrics survey was distributed electronically to US surgeons across all surgical specialties. Female surgical trainees/faculty with current or previous pregnancy were invited to participate. Data pertaining to demographics, workload, and pregnancy outcomes were collected for each individual pregnancy resulting in live birth. Multivariate analysis was used to assess for workload and outcomes, controlling for age, race, gravidity, and use of assisted reproductive technology. A significance level of 0.0056 was used for each outcome (Bonferroni multiple-testing adjustment 0.05/9). Results 817 surgeons experiencing 1348 pregnancies resulting in live birth were included. The mean (SD) age at first live birth was 32(4). The most prevalent major and neonatal complications included preeclampsia/gestational hypertension (n=196, 14.5%) and preterm delivery (n=179, 12.8%), respectively. Most institutions did not have a policy regarding workload modification (n=1189, 88.5%). Most surgeons did not modify their workload (n=862, 63.9%). When looking at individual workload metrics, feeling overworked during the last week of pregnancy correlated with risk of major complication ( P =0.0001), preeclampsia/gestational hypertension ( P =0.0003), and intra/post-partum complication ( P =0.0001). Association with unplanned cesarean section ( P =0.0096) and preterm delivery ( P =0.0036) reached nominal significance. Conclusions Most surgeons do not modify their workload during pregnancy, potentially contributing to feeling overworked and peri-partum complications. There is an urgent need for a cultural shift and institutional policies to safeguard the health and wellbeing of pregnant surgeons.

In the United States, maternal health inequities disproportionately affect Global Majority (e.g., Asian, Black, and Hispanic) populations. Despite a substantial body of research underscoring the influence of racism on these inequities, little research has examined how experiences of gendered racial microaggressions during pregnancy and birth impact racially and ethnically diverse Global Majority pregnant and birthing people in obstetric hospital settings. We evaluated the psychometric properties of an adapted version of Lewis & Neville’s Gendered Racial Microaggressions Scale, using data collected from 417 Global Majority birthing people. Findings from our study indicate that our adapted GRMS is a valid tool for assessing the experiences of gendered racial microaggressions in hospital-based obstetric care settings among Global Majority pregnant and birthing people whose preferred languages are English or Spanish. Item Response Theory (IRT) analysis demonstrated high construct validity of the adapted GRMS scale (Root Mean Square Error of Approximation = 0.1089 (95% CI 0.0921, 0.1263), Comparative Fit Index = 0.977, Standardized Root Mean Square Residual = 0.075, log-likelihood c2 = -85.6, df = 8). IRT analyses demonstrated that the unidimensional model was preferred to the bi-dimensional model as it was more interpretable, had lower AIC and BIC, and all items had large discrimination parameters onto a single factor (all discrimination parameters > 3.0). Given that we found similar response profiles among Black and Hispanic respondents, our Differential Item Functioning analyses support validity among Black, Hispanic, and Spanish-speaking birthing people. Inter-item correlations demonstrated adequate scale reliability, α = 0.97, and empirical reliability = 0.67. Pearsons correlations was used to assess the criterion validity of our adapted scale. Our scale’s total score was significantly and positively related to postpartum depression and anxiety. Researchers and practitioners should seek to address instances of gendered racial microaggressions in obstetric settings, as they are manifestations of systemic and interpersonal racism, and impact postpartum health.

In 2020, the U.S. Food and Drug Administration's Oncology Center of Excellence, in collaboration with the American Association for Cancer Research, launched a novel educational partnership known as the FDA-AACR Oncology Educational Fellowship. This year-long program is aimed for hematology/oncology fellows, scientists, and early-career investigators, offering an in-depth exploration of the regulatory review process by blending didactic learning with practical cases discussing oncology drug approvals. The fellowship has been met with enthusiastic feedback, with participants lauding its role in demystifying the regulatory landscape and enhancing their professional careers. This paper reflects on the experiences of four alumni, showcasing the program's transformative impact across diverse oncology career paths in government, academia, and industry.