An Exploratory Study into the Backgrounds and Perspectives of Equine-Assisted Service Practitioners

Equine-Assisted Services (EASs) are commonplace in today's society, but vary widely in both theoretical and practical applications. Until now, practitioners' experiences and perspectives in relation to these services have received little attention. To address this, a purpose-designed online questionnaire was distributed to EAS practitioners, exploring issues relating to the nature of the service provided, practice patterns, practitioner education, perceived knowledge, challenges faced and the future direction of these services. An analysis revealed a significant association between practitioners' backgrounds and the nature of the service offered, as well as perceived knowledge. Median EAS training received to first practice was 20 days of block release over a year; however, nearly half of the sample (42.4%) reported less training than this. Equine-specific training was more limited, with 41.5% of practitioners having no horse-relevant qualifications. The most important challenges reported by practitioners involved client and equine welfare, financial sustainability and raising awareness of EAS. This research highlights the diverse nature of EAS and also raises important challenges and possible opportunities for development. Findings suggest that more progress is needed to professionalise and legitimise the area to support and help practitioners provide the best service for all concerned.

The social formation of fitness: lifetime consequences of prenatal nutrition and postnatal care in a wild mammal population

Research in medicine and evolutionary biology suggests that the sequencing of parental investment has a crucial impact on offspring life history and health. Here, we take advantage of the synchronous birth system of wild banded mongooses to test experimentally the lifetime consequences to offspring of receiving extra investment prenatally versus postnatally. We provided extra food to half of the breeding females in each group during pregnancy, leaving the other half as matched controls. This manipulation resulted in two categories of experimental offspring in synchronously born litters: (i) 'prenatal boost' offspring whose mothers had been fed during pregnancy, and (ii) 'postnatal boost' offspring whose mothers were not fed during pregnancy but who received extra alloparental care in the postnatal period. Prenatal boost offspring lived substantially longer as adults, but postnatal boost offspring had higher lifetime reproductive success (LRS) and higher glucocorticoid levels across the lifespan. Both types of experimental offspring had higher LRS than offspring from unmanipulated litters. We found no difference between the two experimental categories of offspring in adult weight, age at first reproduction, oxidative stress or telomere lengths. These findings are rare experimental evidence that prenatal and postnatal investments have distinct effects in moulding individual life history and fitness in wild mammals. This article is part of the theme issue 'Evolutionary ecology of inequality'.

An Optimized Search Prognosis Tool to Predict 8/8 HLA Allele-Matched Unrelated Donor Procurement

For patients in need of allogeneic transplantation who lack an HLA-identical sibling, an 8/8 HLA allele-matched unrelated donor (URD) is a standard alternative. However, delays in URD procurement can adversely impact patient care. Recipient genotype and search assessment (MSKv1.0)-based tools can predict search prognosis for many, but both tools have lower performance in non-European ancestry patients. Using the MSKv1.0 tool, we analyzed searches from 1530 potential allograft recipients (including 863 who underwent transplantation) with the aim of creating an optimized MSKv2.0 search prognosis tool that can classify a URD search as either Good or Poor with a high level of accuracy while also limiting an ambiguous Fair search prognosis regardless of patient ancestry. By MSKv2.0, the 8/8 URD search prognosis distribution was 57% Good, 21% Fair, and 22% Poor in Europeans and 15% Good, 21% Fair, and 63% Poor in non-Europeans. Importantly, compared to MSKv1.0, the likelihood of Fair categorization was reduced to <25% with comparable Fair rates (P = .847) in both European and non-European groups. Moreover, all patients with an MSKv2.0 Good prognosis had an 8/8 URD identified, and almost all of those who underwent transplantation had an 8/8 URD (Europeans, 99%; non-Europeans, 98%; P = .504). The MSKv2.0 tool also was highly accurate at classifying Poor searches, with <10% identifying an 8/8 URD, and almost all patients who underwent transplantation (Europeans, 95%; non-Europeans, 96%) receiving an alternative donor. Using preliminary search results, MSKv2.0 accurately classifies patients by likelihood of 8/8 URD procurement, greatly facilitating triage to 8/8 URD (Good prognosis) or alternative donor (Poor prognosis) transplantations.

O-042 ESHRE good practice recommendations on chromosomal mosaicism

The implementation of high-resolution genome-wide methods, usually next-generation sequencing-based, in preimplantation genetic testing (PGT), has led to the frequent detection of embryos with chromosomal mosaicism (whole chromosome and/or segmental aberrations). Despite a growing series of papers showing the birth of healthy babies following the transfer of embryos indicating mosaicism on PGT-A analysis - albeit with lower implantation rates and higher miscarriage rates in comparison with euploid embryo transfer - many questions remain, making it difficult to decide on how to handle chromosomally mosaic embryos in the clinic.

A dedicated ESHRE working group developed good practice recommendations on how to manage chromosomal mosaicism in clinical practice. The recommendations were formulated based on the expert opinion of the working group while taking into consideration the published data and outcomes of a survey on current practices in 239 PGT laboratories and ART clinics, mostly within Europe, Asia and America. The recommendations with regards to detection and management of chromosomal mosaicism were developed following the manual for development of ESHRE good practice recommendations with a stakeholder review of the paper on the ESHRE website. In addition to the recommendations, the working group identified missing information and scientific questions, which should guide further research in PGT, with relevance to the occurrence, detection and impact of chromosomal mosaicism.

Trial registration number:

Identifying and optimizing human endometrial gene expression signatures for endometrial dating

STUDY QUESTION

What are the key considerations for developing an enhanced transcriptomic method for secretory endometrial tissue dating?

SUMMARY ANSWER

Multiple gene expression signature combinations can serve as biomarkers for endometrial dating, but their predictive performance is variable and depends on the number and identity of the genes included in the prediction model, the dataset characteristics and the technology employed for measuring gene expression.

WHAT IS KNOWN ALREADY

Among the new generation of transcriptomic endometrial dating (TED) tools developed in the last decade, there exists variation in the technology used for measuring gene expression, the gene makeup and the prediction model design. A detailed study, comparing prediction performance across signatures for understanding signature behaviour and discrepancies in gene content between them, is lacking.

STUDY DESIGN, SIZE, DURATION

A multicentre prospective study was performed between July 2018 and October 2020 at five different centres from the same group of clinics (Spain). This study recruited 281 patients and finally included in the gene expression analysis 225 Caucasian patients who underwent IVF treatment. After preprocessing and batch effect filtering, gene expression measurements from 217 patients were combined with artificial intelligence algorithms (support vector machine, random forest and k-nearest neighbours) allowing evaluation of different prediction models. In addition, secretory-phase endometrial transcriptomes from gene expression omnibus (GEO) datasets were analysed for 137 women, to study the endometrial dating capacity of genes independently and grouped by signatures. This provided data on the consistency of prediction across different gene expression technologies and datasets.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Endometrial biopsies were analysed using a targeted TruSeq (Illumina) custom RNA expression panel called the endometrial dating panel (ED panel). This panel included 301 genes previously considered relevant for endometrial dating as well as new genes selected for their anticipated value in detecting the secretory phase. Final samples (n = 217) were divided into a training set for signature discovery and an independent testing set for evaluation of predictive performance of the new signature. In addition, secretory-phase endometrial transcriptomes from GEO were analysed for 137 women to study endometrial dating capacity of genes independently and grouped by signatures. Predictive performance among these signatures was compared according to signature gene set size.

MAIN RESULTS AND THE ROLE OF CHANCE

Testing of the ED panel allowed development of a model based on a new signature of 73 genes, which we termed 'TED' and delivers an enhanced tool for the consistent dating of the secretory phase progression, especially during the mid-secretory endometrium (3-8 days after progesterone (P) administration (P + 3-P + 8) in a hormone replacement therapy cycle). This new model showed the best predictive capacity in an independent test set for staging the endometrial tissue in the secretory phase, especially in the expected window of implantation (average of 114.5 ± 7.2 h of progesterone administered; range in our patient population of 82-172 h). Published sets of genes, in current use for endometrial dating and the new TED genes, were evaluated in parallel in whole-transcriptome datasets and in the ED panel dataset. TED signature performance was consistently excellent for all datasets assessed, frequently outperforming previously published sets of genes with a smaller number of genes for dating the endometrium in the secretory phase. Thus, this optimized set exhibited prediction consistency across datasets.

LARGE SCALE DATA

The data used in this study is partially available at GEO database. GEO identifiers GSE4888, GSE29981, GSE58144, GSE98386.

LIMITATIONS, REASONS FOR CAUTION

Although dating the endometrial biopsy is crucial for investigating endometrial progression and the receptivity process, further studies are needed to confirm whether or not endometrial dating methods in general are clinically useful and to guide the specific use of TED in the clinical setting.

WIDER IMPLICATIONS OF THE FINDINGS

Multiple gene signature combinations provide adequate endometrial dating, but their predictive performance depends on the identity of the genes included, the gene expression platform, the algorithms used and dataset characteristics. TED is a next-generation endometrial assessment tool based on gene expression for accurate endometrial progression dating especially during the mid-secretory.

STUDY FUNDING/COMPETING INTEREST(S)

Research funded by IVI Foundation (1810-FIVI-066-PD). P.D.-G. visiting scientist fellowship at Oxford University (BEFPI/2010/032) and Josefa Maria Sanchez-Reyes' predoctoral fellowship (ACIF/2018/072) were supported by a program from the Generalitat Valenciana funded by the Spanish government. A.D.-P. is supported by the FPU/15/01398 predoctoral fellowship from the Ministry of Science, Innovation and Universities (Spanish Government). D.W. received support from the NIHR Oxford Biomedical Research Centre. The authors do not have any competing interests to declare.

O-172 Metabolic imaging of cumulus cells to predict embryo implantation potential

Study question

Can non-invasive metabolic imaging detect variations in cumulus cell metabolic parameters associated with a viable pregnancy of the corresponding embryo?

Summary answer

Noninvasive metabolic imaging can detect differences in the cumulus cell metabolic signatures between embryos that led to a viable pregnancy and those that did not. 

What is known already

Bidirectional metabolic cooperativity between the human oocyte and its surrounding cumulus cells is essential for the oocyte to acquire full developmental competency. However, the relationship between cumulus cell metabolism and oocyte viability is not well established. Metabolic imaging uses Fluorescence Lifetime Imaging Microscopy (FLIM) to non-invasively measure autofluorescence of the endogenous molecules, NADH and FAD+, which are essential coenzymes for cellular respiration and glycolysis. This technique enables quantitative information for these coenzyme concentrations and regarding metabolite enzyme engagement. We have previously shown that this technique is an effective tool for quantitatively measuring metabolic state of mouse embryos.

Study design, size, duration

Cumulus cell clusters (n = 617 from 193 patients) were dissected from cumulus-oocyte complexes prior to insemination or ICSI, vitrified, warmed and their metabolic function assessed. We conducted a prospective observational study to evaluate to what extent cumulus cells from an oocyte that led to a viable pregnancy (presence of a viable fetus &gt;7 weeks gestation) after transfer of the corresponding embryo metabolically differed from those that did not. We also evaluated the associations with embryo morphology.

Participants/materials, setting, methods

Cumulus cell metabolism was assessed non-invasively using FLIM to measure the autofluorescence of NADH and FAD+. Overall a single FLIM measurement provides a total of 8 metabolic parameters (4 for NADH and 4 for FAD+). An additional parameter, the Redox Ratio was also acquired (NADH intensity / FAD+ intensity). We used multilevel models to investigate the association of cumulus cell metabolic parameters with the morphology of the corresponding embryo and clinical outcome.

Main results and the role of chance

Of the cumulus samples analyzed, 75 corresponded to embryos that did not result in a viable pregnancy, and 24 that did so. Significant associations were observed between cumulus cell FAD+ fraction bound to enzyme (p = 0.007), FAD+ long lifetime (p = 0.01) and FAD+ short lifetime (p &lt; 0.001) and the clinical outcome of the corresponding embryo. These significant associations held up after controlling for age. We used a support vector machine algorithm to distinguish between embryos that led to a viable pregnancy and those that did not. The optimum hyperplane derived from a support vector machine algorithm predicted whether a sample with random cumulus cell metabolic parameters will lead to a viable pregnancy or not with an accuracy of 80%. Embryo morphological assessments were stratified as excellent, good, fair and poor. We found no significant associations between cumulus cell metabolic signatures and embryo morphology evaluated on day 3. Significant associations of FAD+ short lifetime (p &lt; 0.001) and day 5 embryo morphology were found. However, these associations were not significant after controlling for age. 

Limitations, reasons for caution

Although we observed significant variations in metabolic parameters, further studies with larger sample sizes are required. Despite our validation studies showing no significant effect of vitrification on cumulus cell metabolic parameters, analyses with fresh clusters are needed to confirm our results.

Wider implications of the findings

Noninvasive FLIM imaging detects metabolic variations of cumulus masses and their association with embryo viability. The ability to correlate metabolic measurements of cumulus clusters, in combination with embryo morphology assessments and patient clinical characteristics, with embryo fate paves the way for this approach to be used in a clinical setting.

Trial registration number

5RO1HD092559-03

Using judgment bias test in pet and shelter dogs (Canis familiaris): Methodological and statistical caveats

It is now widely agreed that a positive affective state is a crucial component of animal well-being. The judgment bias test represents a widespread tool used to assess animals' optimistic/pessimistic attitude and to evaluate their emotional state and welfare. Judgment bias tests have been used several times with dogs (Canis familiaris), in most cases using a spatial test with a bowl placed in ambiguous positions located between a relatively positive trained location (P) which contains a baited bowl and a relatively negative trained location (N) which contains an empty bowl. The latency to approach the bowl in the ambiguous locations is an indicator of the dog's expectation of a positive/negative outcome. However, results from such tests are often inconclusive. For the present study, the judgment bias test performance of 51 shelter dogs and 40 pet dogs was thoroughly analysed. A pattern emerged with shelter dogs behaving in a more pessimistic-like way than pet dogs. However, this difference between the two populations was detected only when analysing the raw latencies to reach the locations and not the more commonly applied adjusted score (i.e. average latency values). Furthermore, several methodological caveats were found. First of all, a non-negligible percentage of dogs did not pass the training phase, possibly due to the experimental paradigm not being fully suited for this species. Second, results showed a high intra-dog variability in response to the trained locations, i.e. the dogs' responses were not consistent throughout the test, suggesting that animals may not have fully learned the association between locations and their outcomes. Third, dogs did not always behave differently towards adjacent locations, raising doubts about the animals' ability to discriminate between locations. Finally, a potential influence of the researcher's presence on dogs' performance emerged from analyses. The implications of these findings and potential solutions are discussed.

Evaluation of Cord Blood Total Nucleated and CD34+ Cell Content, Cell Dose, and 8-Allele HLA Match by Patient Ancestry

How cord blood (CB) CD34⁺ cell content and dose and 8-allele HLA match vary by patient ancestry is unknown. We analyzed cell content, dose, and high-resolution HLA-match of units selected for CB transplantation (CBT) by recipient ancestry. Of 544 units (286 infused, 258 next-best backups) chosen for 144 racially diverse adult patients (median weight, 81 kg), the median total nucleated cell (TNC) and CD34⁺cell ⁺contents were higher for Europeans than for non-Europeans: 216 × 10⁷versus 197 × 10⁷ (P = .002) and 160 × 10⁵ versus 132 × 10⁵ (P = .007), respectively. There were marked cell content disparities among ancestry groups, with units selected for Africans having the lowest TNC (189 × 10⁷) and CD34⁺ cell (122 × 10⁵) contents. Units for non-Europeans were also more HLA-mismatched (P = .017). When only the 286 transplanted units were analyzed, the adverse effect of reduced cell content was exacerbated by the higher weights in some groups. For example, northwestern Europeans (high patient weight, high unit cell content) had the best-dosed units, and Africans (high weight, low unit cell content) had the lowest. In Asians, low cell content was partially compensated for by lower weight. Marked differences in 8-allele HLA-match distribution were also observed by ancestry group; for example, 23% of units for northwestern Europeans were 3/8 to 4/8 HLA-matched, compared with 40% for southern Europeans, 46% for white Hispanics, and 51% for Africans. During the study period, 20 additional patients (17 non-Europeans; median weight, 98 kg) did not undergo CBT owing to the lack of a suitable graft. CB extends transplantation access to most patients, but racial disparities exist in cell content, dose, and HLA match.

Can research align with service? Lessons learned from the Big Experiment and National Biomechanics Day

Public engagement is an important role for the university academic, but is often neglected due to perceived lack of time and prioritized commitments in research and teaching. Yet, public engagement events offer an untapped opportunity for researchers to collect data from members of the general public who arrive on site at university labs. These engagement events could allow for data collection as part of didactic and demonstrative outreach events to be used in research and science. In this proof of concept study, a collaborative group of international researchers investigated the feasibility of embedding research quality assessment into events surrounding National Biomechanics Day. The Big Experiment collected data on 501 secondary school students (age range: 13 to 18 years) across 9 university sites within a 24-hour period. Data included maximal vertical jump height and self-reported physical activity levels. Vertical jump height was positively correlated to participant height, but not age or body mass. Very physically active students had significantly higher vertical jump heights than individuals who reported being somewhat or not physically active. This feasibility project demonstrates that with substantial preparation and a simple research design, focused research questions can be incorporated into educational outreach initiatives and ultimately provide a rich data source.

Rice plants overexpressing OsEPF1 show reduced stomatal density and increased root cortical aerenchyma formation

Stomata are adjustable pores in the aerial epidermis of plants. The role of stomata is usually described in terms of the trade-off between CO₂ uptake and water loss. Little consideration has been given to their interaction with below-ground development or diffusion of other gases. We overexpressed the rice EPIDERMAL PATTERNING FACTOR1 (OsEPF1) to produce rice plants with reduced stomatal densities, resulting in lowered leaf stomatal conductance and enhanced water use efficiency. Surprisingly, we found that root cortical aerenchyma (RCA) is formed constitutively in OsEPF1OE lines regardless of tissue age and position. Aerenchyma is tissue containing air-spaces that can develop in the plant root during stressful conditions, e.g. oxygen deficiency when it functions to increase O₂ diffusion from shoot to root. The relationship with stomata is unknown. We conclude that RCA development and stomatal development are linked by two possible mechanisms: first that reduced stomatal conductance inhibits the diffusion of oxygen to the root, creating an oxygen deficit and stimulating the formation of RCA, second that an unknown EPF signalling pathway may be involved. Our observations have fundamental implications for the understanding of whole plant gas diffusion and root-to-shoot signalling events.

183 Generation of porcine embryonic stem cell lines derived from nuclear transfer embryos reconstructed with induced pluripotent stem cells

To establish a porcine embryonic stem (ES) cell line that not only maintains self-renewing capacity but also exhibits pluripotency [Haraguchi et al. 2012 J. Reprod. Dev. 58, 707-716], 6 synthetic porcine RNAs (Oct4, Sox2, Klf4, c-Myc, Nanog, and Lin28) were chemically transfected into outgrowth cultured cells derived from the inner cell mass of in vitro-produced porcine embryos. Subsequently, cells grew as compact, dome-shaped colonies displaying alkaline phosphatase activity and were cultured for more than 20 passages. Although 13 candidate cell lines were generated (13/43, 30%), none formed teratomas after injection of the cells into SCID (sever combined immunodeficiency) mice. We also observed that when transfection of the exogeneous RNAs was discontinued, the cells no longer maintained a stem cell morphology and began to differentiate (13/13, 100%). This suggests that continuous expression of exogenous reprogramming factors is necessary to maintain induced pluripotency in the pig. Next, we used cloned embryos reconstructed with porcine induced pluripotent stem cells (piPSC), which were created using a recombinant lentivirus expression vector carrying 6 mouse reprogramming factor genes (the same as above) and green fluorescent protein (GFP) (Fukuda et al. 2017 J. Cell Biochem. 118, 537-553]. The piPSC were dispersed to a single cell suspension and electrically fused to cytoplasts prepared following enucleation of in vitro-matured zona-free metaphase II-arrested oocytes. A second cytoplast was then fused to the first reconstruct (double cytoplast nuclear transfer). Reconstructs were electrically activated and cultured in microwells with porcine zygote medium-3 (PZM3). After 5 days, reconstructed embryos developed to GFP-positive blastocysts (10/93, 11%) and 4- to 8-cell stages (25/93, 27%). The blastocysts (10) and 4- to 8-cell-stage embryos (25) were transferred onto mouse embryonic fibroblast feeder cells for outgrowth culture in FCS-based ES cell medium supplemented with 2% polyvinylpyrrolidone. After 24h, the medium was changed to piPSC medium containing CHIR99021, PD0325901, thiazovivin, and GF-109203x. Embryos attached to the feeder cells began to outgrow (8/10 of blastocysts and 6/25 of 4- to 8-cell-stage embryos). To date, 3 ES-like cell lines have been established from blastomeres of embryos (3/25, 12%) but not from blastocysts (0/10, 0%). They show GFP fluorescence and have been maintained continuously in culture for more than 20 passages without any overt changes in morphology. These results suggest that the constant expression of reprogramming factors and the use of combinations of specific small molecule inhibitors largely contribute to the establishment of pluripotent cells in the pig. Further characterisation of the cells is ongoing, including methylation status of the X chromosome and the capacity for in vivo differentiation.

Mitochondrial DNA quantification as a tool for embryo viability assessment: retrospective analysis of data from single euploid blastocyst transfers

STUDY QUESTION

Does the amount of mitochondrial DNA (mtDNA) in blastocyst biopsy specimens have the potential to serve as a biomarker of euploid embryo implantation ability, independent of morphology?

SUMMARY ANSWER

The results of this study strongly suggest that elevated mtDNA levels, above a previously defined threshold, are strongly associated with blastocyst implantation failure and represent an independent biomarker of embryo viability.

WHAT IS KNOWN ALREADY

Improved methods of embryo selection are highly desirable in order to increase the efficiency of IVF treatment. At present, even the transfer of chromosomally normal embryos of high morphological grade cannot guarantee that a pregnancy will follow. Recently, it has been proposed that the quantity of mtDNA in embryonic cells may be an indicator of developmental potential, with higher levels of mtDNA associated with reduced implantation. However, thus far reported data sets have been relatively small and in some cases have lacked appropriate validation.

STUDY DESIGN, SIZE, DURATION

This large, blinded, retrospective study involved the analysis of relative mtDNA levels in 1505 euploid blastocysts obtained from 490 couples undergoing preimplantation genetic testing for aneuploidy. Implantation outcomes were compared to mtDNA levels in order to determine the capacity of the method to predict viability and to assess the validity of previously established thresholds.

PARTICIPANTS/MATERIALS, SETTING, METHODS

DNA from blastocyst biopsy samples was amplified and then subjected to aneuploidy analysis using next generation sequencing or array comparative genomic hybridization. Only those embryos classified as chromosomally normal had their mtDNA levels assessed. This analysis was undertaken retrospectively using quantitative real-time PCR, without knowledge of the outcome of embryo transfer. Predictions of implantation failure, based upon mtDNA levels were subsequently compared to the observed clinical results. All cycles involved the transfer of a single embryo.

MAIN RESULTS AND THE ROLE OF CHANCE

Of all blastocysts analyzed, 9.2% (139/1505) contained mtDNA levels above a previously established viability threshold and were therefore predicted to have reduced chances of implantation. To the date of analysis, 282 euploid blastocysts had been transferred with an overall implantation rate of 65.6% (185/282). Of the transferred embryos, 249 contained levels of mtDNA in the normal range, 185 of which produced a pregnancy, giving an implantation rate of 74.3% for euploid embryos with 'normal' quantities of mtDNA. However, 33 of the transferred embryos were determined to have elevated mtDNA quantities. None of these led to a pregnancy. Therefore, the negative predictive value of mtDNA assessment in this cohort was 100% (33/33). The difference between the implantation rates for embryos with normal and elevated mtDNA levels was highly significant (P < 0.0001). The mtDNA thresholds, used for classification of embryos, were unaffected by female age or the clinic in which the IVF was undertaken. The probability of an embryo having elevated levels of mtDNA was not influenced by variation in embryo morphology.

LIMITATIONS, REASONS FOR CAUTION

This study provides strong evidence that mtDNA quantification can serve as a valuable tool to assist the evaluation of blastocyst viability. However, to determine the true extent of any clinical benefits, other types of investigations, such as non-selection studies and randomized controlled trials, will also be necessary.

WIDER IMPLICATIONS OF THE FINDINGS

The results of this study suggest that mtDNA quantity can serve as an independent biomarker for the prediction of euploid blastocyst implantation potential. Prospective studies should now be undertaken to confirm these results. Additionally, investigations into the underlying biological cause(s) of elevated mtDNA levels and an enhanced understanding of how they relate to diminished implantation potential would be invaluable.

STUDY FUNDING/COMPETING INTEREST(S)

This study was supported by funding provided by Reprogenetics. None of the authors have any competing interests.

Validation of an Algorithm to Predict the Likelihood of an 8/8 HLA-Matched Unrelated Donor at Search Initiation

A strategy to rapidly determine if a matched unrelated donor (URD) can be secured for allograft recipients is needed. We sought to validate the accuracy of (1) HapLogic match predictions and (2) a resultant novel Search Prognosis (SP) patient categorization that could predict 8/8 HLA-matched URD(s) likelihood at search initiation. Patient prognosis categories at search initiation were correlated with URD confirmatory typing results. HapLogic-based SP categorizations accurately predicted the likelihood of an 8/8 HLA-match in 830 patients (1530 donors tested). Sixty percent of patients had 8/8 URD(s) identified. Patient SP categories (217 very good, 104 good, 178 fair, 33 poor, 153 very poor, 145 futile) were associated with a marked progressive decrease in 8/8 URD identification and transplantation. Very good to good categories were highly predictive of identifying and receiving an 8/8 URD regardless of ancestry. Europeans in fair/poor categories were more likely to identify and receive an 8/8 URD compared with non-Europeans. In all ancestries very poor and futile categories predicted no 8/8 URDs. HapLogic permits URD search results to be predicted once patient HLA typing and ancestry is obtained, dramatically improving search efficiency. Poor, very poor, andfutile searches can be immediately recognized, thereby facilitating prompt pursuit of alternative donors.

Precise and Accurate Measurements of Strong-Field Photoionization and a Transferable Laser Intensity Calibration Standard

Ionization of atoms and molecules in strong laser fields is a fundamental process in many fields of research, especially in the emerging field of attosecond science. So far, demonstrably accurate data have only been acquired for atomic hydrogen (H), a species that is accessible to few investigators. Here, we present measurements of the ionization yield for argon, krypton, and xenon with percent-level accuracy, calibrated using H, in a laser regime widely used in attosecond science. We derive a transferable calibration standard for laser peak intensity, accurate to 1.3%, that is based on a simple reference curve. In addition, our measurements provide a much needed benchmark for testing models of ionization in noble-gas atoms, such as the widely employed single-active electron approximation.

Leadership and Ethics in Work Groups

This study explored the relationship between leadership style and individual ethics in work groups. We present a model of how active leadership affects conformity in members’ ethical decision frameworks (formalism and utilitarianism). We tested this model by examining 36 work groups over a 12-week period. Results supported the hypothesis that more active leadership would lead to greater conformity in both types of ethical frameworks. A second hypothesis, that group cohesion would mediate this relationship between leadership style and ethical conformity, was partially supported. Implications of these findings for leadership, groups, and ethics research are discussed.

Approaching Complex Cases With a Crisis Intervention Model and Teamwork

Patients referred for genetic counseling may be in a state of crisis, feeling as though they are incapable of making decisions about the management of their pregnancy, genetic testing options and/or life planning issues. The role of the genetic counselor is to assist a patient through this crisis state by increasing the patient's understanding and by helping to facilitate decision making and adjustment to those decisions. In this paper we present a clinical genetic counseling case that was complicated by numerous medical and psychosocial issues. The wide scope of this case required the involvement of both a prenatal and a medical genetic counselor. Working as a team we utilized a crisis intervention model. Our counseling focused on identifying and isolating the issues, providing factual information, setting a time frame for decisions to be made, and encouraging social support and emotion-focused coping strategies.

Revisiting guidelines for integration of flow cytometry results in the WHO classification of myelodysplastic syndromes-proposal from the International/European LeukemiaNet Working Group for Flow Cytometry in MDS

Definite progress has been made in the exploration of myelodysplastic syndromes (MDS) by flow cytometry (FCM) since the publication of the World Health Organization 2008 classification of myeloid neoplasms. An international working party initiated within the European LeukemiaNet and extended to include members from Australia, Canada, Japan, Taiwan and the United States has, through several workshops, developed and subsequently published consensus recommendations. The latter deal with preanalytical precautions, and propose small and large panels, which allow evaluating immunophenotypic anomalies and calculating myelodysplasia scores. The current paper provides guidelines that strongly recommend the integration of FCM data with other diagnostic tools in the diagnostic work-up of MDS.