Serious Stem Cell Donation Events and Recipient Adverse Reactions Related to Severe Acute Respiratory Syndrome Coronavirus 2: Review of Reports to the World Marrow Donor Association.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has deeply impacted hematopoietic stem cell (HSC) donation and transplantation. Numerous changes in practice have been introduced, and monitoring the impact of these changes on donations and transplantations is of vital importance. As part of a global response to this pandemic, the World Marrow Donor Association (WMDA) asked that its member registries and cord blood banks submit SARS-CoV-2-related adverse events to the WMDA-operated Serious Product Events and Adverse Reactions (SPEAR) database. Here we review SARS-CoV-2-related SPEAR events that occurred in 2020. The WMDA SPEAR Committee reviewed reports submitted via an online tool. The Committee reviewed each report following the European Union definitions of a serious adverse event or reaction and determined the imputability and its impact. Reports submitted in 2020 were included in this analysis. A TOTAL OF: 74 such reports were received, and events were classified as donor-related (n = 41; 55.4%), recipient-related (n = 3; 4.1%), technical issues (n = 31; 41.8%), or transport-related issues (n = 4; 5.4%). Five cases appeared in multiple categories. The most frequently reported adverse events were of cells being unused. Many of these cases were caused by the uncoupling of the donation and transplantation consequent on the cryopreservation of products, as well as technical issues related to cell viability. Experience in some registries suggests that these issues have become less frequent as transplantation centers have become used to the changes in practice. Lessons learned include the importance of confirming recipient eligibility before the start of donor mobilization or collection and of minimizing the time between cell collection and transplantation. Transplantation centers should familiarize themselves with the expected cell losses when peripheral blood stem cell and bone marrow products are cryopreserved and should have validated viability assays in place for quality assurance. Reassuringly, there were no reports of donors becoming severely unwell because of G-CSF or transmission of SARS-CoV-2 to recipients and only 1 report of complete failure of transport of a donation.

The relationship between urban refuse with fecundity and nestlings' success of a generalist seabird in the Río de la Plata Estuary - Uruguay.

Resource acquisition and allocation impacts individual fitness. Using pellet analysis of breeding adults and stable isotopes of carbon and nitrogen of down feathers of Kelp Gull (Larus dominicanus) nestlings, we evaluated the relationship between urban refuse (beef and chicken) and natural food (fish) consumption of individual females during the pre-incubation period, with fecundity and young nesting's success in the Río de la Plata Estuary in Uruguay. Assimilated urban refuse positively correlated with egg weight and negatively with young nestling's success. This suggests a possible impact of urban refuse foraged by females during the pre-incubation period on their immediate fecundity (positively) and young nestling's survival (negatively). Differences between studies at the individual and colony levels are also discussed in light of an "ecological fallacy" of interpretation and we thus argue for the need of additional research to evaluate this relationship further, considering potential confounding factors.

Good Engraftment but Quality and Donor Concerns for Cryopreserved Hemopoietic Progenitor Cell Products Collected During the COVID-19 Pandemic.

Changes to donor availability, collection center capacity, and travel restrictions during the early phase of the COVID-19 pandemic led to routine cryopreservation of most unrelated donor products for hematopoietic transplantation prior to the recipient commencing the conditioning regimen. We investigated the effect of this change on unrelated donor product quality and clinical outcomes. Product information was requested from transplantation centers in Australia and New Zealand and clinical outcome data from the Australasian Bone Marrow Transplant Recipient Registry (ABMTRR). In total, 191 products were collected between April 1, 2021, and September 30, 2021, and most (74%) were from international collection centers. Median post-thaw CD34 recovery was 78% (range 25% to 176%) and median post-thaw CD34 viability was 87% (range 34% to 112%). Median time to neutrophil recovery was 17 days (interquartile range 10 to 24 days), and graft failure occurred in 6 patients (4%). These clinical outcomes were similar to those of "fresh" unrelated donor transplants reported to the ABMTRR in 2019. However, recipient transplantation centers reported problems with 29% of products in the form of damage during transit, low cell dose, inadequate labeling, missing representative samples, or missing documentation. These problems were critical in 7 cases (4%). At last follow-up, 22 products (12%) had not been infused. Routine cryopreservation of unrelated donor hemopoietic progenitor cell products has enabled safe continuation of allogeneic transplant services during the COVID-19 pandemic. However, practices for product tracing, documentation, and transportation can be optimized, and measures to reduce the incidence of unused unrelated donor product are required.

The role of pharmacy personnel in promoting adherence to antiretroviral therapy in the Eastern Cape: communication barriers and breakthroughs.

Background: Many people living with HIV struggle to adhere to their antiretroviral therapy, leading to suboptimal health outcomes and increased costs to the healthcare system. Due to their unique training and position in the health care system, South African pharmacists and pharmacy support personnel have the potential to improve adherence through effective patient counselling. However, they are often underutilised and face multiple barriers to providing these services. The aim of this study was to examine how pharmacists and pharmacy personnel view their impact upon the medication adherence behaviours of people living with and receiving medication therapy for HIV.Methods: The study used an exploratory qualitative research design. Our research team conducted in-depth interviews with 24 pharmacy personnel working in public health clinics in the Eastern Cape of South Africa, then used thematic analysis of the qualitative research data to determine the results.Results: Pharmacy personnel identified three key sets of communication challenges that limited effective patient counselling on antiretroviral therapy. These included environmental barriers presented by clinic design, language barriers between patients and pharmacy personnel, and varying communication styles and education levels of pharmacy staff and patients. Additionally, pharmacy personnel described innovative strategies they use to improve patient-provider communication and address adherence issues.Conclusions: Pharmacy personnel working in public health clinics face daily communication challenges as they attempt to provide counselling to patients with HIV. Both the clinic environment and the complex nature of HIV treatment serve as barriers to patient comprehension. In the face of these challenges, pharmacy personnel do their best to implement strategies that enhance patient counselling and address concerns about adherence. Increased attention should be paid to reducing the barriers to pharmacy-based patient counselling and utilising pharmacy personnel to enhance patient understanding and adherence to antiretroviral therapy.

Lipid profiling suggests species specificity and minimal seasonal variation in Pacific Green and Hawksbill Turtle plasma.

In this study, we applied multiple reaction monitoring (MRM)-profiling to explore the relative ion intensity of lipid classes in plasma samples from sea turtles in order to profile lipids relevant to sea turtle physiology and investigate how dynamic ocean environments affect these profiles. We collected plasma samples from foraging green (Chelonia mydas, n = 28) and hawksbill (Eretmochelys imbricata, n = 16) turtles live captured in North Pacific Costa Rica in 2017. From these samples, we identified 623 MRMs belonging to 10 lipid classes (sphingomyelin, phosphatidylcholine, free fatty acid, cholesteryl ester, phosphatidylserine, phosphatidylinositol, phosphatidylglycerol, phosphatidylethanolamine, ceramide, and triacylglyceride) and one metabolite group (acyl-carnitine) present in sea turtle plasma. The relative ion intensities of most lipids (80%) were consistent between species, across seasons, and were not correlated to body size or estimated sex. Of the differences we observed, the most pronounced was the differences in relative ion intensity between species. We identified 123 lipids that had species-specific relative ion intensities. While some of this variability is likely due to green and hawksbill turtles consuming different food items, we found indications of a phylogenetic component as well. Of these, we identified 47 lipids that varied by season, most belonging to the structural phospholipid classes. Overall, more lipids (n = 39) had higher relative ion intensity in the upwelling (colder) season compared to the non-upwelling season (n = 8). Further, we found more variability in hawksbill turtles than green turtles. Here, we provide the framework in which to apply future lipid profiling in the assessment of health, physiology, and behavior in endangered sea turtles.

Connected While Distant: Networking CUREs Across Classrooms to Create Community and Empower Students.

Connections, collaborations, and community are key to the success of individual scientists as well as transformative scientific advances. Intentionally building these components into science, technology, engineering and mathematics (STEM) education can better prepare future generations of researchers. Course-based undergraduate research experiences (CUREs) are a new, fast-growing teaching practice in STEM that expand opportunities for undergraduate students to gain research skills. Because they engage all students in a course in an authentic research experience focused on a relevant scientific problem, CUREs provide an opportunity to foster community among students while promoting critical thinking skills and positively influencing their identities as scientists. Here, we review CUREs in the biological sciences that were developed as multi-institutional networks, and highlight the benefits gained by students and instructors through participation in a CURE network. Throughout, we introduce Squirrel-Net, a network of ecology-focused and field-based CUREs that intentionally create connections among students and instructors. Squirrel-Net CUREs can also be scaffolded into the curriculum to form connections between courses, and are easily transitioned to distance-based delivery. Future assessments of networked CUREs like Squirrel-Net will help elucidate how CURE networks create community and how a cultivated research community impacts students' performance, perceptions of science, and sense of belonging. We hypothesize networked CUREs have the potential to create a broader sense of belonging among students and instructors alike, which could result in better science and more confident scientists.

Estimating Population Abundance of Burying Beetles Using Photo-Identification and Mark-Recapture Methods.

Successful conservation and management of protected wildlife populations require reliable population abundance data. Traditional capture-mark-recapture methods can be costly, time-consuming, and invasive. Photographic mark-recapture (PMR) is a cost-effective, minimally invasive way to study population dynamics in species with distinct markings or color patterns. We tested the feasibility and the application of PMR using the software Hotspotter to identify Nicrophorus spp. from digital images of naturally occurring spot patterns on their elytra. We conducted a laboratory study evaluating the identification success of Hotspotter on Nicrophorus americanus (Olivier, 1790) and Nicrophorus orbicollis (Say, 1825) before implementation of a mark-recapture study in situ. We compared the performance of Hotspotter using both 'high-quality' and 'low-quality' photographs. For high-quality photographs, Hotspotter had a false rejection rate of 2.7-3.0% for laboratory-reared individuals and 3.9% for wild-caught individuals. For low-quality photographs, the false rejection rate was much higher, 48.8-53.3% for laboratory-reared individuals and 28.3% for wild-caught individuals. We subsequently analyzed encounter histories of wild-caught individuals with closed population models in Program MARK to estimate population abundance. In our study, we demonstrated the utility of using PMR in estimating population abundance for Nicrophorus spp. based on elytral spot patterns.

Variable CD34+ recovery of cryopreserved allogeneic HPC products: transplant implications during the COVID-19 pandemic.

Donor registries and transplantation societies recommend cryopreservation of unrelated donor hemopoietic progenitor cell (HPC) products before the recipient commences conditioning therapy to mitigate the donor and travel risks associated with the COVID-19 pandemic. However, little is known regarding the postthaw quality of such allogeneic products or the effect of precryopreservation storage and processing on these characteristics. We investigated the postthaw CD34+ cell recovery and viability of 305 allogeneic HPC products cryopreserved at 9 laboratories across Australia. Median postthaw CD34+ cell recovery was 76% and ranged from 6% to 122%. Longer transit time before cryopreservation, white cell count (WCC) during storage, and complex product manipulation before cryopreservation were independently associated with inferior postthaw CD34+ cell recovery. Longer precryopreservation transit time and WCC were also associated with inferior postthaw CD34+ cell viability. We conclude that although postthaw CD34+ cell recovery and viability of cryopreserved allogeneic HPC is generally acceptable, there is a significant risk of poor postthaw product quality, associated with prolonged storage time, higher WCC, and complex product manipulation precryopreservation. Awareness of expected postthaw recovery and practices that influence it will assist collection, processing, and transplant centers in optimizing outcomes for transplant recipients.

School Nursing and Public Health: The Case for School Nurse Investigators and Contact Tracing Monitors of COVID-19 Patients in Massachusetts.

School nurses across Massachusetts and the nation rose to the challenges presented by the pandemic of the coronavirus disease 2019 (COVID-19). One of the many ways in which school nurses responded to the pandemic was to work in collaboration with their Local Boards of Health in a variety of capacities. The essential functions of a school nurse uniquely prepare them for the roles of case investigators and contact tracing monitors as a means to ensure population health. In addition to both individual and population health within the school setting, school nurses are effective partner in emergency planning and can help inform decision making and policy making within communities.

Coccidian Parasites of Flying Squirrels, Glaucomys spp. (Rodentia: Sciuridae), from Alaska and Arkansas, with a Description of a New Species of Eimeria (Apicomplexa: Eimeriidae).

New World flying squirrels, Glaucomys spp., are nocturnal arboreal sciurid rodents that have been previously surveyed for coccidial parasites. To date, 4 species of Eimeria have been reported from 2 species of Glaucomys. Here we report 2 species of eimerians from southern flying squirrels (Glaucomys volans) and the endemic Prince of Wales flying squirrel (Glaucomys sabrinus griseifrons). Oocysts of Eimeria dorneyi Levine and Ivens were found to be passing in the feces of 4 G. s. griseifrons from Alaska and a new species of Eimeria was present in feces from 6 G. volans from Arkansas. Oocysts of Eimeria hnidai n. sp. are ellipsoidal with a bilayered wall, measure 23.7 × 13.7 µm, and have a length/width (L/W) ratio of 1.7; a micropyle and oocyst residuum are absent but polar granule(s) are present. Sporocysts are ellipsoidal-elongate and measure 11.8 × 4.9 µm, L/W 2.2; Stieda body is present but sub-Stieda and para-Stieda bodies are absent. The sporocyst residuum is composed of small indistinct granules along the edge or in the center of the sporocyst. This is the first coccidian reported from G. volans from Arkansas as well as the initial coccidian (E. dorneyi) reported from G. s. griseifrons from Alaska. We also provide a summation of the coccidia known from North American flying squirrels.

Isotopic discrimination between carrion and elytra clippings of lab-reared American burying beetles (Nicrophorus americanus): Implications for conservation and evaluation of feeding relationships in the wild.

RATIONALE: Differences in stable isotope composition between an animal and its diet are quantified by experimentally derived diet-tissue discrimination factors. Appropriate discrimination factors between consumers and prey are essential for interpreting stable isotope patterns in ecological studies. While available for many taxa, these values are rarely estimated for organisms within the carrion food web. METHODS: We used a controlled-diet stable isotope feeding trial to quantify isotopic diet-tissue discrimination factors of carbon (δ13 C values) and nitrogen (δ15 N values) from laboratory-reared Nicrophorus americanus raised on carrion. We used exoskeleton samples of beetle elytra (wing covers) to determine diet-tissue discrimination factors using a continuous flow isotope ratio mass spectrometer equipped with an elemental analyzer. We also measured the isotopic compositions of five species of co-occurring, wild-caught burying beetles and evaluated feeding relationships. RESULTS: We found differences in stable carbon discrimination between carrion sources (mammalian and avian) and lab-reared beetles, but no difference in stable nitrogen discrimination. Values for δ13 C did not differ among wild-caught burying beetle species, but values for δ15 N were significantly different for the three species with overlapping breeding seasons. Furthermore, wild-caught burying beetles within our study area do not appear to use avian carrion resources to rear their young. CONCLUSIONS: This study informs future interpretation of stable isotope data for insects within the carrion food web. In addition, these results provide insight into carrion resources used by co-occurring burying beetle species in situ. We also demonstrated that independent of adult food type, the larval food source has a significant impact on the isotopic signatures of adult beetles, which can be estimated using a minimally invasive elytra clipping.

rKIN: Kernel-based method for estimating isotopic niche size and overlap.

The isotopic niche of consumers represents biologically relevant information on resource and habitat use. Several tools have been developed to quantify niche size and overlap. Nonetheless, methods adapted by spatial ecologists to quantify animal home ranges can be modified for use in stable isotope ecology when data are not normally distributed in bivariate space. We offer a tool that draws on existing spatial metrics, such as minimum convex polygon (MCP) and standard ellipse area (SEA), and add novel metrics using kernel utilization density (KUD) estimators to measure isotopic niche size and overlap. We present examples using empirical and simulated data to demonstrate the performance of the package kernel isotopic niches in r (rKIN) under various scenarios. Results of niche size from MCP, SEA and KUD were highly correlated but divergent among datasets. Overall, the KUD method produced the largest niche sizes and was more sensitive to the distribution of the isotopic data. Pairwise estimates of overlap were highly variable, likely because MCP and SEA inherently include or exclude unused areas in the resulting niche estimate. Four bandwidth methods (reference, normal scale, plug-in and biased cross-validation) produced comparable estimates of niche size and overlap at various sample sizes (10-40). Niche size and overlap were consistent across sample sizes >15. Use of rKIN will allow isotope ecologists to quantify niche shifts, expansions or contractions, as well as assess the performance of several estimation methods. The package also can be applied to other data types (e.g. principal component analysis, multi-dimensional scaling) so long as axes and measurement units are identical and can be converted to Cartesian coordinates.

The impact of anthropogenic food subsidies on a generalist seabird during nestling growth.

Anthropogenic food subsidies, such as refuse, are an important driver of animal population changes and gulls heavily forage on this food source. Foraging on refuse during the rearing period could affect the acquisition of resources with potential demographic consequences. Using conventional diet analysis and stable isotopes of δ13C and δ15N of blood of Kelp Gull (Larus dominicanus) nestlings, we studied the variation of the chick growth in response to foraging on refuse on a reproductive colony in the Rio de la Plata Estuary in Uruguay. Using Bayesian mixing models on isotopic data, we estimated the proportion and variation of natural food and refuse in the diet of nestlings. Then, we modelled the variation between the mean posterior densities of the food sources and their standard deviation with the nestling morphometric measurements of different sizes. We found that refuse was gradually delivered to Kelp Gull nestlings during the chick rearing period. Additionally, variation of refuse incorporated into nestling tissues increased with nestlings' size. We propose that parents use more isotopically unique food sources during the nestling growth thereby increasing isotopic diversity. This study highlights the need to improve the current waste management system, which is being reviewed in Uruguay. We believe that decision makers should consider the results of this study, which show that refuse is directly impacting coastal ecosystems through mechanisms poorly explored by the environmental sciences.

Functional and numerical responses of shrews to competition vary with mouse density.

For decades, ecologists have debated the importance of biotic interactions (e.g., competition) and abiotic factors in regulating populations. Competition can influence patterns of distribution, abundance, and resource use in many systems but remains difficult to measure. We quantified competition between two sympatric small mammals, Keen's mice (Peromyscus keeni) and dusky shrews (Sorex monticolus), in four habitat types on Prince of Wales Island in Southeast Alaska. We related shrew density to that of mice using standardized regression models while accounting for habitat variables in each year from 2010-2012, during which mice populations peaked (2011) and then crashed (2012). Additionally, we measured dietary overlap and segregation using stable isotope analysis and kernel utilization densities and estimated the change in whole community energy consumption among years. We observed an increase in densities of dusky shrews after mice populations crashed in 2012 as expected under competitive release. In addition, competition coefficients revealed that the influence of Keen's mice was dependent on their density. Also in 2012, shrew diets shifted, indicating that they were able to exploit resources previously used by mice. Nonetheless, increases in shrew numbers only partially compensated for the community energy consumption because, as insectivores, they are unlikely to utilize all food types consumed by their competitors. In pre-commercially thinned stands, which exhibit higher diversity of resources compared to other habitat types, shrew populations were less affected by changes in mice densities. These spatially and temporally variable interactions between unlikely competitors, observed in a relatively simple, high-latitude island ecosystem, highlight the difficulty in assessing the role of biotic factors in structuring communities.

INTERSPECIFIC COMPARISON OF HANTAVIRUS PREVALENCE IN PEROMYSCUS POPULATIONS FROM A FRAGMENTED AGRO-ECOSYSTEM IN INDIANA, USA.

Comparatively little is known about hantavirus prevalence within rodent populations from the Midwestern US, where two species of native mice, the prairie deer mouse ( Peromyscus maniculatus bairdii) and the white-footed mouse ( Peromyscus leucopus noveboracensis), are dominant members of rodent communities. We sampled both species in central Indiana and tested individuals for presence of hantavirus antibodies to determine whether seroprevalence (percent of individuals with antibodies reactive to Sin Nombre virus antigen) differed between species, or among different habitat types within fragmented agro-ecosystems. Prevalence of hantavirus antibodies varied significantly between species, with seroprevalence in prairie deer mice (21.0%) being nearly four times higher than in white-footed mice (5.5%). Seroprevalence was almost eight times higher within the interior of row-crop fields (37.7%) occupied solely by prairie deer mouse populations, relative to field edges (5.2%) or adjacent forest habitat (6.1%). In the fragmented Midwestern agro-ecosystem of this study, prairie deer mice appear to be the dominant hantavirus reservoir, with particularly high seroprevalence in populations within the interior of row-crop fields.

Estimating leaf area index in Southeast Alaska: a comparison of two techniques.

The relationship between canopy structure and light transmission to the forest floor is of particular interest for studying the effects of succession, timber harvest, and silviculture prescriptions on understory plants and trees. Indirect measurements of leaf area index (LAI) estimated using gap fraction analysis with linear and hemispheric sensors have been commonly used to assess radiation interception by the canopy, although the two methods often yield inconsistent results. We compared simultaneously obtained measurements of LAI from a linear ceptometer and digital hemispheric photography in 21 forest stands on Prince of Wales Island, Alaska. We assessed the relationship between these estimates and allometric LAI based on tree diameter at breast height (LAIDBH). LAI values measured at 79 stations in thinned, un-thinned controls, old-growth and clearcut stands were highly correlated between the linear sensor (AccuPAR) and hemispheric photography, but the latter was more negatively biased compared to LAIDBH. In contrast, AccuPAR values were more similar to LAIDBH in all stands with basal area less than 30 m(2)ha(-1). Values produced by integrating hemispheric photographs over the zenith angles 0-75° (Ring 5) were highly correlated with those integrated over the zenith angles 0-60° (Ring 4), although the discrepancies between the two measures were significant. On average, the AccuPAR estimates were 53% higher than those derived from Ring 5, with most of the differences in closed canopy stands (unthinned controls and old-growth) and less so in clearcuts. Following typical patterns of canopy closure, AccuPAR LAI values were higher in dense control stands than in old-growth, whereas the opposite was derived from Ring 5 analyses. Based on our results we advocate the preferential use of linear sensors where canopy openness is low, canopies are tall, and leaf distributions are clumped and angles are variable, as is common in the conifer forests of coastal Alaska.

Emergency preparedness: school nurses leading the way.

Nurses are trained to think in terms of the nursing process, which encompasses the five steps of assessment, diagnosis, outcomes/planning, implementation, and evaluation. Cities and towns have developed emergency plans based on the "all-hazards" approach. School district plans are also formulated based on the all-hazards approach of hazard mitigation, preparedness, response, and recovery, which mirrors the nursing process. Individual school efforts focus on thesefourprinciples to facilitate development of a comprehensive plan for each school. Utilizing the principles of education, collaboration, resource utilization, leadership, and advocacy throughout the evolution of an updated and functional plan allows for an inclusive and adaptable plan. Like the nursing process, these steps are not separate and distinct, but a continuous process.

Quadrupedal locomotor performance in two species of arboreal squirrels: predicting energy savings of gliding.

Gliding allows mammals to exploit canopy habitats of old-growth forests possibly as a means to save energy. To assess costs of quadrupedal locomotion for a gliding arboreal mammal, we used open-flow respirometry and a variable-speed treadmill to measure oxygen consumption and to calculate cost of transport, excess exercise oxygen consumption, and excess post-exercise oxygen consumption for nine northern flying squirrels (Glaucomys sabrinus) and four fox squirrels (Sciurus niger). Our results indicate that oxygen consumption during exercise by flying squirrels was 1.26-1.65 times higher than predicted based on body mass, and exponentially increased with velocity (from 0.84 ± 0.03 ml O(2) kg(-1) s(-1) at 0.40 m s(-1) to 1.55 ± 0.03 ml O(2) kg(-1) s(-1) at 0.67 m s(-1)). Also, cost of transport in flying squirrels increased with velocity, although excess exercise oxygen consumption and excess post-exercise oxygen consumption did not. In contrast, oxygen consumption during exercise for fox squirrels was similar to predicted, varying from 0.51 (±0.02) ml O(2) kg(-1) s(-1) at 0.63 m s(-1) to 0.54 (±0.03) ml O(2) kg(-1) s(-1) at 1.25 m s(-1). In addition, the cost of transport for fox squirrels decreased with velocity, while excess exercise oxygen consumption and excess post-exercise oxygen consumption did not. Collectively, these observations suggest that unlike fox squirrels, flying squirrels are poorly adapted to prolonged bouts of quadrupedal locomotion. The evolution of skeletal adaptations to climbing, leaping, and landing and the development of a gliding membrane likely has increased the cost of quadrupedal locomotion by >50% while resulting in energy savings during gliding and reduction in travel time between foraging patches.

Health care clinicians in sexual health medicine: focus on erectile dysfunction.

A consensus guidelines model was developed for managing erectile dysfunction (ED) by urology nurses and other health care clinicians. The model emphasizes identification of ED in all males older than 40, education and counseling as keys to intervention, and inclusion of partners whenever possible. These guidelines are intended to provide a comprehensive care model for ED patients and their partners, which would be optimally cost effective and clinically relevant. If successful, this new model will allow quality sexual health care to be provided to increasing numbers of patients and their partners.

Development of pancytopenia with neutralizing antibodies to thrombopoietin after multicycle chemotherapy supported by megakaryocyte growth and development factor.

Clinical trials of thrombopoietin (TPO), the central regulator of megakaryocytopoiesis, have revealed few side effects associated with its use. We here report a case of pancytopenia associated with the development of neutralizing antibodies to TPO that occurred in a patient who had undergone multicycle chemotherapy with multiple cycles of subcutaneous administration of pegylated recombinant human megakaryocyte growth and development factor. Samples of the patient's bone marrow showed trilineage hypoplasia with absence of myeloid, erythroid, and megakaryocyte progenitor cells but with elevated endogenous levels of erythropoietin, granulocyte colony-stimulating factor, and stem-cell factor. To our knowledge, this is the first report of an aplastic anemia-like syndrome associated with neutralizing antibodies to TPO.