Effect of heterologous expression of FT gene from Medicago truncatula in growth and flowering behavior of olive plants.

Olive (Olea europaea L. subsp. europaea) is one of the most important crops of the Mediterranean Basin and temperate areas worldwide. Obtaining new olive varieties adapted to climatic changing conditions and to modern agricultural practices, as well as other traits such as biotic and abiotic stress resistance and increased oil quality, is currently required; however, the long juvenile phase, as in most woody plants, is the bottleneck in olive breeding programs. Overexpression of genes encoding the 'florigen' Flowering Locus T (FT), can cause the loss of the juvenile phase in many perennials including olives. In this investigation, further characterization of three transgenic olive lines containing an FT encoding gene from Medicago truncatula, MtFTa1, under the 35S CaMV promoter, was carried out. While all three lines flowered under in vitro conditions, one of the lines stopped flowering after acclimatisation. In soil, all three lines exhibited a modified plant architecture; e.g., a continuous branching behaviour and a dwarfing growth habit. Gene expression and hormone content in shoot tips, containing the meristems from which this phenotype emerged, were examined. Higher levels of OeTFL1, a gene encoding the flowering repressor TERMINAL FLOWER 1, correlated with lack of flowering. The branching phenotype correlated with higher content of salicylic acid, indole-3-acetic acid and isopentenyl adenosine, and lower content of abscisic acid. The results obtained confirm that heterologous expression of MtFTa1 in olive induced continuous flowering independently of environmental factors, but also modified plant architecture. These phenotypical changes could be related to the altered hormonal content in transgenic plants.

Closing the disparity gap and optimizing advanced hepatocellular carcinoma care in the hispanic community.

Content available: Author Interview and Audio Recording.

Laboratory Value-Based Innovation in Heart Failure Improves Patient Health-Related Outcomes.

BACKGROUND: NT-proBNP is emerging as a novel tool for improving management of patients with heart failure (HF). The concept of health-related outcomes as the primary endpoint for therapeutic intervention in chronic disease, such as HF, should be the focal point going forward. METHODS: We conducted a prospective real-world study in heart failure with reduced ejection fraction (HFrEF) patients. The main target was to evaluate the impact on patient's health-related outcomes of a personalized medical follow-up procedure, based on a laboratory model of risk stratification supported by NT-proBNP. One hundred and five consecutive patients admitted to the Hospital Heart-Failure unit were stratified into three groups (low, medium, and high risk) and prospective follow-ups during the 12 months post discharge. RESULTS: It was found that patients under this new approach experienced early and robust improvements in patient health-related outcomes with consistency in most domains which persisted beyond 12 months post follow-up. Improvements in health related quality of life score (HRQLS) was observed over the time of the study. After 6 months we found a significant improvement in HRQLS of 18.2% (from 76.5 ± 22.4 to 95.0 ± 15.7) and 14.4% (from 76.5 ± 22.4 to 96.3 ± 15.9) after 12 months of follow-up (p < 0.001). The highest improvements were found in the symptom severity domain where patients reported an improvement of 22.6% after 6 months and 18.9% after 12 months (p < 0.001). The lowest scores were reported in the physical domain with increase of 11.0% and 4.3% after 6 months and 12 months (p = 0.089). Psychosocial domain and the ability to carry out the activities of normal life showed improvement as well. CONCLUSIONS: Our strategy based on NT-proBNP optimizes HFrEF management and represents a major new approach for clinical laboratories to improve patient health-related outcomes in HFrEF.

Modification of 13-hydroperoxide lyase expression in olive affects plant growth and results in altered volatile profile.

The C6 aldehydes, alcohols, and the corresponding esters are the most important compounds of virgin olive oil aroma. These C6 volatile compounds are synthesized via the 13-hydroperoxide lyase (13-HPL) branch of the lipoxygenase pathway. In this investigation, a functional analysis of the olive (Olea europaea L.) 13-HPL gene by its overexpression and silencing in olive transgenic lines was carried out. With this aim, sense and RNAi constructs of the olive 13-HPL gene were generated and used for the transformation of embryogenic olive cultures. Leaves from overexpressing lines showed a slight increase in 13-HPL gene expression, whereas RNAi lines exhibited a strong decrease in their transcript levels. Quantification of 13-HPL activity in two overexpressing and two RNAi lines showed a positive correlation with levels of transcripts. Interestingly, RNAi lines showed a high decrease in the content of C6 volatiles linked to a strong increase of C5 volatile compounds, altering the volatile profile in the leaves. In addition, the silencing of the 13-HPL gene severely affected plant growth and development. This investigation demonstrates the role of the 13-HPL gene in the biogenesis of olive volatile compounds and constitutes a functional genomics study in olive related to virgin olive oil quality.

Physiological and Molecular Responses of 'Dusa' Avocado Rootstock to Water Stress: Insights for Drought Adaptation.

Avocado consumption is increasing year by year, and its cultivation has spread to many countries with low water availability, which threatens the sustainability and profitability of avocado orchards. However, to date, there is not much information on the behavior of commercial avocado rootstocks against drought. The aim of this research was to evaluate the physiological and molecular responses of 'Dusa' avocado rootstock to different levels of water stress. Plants were deficit irrigated until soil water content reached 50% (mild-WS) and 25% (severe-WS) of field capacity. Leaf water potential (Ψw), net CO2 assimilation rates (AN), transpiration rate (E), stomatal conductance (gs), and plant transpiration rates significantly decreased under both WS treatments, reaching significantly lower values in severe-WS plants. After rewatering, mild- and severe-WS plants showed a fast recovery in most physiological parameters measured. To analyze root response to different levels of drought stress, a cDNA avocado stress microarray was carried out. Plants showed a wide transcriptome response linked to the higher degree of water stress, and functional enrichment of differentially expressed genes (DEGs) revealed abundance of common sequences associated with water stress, as well as specific categories for mild-WS and severe-WS. DEGs previously linked to drought tolerance showed overexpression under both water stress levels, i.e., several transcription factors, genes related to abscisic acid (ABA) response, redox homeostasis, osmoprotection, and cell-wall organization. Taken altogether, physiological and molecular data highlight the good performance of 'Dusa' rootstock under low-water-availability conditions, although further water stress experiments must be carried out under field conditions.

Reinvigoration/Rejuvenation Induced through Micrografting of Tree Species: Signaling through Graft Union.

Trees have a distinctive and generally long juvenile period during which vegetative growth rate is rapid and floral organs do not differentiate. Among trees, the juvenile period can range from 1 year to 15-20 years, although with some forest tree species, it can be longer. Vegetative propagation of trees is usually much easier during the juvenile phase than with mature phase materials. Therefore, reversal of maturity is often necessary in order to obtain materials in which rooting ability has been restored. Micrografting has been developed for trees to address reinvigoration/rejuvenation of elite selections to facilitate vegetative propagation. Generally, shoots obtained after serial grafting have increased rooting competence and develop juvenile traits; in some cases, graft-derived shoots show enhanced in vitro proliferation. Recent advances in graft signaling have shown that several factors, e.g., plant hormones, proteins, and different types of RNA, could be responsible for changes in the scion. The focus of this review includes (1) a discussion of the differences between the juvenile and mature growth phases in trees, (2) successful restoration of juvenile traits through micrografting, and (3) the nature of the different signals passing through the graft union.

Biomarkers-based personalized follow-up in chronic heart failure improves patient's outcomes and reduces care associate cost.

BACKGROUND: Heart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF with a reduced left ventricular ejection fraction (HFrEF). METHODS: This is a before and after interventional study, that assesses the impact of a personalized follow-up procedure for HF on patient's outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before the intervention and again after the intervention. The primary objective was the rate of readmissions, due to a HF. Secondary outcome compared the rate of ED visits and quality of life improvement assessed by the number of patients who had reduced NYHA score. A cost-analysis was also performed on these data. RESULTS: Admission rates significantly decreased by 19.8% after the intervention (from 30.2 to 10.4), the total hospital admissions were reduced by 32 (from 78 to 46) and the total length of stay was reduced by 7 days (from 15 to 9 days). The rate of ED visits was reduced by 44% (from 64 to 20). Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was € 72,769 per patient (from € 201,189 to € 128,420) and €139,717.65 for the whole group over 1 year. CONCLUSIONS: A personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care-associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.

Olive (Olea europaea L.) Genetic Transformation: Current Status and Future Prospects.

Olive (Olea europaea L.) is the most characteristic and important oil crop of the Mediterranean region. Traditional olive cultivation is based on few tens cultivars of ancient origin. To improve this crop, novel selections with higher tolerance to biotic and abiotic stress, adaptable to high-density planting systems and resilient to climate change are needed; however, breeding programs are hindered by the long juvenile period of this species and few improved genotypes have been released so far. Genetic transformation could be of great value, in the near future, to develop new varieties or rootstocks in a shorter time; in addition, it has currently become an essential tool for functional genomic studies. The recalcitrance of olive tissues to their in vitro manipulation has been the main bottleneck in the development of genetic transformation procedures in this species; however, some important traits such as fungal resistance, flowering or lipid composition have successfully been manipulated through the genetic transformation of somatic embryos of juvenile or adult origin, providing a proof of the potential role that this technology could have in olive improvement. However, the optimization of these protocols for explants of adult origin is a prerequisite to obtain useful materials for the olive industry. In this review, initially, factors affecting plant regeneration via somatic embryogenesis are discussed. Subsequently, the different transformation approaches explored in olive are reviewed. Finally, transgenic experiments with genes of interest undertaken to manipulate selected traits are discussed.

Verticillium dahliae Inoculation and in vitro Propagation Modify the Xylem Microbiome and Disease Reaction to Verticillium Wilt in a Wild Olive Genotype.

Host resistance is the most practical, long-term, and economically efficient disease control measure for Verticillium wilt in olive caused by the xylem-invading fungus Verticillium dahliae (Vd), and it is at the core of the integrated disease management. Plant's microbiome at the site of infection may have an influence on the host reaction to pathogens; however, the role of xylem microbial communities in the olive resistance to Vd has been overlooked and remains unexplored to date. This research was focused on elucidating whether in vitro olive propagation may alter the diversity and composition of the xylem-inhabiting microbiome and if those changes may modify the resistance response that a wild olive clone shows to the highly virulent defoliating (D) pathotype of Vd. Results indicated that although there were differences in microbial communities among the different propagation methodologies, most substantial changes occurred when plants were inoculated with Vd, regardless of whether the infection process took place, with a significant increase in the diversity of bacterial communities when the pathogen was present in the soil. Furthermore, it was noticeable that olive plants multiplied under in vitro conditions developed a susceptible reaction to D Vd, characterized by severe wilting symptoms and 100% vascular infection. Moreover, those in vitro propagated plants showed an altered xylem microbiome with a decrease in total OTU numbers as compared to that of plants multiplied under non-aseptic conditions. Overall, 10 keystone bacterial genera were detected in olive xylem regardless of infection by Vd and the propagation procedure of plants (in vitro vs nursery), with Cutibacterium (36.85%), Pseudomonas (20.93%), Anoxybacillus (6.28%), Staphylococcus (4.95%), Methylobacterium-Methylorubrum (3.91%), and Bradyrhizobium (3.54%) being the most abundant. Pseudomonas spp. appeared as the most predominant bacterial group in micropropagated plants and Anoxybacillus appeared as a keystone bacterium in Vd-inoculated plants irrespective of their propagation process. Our results are the first to show a breakdown of resistance to Vd in a wild olive that potentially may be related to a modification of its xylem microbiome and will help to expand our knowledge of the role of indigenous xylem microbiome on host resistance, which can be of use to fight against main vascular diseases of olive.

Challenges of Racism and Health Equity in Medicine.

The racial/ethnic populations in the United States, in general, have less access to quality health care and behavioral healthcare services than the Caucasian population. They face barriers to access health care access, and experience higher rates of chronic diseases and complications with heart disease, diabetes, cancer, HIV, and obesity. Increasing the number of racial/ethnic physicians is one way to build trust, provide patient-centered and cultural quality care, and attract racial/ethnic patients to healthcare services. However, the inherent structural racism of medicine and implicit bias of physicians makes this challenging. In this collection of stories from racial/ethnic physicians, trainees, and other health care providers, authors focus on the trauma they have experienced with racist patients and colleagues during their careers, yet discuss how what they have learned is important for medical education for other healthcare providers like them.

Heterologous Expression of the AtNPR1 Gene in Olive and Its Effects on Fungal Tolerance.

The NPR1 gene encodes a key component of systemic acquired resistance (SAR) signaling mediated by salicylic acid (SA). Overexpression of NPR1 confers resistance to biotrophic and hemibiotrophic fungi in several plant species. The NPR1 gene has also been shown to be involved in the crosstalk between SAR signaling and the jasmonic acid-ethylene (JA/Et) pathway, which is involved in the response to necrotrophic fungi. The aim of this research was to generate transgenic olive plants expressing the NPR1 gene from Arabidopsis thaliana to evaluate their differential response to the hemibiotrophic fungus Verticillium dahliae and the necrotroph Rosellinia necatrix. Three transgenic lines expressing the AtNPR1 gene under the control of the constitutive promoter CaMV35S were obtained using an embryogenic line derived from a seed of cv. Picual. After maturation and germination of the transgenic somatic embryos, the plants were micropropagated and acclimated to ex vitro conditions. The level of AtNPR1 expression in the transgenic materials varied greatly among the different lines and was higher in the NPR1-780 line. The expression of AtNPR1 did not alter the growth of transgenic plants either in vitro or in the greenhouse. Different levels of transgene expression also did not affect basal endochitinase activity in the leaves, which was similar to that of control plants. Response to the hemibiotrophic pathogen V. dahliae varied with pathotype. All plants died by 50 days after inoculation with defoliating (D) pathotype V-138, but the response to non-defoliating (ND) strains differed by race: following inoculation with the V-1242 strain (ND, race 2), symptoms appeared after 44-55 days, with line NPR1-780 showing the lowest disease severity index. This line also showed good performance when inoculated with the V-1558 strain (ND, race 1), although the differences from the control were not statistically significant. In response to the necrotroph R. necatrix, all the transgenic lines showed a slight delay in disease development, with mean area under the disease progress curve (AUDPC) values 7-15% lower than that of the control.

Medical Spanish Standardization in U.S. Medical Schools: Consensus Statement From a Multidisciplinary Expert Panel.

Medical Spanish (MS) education is in growing demand from U.S. medical students, providers, and health systems, but there are no standard recommendations for how to structure the curricula, evaluate programs, or assess provider performance or linguistic competence. This gap in medical education and assessment jeopardizes health care communication with Hispanic/Latino patients and poses significant quality and safety risks. The National Hispanic Health Foundation and University of Illinois College of Medicine convened a multidisciplinary expert panel in March 2018 to define national standards for the teaching and application of MS skills in patient-physician communication, establish curricular and competency guidelines for MS courses in medical schools, propose best practices for MS skill assessment and certification, and identify next steps needed for the implementation of the proposed national standards. Experts agreed on the following consensus recommendations: (1) create a Medical Spanish Taskforce to, among other things, define educational standards; (2) integrate MS educational initiatives with government-funded research and training efforts as a strategy to improve Hispanic/Latino health; (3) standardize core MS learner competencies; (4) propose a consensus core curricular structure for MS courses in medical schools; (5) assess MS learner skills through standardized patient encounters and develop a national certification exam; and (6) develop standardized evaluation and data collection processes for MS programs. MS education and assessment should be standardized and evaluated with a robust interinstitutional medical education research strategy that includes collaboration with multidisciplinary stakeholders to ensure linguistically appropriate care for the growing Spanish-speaking U.S. population.

The Invisible US Hispanic/Latino HIV Crisis: Addressing Gaps in the National Response.

The federal government has proposed an end to HIV transmission in the United States by 2030. Although the United States has made substantial overall progress in the fight against HIV/AIDS, data released by the Centers for Disease Control and Prevention have raised concerns about widening, yet largely unrecognized, HIV infection disparities among Hispanic and Latino populations.This commentary identifies underlying drivers of increasing new HIV infections among Hispanics/Latinos, discusses existing national efforts to fight HIV in Hispanic/Latino communities, and points to gaps in the federal response. Consideration of the underlying drivers of increased HIV incidence among Hispanics/Latinos is warranted to achieve the administration's 2030 HIV/AIDS goals.Specifically, the proposed reinforcement of national efforts to end the US HIV epidemic must include focused investment in four priority areas: (1) HIV stigma reduction in Hispanic/Latino communities, (2) the availability and accessibility of HIV treatment of HIV-positive Hispanics/Latinos, (3) the development of behavioral interventions tailored to Hispanic/Latino populations, and (4) the engagement of Hispanic/Latino community leaders.

Generation and Selection of Transgenic Olive Plants.

Olive (Olea europaea L.) is one of the most important oil crops in the Mediterranean basin. Biotechnological improvement of this species is hampered by the recalcitrant nature of olive tissue to regenerate in vitro. In previous investigations, our group has developed a reliable Agrobacterium-mediated transformation protocol using olive somatic embryos as explants ( Torreblanca et al., 2010 ). Embryogenic cultures derived from radicles of matured zygotic embryos are infected with Agrobacterium tumefaciens, AGL1 strain, containing a binary plasmid with the gene of interest and the nptII selection gene. After a meticulous selection procedure, carried out using solid and liquid media supplemented with paromomycin, the putative transformed lines are established. A preliminary confirmation of their transgenic nature is carried out through PCR amplification. Afterwards, plants can be obtained through an efficient regeneration protocol, whose main characteristics are the use of a low-ionic-strength mineral formulation, a phase in liquid medium for synchronization of cultures and the use of semi-permeable cellulose acetate membranes for embryo maturation ( Cerezo et al., 2011 ). Final confirmation of transgene insertion is carried out through Southern or Northern analysis using leaf samples of regenerated plants.

Recommendations for a national agenda to substantially reduce cervical cancer.

PURPOSE: Prophylactic human papillomavirus (HPV) vaccines and new HPV screening tests, combined with traditional Pap test screening, provide an unprecedented opportunity to greatly reduce cervical cancer in the USA. Despite these advances, thousands of women continue to be diagnosed with and die of this highly preventable disease each year. This paper describes the initiatives and recommendations of national cervical cancer experts toward preventing and possibly eliminating this disease. METHODS: In May 2011, Cervical Cancer-Free America, a national initiative, convened a cervical cancer summit in Washington, DC. Over 120 experts from the public and private sector met to develop a national agenda for reducing cervical cancer morbidity and mortality in the USA. RESULTS: Summit participants evaluated four broad challenges to reducing cervical cancer: (1) low use of HPV vaccines, (2) low use of cervical cancer screening, (3) screening errors, and (4) lack of continuity of care for women diagnosed with cervical cancer. The summit offered 12 concrete recommendations to guide future national and local efforts toward this goal. CONCLUSIONS: Cervical cancer incidence and mortality can be greatly reduced by better deploying existing methods and systems. The challenge lies in ensuring that the array of available prevention options are accessible and utilized by all age-appropriate women-particularly minority and underserved women who are disproportionately affected by this disease. The consensus was that cervical cancer can be greatly reduced and that prevention efforts can lead the way towards a dramatic reduction in this preventable disease in our country.

Pandemic influenza preparedness and response among immigrants and refugees.

Some immigrants and refugees might be more vulnerable than other groups to pandemic influenza because of preexisting health and social disparities, migration history, and living conditions in the United States. Vulnerable populations and their service providers need information to overcome limited resources, inaccessible health services, limited English proficiency and foreign language barriers, cross-cultural misunderstanding, and inexperience applying recommended guidelines. To increase the utility of guidelines, we searched the literature, synthesized relevant findings, and examined their implications for vulnerable populations and stakeholders. Here we summarize advice from an expert panel of public health scientists and service program managers who attended a meeting convened by the Centers for Disease Control and Prevention, May 1 and 2, 2008, in Atlanta, Georgia.

Physician gender differences in general and cancer-specific prevention attitudes and practices.

BACKGROUND: Findings are inconsistent regarding physician gender differences in general prevention practices and cancer-specific attitudes and practices. METHODS: We analyzed cross-sectional data from randomly selected physicians (N = 722) to test associations of gender with prevention practices and attitudes. RESULTS: Chi-square analyses (P < .05) showed gender differences for 14% (7/49) of the general and cancer-specific practices and attitudes tested. Multivariate analyses revealed that gender significantly (P < .05) predicted general prevention practices and cancer-specific attitudes in 4 models. Female gender predicted discussion of physical activity, violence, and use of substances. Male gender predicted belief in effectiveness of prostate-specific antigen screening. CONCLUSIONS: Overall, male and female physicians showed more similarities than differences, but physician gender was associated with a number of important general and cancer-specific prevention services. Female physicians were more likely to discuss general health prevention activities than male physicians, especially issues considered sensitive. We discuss implications for research and education.

Kidney disease in the Hispanic population: facing the growing challenge.

The incidence of kidney disease in the United States is rising at a steady, alarming pace. The growth rate has been particularly rapid for end-stage renal disease (ESRD), which has been reported to double every 10 years. Of even greater concern is the emergence of striking racial disparities in the prevalence, morbidity, and mortality of kidney disease, and in the provision of optimal care to prevent or slow progression of the disease. Hispanics, who are among the fastest-growing racial groups in the United States, are twice as likely to develop kidney failure as non-Hispanic whites, largely due to the increased prevalence of diabetes mellitus in the Hispanic population. However, Hispanic patients are less likely than the general U.S. population to be screened for risk factors for kidney disease or receive optimal treatment after diagnosis. Several actions are required to redress these racial inequalities. Improved cultural sensitivity on the part of physicians is fundamentally important, as are patient education programs targeted specifically at the diverse Hispanic groups. In addition, local initiatives should be supported on a wider scale by healthcare policymakers to encourage improved medical care within Hispanic communities and thereby reduce the burden of kidney disease on American society as a whole.