Twenty-year record of white pox disease in the Florida Keys: importance of environmental risk factors as drivers of coral health.

Declining coral populations worldwide place a special premium on identifying risks and drivers that precipitate these declines. Understanding the relationship between disease outbreaks and their drivers can help to anticipate when the risk of a disease pandemic is high. Populations of the iconic branching Caribbean elkhorn coral Acropora palmata have collapsed in recent decades, in part due to white pox disease (WPX). To assess the role that biotic and abiotic factors play in modulating coral disease, we present a predictive model for WPX in A. palmata using 20 yr of disease surveys from the Florida Keys plus environmental information collected simultaneously in situ and via satellite. We found that colony size was the most influential predictor for WPX occurrence, with larger colonies being at higher risk. Water quality parameters of dissolved oxygen saturation, total organic carbon, dissolved inorganic nitrogen, and salinity were implicated in WPX likelihood. Both low and high wind speeds were identified as important environmental drivers of WPX. While high temperature has been identified as an important cause of coral mortality in both bleaching and disease scenarios, our model indicates that the relative influence of HotSpot (positive summertime temperature anomaly) was low and actually inversely related to WPX risk. The predictive model developed here can contribute to enabling targeted strategic management actions and disease surveillance, enabling managers to treat the disease or mitigate disease drivers, thereby suppressing the disease and supporting the persistence of corals in an era of myriad threats.

Nutritional adequacy and the role of supplements in the diets of Indigenous Australian women during pregnancy.

OBJECTIVE: To determine sources of key nutrients contributing towards nutritional adequacy during pregnancy (fibre, calcium, iron, zinc and folate) in a cohort of women carrying an Indigenous child. DESIGN: Analysis of cross-sectional data from a prospective longitudinal cohort study that followed Indigenous women through pregnancy. SETTING: Women recruited via antenatal clinics in regional and remote locations in NSW, Australia as part of the Gomeroi gaaynggal project. PARTICIPANTS: One hundred and fifty-two pregnant Australian women who identified as Indigenous or carrying an Indigenous child. MEASUREMENTS AND FINDINGS: Measurement outcomes included demographic information, smoking status, anthropometrics (weight and height,), self-reported pre-pregnancy weight, health conditions and dietary information (24-hour food recall). Findings indicate the inadequate intake of key pregnancy nutrients in this cohort. Supplements contributed to the nutrient adequacy of the cohort with 53% reporting use. As expected, predominant sources of fibre were from core food groups, whereas calcium was attained from a range of sources including food and beverages, with small amounts from supplementation. Importantly, supplements contributed significant amounts of iron, zinc and folate. KEY CONCLUSIONS: There is limited literature on Indigenous Australian maternal nutrition. This study highlights the key dietary contributors of nutritional adequacy during pregnancy for the cohort and that supplementation may be considered a viable source of nutrients during pregnancy for these women. Few women met national nutrient recommendations. The findings present an opportunity to optimise nutrient intakes of Indigenous pregnant women. IMPLICATIONS FOR PRACTICE: Culturally appropriate targeted interventions to optimise dietary intakes of Indigenous Australian pregnant women is required. Collaborative support of health workers, Indigenous Australian communities, dietitians, and researchers to raise awareness of nutrition during pregnancy is imperative to achieving nutrient targets and optimising pregnancy outcomes. Targeted interventions provide positive opportunities to achieve improvements.

Contraception usage and the desired number of offspring of Indigenous women from the Gomeroi lands.

OBJECTIVES: To describe the current contraception usage patterns from a cohort of Australian Indigenous women, including their ideal family size and spacing between children. DESIGN: Cross-sectional analysis of data (2012-2019). SETTING: Data are from a longitudinal study, the Gomeroi gaaynggal (babies from Gomeroi lands) program, based in rural and remote Gomeroi lands in New South Wales. PARTICIPANTS: Women carrying an Indigenous baby who enrolled during pregnancy were eligible for the study. The mother and child are then followed for up to 10 years. MAIN OUTCOME MEASURES: Contraception usage in the postnatal period was recorded, as well as whether they were sexually active, whether they wanted more children and their preferred spacing between children. Medical, social and demographic information was also collected. These measures were self-reported via an online tool (Survey Monkey® ) at their first visit to the study following the birth of their child. RESULTS: Ninety-nine women were included in the analysis. Most women reported that they were sexually active at the time they were questioned about their contraceptive usage. The most popular contraception choices were condoms, the oral contraceptive pill and implant rods. Those answering that they did not want more children had a median of three children already. Those who wanted more children had a median of one child. The majority of the women stated that 2-3 years between babies was ideal. CONCLUSION: The sampled women had clear beliefs about their ideal family size, in which contraceptive usage played an important part.

Benefits, barriers, and incentives for improved resilience to disruption in university teaching.

Pandemics, earthquakes, fire, war, and other disasters place universities at risk. Disasters can disrupt learning and teaching (L&T) for weeks to months or longer. Some institutions have developed business continuity plans to protect key organisational services and structures, allowing L&T to continue. However, little research touches on how academics, learners, and communities of practice might respond before, during, and after disasters and how their resilience to disruption can be fostered to reduce impacts on L&T. In this research, we investigated academics' perceptions of building resilience to major L&T disruptions in the New Zealand context. Specifically, we explored how academics characterise a resilient academic and institution, and identified the benefits, barriers, and incentives to building resilience. We used a pragmatic theoretical approach with a mixed methods methodology, to categorise the results within three distinct levels (individual, school/department, and institution), supporting the design and implementation of resilience-building strategies for academics and institutional leaders. We found that support, community, leadership, and planning at universities are critical in building and inhibiting resilience. Participants reported several 'high impact' incentives, addressing multiple barriers, that could be used to kick-start resilience. Online and flexible learning are key opportunities for resilience-building, but universities should not underestimate the importance of face-to-face interactions between staff and learners. Our results provide a strong starting point for practitioners and researchers aiming to understand how universities can foster resilience to major disruptions and disasters on university teaching.

The relationship between maternal adiposity during pregnancy and fetal kidney development and kidney function in infants: the Gomeroi gaaynggal study.

Maternal obesity during pregnancy has a detrimental impact on offspring renal development and function. This is pertinent to Indigenous Australians as they are twice as likely as non-Indigenous Australians to develop chronic kidney disease (CKD). The aim of this study was to examine whether there was an association between maternal adiposity and fetal kidney growth in late gestation (>28 weeks) and kidney function in infants, <2.5 years of age, from the Gomeroi gaaynggal cohort. Pre-pregnancy body mass index (BMI) was recorded at the first prenatal visit and maternal adiposity indicators (percent body fat and visceral fat area) measured at >28 weeks gestation by bioelectrical impedance analysis. Fetal kidney structure was assessed by ultrasound. Renal function indicators (urinary albumin:creatinine and protein:creatinine) were measured in infants from a spot urine collection from nappies. Multiple linear regression and multi-level mixed effects linear regression models with clustering were used to account for repeated measures of urine. 147 mother-child pairs were examined. Estimated fetal weight (EFW), but not fetal kidney size, was positively associated with maternal adiposity and pre-pregnancy BMI. When adjusted for smoking, combined kidney volume relative to EFW was negatively associated with maternal percentage body fat. Infant kidney function was not influenced by maternal adiposity and pre-pregnancy BMI (n = 84 observations). Current findings show that Indigenous babies born to obese mothers have reduced kidney size relative to EFW. We suggest that these babies are experiencing a degree of glomerular hyperfiltration in utero, and therefore are at risk of developing CKD in later life, especially if their propensity for obesity is maintained. Although no impact on renal function was observed at <2.5 years of age, long-term follow-up of offspring is required to evaluate potential later life impacts.

Draft Genome Sequences of 38 Serratia marcescens Isolates Associated with Acroporid Serratiosis.

Serratia marcescens is a Gram-negative bacterium causally linked to acroporid serratiosis, a form of white pox disease implicated in the decline of elkhorn corals. We report draft genomes of 38 S. marcescens isolates collected from host and nonhost sources. The availability of these genomes will aid future analyses of acroporid serratiosis.

Reprint of characterizing gestational weight gain in a cohort of indigenous Australian women.

OBJECTIVE: to determine the adequacy of gestational weight gain for a cohort of Indigenous Australian women and investigate whether it is associated with pre-pregnancy body mass index. DESIGN: analysis of observational data collected from a longitudinal cohort study that follows Indigenous Australian women through pregnancy. SETTING: women recruited through antenatal clinics in regional and remote towns in NSW, Australia to the Gomeroi gaaynggal program. PARTICIPANTS: 110 pregnant women who either identified as being an Indigenous Australian or as carrying an Indigenous child. MEASUREMENTS AND FINDINGS: measurements included weight and height, self-reported pre-pregnancy weight and smoking status, parity and health conditions that may contribute to gestational weight gain, such as hypertensive or diabetic disorders. Compared to the 2009 Institute of Medicine recommendations for gestational weight gain and based on pre-pregnancy body mass index, the rate of adequate gestational weight gain in this cohort was low (26%). 33% of women had inadequate weight gain and 41% had excessive weight gain. The highest rate of excessive gestational weight gain was found in overweight women (65%), with rates of 39% and 31% found in healthy and obese (all classes) categories, respectively. Parity (coefficient 4.2, p < 0.01) and hypertension (coefficient 4.3, p = 0.049) were found to be significantly associated with gestational weight gain in mixed model linear regression. CONCLUSIONS: few women gained adequate gestational weight gain in this study. Culturally acceptable ways of addressing this issue are needed for this group of women, as inadequate and excessive rates of gestational weight gain have health implications for women and their offspring. IMPLICATIONS FOR PRACTICE: a systematic approach to addressing gestational weight gain within antenatal care is required, including asking about diet and exercise, for all women identifying as Indigenous Australian.

Characterizing gestational weight gain in a cohort of Indigenous Australian women.

OBJECTIVE: to determine the adequacy of gestational weight gain for a cohort of Indigenous Australian women and investigate whether it is associated with pre-pregnancy body mass index. DESIGN: analysis of observational data collected from a longitudinal cohort study that follows Indigenous Australian women through pregnancy. SETTING: women recruited through antenatal clinics in regional and remote towns in NSW, Australia to the Gomeroi gaaynggal program. PARTICIPANTS: 110 pregnant women who either identified as being an Indigenous Australian or as carrying an Indigenous child. MEASUREMENTS AND FINDINGS: measurements included weight and height, self-reported pre-pregnancy weight and smoking status, parity and health conditions that may contribute to gestational weight gain, such as hypertensive or diabetic disorders. Compared to the 2009 Institute of Medicine recommendations for gestational weight gain and based on prepregnancy body mass index, the rate of adequate gestational weight gain in this cohort was very low (15%). 32% of women had inadequate weight gain and 54% had excessive weight gain. The highest rate of excessive gestational weight gain was found in overweight women (74%), with rates of 48% and 50% found in healthy and obese (all classes) categories, respectively. Parity (coefficient 4.5, p<0.01) and hypertension (coefficient 4.8, p = 0.04) were found to be significantly associated with gestational weight gain in mixed model linear regression. CONCLUSIONS: few women gained adequate gestational weight gain in this study. Culturally acceptable ways of addressing this issue are needed for this group of women, as inadequate and excessive rates of gestational weight gain have health implications for women and their offspring. IMPLICATIONS FOR PRACTICE: a systematic approach to addressing gestational weight gain within antenatal care is required, including asking about diet and exercise, for all women identifying as Indigenous Australian.

Shifting white pox aetiologies affecting Acropora palmata in the Florida Keys, 1994-2014.

We propose 'the moving target hypothesis' to describe the aetiology of a contemporary coral disease that differs from that of its historical disease state. Hitting the target with coral disease aetiology is a complex pursuit that requires understanding of host and environment, and may lack a single pathogen solution. White pox disease (WPX) affects the Caribbean coral Acropora palmata. Acroporid serratiosis is a form of WPX for which the bacterial pathogen (Serratia marcescens) has been established. We used long-term (1994-2014) photographic monitoring to evaluate historical and contemporary epizootiology and aetiology of WPX affecting A. palmata at eight reefs in the Florida Keys. Ranges of WPX prevalence over time (0-71.4%) were comparable for the duration of the 20-year study. Whole colony mortality and disease severity were high in historical (1994-2004), and low in contemporary (2008-2014), outbreaks of WPX. Acroporid serratiosis was diagnosed for some historical (1999, 2003) and contemporary (2012, 2013) outbreaks, but this form of WPX was not confirmed for all WPX cases. Our results serve as a context for considering aetiology as a moving target for WPX and other coral diseases for which pathogens are established and/or candidate pathogens are identified. Coral aetiology investigations completed to date suggest that changes in pathogen, host and/or environment alter the disease state and complicate diagnosis.

Complementary approaches to diagnosing marine diseases: a union of the modern and the classic.

Linking marine epizootics to a specific aetiology is notoriously difficult. Recent diagnostic successes show that marine disease diagnosis requires both modern, cutting-edge technology (e.g. metagenomics, quantitative real-time PCR) and more classic methods (e.g. transect surveys, histopathology and cell culture). Here, we discuss how this combination of traditional and modern approaches is necessary for rapid and accurate identification of marine diseases, and emphasize how sole reliance on any one technology or technique may lead disease investigations astray. We present diagnostic approaches at different scales, from the macro (environment, community, population and organismal scales) to the micro (tissue, organ, cell and genomic scales). We use disease case studies from a broad range of taxa to illustrate diagnostic successes from combining traditional and modern diagnostic methods. Finally, we recognize the need for increased capacity of centralized databases, networks, data repositories and contingency plans for diagnosis and management of marine disease.

Systematic Analysis of White Pox Disease in Acropora palmata of the Florida Keys and Role of Serratia marcescens.

White pox disease (WPD) affects the threatened elkhorn coral, Acropora palmata. Owing in part to the lack of a rapid and simple diagnostic test, there have been few systematic assessments of the prevalence of acroporid serratiosis (caused specifically by Serratia marcescens) versus general WPD signs. Six reefs in the Florida Keys were surveyed between 2011 and 2013 to determine the disease status of A. palmata and the prevalence of S. marcescens. WPD was noted at four of the six reefs, with WPD lesions found on 8 to 40% of the colonies surveyed. S. marcescens was detected in 26.9% (7/26) of the WPD lesions and in mucus from apparently healthy colonies both during and outside of disease events (9%; 18/201). S. marcescens was detected with greater frequency in A. palmata than in the overlying water column, regardless of disease status (P = 0.0177). S. marcescens could not be cultured from A. palmata but was isolated from healthy colonies of other coral species and was identified as pathogenic pulsed-field gel electrophoresis type PDR60. WPD lesions were frequently observed on the reef, but unlike in prior outbreaks, no whole-colony death was observed. Pathogenic S. marcescens was circulating on the reef but did not appear to be the primary pathogen in these recent WPD episodes, suggesting that other pathogens or stressors may contribute to signs of WPD. Results highlight the critical importance of diagnostics in coral disease investigations, especially given that field manifestation of disease may be similar, regardless of the etiological agent.

Human pathogen shown to cause disease in the threatened eklhorn coral Acropora palmata.

Coral reefs are in severe decline. Infections by the human pathogen Serratia marcescens have contributed to precipitous losses in the common Caribbean elkhorn coral, Acropora palmata, culminating in its listing under the United States Endangered Species Act. During a 2003 outbreak of this coral disease, called acroporid serratiosis (APS), a unique strain of the pathogen, Serratia marcescens strain PDR60, was identified from diseased A. palmata, human wastewater, the non-host coral Siderastrea siderea and the corallivorous snail Coralliophila abbreviata. In order to examine humans as a source and other marine invertebrates as vectors and/or reservoirs of the APS pathogen, challenge experiments were conducted with A. palmata maintained in closed aquaria to determine infectivity of strain PDR60 from reef and wastewater sources. Strain PDR60 from wastewater and diseased A. palmata caused disease signs in elkhorn coral in as little as four and five days, respectively, demonstrating that wastewater is a definitive source of APS and identifying human strain PDR60 as a coral pathogen through fulfillment of Koch's postulates. A. palmata inoculated with strain PDR60 from C. abbreviata showed limited virulence, with one of three inoculated fragments developing APS signs within 13 days. Strain PDR60 from non-host coral S. siderea showed a delayed pathogenic effect, with disease signs developing within an average of 20 days. These results suggest that C. abbreviata and non-host corals may function as reservoirs or vectors of the APS pathogen. Our results provide the first example of a marine "reverse zoonosis" involving the transmission of a human pathogen (S. marcescens) to a marine invertebrate (A. palmata). These findings underscore the interaction between public health practices and environmental health indices such as coral reef survival.

Effects of temperature, nutrients, organic matter and coral mucus on the survival of the coral pathogen, Serratia marcescens PDL100.

Serratia marcescens is an enteric bacterium that causes white pox disease in elkhorn coral, Acropora palmata; however, it remains unclear if the pathogenic strain has adapted to seawater or if it requires a host or reservoir for survival. To begin to address this fundamental issue, the persistence of strain PDL100 was compared among seawater and coral mucus microcosms. Median survival time across all conditions ranged from a low of 15 h in natural seawater [with a first-order decay constant (k) = -0.173] at 30°C to a maximum of 120 h in glucose-amended A. palmata mucus (k = -0.029) at 30°C. Among seawater and mucus microcosms, median survival time was significantly greater within Siderastrea siderea mucus compared with seawater or mucus of Montastraea faveolata or A. palmata (P < 0.0001). In seawater, the addition of phosphate and especially glucose resulted in significant improvements in survival (P < 0.001), while only the addition of glucose resulted in significant improvement in survival in A. palmata mucus (P < 0.0001). Increasing the temperature of seawater to 35°C resulted in a significantly slower decay than that observed at 30°C (P < 0.0001). The results of this study indicate that PDL100 is not well-adapted to marine water; however, survival can be improved by increasing temperature, the availability of coral mucus from S. siderea and most notably the presence of dissolved organic carbon.

Human sewage identified as likely source of white pox disease of the threatened Caribbean elkhorn coral, Acropora palmata.

Caribbean elkhorn coral, Acropora palmata, has been decimated in recent years, resulting in the listing of this species as threatened under the United States Endangered Species Act. A major contributing factor in the decline of this iconic species is white pox disease. In 2002, we identified the faecal enterobacterium, Serratia marcescens, as an etiological agent for white pox. During outbreaks in 2003 a unique strain of S. marcescens was identified in both human sewage and white pox lesions. This strain (PDR60) was also identified from corallivorious snails (Coralliophila abbreviata), reef water, and two non-acroporid coral species, Siderastrea siderea and Solenastrea bournoni. Identification of PDR60 in sewage, diseased Acropora palmata and other reef invertebrates within a discrete time frame suggests a causal link between white pox and sewage contamination on reefs and supports the conclusion that humans are a likely source of this disease.

Utilization of mucus from the coral Acropora palmata by the pathogen Serratia marcescens and by environmental and coral commensal bacteria.

In recent years, diseases of corals caused by opportunistic pathogens have become widespread. How opportunistic pathogens establish on coral surfaces, interact with native microbiota, and cause disease is not yet clear. This study compared the utilization of coral mucus by coral-associated commensal bacteria ("Photobacterium mandapamensis" and Halomonas meridiana) and by opportunistic Serratia marcescens pathogens. S. marcescens PDL100 (a pathogen associated with white pox disease of Acroporid corals) grew to higher population densities on components of mucus from the host coral. In an in vitro coculture on mucus from Acropora palmata, S. marcescens PDL100 isolates outgrew coral isolates. The white pox pathogen did not differ from other bacteria in growth on mucus from a nonhost coral, Montastraea faveolata. The ability of S. marcescens to cause disease in acroporid corals may be due, at least in part, to the ability of strain PDL100 to build to higher population numbers within the mucus surface layer of its acroporid host. During growth on mucus from A. palmata, similar glycosidase activities were present in coral commensal bacteria, in S. marcescens PDL100, and in environmental and human isolates of S. marcescens. The temporal regulation of these activities during growth on mucus, however, was distinct in the isolates. During early stages of growth on mucus, enzymatic activities in S. marcescens PDL100 were most similar to those in coral commensals. After overnight incubation on mucus, enzymatic activities in a white pox pathogen were most similar to those in pathogenic Serratia strains isolated from human mucosal surfaces.