What Is the Incidence of Anesthesia-Related Adverse Events in Oral and Maxillofacial Surgery Offices? A Review of 61,237 Sedation Cases From a Large Private Practice Consortium.

BACKGROUND: The safety of the anesthesia team model performed in oral and maxillofacial surgery (OMS) offices has been criticized by professional and mainstream media. PURPOSE: This study aims to assess the incidence of adverse events (AEs) associated with the OMS anesthesia team model and identify risk factors associated with AEs. STUDY DESIGN, SETTING, SAMPLE: This was a retrospective cohort study utilizing a patient database from Paradigm Oral Health, Lincoln, Nebraska, a managed service organization (MSO). Subjects included were 14 and older, undergoing open-airway intravenous anesthesia for ambulatory OMS procedures using the OMS anesthesia team model at multiple private practices in the MSO network between June 30, 2010, and September 30, 2022. Exclusion criteria included patients younger than 14 or patients with incomplete medical records. PREDICTOR VARIABLE: Primary predictor variables were age, sex, American Society of Anesthesiologists physical status classification system (ASA) score, type of surgical procedure performed, and the types of medications administered during sedation. MAIN OUTCOME VARIABLE(S): The presence of an AE. The definition of an AE was modeled on the World Society of Intravenous Anesthesia definition. All AEs were identified through surrogate markers, which were identified through chart review. One example of an AE is ventricular fibrillation, which necessitates the application of medications; here the medication is the surrogate marker. COVARIATES: None. ANALYSES: The data were analyzed using t-tests and χ2 tests. P values ≤ .05 were considered statistically significant. RESULTS: Included in the study were 61,237 sedation cases (53.87% female and 46.13% male), for 56,076 unique patients ranging from 14 to 98 years of age (mean 33.26 ± 18.35). An AE incidence of 3 per 100,000 per year (25 total events) was observed. Neither age, sex, ASA score, nor type of surgical procedure exhibited statistically significant associations with AEs. A statistically significant association was found between AEs and fentanyl (P = .0008). CONCLUSION AND RELEVANCE: This investigation shows a smaller incidence of AEs than previous studies of the OMS anesthesia team model.

Do Patients With Mental Illness Undergoing Office-Based Sedation Require an Increased Propofol Dosage?

BACKGROUND: Providers report needing higher sedative doses to achieve adequate sedation in patients with mental illnesses. These claims, however, have not been thoroughly assessed. PURPOSE: The purpose of the study was to measure the association between mental illness and the propofol dosage necessary to achieve a satisfactory level of anesthesia. STUDY DESIGN, SETTING, SAMPLE: The study consisted of a single-center, retrospective cohort consisting of patients treated by oral and maxillofacial surgery at the University of Cincinnati Medical Center in 2020. The study was comprised of subjects 15 or older who were American Society of Anesthesiologists (ASA) classification I or II. Subjects under 15 or ASA III or higher were excluded from the study. PREDICTOR VARIABLE: The predictor variable was the presence or absence of mental illness. MAIN OUTCOME VARIABLE(S): The primary outcome was the total dose of propofol, measured as the total amount of propofol administered divided by the patient's weight in kilograms divided by the length of the procedure in minutes (mg/kg/min). The secondary outcome was the Richmond Agitation-Sedation Scale (RASS) score achieved during sedation. COVARIATES: Sex, race, ethnicity, age, weight, body mass index, ASA score, prior tobacco use, marijuana use, use of adjunct midazolam, fentanyl, and ketamine during the procedure, and type of procedure served as covariates. ANALYSES: Test statistics were calculated using the Wilcoxon rank-sum test, Kruskal-Wallis test, Spearman rank correlation test, and χ2 test for bivariate analyses. Linear and logistic regression models were used to estimate association while controlling for confounding. P values ≤ .05 were considered statistically significant. RESULTS: The study sample was 409 subjects (36.92% male, mean age 28.27 ± 12.20 years). In bivariate analysis, mental illness did not show any association with propofol dose (mean dose with mental illness 150.85 ± 143.97 mg/kg/min, mean dose without mental illness 116.54 ± 104.16, P = .08) or RASS score (sufficiently sedated with mental illness 63.38%, sufficiently sedated without mental illness 58.80%, P = .36). After adjusting for all previously mentioned covariates, mental illness was statistically associated with propofol dose (P < .01). Adjusting for covariates, only sex had a statistically significant association with the RASS score (P < .05). CONCLUSION AND RELEVANCE: The findings suggest that a patient's mental illness may influence the amount of sedative required to achieve satisfactory anesthesia.

Assessing the Efficacy of Buffered Versus Nonbuffered Lidocaine in Dental Extractions: A Double-Blinded Randomized Controlled Trial.

BACKGROUND: Injections using buffered lidocaine may decrease discomfort, have a quicker onset, and be a more efficacious local anesthetic. Previous studies have been inconclusive in the oral context. PURPOSE: To address if bicarbonate buffered 2% lidocaine can decrease pain from the use of local anesthesia, has a quicker onset time, and is more efficacious. STUDY DESIGN: The design was a single-center double-blinded randomized control trial, set in an outpatient oral and maxillofacial clinic housed in the University of Cincinnati Medical Center. Inclusion criteria for the study were patients requiring a single tooth extraction due either to caries or periodontal disease. PREDICTOR VARIABLE: The predictor variable was the local anesthetic used either nonbuffered 2% lidocaine with 1:100,000 epinephrine (control) or bicarbonate buffered 2% lidocaine with 1:100,000 epinephrine (study) was randomly assigned. MAIN OUTCOME VARIABLES: Primary outcome variables were injection pain score, and postoperative pain, time to anesthetic onset, and the number of rounds of injections required to achieve adequate anesthesia. COVARIATES: The covariates were jaw involved, age, sex, and race, American Society of Anesthesiologists score, body mass index, current tobacco use, history of psychiatric illness, chronic pain, and preoperative pain score. ANALYSES: Test statistics were calculated using Wilcoxon rank-sum test, Kruskal-Wallis test, Spearman rank correlation test, χ2 test for bivariate analyses, and Fisher's exact test. P values ≤ .05 were considered statistically significant. RESULTS: The final sample was 114 subjects. The mean age of the sample was 42.97 years, standard deviation ±13.43 years. The sample was 39.47% male. The racial demographics were Caucasian (62.28%) and African American (33.33%). Buffered lidocaine did not have a statistically significant relationship with any of the outcomes. The jaw involved had a statistically significant association to the injection pain score (P value = .006), and the number of rounds of anesthetic required (P value = .047). Age showed a statistically significant association to injection pain score (P value = .032), and the number of rounds of anesthetic required (P value = .027). Finally, preoperative pain had a statistically significant relationship with injection pain score (P value = < .001). CONCLUSION AND RELEVANCE: In this study, bicarbonate buffered lidocaine did not exhibit any discernible advantages over nonbuffered lidocaine for any study outcomes.

Do routine outcome monitoring measures tell the same story? Evaluating outcome trajectories and clinical outcomes for the outcome rating scale and outcome questionnaire - 45.

Routine outcome monitoring (ROM) of psychotherapy improves client outcomes and reduces premature terminations. Two ROM systems with the most empirical support are the OQ System (Lambert, 2010) and the Partners for Change Outcome Management System (PCOMS; Duncan, 2012; Miller et al., 2005). We evaluated if the global distress measures, the Outcome Rating Scale (ORS; PCOMS) and the Outcome Questionnaire-45.2 (OQ-45; OQ System) show similar outcome trajectories and rates of reliable and clinically significant change when completed by the same clients.Participants (N = 290) were clients from archived data collected in a training clinic for a psychology doctoral program in the western United States, who completed both the ORS and OQ-45 across treatment.Bi-variate correlations between the ORS and OQ-45 were highly correlated at the first session (r = -.73), and for later sessions linear and quadratic estimates were only moderately related (rs = -.31 to -.57). Statistically significantly more clients indicated both reliable change and clinically significant change on the ORS compared to the OQ-45.The results indicate that these measures are correlated but not interchangeable in relation to the conclusions they generate about treatment outcomes. Measurement tools should be carefully considered given the potential for different conclusions to be drawn regarding treatment progress and outcomes.

Facial Appearance as Core Expression Scale: Benchmarks and Properties.

Objective: Patients presenting for corrective facial surgery may have ideals that are not congruent with their surgeon's expectations for surgical outcomes. To identify and reduce disparities in expectations, the Facial Appearance as Core Expression Scale (FACES) was developed to assess the extent to which individuals identify their own faces as representing their ideal self. Method: In Study 1, 504 healthy young adult participants answered online questions about their own faces. In Study 2, 165 participants rated their own faces, digitally manipulated images of four patients before and after surgery, and two digitally averaged benchmark images. Results: In Study 1, the final FACES instrument had seven items and was highly reliable across genders and races. Study 2 replicated reliability findings. The before surgery and after surgery pictures yielded significant improvements in ratings, suggesting scale validity. Conclusions: The FACES consists of 14 items including a benchmark image to detect unusual responding. Results indicate the measure is reliable and sensitive to perceptions of surgical changes to faces. While the scale needs to be validated in a clinical sample, the measure may help identify patients with atypical ideal expectations for their face and may be used to quantify surgical outcomes.

Is Psychiatric Illness Associated With Risk for Postoperative Complications in the Outpatient Setting?

PURPOSE: Little is known about the association between psychiatric illness and the risk for postoperative complications following outpatient oral and maxillofacial surgery treatment. The purpose of this study was to examine the significance of the presence of psychiatric illness on postoperative complications. MATERIALS/METHODS: This was a retrospective cohort study conducted in 2018 that identified patients by searching through the University of Cincinnati's electronic health records. The predictor variable in this study is the presence of psychiatric illness and the outcome variable is the presence or absence of postoperative complications. Additional covariates such as age, race, location, procedure type, and anesthesia type were also included. Results of appropriate descriptive statistics and multivariate logistic regression were presented. Statistical significance was set at P value < .05. RESULTS: The total number of patients who underwent procedures involving local anesthetic and intravenous sedition in clinic in 2018 were 3,874, of which 1,588 were males (40.99%) and 2,286 were females (59.01%) with a mean age of 36.14 and 35.08 years, respectively. The sample consisted of White (45.87%), Black (35.34%), Hispanic/Latino (2.27%), Asians (1.60%), other races (3.33%), and 11.59% patients have missing data on race. A psychiatric diagnosis was found in 21.37% patients (n = 828). The percentage of patients with 2 or more psychiatric diagnoses was 5.78% (n = 224). The rate of postoperative was reported as 11.33%. A bivariate logistic regression analysis of postoperative complications as an outcome variable found that postoperative complications were not associated with psychiatric history (Odds ratio = 1.049, 95% confidence interval: 0.825 to 1.333, P value = .695). However, sex (P value = < .0001), surgical procedure (P value = < .0001), and anesthetic technique (P value = < .0001) had statistically significant associations with postoperative complications. Other covariates like race (P value = .5943), American Society of Anesthesiologists score (P value = .2539), location (P value = .5323), and multiple psychiatric diagnoses (P value = .7256) were not found to be significantly associated with postoperative complications. CONCLUSION: Although our study did show a higher prevalence of psychiatric illnesses in our patient population, it did not show any statistically significant correlation between psychiatric illness and postoperative complications. In addition, there were no statistically significant differences in postoperative complications between different Diagnostic and Statistical Manual of Mental Disorders classes.

Incidence and Predictors of Neurologic Death in Patients with Brain Metastases.

OBJECTIVE: Neurologic death is the most serious consequence of intracranial disease among patients with brain metastases. Identifying patients with brain metastases at increased risk of neurologic death can improve care and guide further research. We sought to delineate factors predictive of neurologic death among patients with brain metastases. METHODS: We identified 1218 patients with newly diagnosed brain metastases managed at Brigham and Women's Hospital/Dana-Farber Cancer Institute from 2008-2015. Factors predictive of neurologic death were assessed via univariable and multivariable Fine and Gray competing risks regression. RESULTS: On multivariable analysis, neurologic death was associated with number of brain metastases (hazard ratio [HR] 1.01 per 1 metastasis increase, 95% confidence interval [CI] 1.01-1.02, P < 0.001) and 3 primary tumor sites (reference=non-small cell lung cancer): melanoma (HR 4.67, 95% CI 3.27-6.68, P < 0.001), small cell lung cancer (HR 2.33, 95% CI 1.47-3.68, P < 0.001), and gastrointestinal cancer (HR 2.21, 95% CI 1.28-3.82, P = 0.005). Conversely, a reduction in neurologic death was found in patients with good Karnofsky performance status (90-100 vs. 30-80, HR 0.67, 95% CI 0.48-0.95, P = 0.03) and progressive extracranial metastases at diagnosis of intracranial disease (HR 0.50, 95% CI 0.38-0.67, P = 0.001). Among patients with breast primaries, HER2+ patients displayed increased neurologic death relative to the reference of HR+/HER2- (univariable analysis only: HR 2.41, 95% CI 1.00-5.84, P = 0.05). CONCLUSIONS: Patients with melanoma, small cell lung cancer, gastrointestinal cancer, and HER2+ breast cancer primaries, as well as greater intracranial versus extracranial disease burden, harbor significant risk of neurologic death. Future research investigating novel intracranial approaches should focus on these populations.

Immunoassays are not immune to errors: Examples from two studies of steroid output from freshwater trout farms.

A "reproducibility crisis" is widespread across scientific disciplines, where results and conclusions of studies are not supported by subsequent investigation. Here we provide a steroid immunoassay example where human errors generated unreproducible results and conclusions. Our study was triggered by a scientific report citing abnormally high concentrations (means of 4-79 ng L-1) of three natural sex steroids [11-ketotestosterone (11-KT), testosterone (T) and oestradiol (E2)] in water samples collected from two UK rivers over 4 years (2002-6). Furthermore, the data suggested that trout farms were a major source because reported steroid concentrations were 1.3-6 times higher downstream than upstream. We hypothesised that the reported levels were erroneous due to substances co-extracted from the water causing matrix effects (i.e. "false positives") during measurement by enzyme-linked immunoassay (EIA). Thus, in collaboration with three other groups (including the one that had conducted the 2002-6 study), we carried out field sampling and assaying to examine this hypothesis. Water samples were collected in 2010 from the same sites and prepared for assay using an analogous method [C18 solid phase extraction (SPE) followed by extract clean-up with aminopropyl SPE]. Additional quality control ("spiked" and "blank") samples were processed. Water extracts were assayed for steroids using radioimmunoassay (RIA) as well as EIA. Although there were statistically significant differences between EIA and RIA (and laboratories), there was no indication of matrix effects in the EIAs. Both the EIAs and RIAs (uncorrected for recovery) measured all three natural steroids at <0.6 ng L-1 in all river water samples, indicating that the trout farms were not a significant source of natural steroids. The differences between the two studies were considerable: E2 and T concentrations were ca. 100-fold lower and 11-KT ca. 1000-fold lower than those reported in the 2002-6 study. In the absence of evidence for any marked changes in husbandry practice (e.g. stock, diet) or environmental conditions (e.g. water flow rate) between the study periods, we concluded that calculation errors were probably made in the first (2002-6) study associated with confusion between extract and water sample concentrations. The second (2010) study also had several identified examples of calculation error (use of an incorrect standard curve; extrapolation below the minimum standard; confusion of assay dilutions during result work-up; failure to correct for loss during extraction) and an example of sample contamination. Similar and further errors have been noted in other studies. It must be recognised that assays do not provide absolute measurements and are prone to a variety of errors, so published steroid levels should be viewed with caution until independently confirmed.

The molecular basis of interaction domains of full-length PrP with lipid membranes.

PrP-lipid membrane interactions are critical to PrP structural conversion and neurotoxicity, but its molecular mechanism remains unclear. A two-dimensional histogram of force-distance curves and a worm-like chain model revealed three binding regions at the PrP N-terminal, providing the molecular basis for understanding the interactions between full-length PrP and lipid membranes.

Extensive retreat and re-advance of the West Antarctic Ice Sheet during the Holocene.

To predict the future contributions of the Antarctic ice sheets to sea-level rise, numerical models use reconstructions of past ice-sheet retreat after the Last Glacial Maximum to tune model parameters 1 . Reconstructions of the West Antarctic Ice Sheet have assumed that it retreated progressively throughout the Holocene epoch (the past 11,500 years or so)2-4. Here we show, however, that over this period the grounding line of the West Antarctic Ice Sheet (which marks the point at which it is no longer in contact with the ground and becomes a floating ice shelf) retreated several hundred kilometres inland of today's grounding line, before isostatic rebound caused it to re-advance to its present position. Our evidence includes, first, radiocarbon dating of sediment cores recovered from beneath the ice streams of the Ross Sea sector, indicating widespread Holocene marine exposure; and second, ice-penetrating radar observations of englacial structure in the Weddell Sea sector, indicating ice-shelf grounding. We explore the implications of these findings with an ice-sheet model. Modelled re-advance of the grounding line in the Holocene requires ice-shelf grounding caused by isostatic rebound. Our findings overturn the assumption of progressive retreat of the grounding line during the Holocene in West Antarctica, and corroborate previous suggestions of ice-sheet re-advance 5 . Rebound-driven stabilizing processes were apparently able to halt and reverse climate-initiated ice loss. Whether these processes can reverse present-day ice loss 6 on millennial timescales will depend on bedrock topography and mantle viscosity-parameters that are difficult to measure and to incorporate into ice-sheet models.

Supersnowflakes: Stepwise Self-Assembly and Dynamic Exchange of Rhombus Star-Shaped Supramolecules.

With the goal of increasing the complexity of metallo-supramolecules, two rhombus star-shaped supramolecular architectures, namely, supersnowflakes, were designed and assembled using multiple 2,2':6',2″-terpyridine (tpy) ligands in a stepwise manner. In the design of multicomponent self-assembly, ditopic and tritopic ligands were bridged through Ru(II) with strong coordination to form metal-organic ligands for the subsequent self-assembly with a hexatopic ligand and Zn(II). The combination of Ru(II)-organic ligands with high stability and Zn(II) ions with weak coordination played a key role in the self-assembly of giant heteroleptic supersnowflakes, which encompassed three types of tpy-based organic ligands and two metal ions. With such a stepwise strategy, the self-sorting of individual building blocks was prevented from forming the undesired assemblies, e.g., small macrocycles and coordination polymers. Furthermore, the intra- and intermolecular dynamic exchange study of two supersnowflakes by NMR and mass spectrometry revealed the remarkable stability of these giant supramolecular complexes.

Multifunctional Surface Manipulation Using Orthogonal Click Chemistry.

Polymer brushes are excellent substrates for the covalent immobilization of a wide variety of molecules due to their unique physicochemical properties and high functional group density. By using reactive microcapillary printing, poly(pentafluorophenyl acrylate) brushes with rapid kinetic rates toward aminolysis can be partially patterned with other click functionalities such as strained cyclooctyne derivatives and sulfonyl fluorides. This trireactive surface can then react locally and selectively in a one pot reaction via three orthogonal chemistries at room temperature: activated ester aminolysis, strain promoted azide-alkyne cycloaddition, and sulfur(VI) fluoride exchange, all of which are tolerant of ambient moisture and oxygen. Furthermore, we demonstrate that these reactions can also be used to create areas of morphologically distinct surface features on the nanoscale, by inducing buckling instabilities in the films and the grafting of nanoparticles. This approach is modular, and allows for the development of highly complex surface motifs patterned with different chemistry and morphology.

Diversity and Evolution of Disease Resistance Genes in Barley (Hordeum vulgare L.).

Plant disease resistance genes (R-genes) play a critical role in the defense response to pathogens. Barley is one of the most important cereal crops, having a genome recently made available, for which the diversity and evolution of R-genes are not well understood. The main objectives of this research were to conduct a genome-wide identification of barley Coiled-coil, Nucleotide-binding site, Leucine-rich repeat (CNL) genes and elucidate their evolutionary history. We employed a Hidden Markov Model using 52 Arabidopsis thaliana CNL reference sequences and analyzed for phylogenetic relationships, structural variation, and gene clustering. We identified 175 barley CNL genes nested into three clades, showing (a) evidence of an expansion of the CNL-C clade, primarily due to tandem duplications; (b) very few members of clade CNL-A and CNL-B; and (c) a complete absence of clade CNL-D. Our results also showed that several of the previously identified mildew locus A (MLA) genes may be allelic variants of two barley CNL genes, MLOC_66581 and MLOC_10425, which respond to powdery mildew. Approximately 23% of the barley CNL genes formed 15 gene clusters located in the extra-pericentromeric regions on six of the seven chromosomes; more than half of the clustered genes were located on chromosomes 1H and 7H. Higher average numbers of exons and multiple splice variants in barley relative to those in Arabidopsis and rice may have contributed to a diversification of the CNL-C members. These results will help us understand the evolution of R-genes with potential implications for developing durable resistance in barley cultivars.

Real-time single molecular study of a pretreated cellulose hydrolysis mode and individual enzyme movement.

BACKGROUND: The main challenges of large-scale biochemical conversion involve the high costs of cellulolytic enzymes and the inefficiency in enzymatic deconstruction of polysaccharides embedded in the complex structure of the plant cell wall, leading to ongoing interests in studying the predominant mode of enzymatic hydrolysis. In this study, complete enzymatic hydrolysis of pretreated biomass substrates was visualized in situ and in real time by atomic force microscopy (AFM) topography and recognition imaging. Throughout the entire hydrolytic process, a hydrolysis mode for exoglucanase (CBH I) consisting of a peeling action, wherein cellulose microfibrils are peeled from sites on the pretreated cellulose substrate that have cracks sufficiently large for CBH I to immobilize. RESULTS: We quantitatively monitored the complete hydrolytic process on pretreated cellulose. The synergetic effect among the different enzymes can accelerate the cellulose hydrolysis rate dramatically. However, the combination of CBH I and ß-glucosidases (ß-G) exhibited a similar degradation capacity as did whole enzyme (contains the cellobiohydrolases and endoglucanase as its major enzyme components). We developed a comprehensive dynamic analysis for individual cellulase acting on single pretreated cellulose through use of functional AFM topography and recognition imaging. The single crystalline cellulose was divided into different regions based on the cracks on the substrate surface and was observed to either depolymerize or to peel away by the jammed enzyme molecules. After the exfoliation of one region, new cracks were produced for the enzyme molecules to immobilize. The fiber width may have a relationship with the peeling mode of the fibers. We performed a statistical height measure of the generated peaks of the peeled fibers. The height values range from 11 to 24 nm. We assume that the CBH I enzymes stop progressing along the cellulose microfibril when the peeled microfibril height exceeds 11 nm. CONCLUSION: The combination of CBH I and ß-G can achieve an effective hydrolysis of the pretreated biomass substrates. The single-molecule study of the complete hydrolytic process indicates that the hydrolytic mode involves the peeling of the microfibrils and progressive depolymerization, which depend on the size of the cracks on the surface of the pretreated cellulose microfibrils.

The Relationship Between Pain, Self-Injury, and Other Problem Behaviors in Young Children With Autism and Other Developmental Disabilities.

Research has suggested that individuals who engage in self-injurious behavior may have enhanced expressions of pain, which contradicts previous assertions of blunted pain sensitivity in this population. The purpose of this study was to measure expressions of pain among young children being evaluated for autism and other neurodevelopmental disabilities. The frequency of pain-related behaviors was assessed during everyday routines using the Non-Communicating Children's Pain Checklist (NCCPC-R) for 51 children. Significant group differences between children with and without self-injury were found for the NCCPC-R total scores. The frequency and severity of self-injury, aggression, and stereotypy were also highly correlated with the total scores on the NCCPC-R. These results continue to support that individuals with self-injury may have enhanced expressions of pain.

A toolbox of genes, proteins, metabolites and promoters for improving drought tolerance in soybean includes the metabolite coumestrol and stomatal development genes.

BACKGROUND: The purpose of this project was to identify metabolites, proteins, genes, and promoters associated with water stress responses in soybean. A number of these may serve as new targets for the biotechnological improvement of drought responses in soybean (Glycine max). RESULTS: We identified metabolites, proteins, and genes that are strongly up or down regulated during rapid water stress following removal from a hydroponics system. 163 metabolites showed significant changes during water stress in roots and 93 in leaves. The largest change was a root-specific 160-fold increase in the coumestan coumestrol making it a potential biomarker for drought and a promising target for improving drought responses. Previous reports suggest that coumestrol stimulates mycorrhizal colonization and under certain conditions mycorrhizal plants have improved drought tolerance. This suggests that coumestrol may be part of a call for help to the rhizobiome during stress. About 3,000 genes were strongly up-regulated by drought and we identified regulators such as ERF, MYB, NAC, bHLH, and WRKY transcription factors, receptor-like kinases, and calcium signaling components as potential targets for soybean improvement as well as the jasmonate and abscisic acid biosynthetic genes JMT, LOX1, and ABA1. Drought stressed soybean leaves show reduced mRNA levels of stomatal development genes including FAMA-like, MUTE-like and SPEECHLESS-like bHLH transcription factors and leaves formed after drought stress had a reduction in stomatal density of 22.34 % and stomatal index of 17.56 %. This suggests that reducing stomatal density may improve drought tolerance. MEME analyses suggest that ABRE (CACGT/CG), CRT/DRE (CCGAC) and a novel GTGCnTGC/G element play roles in transcriptional activation and these could form components of synthetic promoters to drive expression of transgenes. Using transformed hairy roots, we validated the increase in promoter activity of GmWRKY17 and GmWRKY67 during dehydration and after 20 µM ABA treatment. CONCLUSIONS: Our toolbox provides new targets and strategies for improving soybean drought tolerance and includes the coumestan coumestrol, transcription factors that regulate stomatal density, water stress-responsive WRKY gene promoters and a novel DNA element that appears to be enriched in water stress responsive promoters.

Tobacco drought stress responses reveal new targets for Solanaceae crop improvement.

BACKGROUND: The Solanaceae are an economically important family of plants that include tobacco (Nicotiana tabacum L.), tomato, and potato. Drought is a major cause of crop losses. RESULTS: We have identified major changes in physiology, metabolites, mRNA levels, and promoter activities during the tobacco response to drought. We have classified these as potential components of core responses that may be common to many plant species or responses that may be family/species-specific features of the drought stress response in tobacco or the Solanaceae. In tobacco the largest increase in any metabolite was a striking 70-fold increase in 4-hydroxy-2-oxoglutaric acid (KHG) in roots that appears to be tobacco/Solanaceae specific. KHG is poorly characterized in plants but is broken down to pyruvate and glyoxylate after the E. coli SOS response to facilitate the resumption of respiration. A similar process in tobacco would represent a mechanism to restart respiration upon water availability after drought. At the mRNA level, transcription factor gene induction by drought also showed both core and species/family specific responses. Many Group IX Subgroup 3 AP2/ERF transcription factors in tobacco appear to play roles in nicotine biosynthesis as a response to herbivory, whereas their counterparts in legume species appear to play roles in drought responses. We observed apparent Solanaceae-specific drought induction of several Group IId WRKY genes. One of these, NtWRKY69, showed ABA-independent drought stress-inducible promoter activity that moved into the leaf through the vascular tissue and then eventually into the surrounding leaf cells. CONCLUSIONS: We propose components of a core metabolic response to drought stress in plants and also show that some major responses to drought stress at the metabolome and transcriptome levels are family specific. We therefore propose that the observed family-specific changes in metabolism are regulated, at least in part, by family-specific changes in transcription factor activity. We also present a list of potential targets for the improvement of Solanaceae drought responses.

Preliminary Evidence for the Integrated Systems Using Telemedicine.

BACKGROUND: Autism affects as many as 1 in 68 children in the United States. Early identification and access to intervention services promote improved outcomes for children with autism and other developmental delays. Children living in rural and underserved areas have limited access to such services and are diagnosed later than those living more suburban and urban areas. Our Integrated Systems Using Telemedicine (ISUT) Model uses a cost-effective method for families to access diagnostic and other specialty care through telemedicine. This model links families, trained early intervention providers and educators, and university-based medical professionals. MATERIALS AND METHODS: We trained autism diagnostic teams throughout the state who completed diagnostic measures and connected to university medical center teams for final diagnosis of autism and coexisting conditions. We gathered preliminary data to measure the impact of the ISUT model on access to services, potential cost savings for families, and parent satisfaction with the model. RESULTS: Preliminary data indicate that our ISUT model provided families in rural and underserved areas improved access to diagnostic services as well as cost savings for travel. Our satisfaction data indicate that parents are equally satisfied with services received through the ISUT and through the University-Based Medical Center Team Model. CONCLUSIONS: The ISUT model provides a unique collaboration among the family, educational system, autism experts in the community, and the university medical center autism team while providing a cost-effective means for families to access specialty care while promoting coordination of care within the community.

Brief report: use of interactive television in identifying autism in young children: methodology and preliminary data.

Children living in rural and underserved areas experience decreased access to health care services and are often diagnosed with autism at a later age compared to those living in urban or suburban areas. This study examines the utility and validity of an ASD assessment protocol conducted via video conferencing (VC). Participants (n = 17) included families with young children (2.5-6 years) requesting an evaluation for ASD in an interdisciplinary clinic. We randomly assigned families to complete an additional evaluation either in-person or via VC prior to their clinic appointment and compared diagnostic impressions to their interdisciplinary clinic evaluation. Results demonstrate excellent inter-rater agreement on diagnoses between clinicians in the VC setting and the interdisciplinary team, which suggests VC may be a viable method to increase access to autism diagnostic services, and ultimately early intervention, for families in rural and underserved areas.

Animal Disease Import Risk Analysis--a Review of Current Methods and Practice.

The application of risk analysis to the spread of disease with international trade in animals and their products, that is, import risk analysis (IRA), has been largely driven by the Sanitary and Phytosanitary (SPS) agreement of the World Trade Organization (WTO). The degree to which the IRA standard established by the World Organization for Animal Health (OIE), and associated guidance, meets the needs of the SPS agreement is discussed. The use of scenario trees is the core modelling approach used to represent the steps necessary for the hazard to occur. There is scope to elaborate scenario trees for commodity IRA so that the quantity of hazard at each step is assessed, which is crucial to the likelihood of establishment. The dependence between exposure and establishment suggests that they should fall within the same subcomponent. IRA undertaken for trade reasons must include an assessment of consequences to meet SPS criteria, but guidance is sparse. The integration of epidemiological and economic modelling may open a path for better methods. Matrices have been used in qualitative IRA to combine estimates of entry and exposure, and consequences with likelihood, but this approach has flaws and better methods are needed. OIE IRA standards and guidance indicate that the volume of trade should be taken into account, but offer no detail. Some published qualitative IRAs have assumed current levels and patterns of trade without specifying the volume of trade, which constrains the use of IRA to determine mitigation measures (to reduce risk to an acceptable level) and whether the principle of equivalence, fundamental to the SPS agreement, has been observed. It is questionable whether qualitative IRA can meet all the criteria set out in the SPS agreement. Nevertheless, scope exists to elaborate the current standards and guidance, so they better serve the principle of science-based decision-making.