Development and dissection of diagnostic SNP markers for the downy mildew resistance genes Pl Arg and Pl 8 and maker-assisted gene pyramiding in sunflower (Helianthus annuus L.).

Diagnostic DNA markers are an invaluable resource in breeding programs for successful introgression and pyramiding of disease resistance genes. Resistance to downy mildew (DM) disease in sunflower is mediated by Pl genes which are known to be effective against the causal fungus, Plasmopara halstedii. Two DM resistance genes, Pl Arg and Pl 8 , are highly effective against P. halstedii races in the USA, and have been previously mapped to the sunflower linkage groups (LGs) 1 and 13, respectively, using simple sequence repeat (SSR) markers. In this study, we developed high-density single nucleotide polymorphism (SNP) maps encompassing the Pl arg and Pl 8 genes and identified diagnostic SNP markers closely linked to these genes. The specificity of the diagnostic markers was validated in a highly diverse panel of 548 sunflower lines. Dissection of a large marker cluster co-segregated with Pl Arg revealed that the closest SNP markers NSA_007595 and NSA_001835 delimited Pl Arg to an interval of 2.83 Mb on the LG1 physical map. The SNP markers SFW01497 and SFW06597 delimited Pl 8 to an interval of 2.85 Mb on the LG13 physical map. We also developed sunflower lines with homozygous, three gene pyramids carrying Pl Arg , Pl 8 , and the sunflower rust resistance gene R 12 using the linked SNP markers from a segregating F2 population of RHA 340 (carrying Pl 8 )/RHA 464 (carrying Pl Arg and R 12 ). The high-throughput diagnostic SNP markers developed in this study will facilitate marker-assisted selection breeding, and the pyramided sunflower lines will provide durable resistance to downy mildew and rust diseases.

Genetics and mapping of a novel downy mildew resistance gene, Pl(18), introgressed from wild Helianthus argophyllus into cultivated sunflower (Helianthus annuus L.).

KEY MESSAGE: A novel downy mildew resistance gene, Pl(18), was introgressed from wild Helianthus argophyllus into cultivated sunflower and genetically mapped to linkage group 2 of the sunflower genome. The new germplasm, HA-DM1, carrying Pl(18) has been released to the public. Sunflower downy mildew (DM) is considered to be the most destructive foliar disease that has spread to every major sunflower-growing country of the world, except Australia. A new dominant downy mildew resistance gene (Pl 18) transferred from wild Helianthus argophyllus (PI 494573) into cultivated sunflower was mapped to linkage group (LG) 2 of the sunflower genome using bulked segregant analysis with 869 simple sequence repeat (SSR) markers. Phenotyping 142 BC1F2:3 families derived from the cross of HA 89 and H. argophyllus confirmed the single gene inheritance of resistance. Since no other Pl gene has been mapped to LG2, this gene was novel and designated as Pl (18). SSR markers CRT214 and ORS203 flanked Pl(18) at a genetic distance of 1.1 and 0.4 cM, respectively. Forty-six single nucleotide polymorphism (SNP) markers that cover the Pl(18) region were surveyed for saturation mapping of the region. Six co-segregating SNP markers were 1.2 cM distal to Pl(18), and another four co-segregating SNP markers were 0.9 cM proximal to Pl(18). The new BC2F4-derived germplasm, HA-DM1, carrying Pl(18) has been released to the public. This new line is highly resistant to all Plasmopara halstedii races identified in the USA providing breeders with an effective new source of resistance against downy mildew in sunflower. The molecular markers that were developed will be especially useful in marker-assisted selection and pyramiding of Pl resistance genes because of their close proximity to the gene and the availability of high-throughput SNP detection assays.

Apparent improvement in survival for carcinoma of the cervix following the introduction of chemoradiation--a Will Rogers phenomenon.

The improved survival for bulky cervical cancers (> 4cm) reported with combination platinum based chemoradiation (1999) prompted a move away from surgery as these cases frequently received adjuvant radiotherapy and were exposed to the morbidity of multimodality treatment. The period pre-1999 (Group 1) was compared with post-1999 (Group 2) when chemoradiation was the preferred treatment for bulky operable cervical cancer. Significantly more cases were treated surgically among Group 1 compared with Group 2 (79% vs. 62%; P < 0.001). Switching from surgery to radiotherapy improved survival in both treatment categories (73% vs. 78% and 37% vs. 44%, respectively) but with no improvement in overall survival (70%/ov.s 70%). Survival (86%) was similar in both groups among surgically treated women with tumors < 4 cm, but significantly more in Group 2 with negative nodes received postoperative adjuvant chemoradiotherapy (Groups 1 vs. 2; 16% vs.37.5%: P < 0.001) and overall the surgically treated patients received more not less multimodality treatment (46.5% vs. 59%; P = 0.7).

Current trends in Irish perinatal mortality.

This was a retrospective review of normally formed perinatal deaths among 176,620 births at the National Maternity Hospital (1984-2007). Prelabor stillbirths were categorised by presumed cause of death including unexplained, intrauterine growth retardation (IUGR), placental abruption, red cell alloimmunisation (RCA) and deaths related to prematurity. Peripartum deaths included intrapartum and first week neonatal deaths. The post-mortem rate, initially almost 100%, fell to 60%. Data were analysed using the Mantel-Haenszel chi square test for trends. In the study period there was a significant reduction in the PNM, largely because of a fall in death related to prematurity, term peripartum death, death at 42 weeks or greater, placental abruption, death related to IUGR and RCA (P < 0.01). Overall the unexplained still birth rate was unchanged throughout the study period (p = 0.8) despite a highly significant (p < 0.001) increase in obstetric intervention particularly induction of labor and caesarean section.

Cerebral palsy following neonatal hypoxic seizures in singleton term infants: the influence of parity.

This was a retrospective review of term singleton neonates (> 37 weeks) with early onset seizures, with and without encephalopathy, from 1989 through 2000. Our aim was to examine the relationship between antepartum and intrapartum obstetric events, neonatal hypoxic seizures and subsequent neurological impairment of 77,838 infants, the incidence of seizures was significantly higher among primiparas (2.4/1000; 67/31,729) compared with multiparas (0.35/1000; 16/46,109)(p < 0.001). Compared with multiparas, seizures with encephalopathy occurred more frequently among primiparas (0.8/1000; 26/31,729) vs. multiparas (0.2/1000; 8/46,109), were more commonly associated with unexplained intrapartum hypoxia (0.6/1000, n = 20 vs.0.04/ 1000, n = 2) and the incidence of cerebral palsy, 45% (9/20) vs. 0% (0/2) was significantly higher(p < 0.001). Seizures with encephalopathy (0.2/1000 vs.0.13/1000) and cerebral palsy (33%) had a similar incidence in primiparas and multiparas following a sentinel event. Neonatal seizures with encephalopathy, related to intrapartum events, were 4 times more common following first delivery and associated with a 9 fold higher incidence of cerebral palsy, implicating primiparous labor in the development of cerebral palsy.

Correlation of perineal outcome at first and second vaginal deliveries.

Perineal outcome in 1000 consecutive term non instrumental second vaginal deliveries was correlated with first delivery method and perineal outcome. Our aim was to determine the relationship between perineal outcome at first and second vaginal deliveries. Overall 75% of first non instrumental vaginal deliveries required sutures. Sutures were required at second delivery in 12% (24 of 199) of cases not sutured at first delivery compared with 60.4% (485 of 801) of those sutured. The rate of second perineal repair correlated with method of first delivery and perineal outcome, instrumental delivery--66.2% (145 of 219), first episiotomy-68.4% (238 of 348) and first sutured tear--43.6% (102 of 234). The incidence of third /fourth degree tear at first delivery was 1.3% (13/1000) (one recurred at second forceps delivery), compared with 0.6% at second delivery. First delivery outcome should be considered when conducting a second delivery as sixty per cent of women require perineal repair following repair at first delivery.

Recurrence of fetal macrosomia in non-diabetic pregnancies.

Fetal macrosomia (birth weight >/=4,500 g) is known to increase a number of adverse maternal and perinatal outcomes. Although there is a clear association between maternal diabetes mellitus and fetal macrosomia, the majority of macrosomic infants are born to non-diabetic mothers. We wished to determine the recurrence rate of macrosomia in non-diabetic pregnancy and to see if a history of multiple prior macrosomic infants confers additional risk. A retrospective analysis of 14,461 term, singleton, infants born to non-diabetic mothers in 1997 and 1998 was performed, using a computerised hospital database. Among 14,461 term pregnancies, 529 infants (3.7%) were macrosomic, and the incidence was significantly higher in parous women (4.6%) compared with nulliparas (2.4%, p < 0.0001). Over the next 5 years, 164 of these women returned for another delivery. Women with a history of one macrosomic infant are at significantly increased risk of another macrosomic infant in a subsequent pregnancy (OR 15.8, 95% CI 11.45 - 21.91, p < 0.0001). For women with two or more macrosomic infants, the risk is even greater (OR 47.4, 95% CI 19.9 - 112.89, p < 0.0001). Macrosomia was associated with increased rates of instrumental delivery and anal sphincter injury regardless of parity, and additionally with increased rates of caesarean delivery and shoulder dystocia among nulliparas. Overall, 88% of women who laboured with a macrosomic infant achieved vaginal delivery.

Isolation of three dormancy QTLs as Mendelian factors in rice.

Seed dormancy is a key adaptive trait under polygenic control in many plants. We introduced the chromosomal regions containing the dormancy QTLs qSD1, qSD7-1, and qSD12 from an accession of weedy rice into a nondormant genetic background to examine component genetic effects and their interactions with time of afterripening (DAR). A BC4F2 plant, which was heterozygous for the three loci, was selected to develop the BC4F3 population. Single point analysis detected only qSD7-1 and qSD12 (R2 = 38-72%) at 10, 30, and 50 DAR in the population. However, multiple linear regression analysis detected genetic effects of the three QTLs and their trigenic epistasis, an environmental effect of DAR (E), and interactions of E with qSD12 and with the qSD1 x qSD7-1 and qSD7-1 x qSD12 epistases. The linear model demonstrates that QTL main effects varied with DAR, and that some epistasis or epistasis-by-DAR interactions partially counteract the main effects. The three QTLs were isolated as single Mendelian factors from the BC4F3 population and estimated for component genic effects based on the BC4F4 populations. Isolation improved estimation of the qSD1 effect and confirmed the major effect of qSD12. The qSD1 and qSD12 loci displayed a gene-additive effect. The qSD7-1, which was further narrowed to a chromosomal region encompassing the red pericarp color gene Rc, displayed gene additive and dominant effects.

Identifying and using tools for reducing risks to patients and health care workers: a nursing perspective.

BACKGROUND: Research efforts and policy initiatives in health care errors and injury to health care workers have attracted increasing attention in recent years. An emerging theme in both these areas is the importance of organizational and other systems factors in the occurrence of medical error and health care worker injury. These commonalities call for the identification of common research efforts and, when appropriate, policy efforts. MOVING FROM HYPOTHESIS TO CONCLUSION: The proposition that health care error and worker injury are linked to the same organizational variables requires further research and deserves the same type of human factors approach that has characterized much of the investigative efforts that have occurred in the patient safety arena during the past decade. Serious problems exist with respect to access to data on staffing levels, skill mix, consecutive work hours, and other information that is crucial to examining the link between practice conditions, health care error, and health care worker injury. HUMAN FACTORS: One important resource in identifying effective approaches to prevent error and health care worker injury is the field of human factors, the discipline concerned with the design of tools, machines, and systems that takes into account human capabilities, limitations, and characteristics. CONCLUSION: The potential benefits of linking patient safety and health care worker safety efforts are significant. The research, experience, and successful practices from multiple disciplines must be utilized in identifying areas of common interest and concern in advancing work in both of these important areas.

Taking account of quality. Discussion.

Another report from the Institute of Medicine in March 2001 has joined a large body of literature documenting serious quality and safety problems. Eight health care leaders discuss ways in which organizations can reduce medical errors and improve patient outcomes.

A genetic model and molecular markers for wild oat (Avena fatua L.) seed dormancy.

Seed dormancy allows weed seeds to persist in agricultural soils. Wild oat (Avena fatua L.) is a major weed of cereal grains and expresses a range of seed dormancy phenotypes. Genetic analysis of wild oat dormancy has been complicated by the difficulty of phenotypic classification in segregating populations. Therefore, little is known about the nature of the genes that regulate dormancy in wild oat. The objectives of our studies were to develop methods to classify the germination responses of segregating wild oat populations and to find molecular markers linked to quantitative trait loci (QTL) that regulate seed dormancy in wild oat. RAPD markers OPX-06 and OPT-04 explained 12.6% and 6.8% respectively, of the F(2) phenotypic variance. OPF-17 was not significant in a simple regression model, but it was linked in repulsion to OPT-04. A three-locus model of seed dormancy in wild oat is presented based on the 41-day germination profiles of F(1), F(2), F(3), BC(1)P(1)F(1), BC(1)P(1)F(2), and BC(1)P(2)F(1) generations, and the 113 day germination profile of 126 F(7) recombinant inbred lines. Loci G (1) and G (2) promote early germination, and the D locus promotes late germination. If at least one copy of the dominant G (1) or G (2 )alleles are present regardless of the genotype at D locus, then the individual will be nondormant. If the genotype is g (1) g (1) g (2) g (2) D_, then the phenotype will be dormant.

Evaluation of "Hope for a Million Kids Immunization Event: "process, outcome, and costs.

This study evaluates the Hope For A Million Kids Immunization Event in East Harlem, New York, in 1996. The methodology: (1) Documented planning and implementation processes. (2) Analyzed numbers of children reached through the outreach initiative and those actually immunized due to the Event. (3) Assessed associated costs. The Event reached and educated 120,000 children through door-to-door canvassing. Substantially fewer children, 562, registered at the Health and Human Services Fair, and 211 children were immunized at a cost of about $594 per immunized child. Immunization registries may be more effective in increasing childhood immunization rates.

Using standardized patients and standardized physicians to improve patient-care quality: results of a pilot study.

BACKGROUND: We conducted evaluation research with a sample of registered professional staff nurses in a large, inner-city, tertiary medical center for a pilot study of videotaped case scenarios using standardized patients and standardized physicians to enhance nurses' communication and collaboration skills. METHOD: Change scores from pre-test to post-test on a self-reported rating scale to assess nurse-physician-patient interactions and communications for 28 nurses were compared with a control group of 38 nurses who did not participate in the videotaped sessions. RESULTS: Repeated measures of analysis of variance (ANOVA) detected no statistically significant differences between the intervention and control groups. However, positive changes were noted in some aspects of nurse-physician and nurse-patient interactions in the intervention group. Immediate feedback from the videotaped scenarios heightened nurses' awareness of the impact of their body language. CONCLUSIONS: Nurses must continuously practice and enhance their collaborative and communication skills. This pilot study suggests that it is beneficial to use videotaping with standardized patients and standardized physicians to enhance such nurses' skills.

Effect of a bicultural community health worker on completion of diabetes education in a Hispanic population.

OBJECTIVE: To determine the effect of a bicultural community health worker (CHW) on completion of diabetes education in an inner-city Hispanic patient population and to evaluate the impact of completion of the education program on patient knowledge, self-care behaviors, and glycemic control. RESEARCH DESIGN AND METHODS: Patients were randomized into CHW intervention and non-CHW intervention groups. All patients received individualized, comprehensive diabetes education from a certified diabetes nurse educator after baseline demographic information, diabetes knowledge, diabetes self-care practices, and glycohemoglobin levels were assessed. Rates of education program completion were determined. Diabetes knowledge, self-care practices, and glycohemoglobin levels were reassessed at program completion and at a later postprogram follow-up medical appointment and compared to baseline. Logistic regression analysis and the Mantel-Haenszel chi 2 statistic were used to determine the effect of the CHW assignment on program completion. Analyses of covariance were performed with end-of-treatment behavior scores, knowledge scores, and glycohemoglobin levels as outcome variables, controlling for baseline values and testing for the effect of CHW assignment. RESULTS: Of 64 patients enrolled in the study, 40 (63%) completed and 24 (37%) dropped out before completing the diabetes education program. Of the patients having CHW intervention, 80% completed the education program, compared with 47% of patients without CHW intervention (P = 0.01). "Dropouts" were younger (age 47.5 +/- 12.5 years [mean +/- SD]) compared with patients who completed the program (55.9 +/- 9.9 years) (P = 0.004). Dropout status showed no significant relationship to educational level achieved or literacy level. For the program "completers," knowledge levels and selected self-care practices significantly improved, and glycohemoglobin levels improved from a baseline level of 11.7% to 9.9% at program completion (P = 0.004) and 9.5% at the postprogram follow-up (P < 0.001). The effect of the CHW assignment on program completion, controlling for financial status and language spoken, was extremely robust (P = 0.007). The effect of the CHW on knowledge, self-care behavior, or glycohemoglobin outcome variables was not statistically significant. CONCLUSIONS: These findings suggest that intervention with a bicultural CHW improved rates of completion of a diabetes education program in an inner-city Hispanic patient population irrespective of literacy or educational levels attained. Our data further suggests that completion of individualized diabetes educational strategies leads to improved patient knowledge, self-care behaviors, and glycemic control.

Transcriptional and Posttranscriptional Regulation of Dormancy-Associated Gene Expression by Afterripening in Wild Oat.

To investigate whether the afterripening-induced changes in gene expression are at the transcriptional or posttranscriptional level in wild oat (Avena fatua) seeds, we chose four dormancy-associated genes to estimate their relative transcription activities and the stability of their corresponding transcripts in afterripened and dormant embryos. The transcription activities for those genes were 1.5 to 7 times higher in dormant embryos than in afterripened embryos 24 h after incubation, as determined by nuclear run-on assays. The half-lives of the transcripts in afterripened and dormant embryos were estimated by the use of actinomycin D. The application of actinomycin D resulted in the stabilization of the transcripts. Nevertheless, the results indicated that the half-lives of the transcripts were much greater in dormant embryos than in afterripened embryos. Considering the great differences in the steady-state levels and the half-lives of the mRNAs, and the relatively small differences in transcription activities of the genes between afterripened and dormant embryos, we conclude that afterripening regulates the expression of dormancy-associated genes in excised embryos mainly at the posttranscriptional level and that transcriptional control plays a minor role.

Cloning and characterization of differentially expressed genes in imbibed dormant and afterripened Avena fatua embryos.

To analyze the patterns of gene expression associated with seed dormancy in wild oat (Avena fatua), we have isolated cDNA clones corresponding to genes that are differentially expressed in dormant and afterripened line M73 embryos. Gene transcripts of these clones were maintained in embryos of imbibed dormant caryopses, but declined rapidly in afterripened embryos after imbibition. GA3 treatment of dormant caryopses, which breaks dormancy, could lower the transcript levels in dormant embryos. When the germination of afterripened caryopses was inhibited by high temperature (35 degrees C), the decline in abundance of the transcripts in afterripened embryos was arrested. These genes were expressed to various degrees in water-stressed, but not in unstressed, 7-day-old seedlings. The expression of the genes was also ABA-inducible in afterripened embryos. The expression patterns in non-dormant line SH430 wild oat were similar to those of afterripened M73. DNA sequence analyses indicated that some of the cDNA clones encode LEA (late embryogenesis-abundant) proteins and aldose reductase. The significance of the expression of these genes in maintaining seed dormancy or longevity is discussed.

Satisfaction with home healthcare services for clients with HIV: preliminary findings.

The Visiting Nurse Service of New York and Empire Blue Cross and Blue Shield implemented in 1990 the "At Home Options Program" (AHOP), an enhanced package of home care and other noninpatient services for HIV-positive clients. AHOP aims to reduce total treatment costs and hospital days. Clients (N = 52) completed mailed satisfaction surveys. Overall, clients were very satisfied with AHOP services. Clients expressed concerns, however, about the uneven quality of substitute paraprofessionals, and said they needed easier access to a knowledgeable healthcare professional. Operational concerns included inadequate information dissemination and administrative oversights. Findings will inform subsequent program activities.