Prevalence of Social Needs & Social Risks Among EMS Providers.

Background: A national shortage of Emergency Medical Service (EMS) providers is a critical issue for the profession that has only worsened during the COVID-19 pandemic. Researchers have identified possible causes, including difficult workplace conditions, low wages, and burnout. However, the impact of EMS providers' social needs and social risks has yet to be thoroughly explored. Methods: Demographic data for 1,112 EMS providers who responded to the 2021 national Social Needs in the Pre-hospital Setting (SNIPS) Study were analyzed to produce descriptive statistics and test for differences in social needs using chi square tests. Results: EMS providers reported experiencing housing insecurity (23.0%), food insecurity (27.4%), struggles with substance use (20.9%), mental health concerns (41.5%), domestic violence (18.5%), and healthcare affordability concerns (30.8%) during their EMS career. Almost 90% of study participants screened positive for burnout. Both women and emergency medical technicians (EMTs) were more likely than men and paramedics respectively to suffer from food and housing insecurity, mental health issues, and domestic violence at some point in their careers. Discussion: EMS providers reported high levels of burnout as well as a variety of social needs. Social needs may necessitate overtime work, increasing risk of burnout and negatively impacting providers' well-being and contributing to the provider shortage. Barriers to entry for paramedic training and gender differences in promotion rates may exacerbate the disparities experienced by EMTs and female providers, respectively. Conclusion: With high levels of burnout, staffing shortages, and EMS professionals leaving the profession, more must be done to support EMS providers. This includes programs to facilitate entry to and advancement within the EMS profession, ability to make ends meet without reliance on overtime pay, and mental health support.

Social Needs in the Prehospital Setting (SNIPS): EMS Attitudes Toward Addressing Patient Social Needs.

Introduction: There has been interest in utilizing EMS to address patients' social determinants of health, which are thought to be the cause of many unnecessary transports, particularly for "super-utilizing" patients. However, existing research is limited regarding EMS clinicians' understanding of social determinants of health and attitudes toward potential interventions. Methods: This cross-sectional study was conducted using an internet-based survey of EMS clinicians across the United States with multiple methods of recruitment. Descriptive statistics and Chi Square Tests analyzed the data. Results: A total of 1,112 EMTs and paramedics completed the survey with 43.4% reporting familiarity with the term, "social determinants of health," and 87.7% screening positive for burnout. Greater than 60% reported willingness to use proposed interventions to address patient social needs. Those who reported familiarity with the term, "social determinants of health," were more likely to indicate willingness to utilize interventions and to believe they were responsible for addressing their patients' social needs. Burnout had no effect on clinicians' willingness to use resources. Discussion: Respondents showed substantial interest in using the proposed resources to address patient social needs, suggesting that EMS clinicians may be receptive to expanding their scope of responsibility to include socioeconomic interventions. EMS clinicians familiar with the term "social determinants of health" were more likely to believe they were responsible for addressing patient social needs and more willing to use interventions, suggesting a potential benefit to more education on the topic. Burnout among EMS clinicians may not be a barrier to implementing such interventions. Conclusion: Our survey suggests that EMS clinicians may be interested in helping to address their patients' social needs. EMS clinicians should be offered education on social determinants of health in their initial training and through continuing education. Partnerships with human services agencies will be important to ensure the effectiveness of prehospital interventions.

Factors Associated With Successful Enrollment in a Community Paramedicine Program for Heart Failure.

Introduction Participation in community paramedicine (CP) programs, sometimes referred to as Mobile Integrated Healthcare (MIH), may improve patient-centered outcomes and reduce hospital readmissions. The objective of this study was to correlate patient and system-specific factors with successful enrollment in a CP program for heart failure.  Methods We conducted a retrospective review of patients enrolled in a CP program after hospitalization for a heart failure-related diagnosis. All patients greater than 18 years of age referred to the CP program with a heart-failure-related diagnosis were included. Factors including age, sex, hospital length of stay, enrollment method, concurrent use of transitional care services, care team, and service line referral were collected. The primary outcome was successful enrollment which led to an initial home visit. Chi-square and t-tests were performed to determine if the outcome differed between cohorts.  Results A total of 908 patients met the inclusion criteria, and 677 (74.7%) received home visits. Increased participation was noted in patients enrolled in person (81.1% vs. 66%, p<0.01) and those also receiving transitional care services (78.9% vs. 62.5%, p<0.01).  Conclusion We conclude that efforts should be made to contact patients in person, prior to hospital discharge, who are eligible for CP services.

Management of routine postoperative pain for children undergoing cardiac surgery: a Paediatric Acute Care Cardiology Collaborative Clinical Practice Guideline.

BACKGROUND: Pain following surgery for cardiac disease is ubiquitous, and optimal management is important. Despite this, there is large practice variation. To address this, the Paediatric Acute Care Cardiology Collaborative undertook the effort to create this clinical practice guideline. METHODS: A panel of experts consisting of paediatric cardiologists, advanced practice practitioners, pharmacists, a paediatric cardiothoracic surgeon, and a paediatric cardiac anaesthesiologist was convened. The literature was searched for relevant articles and Collaborative sites submitted centre-specific protocols for postoperative pain management. Using the modified Delphi technique, recommendations were generated and put through iterative Delphi rounds to achieve consensus. RESULTS: 60 recommendations achieved consensus and are included in this guideline. They address guideline use, pain assessment, general considerations, preoperative considerations, intraoperative considerations, regional anaesthesia, opioids, opioid-sparing, non-opioid medications, non-pharmaceutical pain management, and discharge considerations. CONCLUSIONS: Postoperative pain among children following cardiac surgery is currently an area of significant practice variability despite a large body of literature and the presence of centre-specific protocols. Central to the recommendations included in this guideline is the concept that ideal pain management begins with preoperative counselling and continues through to patient discharge. Overall, the quality of evidence supporting recommendations is low. There is ongoing need for research in this area, particularly in paediatric populations.

Fumarate is a terminal electron acceptor in the mammalian electron transport chain.

For electrons to continuously enter and flow through the mitochondrial electron transport chain (ETC), they must ultimately land on a terminal electron acceptor (TEA), which is known to be oxygen in mammals. Paradoxically, we find that complex I and dihydroorotate dehydrogenase (DHODH) can still deposit electrons into the ETC when oxygen reduction is impeded. Cells lacking oxygen reduction accumulate ubiquinol, driving the succinate dehydrogenase (SDH) complex in reverse to enable electron deposition onto fumarate. Upon inhibition of oxygen reduction, fumarate reduction sustains DHODH and complex I activities. Mouse tissues display varying capacities to use fumarate as a TEA, most of which net reverse the SDH complex under hypoxia. Thus, we delineate a circuit of electron flow in the mammalian ETC that maintains mitochondrial functions under oxygen limitation.

Changes in Sedation Practices in Association with Delirium Screening in Infants After Cardiopulmonary Bypass.

Sedation in the cardiac intensive care unit (CICU) is necessary to keep critically ill infants safe and comfortable. However, long-term use of sedatives may be associated with adverse neurodevelopmental outcomes. We aimed to examine sedation practices in the CICU after the implementation of the Cornell Assessment of Pediatric Delirium (CAPD). We hypothesize the use of the CAPD would be associated with a decrease in sedative weans at CICU discharge. This is a single institution, retrospective cohort study. The study inclusion criteria were term infants, birthweight > 2.5 kg, cardiopulmonary bypass (CPB), and mechanical ventilation (MV) on postoperative day zero. During the study period, 50 and 35 patients respectively, met criteria pre- and post-implementation of CAPD screening. Our results showed a statistically significant increase in the incidence of sedative habituation wean at CICU discharge after CAPD implementation (24% vs. 45.7%, p = 0.036). There was a statistically significant increase in exposure to opiate (56% vs. 88.6%, p = 0.001) and dexmedetomidine infusions (52% vs 80%, p = 0.008), increased likelihood of clonidine use at CICU discharge (OR 9.25, CI 2.39-35.84), and increase in the duration of intravenous sedative infusions (8.1 days vs. 5.1 days, p = 0.04) No statistical difference was found in exposure to fentanyl (42% vs. 58.8%, p = 0.13) or midazolam infusions (22% vs. 25.7%, p = 0.691); and there was no change in benzodiazepine or opiate use at CICU discharge or dosage. The prevalence of delirium in the CAPD cohort was 92%. CAPD implementation in the CICU was associated with changes in sedation practices, specifically an increase in the use of dexmedetomidine, which possibly explains the increased clonidine weans at CICU discharge. This is the first report of the association between CAPD monitoring and changes in sedative practices. Multi-center prospective studies are recommended to evaluate sedative practices, delirium, and its effects on neurodevelopment.

Mouth care training and practice: a survey of nursing staff working in National Health Service hospitals in England.

Background: This study investigated the training and mouth care practice of nursing staff in hospital Trusts across England. Oral health has been found to deteriorate during hospital admission, mouth care standards have been found to be poor. Aims: The objectives of the study were to assess if and what the barriers are to supporting inpatients' mouth care, and to assess how confident nursing staff are in carrying out mouth care assessments and mouth care and see if this is related to previous training. Methods: A cross-sectional descriptive survey was conducted in 33 Trusts in England with 1576 members of the nursing team including nurses and nursing assistants. Nursing staff were asked to complete a questionnaire on previous oral health training and their current practice. Results: Nursing staff reported that they had limited training in mouth care. The main barriers to mouth care were time and patient compliance. Confidence in recognising oral cancer was low. Conclusions: Nursing staff would benefit from mouth care training targeted at assessing the mouth and providing mouth care for all inpatients.

Tibial bone stress injury: diagnostic performance and inter-reader agreement of an abbreviated 5-min magnetic resonance protocol.

OBJECTIVE: To compare the diagnostic performance and inter-reader agreement of an abbreviated (5 min) MR protocol compared to a complete (25 min) protocol, for evaluation of suspected tibial bone stress injury. MATERIALS AND METHODS: This IRB-approved retrospective study consisted of 95 consecutive MR examinations in 88 patients with suspected tibial bone stress injury. Three musculoskeletal radiologists independently classified all examinations utilizing both an abbreviated protocol consisting only of axial T2-weighted images with fat suppression, and after a washout period again classified the complete examinations. Accuracy was calculated as proportion of cases classified exactly, within 1 grade, within 2 grades, and also utilizing a simplified "clinically relevant" classification combining grades 2, 3, and 4A into a single group. Significance testing was performed with the chi-test, and a post-hoc power analysis was performed. Inter-reader agreement was calculated with Kendall's coefficient of concordance, with significance testing performed utilizing the z-test after bootstrapping to obtain the standard error. RESULTS AND CONCLUSIONS: There was no significant difference in accuracy of grading tibial bone stress injuries between complete and abbreviated examinations. For complete exams, pooled exact accuracy was 47.8%; accuracy within 1 grade was 82.8%; and accuracy within 2 grades was 96.1%. For the abbreviated protocol, corresponding accuracies were 50.2, 82.0, and 93.9%. With the "clinically relevant" simplified classification, accuracy was 58.6% for complete exams and 64.2% for abbreviated exams. There was no significant difference in inter-reader agreement, with substantial agreement demonstrated for both complete (Kendall coefficient of concordance 0.805) and abbreviated examinations (coefficient of 0.767).

Reducing Burnout Among Radiology Trainees: A Novel Residency Retreat Curriculum to Improve Camaraderie and Personal Wellness - 3 Strategies for Success.

OBJECTIVES: To describe a residency retreat curriculum established to improve wellness and reduce burnout within a radiology residency. METHODS: A wellness retreat was created and implemented within a large academic medical center's radiology residency. The retreat curriculum was designed by a Radiology Residency Wellness Committee and was supported by departmental funding. The retreat curriculum centered on 3 strategies for success: teambuilding and bonding, Design Thinking, and guided reflection. A questionnaire was distributed at the end of the retreat, asking 12 questions in 5-point Likert format to assess resident satisfaction with different components of the retreat, as well as open-ended questions to more deeply assess the effects of the retreat on the residency experience and personal wellness in our radiology residency. Questionnaire results were summarized using frequency and percentages. Open-ended responses were qualitatively analyzed using the constant comparative method. RESULTS: Thirty-seven of 41 residents (90%) in our radiology residency participated in the retreat. Thirty-five of the 37 residents (95%) participated in the postretreat questionnaire, with 33 of 37 residents (89%) completing the entire questionnaire. Thirty-two of 33 responders (97%) anticipated the retreat would improve their residency experience, and 27 of 33 responders (82%) indicated the retreat would improve their personal wellness. Based upon the open-ended responses, improved camaraderie was the major benefit of the retreat cited by the majority of residents. CONCLUSION: A departmentally sponsored radiology residency retreat may improve personal wellness and reduce burnout.

A survey of the knowledge of junior doctors in managing oral conditions in adult inpatients.

Background Adult inpatients are at risk of developing oral health-related problems during their admission that may require input from their medical team. Doctors have minimal training in oral health which may lead to inappropriate diagnosis and management of oral conditions.Aim The aim of this survey was to investigate the knowledge of junior doctors in managing oral health conditions in hospitalised patients.Method A survey was carried out with 146 junior doctors in Kent, Surrey and Sussex who attended oral health training sessions, which included scenario-based questions on diagnosis and management.Results Ninety-two percent of doctors did not feel confident in diagnosing common oral conditions and 50% did not routinely assess the mouth as part of their overall health assessment. Of those surveyed, 97% expressed that they would like further training in oral health.Conclusion There is a need to incorporate oral health training into the teaching programme for junior doctors to improve their confidence in the diagnosis and management of oral conditions. This would help improve the management of patients who develop oral problems during their hospital stay.

Silicon-rich amendments in rice paddies: Effects on arsenic uptake and biogeochemistry.

An emerging approach to limit rice uptake and grain As targets the shared root-uptake pathway between As(III) and Si. We amended rice paddy mesocosms with Si-rich rice residues (husk and husk char) or silicate fertilizer to evaluate the impact of different Si sources on rice uptake of Si and As including As speciation in grain under background soil As. For a systems-approach, we also measured plant biomass, rice yield, porewater chemistry, mesocosm-scale CH4 and CO2 fluxes, plant concentrations of nutrients and metals, and root Fe plaque mineralogy. Relative to the control, Si-rich amendments increased plant Si and proportion of ferrihydrite on root plaque, decreased root-to-shoot Mn transfer and As uptake, and shifted grain As from inorganic to organic As. The charred husk treatment, which resulted in the most Si accumulation in rice shoots, most decreased plant As and grain As. Husk treatment led to the highest CH4 emissions, but all treatments had lower CH4 emissions than has been reported for straw treatments. Collectively, Si-rich amendments performed similarly across several biogeochemical benchmarks, with charred husk best restricting plant As, suggesting these amendments can be used to reduce toxicity of As from rice grain while maintaining yield.

Improvements of an objective model of compressed breasts undergoing mammography: Generation and characterization of breast shapes.

PURPOSE: To develop a set of accurate 2D models of compressed breasts undergoing mammography or breast tomosynthesis, based on objective analysis, to accurately characterize mammograms with few linearly independent parameters, and to generate novel clinically realistic paired cranio-caudal (CC) and medio-lateral oblique (MLO) views of the breast. METHODS: We seek to improve on an existing model of compressed breasts by overcoming detector size bias, removing the nipple and non-mammary tissue, pairing the CC and MLO views from a single breast, and incorporating the pectoralis major muscle contour into the model. The outer breast shapes in 931 paired CC and MLO mammograms were automatically detected with an in-house developed segmentation algorithm. From these shapes three generic models (CC-only, MLO-only, and joint CC/MLO) with linearly independent components were constructed via principal component analysis (PCA). The ability of the models to represent mammograms not used for PCA was tested via leave-one-out cross-validation, by measuring the average distance error (ADE). RESULTS: The individual models based on six components were found to depict breast shapes with accuracy (mean ADE-CC = 0.81 mm, ADE-MLO = 1.64 mm, ADE-Pectoralis = 1.61 mm), outperforming the joint CC/MLO model (P ≤ 0.001). The joint model based on 12 principal components contains 99.5% of the total variance of the data, and can be used to generate new clinically realistic paired CC and MLO breast shapes. This is achieved by generating random sets of 12 principal components, following the Gaussian distributions of the histograms of each component, which were obtained from the component values determined from the images in the mammography database used. CONCLUSION: Our joint CC/MLO model can successfully generate paired CC and MLO view shapes of the same simulated breast, while the individual models can be used to represent with high accuracy clinical acquired mammograms with a small set of parameters. This is the first step toward objective 3D compressed breast models, useful for dosimetry and scatter correction research, among other applications.

Effects of the P-Selectin Antagonist Inclacumab on Myocardial Damage After Percutaneous Coronary Intervention According to Timing of Infusion: Insights From the SELECT-ACS Trial.

BACKGROUND: The Effects of the P-Selectin Antagonist Inclacumab on Myocardial Damage After Percutaneous Coronary Intervention for Non-ST-Segment Elevation Myocardial Infarction (SELECT-ACS) trial suggested beneficial effects of inclacumab, a monoclonal antibody directed against P-selectin, on periprocedural myocardial damage. This study evaluated the effect of inclacumab on myocardial damage according to varying time intervals between study drug infusion and percutaneous coronary intervention (PCI). METHODS AND RESULTS: Patients (n=544) enrolled in the SELECT-ACS trial and randomized to receive 1 infusion of placebo or inclacumab (5 or 20 mg/kg, administered between 1 and 24 hours before PCI) were divided according to the time interval between study drug infusion and PCI. The primary end point was the change in troponin I from baseline at 16 and 24 hours after PCI. In patients receiving inclacumab 20 mg/kg with a short (less than median) time interval between infusion and PCI, placebo-adjusted geometric mean percent changes in troponin I, creatine kinase-myocardial band, and peak troponin I at 24 hours were -45.6% (P=0.005), -30.7% (P=0.01), and -37.3% (P=0.02), respectively. No significant changes were observed in patients with a long (greater than median) time interval between infusion and PCI. Placebo-adjusted geometric mean percent changes in troponin I and creatine kinase-myocardial band were -43.5% (P=0.02) and -26.0% (P=0.07), respectively, when inclacumab 20 mg/kg was administered between 1 and 3 hours before PCI, whereas the drug had no effect with longer intervals. CONCLUSIONS: Inclacumab 20 mg/kg significantly reduces myocardial damage after PCI in patients with non-ST-segment elevation myocardial infarction, and benefits are larger when the infusion is administered <3 hours before PCI. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01327183.

Soil Incorporation of Silica-Rich Rice Husk Decreases Inorganic Arsenic in Rice Grain.

Arsenic decreases rice yield, and inorganic grain As threatens human health; thus, strategies to decrease rice As are critically needed. Increased plant-available silica (Si) can decrease rice As, yet the source of Si matters. Rice husk, an underutilized and Si-rich byproduct of rice production that contains less labile C and an order of magnitude less As than rice straw, may be an economically viable Si resource to decrease rice As, yet the impact of rice husk incorporation on As in the rice-soil nexus has not been reported. This proof-of-concept study shows that rice husk incorporation to soil (1% w/w) decreases inorganic grain As by 25-50% without negatively affecting grain Cd, yield, or dissolved CH4 levels. Rice husk is a critical yet perhaps overlooked resource to improve soil quality through enhanced nutrient availability and attenuate human health risks through consumption of As-laden grain.

Increased arterial inflammation in individuals with stage 3 chronic kidney disease.

PURPOSE: While it is well known that patients with chronic kidney disease (CKD) are at increased risk for the development and progression of atherosclerosis, it is not known whether arterial inflammation is increased in mild CKD. The aim of this study was to compare arterial inflammation using 18F-FDG PET/CT in patients with CKD and in matched controls. METHODS: This restrospective study included 128 patients undergoing FDG PET/CT imaging for clinical indications, comprising 64 patients with stage 3 CKD and 64 control patients matched by age, gender, and cancer history. CKD was defined according to guidelines using a calculated glomerular filtration rate (eGFR). Arterial inflammation was measured in the ascending aorta as FDG uptake on PET. Background FDG uptake (venous, subcutaneous fat and muscle) were recorded. Coronary artery calcification (CAC) was assessed using the CT images. The impact of CKD on arterial inflammation and CAC was then assessed. RESULTS: Arterial inflammation was higher in patients with CKD than in matched controls (standardized uptake value, SUV: 2.41 ± 0.49 vs. 2.16 ± 0.43; p = 0.002). Arterial SUV correlated inversely with eGFR (r = -0.299, p = 0.001). Venous SUV was also significantly elevated in patients with CKD, while subcutaneous fat and muscle tissue SUVs did not differ between groups. Moreover, arterial SUV remained significantly elevated in patients with CKD compared to controls after correcting for muscle and fat background, and also remained significant after adjusting for clinical risk factors. Further, CKD was associated with arterial inflammation (SUV) independent of the presence of subclinical atherosclerosis (CAC). CONCLUSION: Moderate CKD is associated with increased arterial inflammation beyond that of controls. Further, the increased arterial inflammation is independent of presence of subclinical atherosclerosis. Current risk stratification tools may underestimate the presence of atherosclerosis in patients with CKD and thereby the risk of cardiovascular events.

High School Football Players' Knowledge and Attitudes About Concussions.

OBJECTIVES: To assess high school (HS) football players' knowledge of concussions and to determine whether increased knowledge is correlated with better attitudes toward reporting concussion symptoms and abstaining from play. DESIGN: Two survey tools were used to assess athletes' knowledge and attitudes about concussions. Surveys collected information about demographics, knowledge about concussions, and attitudes about playing sports after a concussion. All athletes present completed one of the 2 surveys. A knowledge and attitude score for each survey was calculated. Frequencies and mean values were used to characterize the population; regression analysis, analysis of variance, and t tests were used to look for associations. SETTING: A football camp for HS athletes in the Cincinnati area. PARTICIPANTS: Male HS football players from competitive football programs in the Cincinnati area. INTERVENTION: None. MAIN OUTCOME MEASURE: Scores on knowledge and attitude sections; responses to individual questions. RESULTS: One hundred twenty (100%) athletes were enrolled although not every athlete responded to every question. Thirty (25%) reported history of a concussion; 82 (70%) reported receiving prior concussion education. More than 75% correctly recognized all concussion symptoms that were asked, except "feeling in a fog" [n = 63 (53%)]. One hundred nine (92%) recognized a risk of serious injury if they return to play too quickly. Sixty-four (54%) athletes would report symptoms of a concussion to their coach; 62 (53%) would continue to play with a headache from an injury. There was no association between knowledge score and attitude score (P = 0.08). CONCLUSIONS: Despite having knowledge about the symptoms and danger of concussions, many HS football athletes in our sample did not have a positive attitude toward reporting symptoms or abstaining from play after a concussion. CLINICAL RELEVANCE: Physicians should be aware that young athletes may not report concussion symptoms.

Selected Reaction Monitoring Mass Spectrometry for Absolute Protein Quantification.

Absolute quantification of target proteins within complex biological samples is critical to a wide range of research and clinical applications. This protocol provides step-by-step instructions for the development and application of quantitative assays using selected reaction monitoring (SRM) mass spectrometry (MS). First, likely quantotypic target peptides are identified based on numerous criteria. This includes identifying proteotypic peptides, avoiding sites of posttranslational modification, and analyzing the uniqueness of the target peptide to the target protein. Next, crude external peptide standards are synthesized and used to develop SRM assays, and the resulting assays are used to perform qualitative analyses of the biological samples. Finally, purified, quantified, heavy isotope labeled internal peptide standards are prepared and used to perform isotope dilution series SRM assays. Analysis of all of the resulting MS data is presented. This protocol was used to accurately assay the absolute abundance of proteins of the chemotaxis signaling pathway within RAW 264.7 cells (a mouse monocyte/macrophage cell line). The quantification of Gi2 (a heterotrimeric G-protein α-subunit) is described in detail.

Maternal and neonatal outcomes after gonadotropin-releasing hormone agonist trigger for final oocyte maturation in patients undergoing in vitro fertilization.

OBJECTIVE: To compare the rate of congenital anomalies, obstetrical complications, and neonatal complications in antagonist cycles where either GnRH agonist (GnRHa) or hCG was used for final oocyte maturation. DESIGN: Retrospective cohort study. SETTING: University-based tertiary fertility center. PATIENT(S): Three hundred ninety-two women under 40 years of age who underwent controlled ovarian stimulation using a GnRH antagonist protocol and who had final oocyte maturation triggered with either a GnRHa or hCG that resulted in pregnancy and delivery after 16 weeks' gestation. INTERVENTION(S): GnRHa versus hCG trigger of final oocyte maturation. MAIN OUTCOME MEASURE(S): Congenital anomaly rates, obstetrical complications, and neonatal complications. RESULT(S): There were no significant differences in the rate of congenital anomalies between GnRHa and hCG trigger (6.6 vs. 9.2%). There were also no differences in the maternal complications (27.6 vs. 20.8%) or neonatal complications (19.7 vs. 20.0%) between the GnRHa trigger and hCG trigger groups. CONCLUSION(S): GnRHa trigger does not affect the rate of congenital anomalies or obstetrical or neonatal complications and remains a viable option in the prevention of ovarian hyperstimulation syndrome.

Anti-adaptors provide multiple modes for regulation of the RssB adaptor protein.

RpoS, an RNA polymerase σ factor, controls the response of Escherichia coli and related bacteria to multiple stress responses. During nonstress conditions, RpoS is rapidly degraded by ClpXP, mediated by the adaptor protein RssB, a member of the response regulator family. In response to stress, RpoS degradation ceases. Small anti-adaptor proteins--IraP, IraM, and IraD, each made under a different stress condition--block RpoS degradation. RssB mutants resistant to either IraP or IraM were isolated and analyzed in vivo and in vitro. Each of the anti-adaptors is unique in its interaction with RssB and sensitivity to RssB mutants. One class of mutants defined an RssB N-terminal region close to the phosphorylation site and critical for interaction with IraP but unnecessary for IraM and IraD function. A second class, in the RssB C-terminal PP2C-like domain, led to activation of RssB function. These mutants allowed the response regulator to act in the absence of phosphorylation but did not abolish interaction with anti-adaptors. This class of mutants is broadly resistant to the anti-adaptors and bears similarity to constitutively activated mutants found in a very different PP2C protein. The mutants provide insight into how the anti-adaptors perturb RssB response regulator function and activation.