Blending Indigenous and western science: Quantifying cultural burning impacts in Karuk Aboriginal Territory.

The combined effects of Indigenous fire stewardship and lightning ignitions shaped historical fire regimes, landscape patterns, and available resources in many ecosystems globally. The resulting fire regimes created complex fire-vegetation dynamics that were further influenced by biophysical setting, disturbance history, and climate. While there is increasing recognition of Indigenous fire stewardship among western scientists and managers, the extent and purpose of cultural burning is generally absent from the landscape-fire modeling literature and our understanding of ecosystem processes and development. In collaboration with the Karuk Tribe Department of Natural Resources, we developed a transdisciplinary Monte Carlo simulation model of cultural ignition location, frequency, and timing to simulate spatially explicit cultural ignitions across a 264,399-ha landscape within Karuk Aboriginal Territory in northern California. Estimates of cultural ignition parameters were developed with Tribal members and knowledge holders using existing interviews, historical maps, ethnographies, recent ecological studies, contemporary maps, and generational knowledge. Spatial and temporal attributes of cultural burning were explicitly tied to the ecology of specific cultural resources, fuel receptivity, seasonal movement patterns, and spiritual practices. Prior to colonization, cultural burning practices were extensive across the study landscape with an estimated 6972 annual ignitions, averaging approximately 6.5 ignitions per Indigenous fire steward per year. The ignition characteristics we document align closely with data on historical fire regimes and vegetation but differ substantially from the location and timing of contemporary ignitions. This work demonstrates the importance of cultural burning for developing and maintaining the ecosystems present at the time of colonization and underscores the need to work collaboratively with Indigenous communities to restore ecocultural processes in these systems.

Experimental Open Air Burning of Vegetation Enhances Organic Matter Chemical Heterogeneity Compared to Laboratory Burns.

Wildfires produce solid residuals that have unique chemical and physical properties compared to unburned materials, which influence their cycling and fate in the natural environment. Visual burn severity assessment is used to evaluate post-fire alterations to the landscape in field-based studies, yet muffle furnace methods are commonly used in laboratory studies to assess molecular scale alterations along a temperature continuum. Here, we examined solid and leachable organic matter characteristics from chars visually characterized as low burn severity that were created either on an open air burn table or from low-temperature muffle furnace burns. We assessed how the different combustion conditions influence solid and dissolved organic matter chemistries and explored the potential influence of these results on the environmental fate and reactivity. Notably, muffle furnace chars produced less leachable carbon and nitrogen than open air chars across land cover types. Organic matter produced from muffle furnace burns was more homogeneous than open air chars. This work highlights chemical heterogeneities that exist within a single burn severity category, potentially influencing our conceptual understanding of pyrogenic organic matter cycling in the natural environment, including transport and processing in watersheds. Therefore, we suggest that open air burn studies are needed to further advance our understanding of pyrogenic organic matter's environmental reactivity and fate.

Pristine carbon nanotubes are efficient absorbers at radio frequencies.

Radio frequency ablation and microwave hyperthermia are powerful tools for destroying dysfunctional biological tissues. However, wireless application of these techniques is hindered by their inability to focus the electromagnetic energy to small targets. The use of locally injected radio frequency- or microwave-absorbing nanomaterials can help to overcome this challenge by confining heat production to the injected region. Previous theoretical work suggests that high-aspect-ratio conducting nanomaterials, such as carbon nanotubes, offer powerful radio frequency and microwave absorption. While carbon nanotubes have been demonstrated as radiothermal agents, common solubilization methods may reduce their absorption efficiency, yielding undesirable nonspecific heating in the biological tissue background. In this manuscript, we hypothesize that pristine carbon nanotubes can act as efficient absorbers at radio frequencies, thus providing differential heating over the tissue background. Specifically, we use a sonication-free preparation technique to preserve both the high aspect ratio and local concentration of pristine carbon nanotubes. We validate the differential heating of these samples by 4.5-fold at 2 GHz compared to the heating of saline at a physiological concentration using infrared thermography. In addition, we successfully achieved local heating of pristine carbon nanotubes within a three-dimensional biological tissue phantom. Numerical simulations further aid in producing a temperature map within the phantom and confirming localized heating. Due to their significant differential and local heating, we believe that pristine carbon nanotubes may facilitate region-specific radio frequency ablation and microwave hyperthermia while keeping nonspecific heating to a low level in the normal tissue background.

Infrared sensor performance with boost and restoration filtering.

The targeting task performance (TTP) model for prediction of target identification range suggests that boost filtering with a well-sampled, low-noise long-wave infrared (LWIR) sensor can substantially increase target ID range (by enhancing contrast at high spatial frequencies). We model a notional high-performance LWIR imaging system with a high F-number, deep electron wells, and a small-pitch focal plane array. System analysis performed with the Night Vision Integrated Performance Model (NVIPM) predicts that a range enhancement upwards of 50% is achievable with Wiener restoration applied to imagery from the modeled sensor. Human perception experiments were performed on simulated target imagery, with range through different boost filters (including a Wiener restoration filter) compared to the no-post-filter case. The TTP model was found to significantly overestimate the performance improvement due to boost and restoration filtering. Alternate predictions based on the Johnson criteria were also performed, and these underestimated the impact of boost. We speculate on reasons for the discrepancy and on promising avenues for future research. Sensor parameters, NVIPM predictions, filter parameters, and experimental data are provided.

Effects of season and interval of prescribed burns on pyrogenic carbon in ponderosa pine stands in the southern Blue Mountains, Oregon, USA.

In ponderosa pine (Pinus ponderosa) forests of the western United States, prescribed burns are used to reduce fuel loads and restore historical fire regimes. The season of and interval between burns can have complex consequences for the ecosystem, including the production of pyrogenic carbon (PyC). PyC plays a crucial role in soil carbon cycling, displaying turnover times that are orders of magnitude longer than unburned organic matter. This work investigated how the season of and interval between prescribed burns affect soil organic matter, including the formation and retention of PyC, in a ponderosa pine forest of eastern Oregon. In 1997 a prescribed burn study was implemented in Malheur National Forest to examine the ecological effects of burning at 5 and 15-year intervals in either the spring or fall. In October 2015, both O-horizon and mineral soil (0-15 cm) samples were collected and analyzed for PyC concentration, content, and structure using the benzene polycarboxylic acid (BPCA) method. O-horizon depth, carbon and nitrogen concentration and content, pH, and bulk density were also measured. Plots burned in the spring and fall had lower C and N stocks in the O-horizon compared to the unburned controls due to a reduction in O-horizon depth; however, we did not observe any differences in O-horizon concentration of C or N. Moreover, the concentration and stock of C and N in the mineral soil of plots burned in the spring or fall was the same as or only very slightly different from the unburned controls, suggesting that the prescribed burns on these sites have not adversely affected SOM quantity. Compared to unburned controls, we estimate that fall burns increased the mean PyC concentration of the mineral soil by 8.42 g BPCA/kg C. We did not detect a difference in mean PyC concentration of the mineral soil between the spring burns and the unburned controls; however, the spring burn plots did contain a number of isolated pockets with very high concentrations of PyC, suggesting a patchier burn pattern for these plots. In general, there was no detectable difference in any of the response variables when comparing the various prescribed burn treatments to one another. The disturbance caused by the reintroduction of fire to this ecosystem may have obscured subtle differences caused by the different seasons and intervals of burn that could become more apparent over time.

Towards a comprehensive wildfire management strategy for Mediterranean areas: Framework development and implementation in Catalonia, Spain.

Southern European countries rely largely on fire suppression and ignition prevention to manage a growing wildfire problem. We explored a more wholistic, long-term approach based on priority maps for the implementation of diverse management options aimed at creating fire resilient landscapes, restoring cultural fire regimes, facilitating safe and efficient fire response, and creating fire-adapted communities. To illustrate this new comprehensive strategy for fire-prone Mediterranean areas, we developed and implemented the framework in Catalonia (northeastern Spain). We first used advanced simulation modeling methods to assess various wildfire exposure metrics across spatially changing fire-regime conditions, and these outputs were then combined with land use maps and historical fire occurrence data to prioritize different fuel and fire management options at the municipality level. Priority sites for fuel management programs concentrated in the central and northeastern high-hazard forestlands. The suitable areas for reintroducing fires in natural ecosystems located in scattered municipalities with ample lightning ignitions and minimal human presence. Priority areas for ignition prevention programs were mapped to populated coastal municipalities and main transportation corridors. Landscapes where fire suppression is the principal long-term strategy concentrated in agricultural plains with a high density of ignitions. Localized programs to build defensible space and improve self-protection on communities could be emphasized in the coastal wildland-urban interface and inner intermix areas from Barcelona and Gerona. We discuss how the results of this study can facilitate collaborative landscape planning and identify the constraints that prevent a longer term and more effective solution to better coexist with fire in southern European regions.

No barrier to emergence of bathyal king crabs on the Antarctic shelf.

Cold-water conditions have excluded durophagous (skeleton-breaking) predators from the Antarctic seafloor for millions of years. Rapidly warming seas off the western Antarctic Peninsula could now facilitate their return to the continental shelf, with profound consequences for the endemic fauna. Among the likely first arrivals are king crabs (Lithodidae), which were discovered recently on the adjacent continental slope. During the austral summer of 2010 ‒ 2011, we used underwater imagery to survey a slope-dwelling population of the lithodid Paralomis birsteini off Marguerite Bay, western Antarctic Peninsula for environmental or trophic impediments to shoreward expansion. The population density averaged ∼ 4.5 individuals × 1,000 m(-2) within a depth range of 1,100 ‒ 1,500 m (overall observed depth range 841-2,266 m). Images of juveniles, discarded molts, and precopulatory behavior, as well as gravid females in a trapping study, suggested a reproductively viable population on the slope. At the time of the survey, there was no thermal barrier to prevent the lithodids from expanding upward and emerging on the outer shelf (400- to 550-m depth); however, near-surface temperatures remained too cold for them to survive in inner-shelf and coastal environments (<200 m). Ambient salinity, composition of the substrate, and the depth distribution of potential predators likewise indicated no barriers to expansion of lithodids onto the outer shelf. Primary food resources for lithodids--echinoderms and mollusks--were abundant on the upper slope (550-800 m) and outer shelf. As sea temperatures continue to rise, lithodids will likely play an increasingly important role in the trophic structure of subtidal communities closer to shore.

Random forests as cumulative effects models: A case study of lakes and rivers in Muskoka, Canada.

Cumulative effects assessment (CEA) - a type of environmental appraisal - lacks effective methods for modeling cumulative effects, evaluating indicators of ecosystem condition, and exploring the likely outcomes of development scenarios. Random forests are an extension of classification and regression trees, which model response variables by recursive partitioning. Random forests were used to model a series of candidate ecological indicators that described lakes and rivers from a case study watershed (The Muskoka River Watershed, Canada). Suitability of the candidate indicators for use in cumulative effects assessment and watershed monitoring was assessed according to how well they could be predicted from natural habitat features and how sensitive they were to human land-use. The best models explained 75% of the variation in a multivariate descriptor of lake benthic-macroinvertebrate community structure, and 76% of the variation in the conductivity of river water. Similar results were obtained by cross-validation. Several candidate indicators detected a simulated doubling of urban land-use in their catchments, and a few were able to detect a simulated doubling of agricultural land-use. The paper demonstrates that random forests can be used to describe the combined and singular effects of multiple stressors and natural environmental factors, and furthermore, that random forests can be used to evaluate the performance of monitoring indicators. The numerical methods presented are applicable to any ecosystem and indicator type, and therefore represent a step forward for CEA.

High-Field NMR Spectroscopy Reveals Aromaticity-Modulated Hydrogen Bonding in Heterocycles.

From DNA base pairs to drug-receptor binding, hydrogen (H-)bonding and aromaticity are common features of heterocycles. Herein, the interplay of these bonding aspects is explored. H-bond strength modulation due to enhancement or disruption of aromaticity of heterocycles is experimentally revealed by comparing homodimer H-bond energies of aromatic heterocycles with analogs that have the same H-bonding moieties but lack cyclic π-conjugation. NMR studies of dimerization in C6 D6 find aromaticity-modulated H-bonding (AMHB) energy effects of approximately ±30 %, depending on whether they enhance or weaken aromatic delocalization. The attendant ring current perturbations expected from such modulation are confirmed by chemical shift changes in both observed ring C-H and calculated nucleus-independent sites. In silico modeling confirms that AMHB effects outweigh those of hybridization or dipole-dipole interaction.

Abundances of Neutron-capture Elements in 62 Stars in the Globular Cluster Messier 15.

M15 is a globular cluster with a known spread in neutron-capture elements. This paper presents abundances of neutron-capture elements for 62 stars in M15. Spectra were obtained with the Michigan/Magellan Fiber System spectrograph, covering a wavelength range from ∼4430 to 4630 Å. Spectral lines from Fe i, Fe ii, Sr i, Zr ii, Ba ii, La ii, Ce ii, Nd ii, Sm ii, Eu ii, and Dy ii were measured, enabling classifications and neutron-capture abundance patterns for the stars. Of the 62 targets, 44 are found to be highly Eu-enhanced r-II stars, another 17 are moderately Eu-enhanced r-I stars, and one star is found to have an s-process signature. The neutron-capture patterns indicate that the majority of the stars are consistent with enrichment by the r-process. The 62 target stars are found to show significant star-to-star spreads in Sr, Zr, Ba, La, Ce, Nd, Sm, Eu, and Dy, but no significant spread in Fe. The neutron-capture abundances are further found to have slight correlations with sodium abundances from the literature, unlike what has been previously found; follow-up studies are needed to verify this result. The findings in this paper suggest that the Eu-enhanced stars in M15 were enhanced by the same process, that the nucleosynthetic source of this Eu pollution was the r-process, and that the r-process source occurred as the first generation of cluster stars was forming.

Sequencing by avidity enables high accuracy with low reagent consumption.

We present avidity sequencing, a sequencing chemistry that separately optimizes the processes of stepping along a DNA template and that of identifying each nucleotide within the template. Nucleotide identification uses multivalent nucleotide ligands on dye-labeled cores to form polymerase-polymer-nucleotide complexes bound to clonal copies of DNA targets. These polymer-nucleotide substrates, termed avidites, decrease the required concentration of reporting nucleotides from micromolar to nanomolar and yield negligible dissociation rates. Avidity sequencing achieves high accuracy, with 96.2% and 85.4% of base calls having an average of one error per 1,000 and 10,000 base pairs, respectively. We show that the average error rate of avidity sequencing remained stable following a long homopolymer.

Interactome analysis of longitudinal pharyngeal infection of cynomolgus macaques by group A Streptococcus.

Relatively little is understood about the dynamics of global host-pathogen transcriptome changes that occur during bacterial infection of mucosal surfaces. To test the hypothesis that group A Streptococcus (GAS) infection of the oropharynx provokes a distinct host transcriptome response, we performed genome-wide transcriptome analysis using a nonhuman primate model of experimental pharyngitis. We also identified host and pathogen biological processes and individual host and pathogen gene pairs with correlated patterns of expression, suggesting interaction. For this study, 509 host genes and seven biological pathways were differentially expressed throughout the entire 32-day infection cycle. GAS infection produced an initial widespread significant decrease in expression of many host genes, including those involved in cytokine production, vesicle formation, metabolism, and signal transduction. This repression lasted until day 4, at which time a large increase in expression of host genes was observed, including those involved in protein translation, antigen presentation, and GTP-mediated signaling. The interactome analysis identified 73 host and pathogen gene pairs with correlated expression levels. We discovered significant correlations between transcripts of GAS genes involved in hyaluronic capsule production and host endocytic vesicle formation, GAS GTPases and host fibrinolytic genes, and GAS response to interaction with neutrophils. We also identified a strong signal, suggesting interaction between host gammadelta T cells and genes in the GAS mevalonic acid synthesis pathway responsible for production of isopentenyl-pyrophosphate, a short-chain phospholipid that stimulates these T cells. Taken together, our results are unique in providing a comprehensive understanding of the host-pathogen interactome during mucosal infection by a bacterial pathogen.

New insights into the phylogenetic relationships of Japanese knotweed (Reynoutriajaponica) and allied taxa in subtribe Reynoutriinae (Polygonaceae).

Japanese knotweed (Reynoutriajaponica) is native to East Asia, but has been introduced to the West where it is a noxious invasive weed. Taxonomically, Japanese knotweed is placed within subtribe Reynoutriinae (Polygonaceae), which also contains the austral genus Muehlenbeckia (incl. Homalocladium) and north temperate Fallopia. In the current study, we conducted a phylogenetic analysis using sequence data from six markers, two nuclear (LEAFYi2, ITS) and four plastid (matK, rbcL, rps16-trnK and trnL-trnF) to further resolve the evolutionary relationships within this group, using the widest sampling of in-group taxa to date. The results of this analysis confirmed that subtribe Reynoutriinae is a monophyletic group, characterised by the presence of extra-floral, nectariferous glands at the base of leaf petioles. Within the subtribe, four main clades were identified: Reynoutria, Fallopiasect.Parogonum, Fallopia s.s. (including Fallopia sects. Fallopia and Sarmentosae) and Muehlenbeckia. The Fallopia s.s. and Muehlenbeckia clades are sister to one another, while the Fallopiasect.Parogonum clade is immediately basal to them and Reynoutria basal to all three. Fallopia, as currently circumscribed, is paraphyletic as Muehlenbeckia is nested within it. To resolve this, we propose that species of Fallopiasect.Parogonum should be treated as a new genus, Parogonum (Haraldson) Desjardins & J.P.Bailey, gen. et stat. nov. Within Reynoutria, the allied specific and infraspecific taxa that fall under the name Japanese knotweed s.l. form a monophyletic group and their taxonomic status is discussed.

Scar Management and Dyschromia: A Summary Report from the 2021 American Burn Association State of the Science Meeting.

Burn scars, and in particular, hypertrophic scars, are a challenging yet common outcome for survivors of burn injuries. In 2021, the American Burn Association brought together experts in burn care and research to discuss critical topics related to burns, including burn scars, at its State of the Science conference. Clinicians and researchers with burn scar expertise, as well as burn patients, industry representatives, and other interested stakeholders met to discuss issues related to burn scars and discuss priorities for future burn scar research. The various preventative strategies and treatment modalities currently utilized for burn scars were discussed, including relatively noninvasive therapies such as massage, compression, and silicone sheeting, as well as medical interventions such as corticosteroid injection and laser therapies. A common theme that emerged is that the efficacy of current therapies for specific patient populations is not clear, and further research is needed to improve upon these treatments and develop more effective strategies to suppress scar formation. This will necessitate quantitative analyses of outcomes and would benefit from creation of scar biobanks and shared data resources. In addition, outcomes of importance to patients, such as scar dyschromia, must be given greater attention by clinicians and researchers to improve overall quality of life in burn survivors. Herein we summarize the main topics of discussion from this meeting and offer recommendations for areas where further research and development are needed.

Rare Reconstruction of Four Metatarsals Using Kirschner Wires After a Severe Crushing Injury: Surgical Decision Making and Prognosis.

Metatarsal fractures are one of the most common injuries after foot trauma. It is debilitating, as the metatarsals are one of the most crucial bones for any weight-bearing movement. This report demonstrates the beneficial outcome of using Kirschner wires (K-wires) in a trauma setting and the complicated healing process. A 56-year-old gentleman was brought into the emergency department after a reinforced cement pipe fell onto the patient's steel-toe boots, striking his left foot immediately proximal to the steel portion of the boot. The patient had sustained displaced comminuted fractures of the left second, third, fourth, and fifth metatarsals with an extensive open wound (Gustilo type II open fracture). Open reduction with internal fixation (ORIF) was performed using K-wires to restore and preserve the anatomical and functional integrity of the foot. Following the surgery, the patient developed a hammer toe of the left fifth metatarsophalangeal (MTP) joint two months after the ORIF; we performed resection arthroplasty to relieve discomfort and further aid the recovery process. Following the resection arthroplasty, eschar had formed at the surgical site, extending from the lateral aspect of the left foot to the plantar surface, for which we had performed a skin graft after excisional debridement of the necrotic tissue. After one year of close follow-ups with rigorous physical therapy exercises, the patient had a fair recovery process and is now able to ambulate without any assistive devices. As such, using K-wires remains a viable option for reducing misaligned metatarsal fractures and providing fairly good outcomes even in the setting of severe foot trauma.

Too hot, too cold, or just right: Can wildfire restore dry forests of the interior Pacific Northwest?

As contemporary wildfire activity intensifies across the western United States, there is increasing recognition that a variety of forest management activities are necessary to restore ecosystem function and reduce wildfire hazard in dry forests. However, the pace and scale of current, active forest management is insufficient to address restoration needs. Managed wildfire and landscape-scale prescribed burns hold potential to achieve broad-scale goals but may not achieve desired outcomes where fire severity is too high or too low. To explore the potential for fire alone to restore dry forests, we developed a novel method to predict the range of fire severities most likely to restore historical forest basal area, density, and species composition in forests across eastern Oregon. First, we developed probabilistic tree mortality models for 24 species based on tree characteristics and remotely sensed fire severity from burned field plots. We applied these estimates to unburned stands in four national forests to predict post-fire conditions using multi-scale modeling in a Monte Carlo framework. We compared these results to historical reconstructions to identify fire severities with the highest restoration potential. Generally, we found basal area and density targets could be achieved by a relatively narrow range of moderate-severity fire (roughly 365-560 RdNBR). However, single fire events did not restore species composition in forests that were historically maintained by frequent, low-severity fire. Restorative fire severity ranges for stand basal area and density were strikingly similar for ponderosa pine (Pinus ponderosa) and dry mixed-conifer forests across a broad geographic range, in part due to relatively high fire tolerance of large grand (Abies grandis) and white fir (Abies concolor). Our results suggest historical forest conditions created by recurrent fire are not readily restored by single fires and landscapes have likely passed thresholds that preclude the effectiveness of managed wildfire alone as a restoration tool.

American Burn Association Strategic Quality Summit 2022: Setting the Direction for the Future.

The American Burn Association (ABA) hosted a Burn Care Strategic Quality Summit (SQS) in an ongoing effort to advance the quality of burn care. The goals of the SQS were to discuss and describe characteristics of quality burn care, identify goals for advancing burn care, and develop a roadmap to guide future endeavors while integrating current ABA quality programs. Forty multidisciplinary members attended the two-day event. Prior to the event, they participated in a pre-meeting webinar, reviewed relevant literature, and contemplated statements regarding their vision for improving burn care. At the in-person, professionally facilitated Summit in Chicago, Illinois, in June 2022, participants discussed various elements of quality burn care and shared ideas on future initiatives to advance burn care through small and large group interactive activities. Key outcomes of the SQS included burn-related definitions of quality care, avenues for integration of current ABA quality programs, goals for advancing quality efforts in burn care, and work streams with tasks for a roadmap to guide future burn care quality-related endeavors. Work streams included roadmap development, data strategy, quality program integration, and partners and stakeholders. This paper summarizes the goals and outcomes of the SQS and describes the status of established ABA quality programs as a launching point for futurework.

Multimodal quantitative analysis of early pulsed-dye laser treatment of scars at a pediatric burn hospital.

BACKGROUND: The pulsed-dye laser (PDL) is a potential adjunctive therapy for treatment of hyperemic and hypertrophic scars. OBJECTIVE: To compare the effects of early PDL treatment plus compression therapy (CT) with those of CT alone in patients undergoing burn scar reconstruction with split-thickness grafts on an extremity. METHODS: Laser treatments were applied to one half of the graft seam. Standard CT was applied to both halves. Laser treatment was repeated at 6-week intervals until one half reached sufficient clinical improvements. Each half was evaluated just before treatments using quantitative measures of color, scar height, biomechanical properties and clinical features using the Vancouver Scar Scale (VSS). RESULTS: Less quantitative scar erythema and height and greater tissue elasticity were observed after two or three treatments for PDL plus compression than with compression alone. VSS scores showed greater improvement for vascularity, pliability, pigmentation, and height for PDL plus compression than for compression alone. CONCLUSION: PDL treatment in combination with CT appears to reduce scar hyperemia and height and normalize the biomechanical properties of burn-related scars.

Early intervention of intravenous KB220IV--neuroadaptagen amino-acid therapy (NAAT) improves behavioral outcomes in a residential addiction treatment program: a pilot study.

Substance use disorders (SUD) are inheritable and the culprit is hypodopaminergic function regulated by reward genes. We evaluated a natural dopaminergic agonist; KB220 intravenous (IV) and oral variants, to improve dopaminergic function in SUD. Our pilot experiment found a significant reduction of chronic symptoms, measured by the Chronic Abstinence Symptom Severity (CASS) Scale. The combined group (IV and oral) did significantly better than the oral-only group over the first week and 30-day follow-up period. Next, the combination was given to 129 subjects and three factors; Emotion, Somatic, and Impaired Cognition, with eigenvalues greater than one were extracted for baseline CASS-Revised (CASS-R) variables. Paired sample t-tests for pre and post-treatment scales showed significant declines (p = .00001) from pre- to post-treatment: t = 19.1 for Emotion, t = 16.1 for Somatic, and t = 14.9 for Impaired Cognition. In a two-year follow-up of 23 subjects who underwent KB220IV therapy (at least five IV treatments over seven days) plus orals for 30+ days: 21 (91%) were sober at six months, 19 (82%) having no relapse; 19 (82%) were sober at one year, 18 (78%) having no relapse; and 21 (91%) were sober two-years post-treatment, 16(70%) having no relapse. We await additional research and advise caution in interpreting these encouraging results.