A Development and Implementation of a Preconception Counseling Program for Black Women and Men in the Southeastern United States: A Pilot Protocol

Introduction

Racial/ethnic disparities in maternal mortality rates represent one of the most significant areas of disparities amongst all conventional population perinatal health measures in the U.S. The alarming trends and persistent disparities of outcomes by race/ethnicity and geographic location reinforce the need to focus on ensuring quality and safety of maternity care for all women. Despite complex multilevel factors impacting maternal mortality and morbidity, there are evidence-based interventions that, when facilitated consistently and properly, are known to improve the health of mothers before, during and after pregnancy. The objective of this project is to test implementation of pre-conception counseling with father involvement in community-based settings to improve cardiovascular health outcomes before and during pregnancy in southeastern United States.

Methods and Analysis

This study has two components: a comprehensive needs and assets assessment and a small-scale pilot study. We will conduct a community informed needs and assets assessment with our diverse stakeholders to identify opportunities and barriers to preconception counseling as well as develop a stakeholder-informed implementation plan. Next, we will use the implementation plan to pilot preconception counseling with father involvement in community-based settings. Finally, we will critically assess the context, identify potential barriers and facilitators, and iteratively adapt the way preconception counseling can be implemented in diverse settings. Results of this research will support future research focused on identifying barriers and opportunities for scalable and sustainable public health approaches to implementing evidence-based strategies that reduce maternal morbidity and mortality in the southeastern United States' vulnerable communities.

Discussion

Findings will demonstrate that preconception counseling can be implemented in community health settings in the southeastern United States. Furthermore, this study will build the capacity of community-based organizations in addressing the preconception health of their clients. We plan for this pilot to inform a larger scaled-up clinical trial across community health settings in multiple southeastern states.

Impact of an inpatient pharmacist-driven renal dosing policy on order verification time and patient safety

Research regarding pharmacist-driven renal dosing policies has focused on cost savings or prevention of adverse drug events. However, little is known about how these policies influence time from order signature to order verification or how this efficiency may reduce the incidence of adverse outcomes. Objectives: The primary endpoint compared time from prescriber electronic order signature to pharmacist electronic order verification between pre- and post-renal dosing policy implementation. The secondary endpoint evaluated electrocardiogram QTc prolongation attributed to fluconazole accumulation in renal impairment. Methods: This retrospective analysis included adults with a creatine clearance ⩽50 mL/min who received at least two inpatient doses from a 34-medication renal dosing protocol between January-February 2020 and April-May 2020. Results: 502 patients met eligibility for the primary outcome. The pre- and post-policy cohorts shared similar baseline characteristics. Time from order signature to verification was 9 and 8 min in the pre- and post-policy groups, respectively (p = 0.0861). In all, 56 patients met inclusion criteria for the secondary outcome. The QTc interval during fluconazole increased relative to baseline in 3 of 7 (43%) pre-policy and 4 of 5 (80%) post-policy. The QTc interval exceeded 500 ms in two patients, both in the post-policy cohort. Conclusions: There was no difference in order signature to verification time. Post-policy fluconazole renal adjustment did not reduce QTc prolongation.

Sex differences in functional outcome after hospitalisation: A systematic review and meta-analysis

The aims of this review were to determine: i) how many studies have examined global functioning outcomes from a psychiatric inpatient stay disaggregated by sex; and ii) if women have worse global functioning outcomes than men following an admission. A systematic review following PRISMA guidance and meta-analysis were conducted. Thirty-six studies met eligibility criteria for inclusion in the review. Of these, eleven papers provided sufficient data to conduct a meta-analysis of global functioning outcomes comparing men and women. Overall, differences between men and women were small. The meta-analysis revealed either no difference or a small significant difference in global functioning outcomes in favour of women, contrary to expectations. As many as 93% of otherwise eligible studies had to be excluded for not disaggregating data by sex. Women may have slightly superior functioning outcomes than men suggesting that inpatient services should be more heavily focused on applying principles of gender-informed care for men as well as women. The finding that so many potential studies had to be excluded for not reporting sex differences is consistent with other mental health literature and highlights a need for better reporting practices in relation to sex differences.

Health professionals' experiences of and attitudes towards mental healthcare for migrants and refugees in Europe: A qualitative systematic review

Migrants living in Europe constitute over half of the world's international migrants and are at higher risk of poor mental health than non-migrants, yet also face more barriers in accessing and engaging with services. Furthermore, the quality of care received is shaped by the experiences and attitudes of health professionals. The aim of this review was to identify professionals' attitudes towards migrants receiving mental healthcare and their perceptions of barriers and facilitators to service provision. Four electronic databases were searched, and 23 studies met the inclusion criteria. Using thematic synthesis, we identified three themes: 1) the management of multifaceted and complex challenges associated with the migrant status; 2) professionals' emotional responses to working with migrants; and 3) delivering care in the context of cultural difference. Professionals employed multiple strategies to overcome challenges in providing care yet attitudes towards this patient group were polarized. Professionals described mental health issues as being inseparable from material and social disadvantage, highlighting a need for effective collaboration between health services and voluntary organizations, and partnerships with migrant communities. Specialist supervision, reflective practice, increased training for professionals, and the adoption of a person-centered approach are also needed to overcome the current challenges in meeting migrants' needs. The challenges experienced by health professionals in attempting to meet migrant needs reflect frustrations in being part of a system with insufficient resources and without universal access to care that effectively stigmatizes the migrant status.

Retrospective audit of serum vitamin D levels in patients who underwent Latarjet procedure for anterior shoulder instability

BACKGROUND: The aim of this study was to review vitamin D levels in patients who underwent Latarjet procedures at a tertiary teaching hospital and a private clinic. METHODS: A retrospective review of clinical and radiological records was performed for 22 patients who underwent Latarjet procedure between November 2017 and June 2019. Postoperative vitamin D levels were retrieved and classified into sufficient (> 75 nmol/L), insufficient (25-75 nmol/L), and deficient (< 25 nmol/L) groups. Two observers assessed radiographic images of the patients at six weeks and three months after surgery. Any bone resorption, fracture and nonunion were reported, and interobserver reliability was analysed using the intraclass correlation coefficient (ICC). RESULTS: The median age was 20.5 years and was predominantly male. A little more than two-thirds (68.1%) of the patients were found to have insufficient or deficient levels of vitamin D. One patient from the insufficient group had postoperative bone resorption. Good interobserver reliability was observed with the ICC value being 0.86. CONCLUSION: This study found a prevalence of insufficient/deficient vitamin D levels in young patients undergoing a Latarjet procedure. This study serves as a reminder to orthopaedic surgeons that vitamin D deficiency is prevalent among patients undergoing Latarjet Level of evidence: Level 4.

Age differences in the association of comorbid burden with adverse outcomes in SARS-CoV-2

Background

Older age and comorbid burden are both associated with adverse outcomes in SARS-CoV-2, but it is not known whether the association between comorbid burden and adverse outcomes differs in older and younger adults.

Objective

To compare the relationship between comorbid burden and adverse outcomes in adults with SARS-CoV-2 of different ages (18–64, 65–79 and ≥ 80 years).

Design, setting, and participants

Observational longitudinal cohort study of 170,528 patients who tested positive for SARS-CoV-2 in the US Department of Veterans Affairs (VA) Health Care System between 2/28/20 and 12/31/2020 who were followed through 01/31/2021.

Measurements

Charlson Comorbidity Index (CCI); Incidence of hospitalization, intensive care unit (ICU) admission, mechanical ventilation, and death within 30 days of a positive SARS-CoV-2 test.

Results

The cumulative 30-day incidence of death was 0.8% in cohort members < 65 years, 7.1% in those aged 65–79 years and 20.6% in those aged ≥80 years. The respective 30-day incidences of hospitalization were 8.2, 21.7 and 29.5%, of ICU admission were 2.7, 8.6, and 11% and of mechanical ventilation were 1, 3.9 and 3.2%. Median CCI (interquartile range) ranged from 0.0 (0.0, 2.0) in the youngest, to 4 (2.0, 7.0) in the oldest age group. The adjusted association of CCI with all outcomes was attenuated at older ages such that the threshold level of CCI above which the risk for each outcome exceeded the reference group (1st quartile) was lower in younger than in older cohort members (p < 0.001 for all age group interactions).

Limitations

The CCI is calculated based on diagnostic codes, which may not provide an accurate assessment of comorbid burden.

Conclusions

Age differences in the distribution and prognostic significance of overall comorbid burden could inform clinical management, vaccination prioritization and population health during the pandemic and argue for more work to understand the role of age and comorbidity in shaping the care of hospitalized patients with SARS-CoV-2.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02340-5.

New search for mirror neutron regeneration

The possibility of relatively fast neutron oscillations into a mirror neutron state is not excluded experimentally when a mirror magnetic field is considered. Direct searches for the disappearance of neutrons into mirror neutrons in a controlled magnetic field have previously been performed using ultracold neutrons, with some anomalous results reported. We describe a technique using cold neutrons to perform a disappearance and regeneration search, which would allow us to unambiguously identify a possible oscillation signal. An experiment using the existing General Purpose-Small Angle Neutron Scattering instrument at the High Flux Isotope Reactor at Oak Ridge National Laboratory will have the sensitivity to fully explore the parameter space of prior ultracold neutron searches and confirm or refute previous claims of observation. This instrument can also conclusively test the validity of recently suggested oscillation-based explanations for the neutron lifetime anomaly.

An exploratory study into therapeutic alliance, defeat, entrapment and suicidality on mental health wards

WHAT IS KNOWN ON THE SUBJECT?: The strength of a relationship between people with mental health difficulties and professionals has been linked to patients feeling suicidal. A relationship has been found between how defeated and trapped people with mental health difficulties feel and how suicidal they feel. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This study explored the relationship between alliance, suicidality, defeat and entrapment in people admitted to mental health wards as previous research has focused on people in the community. Patient-rated defeat, entrapment and suicidality are related in this sample of people admitted to mental health wards. A relationship was found between how well nurses said they bonded with their named patient and how trapped the patients felt by their environment. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses should consider if patients are feeling defeated or trapped when helping people with mental health difficulties to feel less suicidal.

ABSTRACT

Introduction Suicidality is prevalent worldwide, particularly in people who access mental health services. The quality of therapeutic alliance between people with mental health difficulties and staff has been associated with suicidality but only in community settings. Defeat and entrapment are correlated with suicidality and may mediate any relationship between alliance and suicidality. Therefore, this exploratory study explored these relationships in people admitted to mental health wards. Aim To explore defeat, entrapment, suicidality and alliance between nurses and people admitted to mental health wards. Method Fifty inpatient nurse-patient dyads completed questionnaires regarding demographics, defeat, entrapment, suicidality and alliance with their named nurse. Nurses completed questionnaires on demographics, alliance with their patient and the patients' suicidality. Results Defeat, entrapment and suicidality were correlated. A correlation between nurse-rated bond and external entrapment was found, but no other correlations between alliance, defeat, entrapment and suicidality were statistically significant. Discussion and clinical implications Ward-based nurses should consider the relationship between defeat, entrapment and suicidality when developing interventions to improve suicidality. Although there was no evidence of a relationship between total alliance and suicidality, developing closer bonds with patients may reduce patients' feelings of being trapped by their environment.

Transformation of hepatitis C antiviral treatment in a national healthcare system following the introduction of direct antiviral agents

BACKGROUND

Highly effective direct antiviral agents (DAAs) for hepatitis C virus (HCV) were introduced recently. Their utilisation has been limited by high cost and low access to care.

AIM

To describe the effect of DAAs on HCV treatment and cure rates in the United States Veterans Affairs (VA) national healthcare system.

METHODS

We identified all HCV antiviral treatment regimens initiated from 1 January 1999 to 31 December 2015 (n = 105 369) in the VA national healthcare system, and determined if they resulted in sustained virological response (SVR).

RESULTS

HCV antiviral treatment rates were low (1981-6679 treatments/year) in the interferon era (1999-2010). The introduction of simeprevir and sofosbuvir in 2013 and ledipasvir/sofosbuvir and paritaprevir/ombitasvir/ritonavir/dasabuvir in 2014 were followed by increases in annual treatment rates to 9180 in 2014 and 31 028 in 2015. The number of patients achieving SVR was 1313 in 2010, the last year of the interferon era, and increased 5.6-fold to 7377 in 2014 and 21-fold to 28 084 in 2015. The proportion of treated patients who achieved SVR increased from 19.2% in 1999 and 36.0% in 2010 to 90.5% in 2015. Within 2015, monthly treatment rates ranged from 727 in July to 6868 in September correlating with the availability of funds for DAAs.

CONCLUSIONS

DAAs resulted in a 21-fold increase in the number of patients achieving HCV cure. Treatment rates in 2015 were limited primarily by the availability of funds. Further increases in funding and cost reductions of DAAs in 2016 suggest that the VA could cure the majority of HCV-infected Veterans in VA care within the next few years.

Relationship between childhood adversity and bipolar affective disorder: systematic review and meta-analysis

BACKGROUND

The relationship between childhood adversity and bipolar affective disorder remains unclear.

AIMS

To understand the size and significance of this effect through a statistical synthesis of reported research.

METHOD

Search terms relating to childhood adversity and bipolar disorder were entered into Medline, EMBASE, PsycINFO and Web of Science. Eligible studies included a sample diagnosed with bipolar disorder, a comparison sample and a quantitative measure of childhood adversity.

RESULTS

In 19 eligible studies childhood adversity was 2.63 times (95% CI 2.00-3.47) more likely to have occurred in bipolar disorder compared with non-clinical controls. The effect of emotional abuse was particularly robust (OR = 4.04, 95% CI 3.12-5.22), but rates of adversity were similar to those in psychiatric controls.

CONCLUSIONS

Childhood adversity is associated with bipolar disorder, which has implications for the treatment of this clinical group. Further prospective research could clarify temporal causality and explanatory mechanisms.

The 5-amino acid N-terminal extension of non-sulfated drosulfakinin II is a unique target to generate novel agonists

The ability to design agonists that target peptide signaling is a strategy to delineate underlying mechanisms and influence biology. A sequence that uniquely characterizes a peptide provides a distinct site to generate novel agonists. Drosophila melanogaster sulfakinin encodes non-sulfated drosulfakinin I (nsDSK I; FDDYGHMRF-NH2) and nsDSK II (GGDDQFDDYGHMRF-NH2). Drosulfakinin is typical of sulfakinin precursors, which are conserved throughout invertebrates. Non-sulfated DSK II is structurally related to DSK I, however, it contains a unique 5-residue N-terminal extension; drosulfakinins signal through G-protein coupled receptors, DSK-R1 and DSK-R2. Drosulfakinin II distinctly influences adult and larval gut motility and larval locomotion; yet, its structure-activity relationship was unreported. We hypothesized substitution of an N-terminal extension residue may alter nsDSK II activity. By targeting the extension we identified, not unexpectedly, analogs mimicking nsDSK II, yet, surprisingly, we also discovered novel agonists with increased (super) and opposite (protean) effects. We determined [A3] nsDSK II increased larval gut contractility rather than, like nsDSK II, decrease it. [N4] nsDSK II impacted larval locomotion, although nsDSK II was inactive. In adult gut, [A1] nsDSK II, [A2] nsDSKII, and [A3] nsDSK II mimicked nsDSK II, and [A4] nsDSK II and [A5] nsDSK II were more potent; [N3] nsDSK II and [N4] nsDSK II mimicked nsDSK II. This study reports nsDSK II signals through DSK-R2 to influence gut motility and locomotion, identifying a novel role for the N-terminal extension in sulfakinin biology and receptor activation; it also led to the discovery of nsDSK II structural analogs that act as super and protean agonists.

T-lymphocyte-rich thymoma and myasthenia gravis in a Siberian tiger (Panthera tigris altaica)

A 10-year-old captive male Siberian tiger (Panthera tigris altaica) presented with acute onset collapse, vomiting and dyspnoea, preceded by a 6-month period of progressive muscle wasting. Following humane destruction, post-mortem examination revealed a large multilobulated mass in the cranial mediastinum, which was diagnosed as a T-lymphocyte-rich thymoma with the aid of immunohistochemistry. Retrospective serology for acetylcholine receptor antibodies (titre 3.90 nmol/l) confirmed a diagnosis of thymoma-associated myasthenia gravis. Thymomas are reported rarely in wild carnivores, but when detected they appear to be similar in morphology to those seen in domestic carnivores and may also be accompanied by paraneoplastic syndromes. The clinical signs of myasthenia gravis in the tiger were consistent with those reported in cats and dogs and the condition is proposed as an important differential diagnosis for generalized weakness in captive Felidae.

Identification of primary chromosome-abnormalities in a patient with endometrial carcinoma - analyses of tumor-biopsy and lymphocyte-cultures

The development of human cancer is generally considered to be the result of genetic mutations that cause a progressively more malignant phenotype. We propose that such genetic changes can be observed in a small number of lymphocytic metaphase plates. We have identified a specific chromosome marker formation in a primary endometrial adenocarcinoma obtained from a 74-year-old woman. After observing an isochromosome for 1q in the tumor cells, we predicted that in her lymphocytes this particular chromosome must show susceptibility to breakage. After 6 months, when lymphocytes were available from this patient, 4.0% of her metaphases exhibited chromatid breaks in the pericentromeric region of one homolog of chromosome 1, thus confirming our prediction. Since then, the primary endometrial tumor cell line has been passaged through nude mice and has become highly metastatic. Examination of tumors obtained from different organ sites of these mice has revealed that the same altered homolog 1 underwent various types of chromosome and chromatid aberrations, thereby confirming the presence of instability in this particular chromosome in this particular cancer. A detailed karyotypic evolution from normal lymphocyte cultures --> primary endometrial tumor --> highly metastatic endometrial tumor was therefore possible to construct. Our results further support the idea that peripheral blood lymphocytes can be used as the tissue for studying genetics of cancer predisposition.

Development of a metastatic model for human endometrial carcinoma using orthotopic implantation in nude-mice

We have developed an orthotopic model for human endometrial carcinoma in nude mice. The human serous papillary endometrial carcinoma cell line SPEC-2 was injected into the subcutis (ectopic site) or uterine wall (orthotopic site) of athymic mice. Tumors grew in both locations locally. However, only uterine wall tumors produced metastases in regional and distant lymph nodes and to the lungs and liver. Cell lines were established in culture from these uterine tumors and from lung and liver metastases, and then these cells were injected into the uteri of additional mice. The metastatic potential of the lines subsequently established from tumors growing in vivo was not significantly higher than the already highly metastatic parental culture cells. All SPEC-2 cell lines expressed high levels of both 72-kDa and 92-kDa collagenase type IV activity. mRNA for transforming growth factor-alpha, basic fibroblast growth factor, and epidermal growth factor-receptor was constant among the cell lines. These data support the concept that the orthotopic implantation of human endometrial carcinoma cells into the uteri of nude mice provides a valuable model for studying the biology of human endometrial adenocarcinoma.

Are patients with Child's A cirrhosis and hepatocellular carcinoma appropriate candidates for liver transplantation?

We aimed to estimate the survival benefit derived from transplantation in patients with stage II hepatocellular carcinoma (HCC) and Child's A cirrhosis, defined as the mean lifetime with transplantation minus the mean lifetime with treatments other than transplantation. We calculated the posttransplantation survival of all adult, first-time, deceased-donor, liver transplant recipients in the United States since the introduction of the Model for End-Stage Liver Disease based priority system in February 2002 (n = 36,791). We estimated the posttreatment survival of patients with Child's A cirrhosis and stage II HCC treated by radiofrequency ablation (RFA) ± transarterial chemoembolization (TACE) or surgical resection by conducting a systematic review of the medical literature. In patients with Child's A cirrhosis and stage II HCC, the estimated median survival benefit of liver transplantation compared to RFA ± TACE was 1.5 months at 3 years (range -3.5 to 5.6) and 5.7 months at 5 years (range 0.7-11.4), whereas compared to surgical resection it was 0.7 months at 3 years (range -2.9 to 3) and 2.8 months at 5 years (range -4.4 to 5.7). Liver transplantation in patients with stage II HCC and Child's A cirrhosis results in a very low survival benefit and may not constitute optimal use of scarce liver donor organs.

Review of a paediatric emergency department observation unit

AIM

To review the function of an emergency department paediatric observation unit.

METHOD

A retrospective observational study reviewing the activity of the observation unit for 12 months

RESULTS

During 12 months, 4446 children were admitted to the observation unit and 76% were discharged home: usually within 8 hours. The average admission rate was 12 children in 24 hours. The commonest causes for children being admitted to the observation unit were respiratory problems and gastroenteritis or dehydration.

CONCLUSION

The emergency paediatric observational unit was used to assess and treat children with a variety of conditions. This enabled many children to be managed in the emergency department rather than being admitted to the paediatric wards.

Immunization information systems progress - United States, 2005

Immunization registries are confidential, computerized information systems that collect and consolidate vaccination data from multiple health-care providers, generate reminder and recall notifications, and assess vaccination coverage within a defined geographic area. A registry with added capabilities, such as vaccine management, adverse event reporting, lifespan vaccination histories, and linkages with electronic data sources, is called an immunization information system (IIS). This report summarizes data from CDC's 2005 Immunization Information System Annual Report (IISAR), a survey of grantees in 50 states, five cities, and the District of Columbia (DC) that receive funding under section 317b of the Public Health Service Act. These data indicated that approximately 56% of U.S. children aged <6 years participated in an IIS, an increase from 48% in 2004. Moreover, 75% percent of public vaccination provider sites and 44% of private vaccination provider sites submitted vaccination data to an IIS during July-December 2005. These findings underscore the need to increase the number of participating children, from the current 13 million to approximately 21 million, to assure 95% participation of children aged <6 years and improve the effectiveness of U.S. immunization programs.

Childhood diabetes presenting with hyperosmolar dehydration but without ketoacidosis: a report of three cases

BACKGROUND

Diabetic ketoacidosis (DKA) is a common mode of presentation of diabetes mellitus in children, accounting for 26% of new cases. Rarely, children with diabetes may develop other forms of metabolic decompensation associated with hyperglycaemia and hyperosmolality. Hyperglycaemia and hyperosmolality without ketoacidosis has high mortality in adults, although there is no data on mortality in children.

CASE REPORTS

We describe three children who presented to Birmingham Children's Hospital and were initially suspected to have DKA. Each child was severely hyperglycaemic and hyperosmolar but without significant ketosis or acidosis. In two of the three children, the hyperosmolar state was associated with the ingestion of large volumes of high calorie fluids preceding the presentation. These children were exquisitely sensitive to insulin and may be at a significantly higher risk of cerebral oedema in view of their hyperosmolar state.

CONCLUSIONS

Hyperosmolar hyperglycaemia is a serious and rare complication at presentation of diabetes in children, and should be distinguished from DKA. These children are at an increased risk of cerebral oedema compared with DKA, and one should have a low threshold for suspicion of this complication.

Prevalence of pedigrees suggestive of hereditary nonpolyposis colorectal cancer among a community sample of women eligible for screening mammography

OBJECTIVE

To determine from a large cohort of women eligible for screening mammography, the number who would meet criteria for genetic testing for hereditary nonpolyposis colorectal cancer (HNPCC).

METHODS

Detailed personal and family cancer histories, obtained from 6,682 women aged 50-80 years randomly selected from communities in Washington State, were matched to the Amsterdam criteria, Bethesda guidelines, and Japanese criteria for HNPCC.

RESULTS

One (0.015%) respondent met the Amsterdam criteria, 2 (0.035%) met the Japanese criteria and 5 (0.075%) met the Bethesda guidelines.

CONCLUSION

Using the time of presentation for initial mammography as an opportunity to screen for HNPCC would detect very few families at high risk for this condition.

Shoot meristem: an ideal explant for Zea mays L. transformation

We report on a rapid high-frequency somatic embryogenesis and plant regeneration protocol for Zea mays. Maize plants were regenerated from complete shoot meristem (3-4 mm) explants via organogenesis and somatic embryogenesis. In organogenesis, the shoot meristems were directly cultured on a high-cytokinin medium comprising 5-10 mg x L(-1) 6-benzylaminopurine (BAP). The number of multiple shoots produced per meristem varied from six to eight Plantlet regeneration through organogenesis resulted in just four weeks. Callus was induced in five days of incubation on an auxin-modified Murashige and Skoog (MS) medium. Prolific callus, with numerous somatic embryos, developed within 3-4 weeks when cultured on an auxin medium containing 5 mg 2,4-dichlorophenoxyacetic acid x L(-1). The number of multiple shoots varied from three to six per callus. Using R23 (Pioneer, Hi-Bred, Johnston, Iowa), the frequency of callus induction was consistently in excess of 80% and plant regeneration ranged between 47 and 64%. All regenerated plantlets survived in the greenhouse and produced normal plants. Each transgenic plant produced leaves, glumes, and anthers that uniformly expressed green fluorescent protein (GFP). The GFP gene segregated in the pollen. Based on this data it is concluded that the transgenics arose from single-cell somatic embryos. The rate of transfer DNA (T-DNA) transfer to complete shoot meristems of Zea mays was high on the auxin medium and was independent of using super-virulent strains of Agrobacterium.