Nursing strategic pillars to enhance nursing preparedness and response to COVID-19 pandemic at a tertiary care hospital in Saudi Arabia.

BACKGROUND: COVID-19 pandemic caused enormous implications on the frontline staff. The objective was to share our nursing experience in responding to COVID-19 pandemic at a large hospital and its impact on nursing safety and healthcare services. METHODS: Six nursing strategic pillars were implemented. Pillar 1: establishing corona command centre. Pillar 2: limiting exposure by virtual care model, strict infection control measures, altered patient flow, active surveillance, and contact tracing. Pillar 3: maintaining sufficient supplies of personal protective equipment. Pillar 4: creating surge capacity by establishing dedicated COVID-19 units and increasing critical care beds. Pillar 5: training and redeployment of nurses and implementing alternate staffing models. Pillar 6: monitoring staff wellbeing, establishing mental health support hotline and clinic, providing hotel self-quarantine, and financial incentives. RESULTS: Out of 5483 nurses, 543 (10%) were trained for redeployment, mainly at acute and intensive care units. After serving 11,623 infected patient including 1646 hospitalizations during the first 9 months of the pandemic, only 385 (7.0%) nurses were infected with COVID-19. Out of them, only 10 (2.6%) required hospitalization, one (0.3%) required ICU admission, and none died. Although the number of patients hospitalized at our hospital during the current pandemic was 17 folds higher than the 2015 outbreak of middle East respiratory syndrome coronavirus, the hospital administration did not have to close the hospital as they did in 2015. CONCLUSIONS: Proactive nursing leadership and implementation of multiple nursing pillars enabled the facility to maintain the safety of nursing workforce while serving large influx of COVID-19 patients.

Correction to: Quantifying and understanding carbon storage and sequestration within the Eastern Arc Mountains of Tanzania, a tropical biodiversity hotspot.

Upon publication of the original article [1], the authors noticed that the figure labelling for Fig. 4 in the online version was processed wrong. The top left panel should be panel a, with the panels to its right being b and c. d and e should be the panels on the lower row, and f is correct. The graphs themselves are all correct. It is simply the letter labels that are wrong.

Should Student Evaluation of Teaching Play a Significant Role in the Formal Assessment of Dental Faculty? Two Viewpoints: Viewpoint 1: Formal Faculty Assessment Should Include Student Evaluation of Teaching and Viewpoint 2: Student Evaluation of Teaching Should Not Be Part of Formal Faculty Assessment.

Student evaluation of teaching (SET) is often used in the assessment of faculty members' job performance and promotion and tenure decisions, but debate over this use of student evaluations has centered on the validity, reliability, and application of the data in assessing teaching performance. Additionally, the fear of student criticism has the potential of influencing course content delivery and testing measures. This Point/Counterpoint article reviews the potential utility of and controversy surrounding the use of SETs in the formal assessment of dental school faculty. Viewpoint 1 supports the view that SETs are reliable and should be included in those formal assessments. Proponents of this opinion contend that SETs serve to measure a school's effectiveness in support of its core mission, are valid measures based on feedback from the recipients of educational delivery, and provide formative feedback to improve faculty accountability to the institution. Viewpoint 2 argues that SETs should not be used for promotion and tenure decisions, asserting that higher SET ratings do not correlate with improved student learning. The advocates of this viewpoint contend that faculty members may be influenced to focus on student satisfaction rather than pedagogy, resulting in grade inflation. They also argue that SETs are prone to gender and racial biases and that SET results are frequently misinterpreted by administrators. Low response rates and monotonic response patterns are other factors that compromise the reliability of SETs.

Determination of origin and intended use of plutonium metal using nuclear forensic techniques.

Nuclear forensics techniques, including micro-XRF, gamma spectrometry, trace elemental analysis and isotopic/chronometric characterization were used to interrogate two, potentially related plutonium metal foils. These samples were submitted for analysis with only limited production information, and a comprehensive suite of forensic analyses were performed. Resulting analytical data was paired with available reactor model and historical information to provide insight into the materials' properties, origins, and likely intended uses. Both were super-grade plutonium, containing less than 3% 240Pu, and age-dating suggested that most recent chemical purification occurred in 1948 and 1955 for the respective metals. Additional consideration of reactor modeling feedback and trace elemental observables indicate plausible U.S. reactor origin associated with the Hanford site production efforts. Based on this investigation, the most likely intended use for these plutonium foils was 239Pu fission foil targets for physics experiments, such as cross-section measurements, etc.

Land cover change and carbon emissions over 100 years in an African biodiversity hotspot.

Agricultural expansion has resulted in both land use and land cover change (LULCC) across the tropics. However, the spatial and temporal patterns of such change and their resulting impacts are poorly understood, particularly for the presatellite era. Here, we quantify the LULCC history across the 33.9 million ha watershed of Tanzania's Eastern Arc Mountains, using geo-referenced and digitized historical land cover maps (dated 1908, 1923, 1949 and 2000). Our time series from this biodiversity hotspot shows that forest and savanna area both declined, by 74% (2.8 million ha) and 10% (2.9 million ha), respectively, between 1908 and 2000. This vegetation was replaced by a fivefold increase in cropland, from 1.2 million ha to 6.7 million ha. This LULCC implies a committed release of 0.9 Pg C (95% CI: 0.4-1.5) across the watershed for the same period, equivalent to 0.3 Mg C ha(-1)  yr(-1) . This is at least threefold higher than previous estimates from global models for the same study area. We then used the LULCC data from before and after protected area creation, as well as from areas where no protection was established, to analyse the effectiveness of legal protection on land cover change despite the underlying spatial variation in protected areas. We found that, between 1949 and 2000, forest expanded within legally protected areas, resulting in carbon uptake of 4.8 (3.8-5.7) Mg C ha(-1) , compared to a committed loss of 11.9 (7.2-16.6) Mg C ha(-1) within areas lacking such protection. Furthermore, for nine protected areas where LULCC data are available prior to and following establishment, we show that protection reduces deforestation rates by 150% relative to unprotected portions of the watershed. Our results highlight that considerable LULCC occurred prior to the satellite era, thus other data sources are required to better understand long-term land cover trends in the tropics.

Spiritual care in a crisis: what is enough?

Nurses encounter crisis regularly. What are appropriate spiritual interventions? Christians are encouraged to use every opportunity to be a witness for Christ. Should nurses share their faith in times of crisis? The experience of a nurse caring for a mother after perinatal loss is explored by a philosopher, mental health clinical nurse specialist, and the nurse, who wonders if she should have done things differently.

Quantifying and understanding carbon storage and sequestration within the Eastern Arc Mountains of Tanzania, a tropical biodiversity hotspot.

BACKGROUND: The carbon stored in vegetation varies across tropical landscapes due to a complex mix of climatic and edaphic variables, as well as direct human interventions such as deforestation and forest degradation. Mapping and monitoring this variation is essential if policy developments such as REDD+ (Reducing Emissions from Deforestation and Forest Degradation) are to be known to have succeeded or failed. RESULTS: We produce a map of carbon storage across the watershed of the Tanzanian Eastern Arc Mountains (33.9 million ha) using 1,611 forest inventory plots, and correlations with associated climate, soil and disturbance data. As expected, tropical forest stores more carbon per hectare (182 Mg C ha(-1)) than woody savanna (51 Mg C ha(-1)). However, woody savanna is the largest aggregate carbon store, with 0.49 Pg C over 9.6 million ha. We estimate the whole landscape stores 1.3 Pg C, significantly higher than most previous estimates for the region. The 95% Confidence Interval for this method (0.9 to 3.2 Pg C) is larger than simpler look-up table methods (1.5 to 1.6 Pg C), suggesting simpler methods may underestimate uncertainty. Using a small number of inventory plots with two censuses (n = 43) to assess changes in carbon storage, and applying the same mapping procedures, we found that carbon storage in the tree-dominated ecosystems has decreased, though not significantly, at a mean rate of 1.47 Mg C ha(-1) yr(-1) (c. 2% of the stocks of carbon per year). CONCLUSIONS: The most influential variables on carbon storage in the region are anthropogenic, particularly historical logging, as noted by the largest coefficient of explanatory variable on the response variable. Of the non-anthropogenic factors, a negative correlation with air temperature and a positive correlation with water availability dominate, having smaller p-values than historical logging but also smaller influence. High carbon storage is typically found far from the commercial capital, in locations with a low monthly temperature range, without a strong dry season, and in areas that have not suffered from historical logging. The results imply that policy interventions could retain carbon stored in vegetation and likely successfully slow or reverse carbon emissions.

Thrombolytic dosing in acute ischaemic stroke.

Thrombolysis treatment for acute ischaemic stroke is effective if it is administered within 4.5 hours of stroke onset. Alteplase is a licensed thrombolytic treatment for ischaemic stroke. The dose of alteplase is dependent on a patient's weight. The stroke team involved in the administration of the treatment usually estimates a patient's weight prior to the treatment in order to ensure the correct dosage. This paper highlights the reliability of body weight estimates in determining the accuracy of thrombolysis dosing and the implication of dosing errors to post-thrombolysed patients.

Time taken to seek and receive medical attention after TIA.

A transient ischaemic attack (TIA) is a warning sign that a debilitating stroke could occur unless preventive action is taken. People with suspected TIAs should be seen urgently in a specialist service that provides rapid assessment, preventive care and treatment. This article highlights the importance of seeking medical attention urgently for suspected TIAs. It examines how quickly a specialist TIA clinic investigates and treats TIAs. It also identifies factors that affect how quickly patients with TIAs seek medical attention.

Towards regional, error-bounded landscape carbon storage estimates for data-deficient areas of the world.

Monitoring landscape carbon storage is critical for supporting and validating climate change mitigation policies. These may be aimed at reducing deforestation and degradation, or increasing terrestrial carbon storage at local, regional and global levels. However, due to data-deficiencies, default global carbon storage values for given land cover types such as 'lowland tropical forest' are often used, termed 'Tier 1 type' analyses by the Intergovernmental Panel on Climate Change (IPCC). Such estimates may be erroneous when used at regional scales. Furthermore uncertainty assessments are rarely provided leading to estimates of land cover change carbon fluxes of unknown precision which may undermine efforts to properly evaluate land cover policies aimed at altering land cover dynamics. Here, we present a repeatable method to estimate carbon storage values and associated 95% confidence intervals (CI) for all five IPCC carbon pools (aboveground live carbon, litter, coarse woody debris, belowground live carbon and soil carbon) for data-deficient regions, using a combination of existing inventory data and systematic literature searches, weighted to ensure the final values are regionally specific. The method meets the IPCC 'Tier 2' reporting standard. We use this method to estimate carbon storage over an area of33.9 million hectares of eastern Tanzania, reporting values for 30 land cover types. We estimate that this area stored 6.33 (5.92-6.74) Pg C in the year 2000. Carbon storage estimates for the same study area extracted from five published Africa-wide or global studies show a mean carbon storage value of ∼50% of that reported using our regional values, with four of the five studies reporting lower carbon storage values. This suggests that carbon storage may have been underestimated for this region of Africa. Our study demonstrates the importance of obtaining regionally appropriate carbon storage estimates, and shows how such values can be produced for a relatively low investment.

Emergency reversal of pentasaccharide anticoagulants: a systematic review of the literature.

OBJECTIVES: To conduct a systematic review of the literature to answer the question: Has administration of recombinant activated factor VII (rFVIIa) or prothombin complex concentrate (PCC) or activated PCC (aPCC) been demonstrated to be effective in reversing pendasaccharide anticoagulants (PSAs)? BACKGROUND: Fondaparinux and idraparinux are ultra-short, synthetic PSAs. Typical anticoagulation reversal with either vitamin K and fresh frozen plasma or protamine sulphate does not reverse PSAs. Mechanistically, it is plausible that rFVIIa, PCC and aPCC may be effective reversal agents for PSAs. However, the available data are limited. MATERIALS/METHODS: We conducted a systematic review of MEDLINE, EMBASE, CINAHL and the Cochrane Library without date or language limitations designed to answer the question: Has administration of rFVIIa, PCC or aPCC been demonstrated to be effective in reversing PSAs? The quality of the included studies was assessed based on standard methodologies. Relevant information was synthesised and reported. RESULTS: After an initial literature search, 197 abstracts were identified, of which 14 articles were reviewed in their entirety. Ultimately, five studies were identified that met inclusion and exclusion criteria. Although the literature is limited, the best available data support the use of rFVIIa for serious bleeding in patients anticoagulated with PSAs. CONCLUSIONS: Limited data support the use of rFVIIa as a reversal agent for serious bleeding in patients who are anticoagulated with PSAs. The optimal dose, role for concomitant use of platelets or antifibrinolytic agents and exact indications for reversal remain to be determined. Such investigations are urgently needed as use of PSAs increases.

Evaluation of propofol as an anesthetic in swine tracheal transplant surgery / Evaluación del propofol como anestésico para cerdos sometidosa trasplante de tráquea

Because the swine have been used as an ideal animal model for different medical investigations, it has been useful to the advance in vital organs transplant field. The trachea transplant is a surgical procedure which requires special conditions in anesthetic depth and muscular relax, for a long period, and in addition, an excellent intra and post-operatory analgesic. The aim of this study was to use a combination of xylacine and ketamine, as premedication and evaluate propofol as a general anesthetic in trachea transplant donor or recipient pigs. All the methodology was under the approval of the Committee of Ethics for the Experimentation with Animals of the University of Antioquia. Ten donors and 10 recipients female Yorkshire pigs having a body weight of about 30 kg were used. Trachea extraction from a donor and its transplantation to a recipient in the same surgical procedure was performed. The average body weight (PP) was 30 ± 2.92 kg for both the groups, the average value were as follows: time of recumbency (TR) 8.25 ± 2:85 min; latency period (PL) 6.05 ± 1.73 min, (for both groups); surgical time (TQ) for donors and recipients was 80 ± 0.02, and 247 ± 0.02 min, respectively; heartbeat rate (FC) 90.34 ± 8.14 bpm, O2 saturation (SO2) 95.47 ± 1.79 %; exhaled PCO2 31.13 ± 1.89 mmHg; temperature (T) for both groups was 37.51 ± 0.74oC. The mean arterial pressure average (PAM) for both group was 65.47 ± 5.94 mmHg; the average time of esternal recumbecency (TRE) for donor female pigs was 16.50 ± 4.09 min, and the average time to stand up (TP) for swine recipients was 30.70 + 3.27 min. These results indicate that Propofol can be considered as a safe anesthetic for use in continuous perfusion. Since it has not an analgesic effect it is strongly recommended to combine it with opioids during anesthetic-surgical procedures; it can be also used with neuromuscular preanesthetics or inhaled anesthetics.

Los cerdos se han utilizado como modelo animal ideal para diversas investigaciones médicas; han sido útiles para el avance en el trasplante de órganos. El trasplante de tráquea es un procedimiento quirúrgico que requiere condiciones especiales en profundidad anestésica y relajación muscular por un período largo, y además, una analgesia intra y del postoperatoria excelente. Nuestra investigación utiliza una combinación de xylacine y ketamina, como premedicación y evaluar el propofol como anestésico general en cerdos donantes y receptores en quienes el trasplante de la tráquea sería hecho. Toda la metodología contó con la aprobación del Comité de Ética para la Experimentación con los Animales de la Universidad de Antioquia. Utilizamos 10 donantes y 10 cerdos raza Yorkshire hembras con un peso corporal de cerca de 30 kilogramos. Se realizó la extracción de la tráquea de un donante y el trasplante a un receptor en el mismo procedimiento quirúrgico. El peso corporal (PP) fue de 30 ± 2.92 kg para todo el grupo, el tiempo de recumbencia (TR) para ambos grupos fue de 8.25 ± 2.85 min, el período de latencia (PL) para ambos grupos fue de 6.05 ± 1.73 min, el promedio de tiempo quirúrgico (TQ) para los donantes fue de 80 min ± 0.02, el TQ de los receptores fue de  247m ± 0.02. La presión arterial media (PAM) para todo el grupo fue de 65.47 ± 5.94 mmHg, el promedio de frecuencia cardiaca (FC) para ambos grupos fue de 90.34 ± 8.14 ppm, el promedio de saturación de oxigeno (SO2) fue de 95.47 ± el 1.79% y el CO2 espirado fue de 31.13 ± 1.89 mmHg y el promedio de la temperatura (t) para ambos grupos fue de  37.51 ± 0.74oC. La tiempo de recumbencia esternal (TRE) para las cerdas donantes fue de 16.50 ± 4.09 min y el tiempo para pararse (TP) para los receptores fue de 30.70 ± 3.27 min. El propofol se puede considerar como anestésico seguro para el uso en la perfusión continua durante la anestesia. Puesto que no tiene un efecto analgésico se recomienda combinarlo con opioides.

Combination of clopidogrel and statins: a hypothetical interaction or therapeutic dilemma?

BACKGROUND: The 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) and clopidogrel are frequently used in the treatment of patients with various cardiovascular disorders. The possibility of a drug-drug interaction between certain statins and clopidogrel has been extensively investigated in the literature recently. Investigators have proposed that the use of statins that are metabolized by the cytochrome P450 (CYP) system may diminish the conversion of clopidogrel to its active form by inhibiting the CYP3A4 isoenzyme. This inhibition could result in a decreased antiplatelet effect of clopidogrel, which could translate into an increased risk of cardiovascular events. METHODS: We performed a MEDLINE search of the literature from 1993-2005 to evaluate and discuss the existing data on a possible interaction between clopidogrel and statins and to provide clinicians with relevant and practical recommendations. Additional studies were identified from the bibliographies of the reviewed literature. RESULTS: Several articles were discovered that discuss this potential drug-drug interaction. Whereas some studies indicated that there was not a relevant interaction between statins and clopidogrel, other studies demonstrated that the concomitant administration of some statins with clopidogrel resulted in diminished platelet inhibition activity of clopidogrel. CONCLUSIONS: Although the interaction between certain statins and clopidogrel seems to be a pharmacologic certainty, the clinical relevance of this interaction needs further clarification. While investigators continue to evaluate the clinical relevance, we provide several recommendations for clinicians responsible for treating patients who require combination therapy with statins and clopidogrel.

Diagnosis, management, and evaluation of chemotherapy-induced peripheral neuropathy.

Peripheral neuropathy induced by cancer chemotherapy represents a large unmet need for patients due to the absence of treatment that can prevent or mitigate this common clinical problem. Chemotherapy-induced peripheral neuropathy (CIPN) diagnosis and management is further compounded by the lack of reliable and standardized means to diagnose and monitor patients who are at risk for, or who are symptomatic from, this complication of treatment. The pathogenesis and pathophysiology of CIPN are not fully elucidated, but there is increasing evidence of damage or interference with tubulin function. The diagnosis of CIPN may present a diagnostic dilemma due to the large number of potential toxic etiologies and conditions, which may mimic some of the clinical features; the diagnosis must be approached with care in such patients. The incidence and severity of CIPN is commonly under-reported by physicians as compared with patients. The development of new and reliable methods for the assessment of CIPN as well as safe and effective treatments to prevent this complication of treatment would represent important medical advancements for cancer patients.

The toxicity of SCH 351591, a novel phosphodiesterase-4 inhibitor, in Cynomolgus monkeys.

SCH351591, a novel phosphodiesterase-4 inhibitor under investigation as a potential therapeutic for asthma and chronic obstructive pulmonary disease (COPD), was evaluated in a 3-month rising-dose study in Cynomolgus monkeys. Four groups, containing four monkeys/sex, received vehicle control or rising doses up to 12, 24, or 48 mg/kg of SCH351591 daily. Although initial exposure produced clinical signs of emesis, reduced food intake, and reduced body weight, tachyphylaxis to the emesis allowed dose escalation up to 48 mg/kg/day. Two monkeys died and 3 were sacrificed in moribund condition over the course of the study. Early mortality, involving monkeys dosed with 12 or 24 mg/kg, was attributed to sepsis (2 monkeys) or colon inflammation (3 monkeys). Leukocyte function assays on low- and mid-dose group survivors revealed an inhibition of T lymphocyte proliferation for 12 mg/kg group males and 24 mg/kg group monkeys of both sexes. Necropsy findings, unassociated with early mortality, included reduced size and weight of the thymus, depletion of body fat, red discoloration of the gastric mucosa, and perivascular hemorrhage of the stomach and heart. Stomach and heart gross findings were present in the high-dose group only. Histopathologic lesions, in addition to those attributed to concurrent bacterial infection, included thymic atrophy, serous atrophy of fat, myocardial degeneration and acute to chronic inflammation of small to medium-sized arteries in various organs and tissues including the heart, kidneys, stomach, salivary glands, pancreas, esophagus, gallbladder, and mesentery. The findings of this study demonstrate the potential of a PDE4 inhibitor to alter immunologic response as well as to produce arteriopathy in nonhuman primates.

Tetraacyldiborates: selective and efficient acylation reagents suitable for multiple parallel synthetic applications.

Boron-based mixed anhydrides are rapidly reactive, easy to prepare, cheap, efficient, and general acylating reagents capable of selectivity when chelation is possible. High yields of various esters, amides and thioesters are quickly obtainable and the products are easy to isolate in high purity. The method is readily used under multiple parallel synthesis conditions and is readily scaleable.

Arthropod-Borne viral Diseases in Peru

Arthropode-Borne viral diseases have been a significant cause of morbidity and mortality for several decades in Peru. Epidemics and epizootics of Venezuelan equine encephalitis (VEE), subtype IAB virus occurred among humans and equine at intermittent intervals from 1925 through 1973 along the Pacific coastal plains, extending southward from the most northern Departament of Tumbes to the Departament of Ica. While the VEE IAB virus has not been detected since 1973, several isolates of VEE ID and an isolate VEE IIIC were obtained during 1971 and 1975 from mosquitoes and/or sentinel hamster in Quistococha, northeastern Amazon region. In 1994, the first human cases, associated with VEE virus ID were diagnosed among Peruvian soldiers near Pantoja, northern Amazon region, and during 1995, primarily among students and military personnel in Iquitos, northastern Amazon region. As early as 1913 , a disease resembling yellow fever was recognized in the Amazon region Peru. Outbreaks of this disease have continued to occur, apparently at annual interval, with the most recent and the largest sylvan outbreak ever recorded in Peru being documented during 1995 along the eastern foothills of the Andes Mountains. In 1990, dengue (DEN) 1 and DEN4 were first isolated in Peru during an outbreak of DEN fever among residents of the city of Iquitos, northeastern Amazon basin region. Seroepidemiological and case surveillance studies conducted 1992 through 1995 documented that DEN 1 continued to cause cases of DEN fever in Iquitos, and in 1995, an outbreak was associated with the introduction of DEN 2 into the community. Outbreaks of DEN fever, associated with DEN 1 occurred during 1994 and 1995 in the northern coastal cities of Tumbes and Piura, and in Pucallpa, Amazon basin region. In 1995, the first isolations of DEN 2 were obtained from febriles cases in Tumbes, Piura and Pucallpa. Although 2 serotypes of DEN were associated with human infection, none of the cases presented with hemorragic manifestations. The first isolations of Oropouche (ORO) fever virus were obtained during 1992 from febrile patients in Iquitos. The virus was isolated during 1994 from febrile cases and serological results revealed that ORO was the cause of an outbreak in the southeastern Amazon region. A single isolate of ORO virus was obtained during 1995 from a febrile patient in Iquitos

Specificity of a promoter from the rice tungro bacilliform virus for expression in phloem tissues.

The major promoter region for the transcription of the genome of rice tungro bacilliform virus (RTBV), a newly described badnavirus, has been identified. Fragments of the RTBV genome upstream of the site of transcription initiation were isolated and tested for promoter activity using a beta-glucuronidase receptor gene (gusA). Assays of transient gusA expression were performed following introduction of the chimeric gene into protoplasts via electroporation. The chimeric RTBV-promoter: gusA gene was more active in rice protoplasts than in maize or tobacco protoplasts, but was weaker than gusA controlled by an enhanced 35S promoter from cauliflower mosaic virus. Analysis of gusA gene expression following introduction of chimeric reporter genes into intact leaves via micro-projectile bombardment indicated that the GUS activity is present primarily in vascular tissues. Transgenic rice plants carrying the chimeric gusA gene had GUS activity only in the phloem of the vascular bundles in the leaf. Tissue printing studies demonstrated that RTBV accumulates in the vascular bundles of infected rice leaves. The results of our study indicate that phloem-specific expression from the RTBV promoter is an intrinsic property of the viral promoter.

Sequence-specific interaction with the viral AL1 protein identifies a geminivirus DNA replication origin.

The bipartite geminiviruses such as tomato golden mosaic virus (TGMV) and squash leaf curl virus (SqLCV) have two single-stranded circular genomic DNAs, the A and B components, thought to be replicated from double-stranded circular DNA intermediates. Although it has been presumed that the origin sequences for viral replication are located in the highly conserved 200-nucleotide common region (CR) present in both genomic components and that the viral-encoded AL1 protein interacts with these sequences to effect replication, there has been no evidence that this is in fact so. We have investigated these questions, demonstrating selectivity and sequence specificity in this protein-DNA interaction. Simple component switching between the DNAs of TGMV and SqLCV and analysis of replication in leaf discs showed that whereas the A components of both TGMV and SqLCV promote their own replication and that of their cognate B component, neither replicates the noncognate B component. Furthermore, using an in vivo functional replication assay, we found that cloned viral CR sequences function as a replication origin and direct the replication of nonviral sequences in the presence of AL1, with both circular single-stranded and double-stranded DNA being synthesized. Finally, by the creation of chimeric viral CRs and specific subfragments of the viral CR, we demonstrated sequence-specific recognition of the replication origin by the AL1 protein, thereby localizing the origin to an approximately 90-nucleotide segment in the AL1 proximal side of the CR that includes the conserved geminiviral stem-loop structure and approximately 60 nucleotides of 5' upstream sequence. By deletional analysis, we further demonstrated that the conserved stem-loop structure is essential for replication. These studies identify the functional viral origin of replication within the CR, demonstrating that sequence-specific recognition of this origin by the AL1 protein is required for replication.