Adolescent and Young Adult Preventive Care: Comparing National Survey Rates

INTRODUCTION

The Affordable Care Act's preventive healthcare provisions have the potential to increase adolescents' and young adults' receipt of recommended preventive services. Assessing whether this potential is realized requires valid monitoring data in several areas, including receipt of an annual preventive visit. The purpose of this study is to describe and compare preventive visit rates across national surveys for adolescents and young adults.

METHODS

This study, conducted in 2014: (1) identified national surveys with past-year preventive visit measures; (2) compared survey features, including mode of administration, respondent, response rate, demographic profile (univariate analysis), preventive visit measure wording, and method of construction; and (3) compared preventive visit rates, including rates among sociodemographic subgroups (bivariate analyses).

RESULTS

Four 2011 surveys were identified: National Health Interview Survey, National Survey of Children's Health (2011-2012), and Medical Expenditure Panel Survey (MEPS) for adolescents, and MEPS and Behavioral Risk Factor Surveillance System for young adults. Surveys varied by most assessed features; demographic profiles were similar. Preventive visit rates varied significantly across adolescents (43%-81%) and young adults (26%-58%). The largest differences in visit rates were in comparisons of subjective assessments to a more detailed assessment coded from specific records of visits kept by respondents. Sociodemographic differences in visit rates were consistent across surveys.

CONCLUSIONS

Further research is needed to assess reasons for the different estimates of preventive visits across national surveys. Those who monitor trends in receipt of recommended care for adolescents and young adults should take survey differences into account. Monitoring content of care is also needed.

Improvement in preventive care of young adults after the affordable care act: the affordable care act is helping

IMPORTANCE

The 2010 Affordable Care Act (ACA) included expansion of insurance coverage for young adults and improved access to preventive care.

OBJECTIVE

To examine the ACA's initial effects on young adults' receipt of preventive care.

DESIGN, SETTING, AND PARTICIPANTS

Secondary data analysis using a pre-post design that compared health care use by young adults (aged 18 to 25 years) from 2009 and 2011 Medical Expenditure Panel Surveys. Data were collected through computer-assisted personal interviews of a nationally representative sample of the noninstitutionalized US population.

MAIN OUTCOMES AND MEASURES

Differences by year in rates of receiving a routine examination in the past year, blood pressure screening, cholesterol screening, influenza vaccination, and annual dental visit. Three logistic regression models were developed to (1) compare pre-ACA (2009) and post-ACA (2011) rates of receiving preventive care and (2) determine if post-ACA increases in insurance coverage accounted for changes in preventive care rates. Model 1 was a bivariate model to determine differences in preventive care rates by year; model 2, a multivariable model adding insurance status (full-year private, full-year public, partial-year uninsured, and full-year uninsured) to determine whether insurance accounted for survey year differences; and model 3, a multivariable model adding covariates (usual source of care and sociodemographic variables) to determine whether they further accounted for differences by survey year or insurance status.

RESULTS

After ACA, young adults had significantly higher rates of receiving a routine examination (47.8% vs. 44.1%; P < .05), blood pressure screening (68.3% vs. 65.2%; P < .05), cholesterol screening (29.1% vs. 24.3%; P < .001), and annual dental visit (60.9% vs. 55.2%; P < .001) but not an influenza vaccination (22.1% vs. 21.5%; P = .70). Full-year private insurance coverage increased (50.1% vs. 43.4%; P < .001), and rates of lacking insurance decreased (partial-year uninsured, 18.4% vs. 20.7%; P = .03; and full-year uninsured, 22.2% vs. 27.1%; P < .001). Full-year public insurance rates remained stable (9.4% vs. 8.8%; P = .53). Insurance status fully accounted for the pre- and post-ACA differences in routine examination and blood pressure screening and partially accounted for year differences for cholesterol screening and annual dental visits. Covariate adjustment did not affect year differences.

CONCLUSIONS AND RELEVANCE

The ACA provisions appear to increase insurance coverage and receipt of preventive services among young adults. Further studies are needed to replicate these findings as other ACA provisions are implemented.

Alanine aminotransferase and metabolic syndrome in adolescents: the Korean National Health and Nutrition Examination Survey Study

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

Adolescent NAFLD has increased in parallel with obesity. Elevated serum ALT level is a surrogate marker for NALFD. Increased ALT levels are closely related to NAFLD and metabolic syndrome.

WHAT THIS STUDY ADDS

Increased ALT within normal range are associated with an increased risk of metabolic syndrome. All of the five components of metabolic syndrome were associated with high ALT within normal range. By elevation of ALT, the prevalence of metabolic syndrome increased in obese adolescents and normal-weight adolescents as well.

BACKGROUND/AIMS

The potential interactions between alanine aminotransferase (ALT) and components of metabolic syndrome (MetS) have not been fully investigated in healthy adolescents. This study investigated the impact of a mild ALT elevation on the risks of MetS in healthy Korean adolescents.

METHODS

From the Korean National Health and Nutrition Examination Surveys 1998-2009, the data of 5026 adolescents aged 10-18 years (2604 boys and 2422 girls) were analysed. Individuals who had ALT levels equal or more than 40 IU L(-1) were excluded.

RESULTS

Subjects in the upper ALT tertile had higher mean values of body mass index (BMI), homeostasis model assessment-insulin resistance and prevalence of MetS than subjects in the lower tertile. The risk of each five components of MetS was significantly higher than subjects in the lower tertile. Compared with the subjects in the lower ALT tertile, the prevalence of MetS was higher in the upper tertile among obese adolescents (44.6-50.7% vs. 31.2-40.0%) as well as normal-weight adolescents (5.2-7.7% vs. 2.7-3.2%). Subjects in the upper ALT tertile were at a higher risk of MetS than those in the lower tertile (odds ratio [OR] = 1.95 for boys, OR = 2.00 for girls) after controlling for age and BMI.

CONCLUSIONS

A high serum ALT within normal range increased the risk of all the components of MetS. The prevalence of MetS increased with the elevation of obesity level, and it increased further with the elevation of ALT tertile. Thus, serum ALT levels in addition to BMI might be useful as a marker for early detection of MetS.

Adolescent and young adult health in the United States in the past decade: little improvement and young adults remain worse off than adolescents

Adolescence and young adulthood are unique developmental periods that present opportunities and challenges for improving health. Health at this age can affect health throughout the lifespan. This review has two aims: (1) to examine trends in key indicators in outcomes, behaviors, and health care over the past decade for U.S. adolescents and young adults; and (2) to compare U.S. adolescents and young adults on these indicators. The review also assesses sociodemographic differences in trends and current indicators. Guided by our aims, previous reviews, and national priorities, the present review identified 21 sources of nationally representative data to examine trends in 53 areas and comparisons of adolescents and young adults in 42 areas. Most health and health care indicators have changed little over the past decade. Encouraging exceptions were found for adolescents and young adults in unintentional injury, assault, and tobacco use, and, for adolescents, in sexual/reproductive health. Trends in violence and chronic disease and related behaviors were mixed. Review of current indicators demonstrates that young adulthood continues to entail greater risk and worse outcomes than adolescence. Young adults fared worse on about two-thirds of the indicators examined. Differences among sociodemographic subgroups persisted for both trends and current indicators.

First Report of Powdery Mildew Caused by Erysiphe heraclei on Parsley in Korea

Parsley, Petroselinum crispum (Mill.) Nyman, is a minor but important leaf crop in Korea. In June 2010, parsley plants (cv. Paramount) showing typical symptoms of powdery mildew were found with approximately 90% incidence (percentage of plants showing symptoms) in polyethylene-film-covered greenhouses in an organic farm in Icheon County of Korea. Symptoms first appeared as thin white colonies, which subsequently showed abundant growth on the leaves with chlorosis and crinkling. Most diseased plantings were unmarketable and shriveled without being harvested. The damage due to powdery mildew infections on parsley has reappeared in Icheon County and Gangneung City with confirmation of the causal agent made again in 2011 and 2012. Voucher specimens were deposited in the Korea University Herbarium (KUS). Appressoria on the mycelium were multilobed or moderately lobed. Conidiophores were cylindrical, 75 to 125 × 8 to 10 μm, straight in foot-cells, and produced conidia singly, followed by 2 to 3 cells. Conidia were oblong-elliptical to oblong, 32 to 55 × 14 to 20 μm with a length/width ratio of 1.7 to 2.9, lacked fibrosin bodies, and produced germ tubes on the perihilar position, with angular/rectangular wrinkling of the outer walls. First-formed conidia were apically conical, basally subtruncate to rounded, and generally smaller than the secondary conidia. Chasmothecia were not found. These structures are typical of the powdery mildew Pseudoidium anamorph of the genus Erysiphe. The specific measurements and morphological characteristics were consistent with those of E. heraclei DC. (1). To confirm the identity of the causal fungus, the complete ITS region of rDNA from isolate KUS-F25037 was amplified with primers ITS5 and P3 (3) and sequenced directly. The resulting 606-bp sequence was deposited in GenBank (Accession No. KF680162). A GenBank BLAST search of this sequence revealed 100% identity with that of E. heraclei on Anethum graveolens from Korea (JN603995) and >99% similarity with those of E. heraclei on Daucus carota from Mexico (GU252368), Pimpinella affinis from Iran (AB104513), Anthriscus cerefolium from Korea (KF111807), and many other parsley family (Apiaceae) plants. Pathogenicity was verified through inoculation by gently pressing diseased leaves onto leaves of five healthy potted parsley plants. Five non-inoculated plants served as negative controls. Inoculated plants developed symptoms after 7 days, whereas the control plants remained symptomless. The fungus present on the inoculated plants was morphologically identical to that originally observed on diseased plants. Parsley powdery mildew caused by E. heraclei has been known in Europe, North America, Brazil, and Japan (2,4). To our knowledge, this is the first report of powdery mildew infections by E. heraclei on parsley in Korea. Since cultivation of parsley was only recently started on a commercial scale in Korea, powdery mildew infections pose a serious threat to safe production of this herb, especially those grown in organic farming where chemical options are limited. References: (1) U. Braun and R. T. A. Cook. Taxonomic Manual of the Erysiphales (Powdery Mildews), CBS Biodiversity Series No. 11. CBS, Utrecht, 2012. (2) D. F. Farr and A. Y. Rossman. Fungal Databases. Syst. Mycol. Microbiol. Lab., Online publication, ARS, USDA, retrieved September 17, 2013. (3) S. Takamatsu et al. Mycol. Res. 113:117, 2009. (4) Y. Tsuzaki and K. Sogou. Proc. Assoc. Plant Prot. Shikoku 24:47, 1989.

Multidetector CT imaging features of solid pseudopapillary tumours of the pancreas in male patients: distinctive imaging features with female patients

OBJECTIVE

To describe multidetector CT imaging features of solid pseudopapillary tumours (SPTs) in male patients and to compare these imaging features with those found in female patients.

METHODS

The institutional review board approved this retrospective study. We included the CT images of 72 patients (M:F = 12:60; mean age, 35.0 years) diagnosed with SPT by histology. CT images were reviewed on the following: location of the tumour, maximal diameter, shape, margin and the fraction of the tumour composition. Statistical differences in CT imaging features were analysed.

RESULTS

Male patients with SPTs were significantly older than female patients (42.4 years vs 33.4 years, p = 0.0408) and the mean size of the SPTs in male patients was larger (6.3 cm vs 4.6 cm, p = 0.0413) than that of SPTs in female patients. Lobulated shape of the SPTs was most frequent in male patients, whereas oval shape was most frequent in female patients (p = 0.0133). SPTs in male patients tended to have a solid component (p = 0.0434). Progressive enhancement in the solid portion of the tumour was seen in 9 (81.8%) of 11 SPTs in male patients and in 30 (79.0%) of 38 SPTs in female patients on multiphasic CT.

CONCLUSION

The imaging features of SPTs in male patients usually appeared as a somewhat large-sized solid mass with a lobulated margin and progressive enhancement. These imaging features may help to differentiate SPTs from other pancreatic tumours for their proper management.

ADVANCES IN KNOWLEDGE

SPTs in male patients appear as somewhat large-sized solid masses with lobulated margins, and this form occurs more frequently in older male patients than in female patients.

First Report of Corynespora Leaf Spot on Beach Vitex Caused by Corynespora cassiicola in Korea

Beach vitex, Vitex rotundifolia L. fil., is a perennial that grows in temperate and tropical areas of the Pacific. In areas where it has been introduced outside of its native range, beach vitex has proven to be an invasive species. This plant dominates dune ecosystems leading to a reduction in the prevalence of native species (1). In October 2010, previously unknown leaf spots were observed on the beach vitex growing on sand dunes in Incheon City of Korea. The same symptoms were repeated in 2011 and 2012. In September 2012, the same leaf spots were found on the beach vitex in Samcheok and Gyeongju in Korea. The symptoms usually started as small, dark brown to purplish leaf spots with more or less concentric rings, eventually causing leaf blights or yellowing with 50% or more defoliation by the end of September. Representative samples (n = 6) were deposited in the Korea University Herbarium (KUS). Conidiophores of the fungus observed microscopically on the leaf spots were erect, brown to dark brown, single or occasionally in clusters, 80 to 500 × 5 to 9 μm, and mostly arose on the abaxial surface of symptomatic leaves. Conidia were borne singly or in short chains of 2 to 4, ranging from cylindrical to broadest at the base and tapering apically, straight to slightly curved, pale olivaceous brown, 1 to 12 pseudoseptate, 50 to 250 × 8 to 18 μm, each with a conspicuous thickened hilum. On potato dextrose agar (PDA), single-spore cultures of two isolates were identified as Corynespora cassiicola (Berk. & M.A. Curtis) C.T. Wei on the basis of morphological and cultural characteristics (3). Two monoconidial isolates were preserved at the Korean Agricultural Culture Collection (Accession Nos. KACC45712 and KACC46953). Isolate KACC45712 was used for molecular works and pathogenicity test. Genomic DNA was extracted using the DNeasy Plant Mini DNA Extraction Kit (Qiagen Inc., Valencia, CA). The complete internal transcribed spacer (ITS) region of rDNA was amplified with the primers ITS1/ITS4 and sequenced. The resulting sequence of 520 bp was deposited in GenBank (Accession No. KC987359). A BLAST search in GenBank revealed that the sequence showed 100% identity with those of C. cassiicola (e.g., JQ801302). To conduct a pathogenicity test, a conidial suspension (ca. 2 × 10⁴ conidia/ml) was prepared by harvesting conidia from 2-week-old cultures, and the suspension was sprayed onto the leaves of three healthy seedlings. Inoculated plants were kept in humid chambers for 48 h in a glasshouse. After 5 days, typical leaf spot symptoms started to develop on the leaves of all three inoculated plants. C. cassiicola was reisolated from the lesions, confirming Koch's postulates. Control plants treated with sterile water remained symptomless. C. cassiicola is cosmopolitan with a very wide host range (2,4). To our knowledge, C. cassiicola has not been reported on Vitex spp. anywhere in the world. According to field observations in Korea, Corynespora leaf spot was most severe in August and September, especially following a prolonged period of moist weather. C. cassiicola may be a potential biocontrol agent for this highly invasive species. References: (1) M. C. Cousins et al. Invasive Plant Sci. Manag. 3:340, 2010. (2) L. J. Dixon et al. Phytopathology 99:1015, 2009. (3) M. B. Ellis. Dematiaceous Hyphomycetes. Commonw. Mycol. Inst.: Kew, UK, 1971. (4) D. F. Farr and A. Y. Rossman. Fungal Databases. Syst. Mycol. Microbiol. Lab., Online publication, ARS, USDA, Retrieved April 30, 2013.

Electron beam irradiated ITO films as highly transparent p-type electrodes for GaN-based LEDs

We have investigated the effect of electron beam irradiation on the electrical and optical properties of ITO film prepared by magnetron sputtering method at room temperature. Electron beam irradiation to the ITO films resulted in a significant decrease in sheet resistance from 1.28 x 10(-3) omega cm to 2.55 x 10(-4) omega cm and in a great increase in optical band gap from 3.72 eV to 4.16 eV, followed by improved crystallization and high transparency of 97.1% at a wavelength of 485 nm. The overall change in electrical, optical and structural properties of ITO films is related to annealing effect and energy transfer of electron by electron beam irradiation. We also fabricated GaN-based light-emitting diodes (LEDs) by using the ITO p-type electrode with/without electron beam irradiation. The results show that the LEDs having ITO p-electrode with electron beam irradiation produced higher output power due to the low absorption of light in the p-type electrode.

Whitening and antioxidant activities of bornyl acetate and nezukol fractionated from Cryptomeria japonica essential oil

OBJECTIVES

The aim of this study was to investigate the whitening and antioxidant activities of essential oils from Cryptomeria japonica by determining their tyrosinase inhibition, 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging and superoxide dismutase (SOD)-like activities.

METHODS

Essential oils of C. japonica leaves were extracted with distilled water, and after condensation of volatile constituents, the condensates were extracted with ethyl acetate. Crude essential oils of C. japonica were divided into six fractions by thin layer chromatography and open column chromatography, and their chemical analysis was performed by GC/MS. Major compounds of fractions were composed of kaurene, bornyl acetate, nezukol, (-)-4-terpineol, δ-cadinene, α-terpineol, γ-eudesmol, α-eudesmol and elemol.

RESULTS

For tyrosinase inhibitory activity using two substrates, l-tyrosine and 3,4-dihydroxyphenylalanine (l-DOPA), kaurene, bornyl acetate and nezukol were highly effective. In antioxidant activity, (-)-4-terpinenol and δ-cadinene showed high DPPH radical scavenging activity, and bornyl acetate and nezukol indicated extremely high SOD-like activity.

CONCLUSION

Therefore, bornyl acetate and nezukol fractionated from C. japonica essential oil, which showed highly active whitening and antioxidant activities, have potential applications in cosmeceutical materials.

Decay of impact after self-management education for people with chronic illnesses: changes in anxiety and depression over one year

BACKGROUND

In people with chronic illnesses, self-management education can reduce anxiety and depression. Those benefits, however, decay over time. Efforts have been made to prevent or minimize that "decay of impact", but they have not been based on information about the decay's characteristics, and they have failed. Here we show how the decay's basic characteristics (prevalence, timing, and magnitude) can be quantified. Regarding anxiety and depression, we also report the prevalence, timing, and magnitude of the decay.

METHODS

Adults with various chronic conditions participated in a self-management educational program (n = 369). Data were collected with the Hospital Anxiety and Depression Scale four times over one year. Using within-person effect sizes, we defined decay of impact as a decline of ≥0.5 standard deviations after improvement by at least the same amount. We also interpret the results using previously-set criteria for non-cases, possible cases, and probable cases.

RESULTS

Prevalence: On anxiety, decay occurred in 19% of the participants (70/369), and on depression it occurred in 24% (90/369). Timing: In about one third of those with decay, it began 3 months after the baseline measurement (6 weeks after the educational program ended). Magnitude: The median magnitudes of decay on anxiety and on depression were both 4 points, which was about 1 standard deviation. Early in the follow-up year, many participants with decay moved into less severe clinical categories (e.g., becoming non-cases). Later, many of them moved into more severe categories (e.g., becoming probable cases).

CONCLUSIONS

Decay of impact can be identified and quantified from within-person effect sizes. This decay occurs in about one fifth or more of this program's participants. It can start soon after the program ends, and it is large enough to be clinically important. These findings can be used to plan interventions aimed at preventing or minimizing the decay of impact.

Effect of wrist position on the measurement of carpal indices on the lateral radiograph

The purpose of this study was to find out whether the carpal indices measured on lateral radiographs with a slightly malpositioned wrist are the same as those measured in the true neutral position. Lateral radiographic views of 25 wrists were taken with 5° intervals from 20° of flexion to 20° of extension. Most carpal indices measured in the flexed or extended position were significantly different from the wrist in zero flexion-extension, except scapholunate angle at 5° of extension and scaphocapitate angle at 5° and 10° of flexion. Starting from the flexed position, there was an average of -4.0° change in radioscaphoid angle, -1.0° in scapholunate angle, -1.0° in scaphocapitate angle, +3.0° in radiolunate angle, and +2.0° in lunocapitate angle for each 5° of extension with linear trends. The results from this study suggest that even minimal degrees of flexion-extension can affect the measurements of carpal indices on lateral radiographs.

Clinical characteristics of patients with tuberculosis-destroyed lung

SETTING

Multicentre study.

OBJECTIVE

To define the clinical characteristics of patients with tuberculosis (TB) destroyed lung due to past TB.

DESIGN

We reviewed patients with TB-destroyed lung between May 2005 and June 2011.

RESULTS

A total of 595 patients from 21 hospitals were enrolled. The mean age was 65.63 ± 0.47 (mean ± standard error); 60.5% were male. The mean number of lobes involved was 2.59 ± 0.05. Pleural thickening was observed in 54.1% of the patients. Mean forced vital capacity (FVC), forced expiratory volume in 1 s (FEV(1)), FEV(1)/FVC, bronchodilator response and number of exacerbations per year were respectively 2.06 ± 0.03 l (61.26% ± 0.79), 1.16 ± 0.02 l (49.05% ± 0.84), 58.03% ± 0.70, 5.70% ± 0.34, and 0.40 ± 0.04. The number of lobes involved was significantly correlated with FVC and FEV(1), and with the number of exacerbations per year. Use of long-acting muscarinic antagonists or long-acting beta-2 agonists plus inhaled corticosteroids resulted in bronchodilatory effects. Multivariable regression analysis showed that age, initial FEV(1) (%) and number of exacerbations during follow-up were independent factors affecting change in FEV(1).

CONCLUSION

Decreased lung function with exacerbation, and progressive decline of FEV(1) were observed in patients with TB-destroyed lung.

First Confirmed Report of Powdery Mildew Caused by Podosphaera xanthii on Farfugium japonicum in Korea

Farfugium japonicum (L.) Kitam., known as Japanese silver leaf, is native to Japan, Korea, and Taiwan. It is grown as an ornamental plant for garden plantings and containers not only in East Asia but more recently also in Europe and North America. Since 2003, powdery mildew infections of F. japonicum 'Gigantea' have been consistently found in the southern part of Korea, including the districts of Jeju, Seogwipo, Busan, Wando, and Ulleungdo. Specimens have been deposited in the Korea University Herbarium (KUS). Signs of powdery mildew first appeared as circular to irregular white patches on both sides of the leaves. The infections were usually severe on young leaves and caused malformation and browning. Appressoria on the mycelium were nipple-shaped or nearly absent. Conidiophores, measuring 160 to 280 × 10 to 12.5 μm, were simple and produced 2 to 12 immature conidia in chains, followed by 2 to 3 cells. Foot-cells in conidiophores were relatively short, 50 to 95 μm long, and constricted at the base. Conidia were hyaline, ellipsoid to ovate, 32 to 48 × 17.5 to 25 μm (length/width ratio = 1.4 to 2.3), had distinct fibrosin bodies, and produced germ tubes on the lateral position. No chasmothecia were observed. The morphology and dimentions of reproductive structures were compatible with those of Podosphaera xanthii (Castagne) U. Braun & Shishkoff (1). To confirm the identity of the causal fungus, the complete ITS region of rDNA from isolate KUS-F26469 was amplified with primers ITS5 and P3 (4) and directly sequenced. The resulting sequence of 475 bp was deposited in GenBank (Accession No. KC155426). A GenBank BLAST search of this sequence revealed 100% identity (475/475 bp) with those of many P. fusca isolates on plants in the Aster family plants including Calendula officinalis, Euryops pectinatus, Syneilesis palmata, and F. japonicum from Japan (e.g., AB040346). The P. fusca isolates listed above are now placed in P. xanthii (1). Pathogenicity was confirmed through inoculation by gently pressing diseased leaves onto leaves of three healthy potted plants of the same cultivar. Three non-inoculated plants served as controls. Plants were maintained in a greenhouse at 25 ± 2°C. Inoculated plants developed typical signs and symptoms of powdery mildew after 8 days, whereas the control plants remained symptomless. The fungus present on the inoculated leaves was morphologically identical to that originally observed on diseased plants. Powdery mildew infections of F. japonicum caused by P. fusca (syn. P. fuliginea) have been reported previously in both Japan and Korea (2). In Korea, it was listed simply as a host fungus of Ampelomyces quisqualis, which is hyperparasitic to powdery midlews, without any data on its identity (3). To our knowledge, this is the first confirmed report of powdery mildew caused by P. xanthii on F. japonicum in Korea. References: (1) U. Braun and R. T. A. Cook. Taxonomic Manual of the Erysiphales (Powdery Mildews), CBS Biodiversity Series No.11. CBS, Utrecht, 2012. (2) D. F. Farr and A. Y. Rossman. Fungal Databases. Syst. Mycol. Microbiol. Lab., Online publication, ARS, USDA, Retrieved November 14, 2012. (3) M. J. Park et al. Fungal Biol. 114:235, 2010. (4) S. Takamatsu et al. Mycol. Res. 113:117, 2009.

Hidden decay of impact after education for self-management of chronic illnesses: hypotheses

People with chronic illnesses can benefit from self-management education. However, those benefits are said to decay over time (there is some evidence that this 'decay of impact' does occur), and the reinforcements used to prevent that decay appear to be ineffective. We hypothesize that the reinforcements appear to be ineffective because decay of impact occurs only in a subgroup of these programs' participants, so any benefits of reinforcements in that subgroup are concealed by whole-group summary statistics. We also hypothesize that reinforcements can benefit those who need them - those who would otherwise have decay. One approach to testing these hypotheses requires analysis of individual-level data, which is uncommon in this field. Some useful data could come from studies that have already been completed, but the strongest evidence will require prospectively designed tests in future trials. If the hypotheses are false, then time and resources spent on reinforcements can be saved or redirected. If the hypotheses are true, then reinforcements can be implemented with less waste and they can be made more effective. These programs can also be improved to better fit their users' needs, and there can be a new basis for evaluating the programs' effectiveness.

First Report of Black Stem Caused by Botryosporium longibrachiatum on Sweet Basil in Korea

Sweet basil, Ocimum basilicum L., is cultivated mainly for fresh consumption in Korea. In March 2009, in Icheon, Korea, several dozen plants showing symptoms of black stems were found in an organic farm that used polyethylene tunnels for production. The black stems were usually covered with a fungus that gave the appearance of hoar-frost on the stems, especially when plants were grown under a cool and humid environment. According to the farmer, black stems appear during the winter season of November to March when the tunnels were mostly closed. The relative humidity (RH) during that period was around 100% every night due to poor ventilation. Beginning the middle of April when both sides of the tunnels were open, providing good ventilation, no further disease development was observed. The fungus on the stems had an elongate, upright conidiophore, reaching 5 mm in length. At intervals along its length, the main axis of conidiophores produced lateral fertile branches in acropetal succession. Each lateral branch terminated in a cluster of four or five ampullae. Conidia were hyaline, oval, and 5.5 to 9.5 × 3.5 to 6 μm. The fungus was non-pigmented and colonies on potato dextrose agar were chalk white. Morphological and cultural characteristics of the fungus were consistent with the previous reports of Botryosporium longibrachiatum (Oudem.) Maire (3,4). Voucher specimens (n = 4) were housed at Korea University Herbarium (KUS). An isolate from KUS-F24010 was deposited in the Korean Agricultural Culture Collection (Accession No. KACC44849) and used for molecular analysis and pathogenicity tests. The complete internal transcribed spacer (ITS) region of rDNA was amplified with the primers ITS1/ITS4 and sequenced. The resulting sequence of 592 bp was deposited in GenBank (Accession No. JX666334). A BLAST search in GenBank showed that there was no comparable sequence of B. longibrachiatum and thus this was the first ITS sequence for the species submitted in GenBank. To confirm the pathogenicity, colonized mycelial plugs (3 mm in diameter) from 10-day-old PDA cultures were placed onto the stem apices (n = 10) of 2-month-old sweet basil pot plants, which were topped as normally harvested. Control plants were inoculated with uncolonized agar plugs. All plants were incubated at 22 ± 2°C in a humidified chamber with a 12-h photoperiod for 48 h, and then maintained in a greenhouse (22 ± 2°C). Three to four days after inoculation, necrotic lesions developed around the points of inoculation on all stems and expanded downwards, leading to black stems covered with the hoar-frost like fungus after 14 days. B. longibrachiatum was successfully reisolated from all inoculated stems, while control plants remained symptomless. The pathogenicity test was conducted twice with the same result. The association of B. longibrachiatum and sweet basil was previously reported (4). Several other plants including burley tobacco are also reported to be infected by this fungus (1,2). To our knowledge, this is the first etiological report of B. longibrachiatum on sweet basil globally as well as in Korea. References: (1) T. R. Anderson. Plant Dis. 67:1158, 1983. (2) D. F. Farr and A. Y. Rossman. Fungal Databases. Systematic Mycology & Microbiology Laboratory, ARS, USDA. Retrieved from http://nt.ars-grin.gov/fungaldatabases/ , September 7, 2012. (3) C. V. Subramanian. Hyphomycetes. Indian Council of Agricultural Research, New Delhi, India, 1971. (4) H. T. Tribe and R. W. S. Weber. Mycologist 15:158, 2001.

Medical home for adolescents: low attainment rates for those with mental health problems and other vulnerable groups

BACKGROUND

The importance of the medical home for children has been demonstrated but has not been examined comprehensively for adolescents. Adolescence is a unique period of physical, cognitive, and psychosocial changes when many mental disorders first emerge; thus, receiving care within a medical home could improve well-being. This study examines rates of medical home attainment and its components for adolescents and subgroups, including those with mental health conditions.

METHODS

Utilizing the 2007 National Survey of Children's Health, we determined the following for adolescents aged 10 to 17 years (n = 45 897): 1) rates of medical home attainment and its 5 components (usual source of care, having a personal doctor, and receiving needed referrals, effective care coordination, and family-centered care); and 2) subgroup differences; gender, race/ethnicity, income, insurance, region, language spoken at home, respondent education, and the presence of mental health conditions.

RESULTS

Fifty-four percent of adolescents had a past-year medical home. Rates were lower for minority youth compared to whites; lower-income and uninsured youth; those in households that are non-English speaking in which the respondent did not have some college; and those with mental health as opposed to physical health conditions (all P < .01). Patterns of disparities in the medical home components were similar, and rates were lowest for effective care coordination and family-centered care components.

CONCLUSIONS

Nearly half of adolescents lacked a medical home in the past year. Even lower rates for subgroups highlight the need to increase access to comprehensive quality health care. Efforts to improve effective care coordination and family-centered care could result in higher quality of care for all children and adolescents, and specifically for disadvantaged adolescents and those with mental health conditions.

Spatial analysis for identifying hotspots of EDC and PPCP sources for monitoring systems

This study utilized spatial analysis to identify hotspots for endocrine disrupting chemicals (EDCs), pharmaceuticals, and personal care products (PPCPs) using data from potential sources including wastewater treatment plants, National Pollutant Discharge Elimination System (NPDES)-permitted pollution sources, septic systems, and agricultural and grazing areas. The study area is Lake Mead, to which the return of treated effluent is one of the largest water reuse practices in the USA. Based on Getis-Ord's Gi* statistic, clusters of pollution sources were identified based on the values of each feature and its neighboring features. Spatial analysis was applied to evaluate the impact from point and nonpoint source pollution. The results of spatial statistical analyses were used to evaluate the existing sampling locations in Las Vegas Wash. The results indicated that sampling locations with highest concentrations of EDCs/PPCPs were close to the outlets of subbasins with high susceptibility to EDCs/PPCPs, which confirms the suitability of sampling locations.

Preliminary study of online machine translation use of nursing literature: quality evaluation and perceived usability

Background

Japanese nurses are increasingly required to read published international research in clinical, educational, and research settings. Language barriers are a significant obstacle, and online machine translation (MT) is a tool that can be used to address this issue. We examined the quality of Google Translate® (English to Japanese and Korean to Japanese), which is a representative online MT, using a previously verified evaluation method. We also examined the perceived usability and current use of online MT among Japanese nurses.

Findings

Randomly selected nursing abstracts were translated and then evaluated for intelligibility and usability by 28 participants, including assistants and research associates from nursing universities throughout Japan. They answered a questionnaire about their online MT use. From simple comparison of mean scores between two language pairs, translation quality was significantly better, with respect to both intelligibility and usability, for Korean-Japanese than for English-Japanese. Most respondents perceived a language barrier. Online MT had been used by 61% of the respondents and was perceived as not useful enough.

Conclusion

Nursing articles translated from Korean into Japanese by an online MT system could be read at an acceptable level of comprehension, but the same could not be said for English-Japanese translations. Respondents with experience using online MT used it largely to grasp the overall meanings of the original text. Enrichment in technical terms appeared to be the key to better usability. Users will be better able to use MT outputs if they improve their foreign language proficiency as much as possible. Further research is being conducted with a larger sample size and detailed analysis.

First Report of Leaf Blight Caused by Phomopsis ipomoeae-batatas on Sweet Potato in Korea

Ipomoea batatas (L.) Lam., belonging to the Convolvulaceae, is widely cultivated and used as an industrial resource as well as for food and feed worldwide (2). In September 2010, an unknown leaf blight was observed on leaves in Hoengseong County and Jecheon City in Korea. Symptoms were mostly observed in older leaves as cream to tan-brown lesions surrounded by purplish brown-to-dark brown margin. Each lesion was circular to irregular, not exceeding 10 mm, but coalesced to form larger lesions. Necrotic tissue fell out giving rise to shot-holes. A number of black pycnidia were present in the lesions of diseased leaves. The same symptoms were observed at several localities in Korea during 2010 and 2011 seasons. The voucher specimens (n = 5) were preserved in the Korea University Herbarium (KUS). Two isolates were obtained from the two samples (KUS-F25274 and KUS-F25361) and deposited in the Korean Agricultural Culture Collection (Accession Nos. KACC45680 and KACC45702). Pycnidia were amphigenous, but mostly epigenous, scattered, dark brown-to-rusty brown, globose, embedded in host tissue or partly erumpent, 110 to 170 μm in diameter, and with an ostiole of 25 to 40 μm in diameter. Alpha conidia were aseptate, lageniform, biguttulate, hyaline, and 5.5 to 8.0 × 3.5 to 4.5 μm. Beta conidia were absent. Based on the morphological characteristics, the fungus was consistent with Phomopsis ipomoeae-batatas Punith. (1,3). Preliminary identification of the fungal isolate was confirmed by molecular data. Genomic DNA was extracted from the two isolates. The D1/D2 region of 28S rDNA was amplified using the primers LROR and LR7, and sequenced. The resulting sequences of the two isolates were identical to each other, and were deposited in GenBank (Accession Nos. JX157848 and JX157849). A BLAST search showed that there was no matching sequence of P. ipomoeae-batatas. Therefore, these were the first 28S sequences for the species submitted to GenBank. The present sequences showed >98% similarity with 24 entries of Phomopsis spp. and Diaporthe spp. (teleomorph of Phomopsis spp.), indicating their close phylogenetic relationship. Pathogenicity was tested by spraying leaves of three potted plants with a conidial suspension (2 × 10⁶ conidia/ml), which was harvested from a 3-week-old culture on potato dextrose agar. Control leaves were sprayed with sterile water. The plants were placed in a dew chamber at 24°C in darkness and continuous dew for the first 24 h and then moved to a greenhouse bench. After 10 days, leaf blight symptoms that were identical to those observed in the field started to develop on the leaves inoculated with the fungus. No symptoms were observed on control plants. P. ipomoeae-batatas was reisolated from the lesions of inoculated plants, confirming Koch's postulates. Occurrence of leaf blight caused by P. ipomoeae-batatas on sweet potato has been reported in many countries (1,3). To our knowledge, this is the first report of the disease in Korea. The economic losses are of minor importance, because the disease is mostly present toward the end of growing season; however, attention must be paid considering that the pathogen may reduce the quality of vines used as fodder. References: (1) C. A. Clark and J. W. Moyer. Compendium of Sweet Potato Diseases. The American Phytopathological Society. St. Paul, MN, 1988. (2) I. G. Mok et al. J. Plant Biotechnol. 36:202, 2009. (3) E. Punithalingam. Phomopsis ipomoeae-batatas. IMI Descriptions of Fungi and Bacteria. Sheet 739, 1982.

First Report of Powdery Mildew Caused by Erysiphe sedi on Kalanchoe blossfeldiana in Korea

Kalanchoe blossfeldiana Poelln., belonging to the Crassulaceae, is a common ornamental houseplant with many cultivars. In May 2010, powdery mildew was observed on about 50% of 3,000 potted kalanchoe 'Rose Queen' plants in plastic greenhouses located in Yongin city of central Korea. Farmers producing potted kalanchoes in Yongin region stated that powdery mildew on kalanchoes was mild without causing problems for the last several years. The disease became severe from April 2010 and caused economic losses. The economic and esthetic value was reduced by the unsightly appearance of infected plants with most being unmarketable. Damage due to powdery mildew infections on kalanchoes appeared every year. A representative specimen was deposited in the Korea University herbarium (Accession No. KUS-F24911). Mycelial colonies were white, conspicuous and epiphytic on leaves and stems. Hyphae were septate, branched, and 3 to 6 μm wide. Appressoria on the hyphae were well developed, lobed, and mostly positioned in pairs. Conidiophores were cylindrical, 70 to 145 × 7 to 11.5 μm, and composed of three to four cells. Foot-cells of conidiophores were straight, cylindrical, and 28 to 48 μm long. Conidia produced singly were variable in shape, oval to cylindrical, oval or oblong-elliptical, 30 to 55 × 14 to 24 μm, lacked distinct fibrosin bodies, and showed angular/rectangular wrinkling of outer walls. Germ tubes were produced on the perihilar position of conidia. No chasmothecia were found. The morphological characteristics were consistent with descriptions of Erysiphe sedi U. Braun (1). To confirm the identity of the causal fungus, the complete ITS region of rDNA from KUS-F24911 was amplified with primers ITS5 and P3 as described by Takamatsu et al. (4) and directly sequenced. The resulting sequence was deposited in GenBank (Accession No. JX173288). A GenBank BLAST search using the present data revealed that the ITS sequence shares 100% (552/552 bp) similarity with those of E. sedi on Sedum spp. (Accession Nos. JX173289, JX173290). Pathogenicity was confirmed through inoculation by gently pressing diseased leaves onto leaves of five healthy potted kalanchoe plants. Five non-inoculated plants served as controls. Plants were maintained in a greenhouse at 22 ± 2°C. Inoculated plants developed signs and symptoms after 7 days, whereas the control plants remained symptomless. The fungus present on the inoculated plants was morphologically identical to that originally observed on diseased plants, fulfilling Koch's postulates. E. sedi is also known to infect Kalanchoe pinnata (Lam.) Pers. (= Bryophyllum calycinum Salisb.) in Romania (1,2) and other crassulaceous plants including Sedum spectabile in North America (3). To our knowledge, this is the first report of E. sedi infections of K. blossfeldiana in Korea. This disease seems to be a serious threat to the commercial production of kalanchoe plants which are cultivated under plastic greenhouses of poor ventilation and low light levels in Korea. References: (1) U. Braun and R. T. A. Cook. Taxonomic Manual of the Erysiphales (Powdery Mildews), CBS Biodiversity Series No. 11. CBS, Utrecht, 2012. (2) D. F. Farr and A. Y. Rossman. Fungal Databases, Systematic Mycology & Microbiology Laboratory, ARS, USDA. Retrieved from http://nt.ars-grin.gov/fungaldatabases/ , June 13, 2012. (3) L. Kiss and M. L. Daughtrey. Plant Dis. 85:1207, 2001. (4) S. Takamatsu et al. Mycol. Res. 113:117, 2009.

First Report of Powdery Mildew Caused by Erysiphe macleayae on Macleaya microcarpa in Poland

Macleaya microcarpa (Maxim.) Fedde, also known as smallfruit plume poppy, is a perennial herb belonging to the family Papaveraceae. The plant, together with the better-known species M. cordata (Willd.) R. Br., is native to central China and is now planted worldwide for medicinal purposes. In October 2008 and August 2009, dozens of smallfruit plume poppy planted in the Kraków Botanical Garden, Poland, were found to be severely infected with a powdery mildew. White colonies with abundant sporulation developed on both sides of leaves and young stems, forming circular to irregular patches. Infections caused leaf yellowing and premature defoliation. The damage has been observed every year since 2009. Representative voucher specimens were deposited in the fungal herbarium of the W. Szafer Institute of Botany of the Polish Academy of Sciences (KRAM) and the Korea University herbarium (KUS). Appressoria on the mycelia were lobed, often in pairs. Conidiophores composed of three to four cells arose from the upper part of creeping hyphae, 65 to 120 × 7 to 10 μm, attenuated toward the base, sub-straight or slightly flexuous in foot-cells, and produced conidia singly. Conidia were hyaline, oblong-elliptical to doliiform, 25 to 38 × 12 to 18 μm with a length/width ratio of 1.8 to 2.6; lacked fibrosin bodies; and produced germ tubes on the subterminal position with club-shaped or lobed appressoria. The conidial surface was wrinkled to irregularly reticulate. No chasmothecia were found. The structures described above match well with the anamorph of Erysiphe macleayae R.Y. Zheng & G.Q. Chen (3). To confirm the identity of the causal fungus, the internal transcribed spacer (ITS) region of rDNA from KUS-F24459 was amplified using primers ITS5 and P3 (4) and directly sequenced. The resulting sequence of 553 bp was deposited in GenBank (Accession No. JQ681217). A GenBank BLAST search using the present data revealed >99% sequence similarity of the isolate with E. macleayae on M. cordata from Japan (AB016048). Pathogenicity was confirmed through inoculation by gently pressing diseased leaves onto leaves of three healthy potted plants. Three noninoculated plants served as controls. Plants were maintained in a greenhouse at 25°C. Inoculated plants developed signs and symptoms after 7 days, whereas the control plants remained healthy. The fungus present on the inoculated plants was morphologically identical to that originally observed on diseased plants. The powdery mildew infections of M. cordata associated with E. macleayae have been recorded in China and Japan (2), and more recently in Germany (1,3). To our knowledge, this is the first report of E. macleayae on M. microcarpa globally as well as in Poland. This mildew species was described in China and is endemic to Asia, where chasmothecia of the fungus were found. Only recently have powdery mildews been found on M. cordata in Germany (1,3) and now on M. microcarpa in Poland, indicating the fungus is spreading in Europe. References: (1) N. Ale-Agha et al. Schlechtendalia 17:39, 2008. (2) D. F. Farr and A. Y. Rossman. Fungal Databases, Systematic Mycology and Microbiology Laboratory, ARS, USDA. Retrieved from http://nt.ars-grin.gov/fungaldatabases/ , February 7, 2012. (3) A. Schmidt and M. Scholler. Mycotaxon 115:287, 2011. (4) S. Takamatsu et al. Mycol. Res. 113:117, 2009.

First Report of Powdery Mildew Caused by Oidium hortensiae on Mophead Hydrangea in Korea

Hydrangea macrophylla (Thunb.) Ser., known as mophead hydrangea, is native to Japan and is used as a potted ornamental or is planted for landscaping in gardens worldwide. In May 2011, powdery mildew occurred on potted mophead hydrangea cv. Emerald plants in polyethylene-film-covered greenhouses in Icheon, Korea. Heavily infected plantings were unmarketable, mainly due to purplish red discoloration and crinkling of leaves. Such powdery mildew symptoms on mophead hydrangea in gardens had been often found in Korea since 2001, and the collections (n = 10) were deposited in the Korea University herbarium (KUS). In all cases, there was no trace of chasmothecia formation. Mycelium was effuse on both sides of leaves, young stems, and flower petals. Appressoria were well developed, lobed, and solitary or in opposite pairs. Conidiophores were cylindrical, 70 to 145 × 7.5 to 10 μm, and composed of three to four cells. Foot-cells of conidiophores were straight to sub-straight, cylindric, short, and mostly less than 30 μm long. Conidia produced singly were ellipsoid to oval, 32 to 50 × 14 to 22 μm with a length/width ratio of 1.7 to 2.8, lacked fibrosin bodies, and showed angular/rectangular wrinkling of outer walls. Germ tubes were produced on the perihilar position of conidia. Primary conidia were apically conical, basally rounded to subtruncate, 32 to 42 × 14 to 18 μm, and thus generally smaller than the secondary conidia. The morphological characteristics are consistent with previous descriptions of Oidium hortensiae Jørst. (3,4). To confirm the identification, the complete internal transcribed spacer (ITS) region of rDNA from KUS-F25514 was amplified with primers ITS5 and P3 and directly sequenced. The resulting sequence of 694 bp was deposited in GenBank (Accession No. JQ669944). There was no ITS sequence data known from powdery mildews on Hydrangea. Therefore, this is the first sequence of O. hortensiae submitted to GenBank. Nevertheless, a GenBank BLAST search of this sequence showed >99% similarity with those of Oidium spp. recorded on crassulacean hosts (e.g. GenBank Accession Nos. EU185641 ex Sedum, EU185636 ex Echeveria, and EU185639 ex Dudleya) (2), suggesting their close phylogenetic relationship. Pathogenicity was confirmed through inoculation by gently pressing diseased leaves onto leaves of five healthy potted mophead hydrangea cv. Emerald plants. Five noninoculated plants of the same cultivar served as controls. Plants were maintained in a greenhouse at 22 ± 2°C. Inoculated plants developed signs and symptoms after 6 days, whereas the control plants remained healthy. The fungus present on the inoculated plants was morphologically identical to that originally observed on diseased plants, fulfilling Koch's postulates. Occurrence of powdery mildew disease on mophead hydrangea is circumglobal (1). To our knowledge, this is the first report of powdery mildew disease caused by O. hortensiae on mophead hydrangea in Korea. Powdery mildew infections in Korea pose a serious threat to the continued production of quality potted mophead hydrangea in polyethylene-film-covered greenhouses. References: (1) D. F. Farr and A. Y. Rossman. Fungal Databases, Systematic Mycology and Microbiology Laboratory, ARS, USDA. Retrieved March 19, 2012, from http://nt.ars-grin.gov/fungaldatabases/ . (2) B. Henricot. Plant Pathol. 57:779, 2008. (3) A. Schmidt and M. Scholler. Mycotaxon 115:287, 2011. (4) S. Tanda. J. Agric. Sci. Tokyo Univ. Agric. 43:253, 1999.

Mechanically and structurally robust sulfonated block copolymer membranes for water purification applications

The effective removal of ionic pollutants from contaminated water using negatively charged nanofiltration membranes is demonstrated. Block copolymers comprising polystyrene (PS) and partially hydrogenated polyisoprene (hPI) were synthesized by varying chain architectures. A one step procedure of cross-linking (hPI blocks) and sulfonation reactions (PS chains) was then carried out, which was revealed as an effective method to enhance mechanical integrity of membranes while hydrophilic sulfonated chains remain intact. In particular, the control of chain architecture allows us to create a synergetic effect on optimizing charge densities of the membrane, water permeability, and mechanical integrity under water purification conditions. The best performing membrane can almost completely (>99%) reject various divalent cations and also show NO(3)(-) rejection > 85% and Na(+) rejection > 87%. Well defined nanostructures (tens of nanometers) as well as the periodically arranged water domains (a few nanometers) within hydrophilic phases of the hydrated membranes were confirmed by in situ neutron scattering experiments.