Can Copper Be Used to Treat Foliar Phytophthora Infections in Pinus radiata?

Red needle cast is a significant foliar disease of commercial stands of Pinus radiata caused by Phytophthora pluvialis in New Zealand. The effect of copper, applied as a foliar spray of cuprous oxide at a range of doses between 0 and 1.72 kg ha^-1, was investigated in two controlled trials with potted plants and in an operational trial with mature P. radiata. In all trials, lesions formed on needles after artificial exposure to the infecting propagules (zoospores) of P. pluvialis were used to determine treatment efficacy, with the number and/or length of lesions as the dependent variable. Results across all trials indicated that cuprous oxide was highly effective at reducing infection of P. radiata with P. pluvialis. Application rates equivalent to ≥0.65 kg ha^-1 significantly reduced infection levels relative to a control treatment, with foliar surface copper levels as low as 13 to 26 mg kg^-1 of needle tissue preventing infection. Greater copper content was associated with a reduction in the proportion of needles with P. pluvialis lesions, with the probability of lesions developing decreasing approximately 1% for every 1 unit (in milligrams per kilogram) increase in copper content. Over a 90-day period, surface copper content declined to 30% of that originally applied, indicating an approximate period of treatment efficacy of 3 months. Our findings highlight the potential of cuprous oxide for the control of red needle cast in P. radiata stands. Further information about the optimal field dose, timing, and the frequency of foliar cuprous oxide application is key to prevent infection and also reduce the build up of inoculum during severe outbreaks of this pathogen.

Older People Who Are Frequent Users of Acute Care: A Symptom of Fragmented Care? A Case Series Report on Patients' Pathways of Care

Older frequent users of acute care can experience fragmented care. There is a need to understand the issues in a local context before attempting to address fragmented care. 0.5% (n=61) of the population in a defined local government area were identified as having ≥4 unplanned emergency department (ED) presentations/ admissions to an acute-care hospital over 13 months. A retrospective case-series study was conducted to examine detailed pathways of care for 17 patients within the identified population. The two dominant presentation reasons were clinical symptoms associated with a declining/significant loss of capacity in fundamental self-care activities and chronic cardiac/respiratory conditions. Of patients discharged home, 21% of discharge letters were delayed >7 days and only 19% received a written discharge plan. Half of community dwelling patients received home nursing and/or assistance. Frequent users of acute care can experience untimely hospital communication and may require more coordinated care provided in the community to assist self-care and manage chronic conditions.

Peak Pruritus Numerical Rating Scale: psychometric validation and responder definition for assessing itch in moderate-to-severe atopic dermatitis

BACKGROUND

Moderate-to-severe atopic dermatitis (AD) is a chronic disease characterized by intense, persistent and debilitating itch, resulting in sleep deprivation, signs of anxiety and depression, impaired quality of life and reduced productivity. The Peak Pruritus Numerical Rating Scale (NRS) was developed and validated as a single-item, patient-reported outcome (PRO) of itch severity.

OBJECTIVES

To describe the content validity and psychometric assessment (test-retest reliability, construct validity, known-groups validity, sensitivity to change) of the Peak Pruritus NRS, and to derive empirically a responder definition to identify adults with a meaningful change in itch.

METHODS

Content validity was assessed through in-depth patient interviews. Psychometric assessments used data from phase IIb and phase III dupilumab clinical trials and included test-retest reliability, construct validity, known-groups validity and sensitivity to change in patients with moderate-to-severe AD.

RESULTS

Interview participants indicated that the Peak Pruritus NRS was a relevant, clear and comprehensive assessment of itch severity. Peak Pruritus NRS scores showed large, positive correlations with existing PRO measures of itch, and weak or moderate correlations with clinician-reported measures assessing objective signs of AD. Peak Pruritus NRS score improvements were highly correlated with improvements in other itch PROs, and moderately correlated with improvements in clinician-reported measures assessing objective signs of AD. The most appropriate threshold for defining a clinically relevant, within-person response was ≥ 2-4-point change in the Peak Pruritus NRS.

CONCLUSIONS

The Peak Pruritus NRS is a well-defined, reliable, sensitive and valid scale for evaluating worst itch intensity in adults with moderate-to-severe AD.