Difference in general practice telehealth utilisation associated with birth country during COVID-19 from two Australian states

Objective

Telehealth has been an integral part of ensuring continued general practice access during the COVID-19 pandemic. Whether telehealth was similarly adopted across different ethnic, cultural, and linguistic groups in Australia is unknown. In this study, we assessed how telehealth utilisation differed by birth country.

Methods

In this retrospective observational study, electronic health record data from 799 general practices across Victoria and New South Wales, Australia between March 2020 to November 2021 were extracted (12,403,592 encounters from 1,307,192 patients). Multivariate generalised estimating equation models were used to assess the likelihood of a telehealth consultation (against face-to-face consultation) by birth country (relative to Australia or New Zealand born patients), education index, and native language (English versus others).

Results

Patients born in Southeastern Asia (aOR: 0.54; 95% CI: 0.52-0.55), Eastern Asia (aOR: 0.63; 95% CI: 0.60-0.66), and India (aOR: 0.64; 95% CI: 0.63-0.66) had a lower likelihood of having a telehealth consultation compared to those born in Australia or New Zealand. Northern America, British Isles, and most European countries did not present with a statistically significant difference. Additionally, higher education levels (aOR: 1.34; 95% CI: 1.26-1.42) was associated with an increase in the likelihood of a telehealth consultation, while being from a non-English-speaking country was associated with a reduced likelihood (aOR: 0.83; 95% CI: 0.81-0.84).

Conclusions

This study provides evidence showing differences in telehealth use associated with birth country. Strategies to ensure continued healthcare access for patients, whose native language is not English, such as providing interpreter services for telehealth consultations, would be beneficial.

Perspectives

Understanding cultural and linguistic differences may reduce health disparities in telehealth access in Australia and could present an opportunity to promote healthcare access in diverse communities.

Where is the greatest potential for resource recovery in wastewater treatment plants?

The restorative and regenerative ability of the circular economy has led to the rapid growth of this concept over the past decade, as it facilitates the broadly adopted principles of sustainable development and beyond, through restorative and regenerative actions. The water sector is poised to benefit from this transition, due to its intrinsic circularity and the resources it handles, predominantly found in wastewater, that are valuable and critical. Currently, the vast range of resource recovery technologies coupled with few industrial examples hinder strategic decision making. Resource recovery on a regional scale improves market share and mitigates investment risk, therefore, a structured approach has been developed for the selection of priority technologies to act as a guide for strategic planning. A representative UK wastewater model acts as the baseline, with multi-criteria analysis used to select resources and create an enhanced resource recovery scenario. It was found that implementing the recovery of 5 'priority resources' (and technology pathways) increased nitrogen and phosphorus recovery by 68% and 71%, respectively. Lastly, the need for a cross-cutting approach for the holistic assessment of circular solutions is discussed.

Phosphonate Treatment Effects on Phytophthora Root Rot Control, Phosphite Residues and Phytophthora cactorum Inoculum in Young Apple Orchards

Phytophthora root rot, caused by Phytophthora cactorum, is an economically important disease on young apple trees. Limited information is available on the effect of different phosphonate application methods and dosages on disease control, fruit and root phosphite concentrations, and soil and root pathogen inoculum levels. Evaluation of phosphonate treatments in three apple orchard trials (two in the Grabouw and one in the Koue Bokkeveld region) showed that foliar sprays (ammonium or potassium phosphonate), trunk sprays and trunk paints, were equally effective at increasing trunk diameter in one trial and yield in a second trial over a 25-month period. Foliar ammonium and potassium phosphonate sprays (12 g of phosphorous acid/tree), and two different dosages of the ammonium phosphonate sprays (∼4.8 g or 12 g of phosphorous acid/tree) were all equally effective at improving tree growth. The addition of a bark penetrant (polyether-polymethylsiloxane-copolymer) to trunk sprays did not improve the activity of trunk sprays. The low dosage ammonium phosphonate foliar spray (∼4.8 g a.i./tree) was the only treatment that, in general, yielded significantly lower root phosphite concentrations than the other phosphonate treatments. Root phosphite concentrations were significantly positively correlated (P < 0.0001) with an increase in trunk diameter and negatively (P < 0.0001) with P. cactorum root DNA quantities. Phosphite fruit residues were <31 ppm for all treatments, with the trunk paint treatment (80 g of phosphorous acid/tree applied annually) yielding significantly lower residues than the higher dosage foliar sprays (∼12 g a.i./tree). Twenty-one months posttreatment, most of the phosphonate treatments in all of the trials similarly significantly reduced P. cactorum DNA quantities estimated directly from roots, but not from soil based on soil baiting DNA analysis. Pathogen quantities in fine feeder roots did not differ significantly from those in higher-order roots (<5 mm diameter). P. cactorum DNA quantities estimated using DNA quantification directly from roots were significantly correlated (P < 0.0001) with those obtained through root leaf baiting DNA analysis and, to a lesser extent, with soil leaf baiting DNA quantities (P = 0.025).

Increased case-finding and uptake of direct-acting antiviral treatment essential for micro-elimination of hepatitis C among people living with HIV: a national record linkage study

OBJECTIVES

Micro-elimination of hepatitis C virus (HCV) in people living with HIV (PLHIV) and co-infected with HCV has been proposed as a key contribution to the overall goal of HCV elimination. While other studies have examined micro-elimination in HIV-treated cohorts, few have considered HCV micro-elimination among those not treated for HIV or at a national level.

METHODS

Through data linkage of national and sentinel surveillance data, we examined the extent of HCV testing, diagnosis and treatment among a cohort of PLHIV in Scotland identified through the national database of HIV-diagnosed individuals, up to the end of 2017.

RESULTS

Of 5018 PLHIV, an estimated 797 (15%) had never been tested for HCV and 70 (9%) of these had undiagnosed chronic HCV. The odds of never having been tested for HCV were the highest in those not on HIV treatment [adjusted odds ratio (aOR) = 7.21, 95% confidence interval (CI): 5.15-10.10). Overall HCV antibody positivity was 11%, and it was at its highest among people who inject drugs (49%). Most of those with chronic HCV (91%) had attended an HCV treatment clinic but only half had been successfully treated (54% for those on HIV treatment, 12% for those not) by the end of 2017. The odds of never having been treated for HCV were the highest in those not on HIV treatment (aOR = 3.60, 95% CI: 1.59-8.15).

CONCLUSIONS

Our data demonstrate that micro-elimination of HCV in PLHIV is achievable but progress will require increased effort to engage and treat those co-infected, including those not being treated for their HIV.

The contribution of iron deficiency to the risk of peripartum transfusion: a retrospective case control study

Background

Iron deficiency in pregnancy is associated with inferior maternal and fetal outcomes. Postpartum depression, prematurity, intrauterine growth restriction, impaired childhood cognition and transfusion are all sequelae of maternal iron deficiency anemia. Transfusion to women of childbearing age has important consequences including increasing the risk of hemolytic disease of the fetus and newborn with future pregnancies. The relative contribution of iron deficiency to transfusion rates in the peripartum period is unknown. This study aimed to identify the prevalence of iron deficiency and anemia in pregnant women that received peripartum transfusions relative to age-matched non-transfused controls.

Methods

We performed a retrospective case-control study of all women that were transfused in the peripartum period from January, 2014 to July, 2018. Cases were compared to the next age matched control to deliver at our institution. The primary objective was to determine the proportion of patients with iron deficiency in pregnancy or anemia in pregnancy in cases and controls. Charts were reviewed for predisposing risk factors for iron deficiency, laboratory measures of iron deficiency and anemia, iron supplementation history and maternal and fetal outcomes. Factors associated with peripartum transfusion were analyzed using a multivariate logistic regression.

Results

169 of 18, 294 (0.9%) women were transfused in the peripartum period and 64 (44%) of those transfused received 1 unit. Iron deficiency or anemia were present in 103 (71%) transfused women and 74 (51%) control women in pregnancy (OR 2.34, 95% CI: 3.7–18.0). Multivariate analysis identified social work involvement (adjusted OR 4.1, 95% CI: 1.8–10.1), intravenous iron supplementation in pregnancy (adjusted OR 3.8, 95% CI: 1.2–17.4) and delivery by unscheduled cesarean section (adjusted OR 2.8, 95% CI: 1.3–6.2) as significant predictors of peripartum transfusion.

Conclusions

Pregnant women being followed by a social worker, receiving intravenous iron supplementation in pregnancy or who deliver by unscheduled cesarean section are more likely to receive a red blood cell transfusion. Women with iron deficiency or anemia in pregnancy are at increased risk of peripartum blood transfusions and warrant early and rigorous iron supplementation.

Determining Mancozeb Deposition Benchmark Values on Apple Leaves for the Management of Venturia inaequalis

Apple scab, caused by Venturia inaequalis, is the most common fruit and foliar disease in commercial apple production worldwide. Early in the production season, preventative contact fungicide sprays are essential for protecting highly susceptible continuously unfolding and expanding young leaves. In South Africa, mancozeb is a key contact fungicide used for controlling apple scab early in the season. The current study developed deposition benchmarks indicative of the biological efficacy of mancozeb against apple scab, using a laboratory-based apple seedling model system. The model system employed a yellow fluorescent pigment that is known to be an effective tracer of mancozeb deposition. A concentration range of mancozeb (0.15 to 1 times the registered dosage) and fluorescent pigment concentrations was sprayed onto seedling leaves, which yielded various fluorescent particle coverage (FPC%) levels. Modeling of the FPC% values versus percent disease control yielded different benchmark values when disease quantification was conducted using two different methods. Thermal infrared imaging (TIRI) disease quantification resulted in a benchmark model where 0.40%, 0.79%, and 1.35 FPC% yielded 50, 75, and 90% apple scab control, respectively. These FPC% values were higher than the benchmarks (0.10, 0.20, and 0.34 FPC%, respectively) obtained with quantitative real-time PCR (qPCR) disease quantification. The qPCR benchmark model is recommended as a guideline for evaluating the efficacy of mancozeb sprays on leaves in apple orchards since the TIRI benchmark model underestimated disease control. The TIRI benchmark model yielded 68% disease control at the lowest mancozeb dosage, yet no visible lesion developed at this dosage. Both benchmark models showed that mancozeb yielded high levels of disease control at very low concentrations; for the qPCR benchmark model the FPC% value of the FPC₉₀ (90% control) corresponded to 0.15 times that of the registered mancozeb concentration in South Africa, i.e., 85% lower than the registered dosage.

The Efficacy of Semiselective Chemicals and Chloropicrin/1,3-Dichloropropene-Containing Fumigants in Managing Apple Replant Disease in South Africa

Apple replant disease (ARD) is a biological phenomenon that is encountered when old apple orchards are replanted, resulting in tree growth and yield reductions in young trees. Three ARD orchard trials were conducted, which showed that semiselective chemicals (fenamiphos, metalaxyl, imidacloprid, and phosphonates) used independently, two fumigant formulations (33.3% chloropicrin and 60.8% 1,3-dichloropropene [Pic33-1,3D] and 57.% chloropicrin and 38% 1,3 dichloropropene [Pic57-1,3D]), and semiselective chemicals combined with Pic33-1,3D or Pic57-1,3D all contributed to significant increases in tree growth (trunk diameter and shoot length) relative to the untreated control 3 to 4 years postplanting. The treatments did not differ significantly from each other in improving tree growth. Yield was more indicative of treatment efficacy, but this varied between the three orchards. The Pic33-1,3D fumigant in combination with semiselective chemistries was the most consistent in significantly increasing cumulative yields. The Pic57-1,3D treatment was superior in increasing yields relative to the Pic33-1,3D treatment, because (i) it significantly increased cumulative yields in comparison with the Pic33-1,3D treatment in one orchard and (ii) in another orchard, a significant increase in yield was obtained with Pic57-1,3D relative to the control treatment but not with the Pic33-1,3D treatment. The quantification of ARD causative agents 20 months postplant showed that Phytophthora cactorum contributed to disease development in all three orchards; significant negative correlations existed between the quantity of P. cactorum DNA detected in tree roots and tree growth and less often, yield. In two orchards, only some of the treatments that significantly reduced the quantity of P. cactorum DNA in tree roots relative to the control also resulted in a significant increase in tree growth. Some of the aforementioned trends were also evident for Pratylenchus spp. root densities in two of the orchards. There was a significant positive correlation between P. cactorum root DNA quantities and Pratylenchus spp. root densities. Pythium spp. and "Cylindrocarpon"-like DNA quantities detected in tree roots typically were not indicative of treatment efficacy. However, a significant positive correlation existed between these two pathogen groups, suggesting complex interactions not associated with pathogen quantities per se.

Limited impact of awareness-raising campaigns on hepatitis C testing practices among general practitioners

The global hepatitis strategy calls for increased effort to diagnose those infected, with a target of 90% diagnosed by 2030. Scotland's Action Plan on Hepatitis C included awareness-raising campaigns, undertaken during 2008-2011, to promote testing by general practitioners. We examined hepatitis C virus (HCV) testing practice among general practitioners before and following these campaigns. Scottish general practitioners were surveyed, using Dillman's method, in 2007 and 2013; response rates were 69% and 60%, respectively. Most respondents offer testing when presented with a risk history (86% in 2007, 88% in 2013) but only one-fifth actively sought out risk factors (19% in 2007, 21% in 2013). Testing was reportedly always/almost always/usually offered to people who inject drugs (84% in 2007, 87% in 2013). Significant improvements in the offer of testing were reported in patients with abnormal LFTs (41% in 2007, 65% in 2013, P<.001) and who had received medical/dental treatment in high prevalence countries (14% in 2007, 24% in 2013, P=.001). In 2013, 25% of respondents had undertaken HCV-related continued professional development. This group was significantly more likely to actively seek out risk factors (P=.009) but only significantly more likely to offer a test to patients who had received medical/dental treatment in high prevalence countries (P=.001). Our findings suggest that government-led awareness raising campaigns have limited impact on general practitioners' testing practices. If the majority of the HCV-infected population are to be diagnosed, practitioner-based or physician-centred interventions should be considered alongside educational initiatives targeted at professionals.

New horizons in comprehensive geriatric assessment

In this article, we discuss the emergence of new models for delivery of comprehensive geriatric assessment (CGA) in the acute hospital setting. CGA is the core technology of Geriatric Medicine and for hospital inpatients it improves key outcomes such as survival, time spent at home and institutionalisation. Traditionally It is delivered by specialised multidisciplinary teams, often in dedicated wards, but in recent years has begun to be taken up and developed quite early in the admission process (at the 'front door'), across traditional ward boundaries and in specialty settings such as surgical and pre-operative care, and oncology. We have scanned recent literature, including observational studies of service evaluations, and service descriptions presented as abstracts of conference presentations to provide an overview of an emerging landscape of innovation and development in CGA services for hospital inpatients.

A Global Perspective on the Population Structure and Reproductive System of Phyllosticta citricarpa

The citrus pathogen Phyllosticta citricarpa was first described 117 years ago in Australia; subsequently, from the summer rainfall citrus-growing regions in China, Africa, and South America; and, recently, the United States. Limited information is available on the pathogen's population structure, mode of reproduction, and introduction pathways, which were investigated by genotyping 383 isolates representing 12 populations from South Africa, the United States, Australia, China, and Brazil. Populations were genotyped using seven published and eight newly developed polymorphic simple-sequence repeat markers. The Chinese and Australian populations had the highest genetic diversities, whereas populations from Brazil, the United States, and South Africa exhibited characteristics of founder populations. The U.S. population was clonal. Based on principal coordinate and minimum spanning network analyses, the Chinese populations were distinct from the other populations. Population differentiation and clustering analyses revealed high connectivity and possibly linked introduction pathways between South Africa, Australia, and Brazil. With the exception of the clonal U.S. populations that only contained one mating type, all the other populations contained both mating types in a ratio that did not deviate significantly from 1:1. Although most populations exhibited sexual reproduction, linkage disequilibrium analyses indicated that asexual reproduction is important in the pathogen's life cycle.

Inter- and intrasubject variability of the inflammatory response to segmental endotoxin challenge in healthy volunteers

Segmental endotoxin challenge with lipopolysaccharide (LPS) can be used as a pharmacodynamic model to safely induce a transient airway inflammation in the peripheral lung of healthy subjects and to test the anti-inflammatory efficacy of investigational new drugs. In contrast to whole lung LPS challenge only a fraction of the dose is required that can be precisely administered to a specific lung region and a vehicle challenged segment as an intra-subject control can be included. The aim of this study was to assess the intra- and inter-individual variability of the response to segmental LPS challenge for the appropriate design and power calculation of future clinical trials. Two cohorts with 10 subjects each underwent two segmental LPS challenges within five weeks. The inflammatory response was evaluated in bronchoalveolar lavage (BAL) fluid at 6 (cohort 1) and 24 h (cohort 2) both in the LPS and in a vehicle challenged segment, as well as in plasma for up to 26 h post LPS challenge. While the cytokine response was more pronounced at 6 h, the influx of neutrophils and monocytes dominated at 24 h; e.g. neutrophils increased from a median (inter-quartile range, IQR) of 0.14 (0.16) and 0.09 (0.08)x10(4) cells/mL BAL fluid at baseline to 10.2 (17.1) and 19.3 (15.9)x10(4) cells/mL 24 h after the two separate challenges. The within-subject variability was higher than the between-subject variability for most of the markers. However, sample size estimations based on the variability of outcome variables found lower or equal numbers with cross-over designs compared to parallel group designs for cellular markers at 24 h and cytokine variables at 6 h. The segmental LPS challenge model was safe. Future study designs have to balance between burden to the study subjects (4 versus 2 bronchoscopies), variability (within-versus between-subject), and the desired outcome variable (cells versus chemo/cytokine).

Anisotropic electronic state via spontaneous phase separation in strained vanadium dioxide films

We resolved the enigma of anisotropic electronic transport in strained vanadium dioxide (VO2) films by inquiring into the role that strain plays in the nanoscale phase separation in the vicinity of the insulator-to-metal transition. The root source of the anisotropy was visualized as the formation of a peculiar unidirectional stripe state which accompanies the phase transition. Furthermore, nanoscale infrared spectroscopy unveils distinct facets of electron-lattice interplay at three different stages of the phase transition. These stages include the initial formation of sparse nonpercolating metallic domains without noticeable involvement of the lattice followed by an electron-lattice coupled anisotropic stripe state close to percolation which ultimately evolves into a nearly isotropic rutile metallic phase. Our results provide a unique mesoscopic perspective for the tunable macroscopic phenomena in strained metal oxide films.

The 2009 Late Blight Pandemic in the Eastern United States - Causes and Results

The tomato late blight pandemic of 2009 made late blight into a household term in much of the eastern United States. Many home gardeners and many organic producers lost most if not all of their tomato crop, and their experiences were reported in the mainstream press. Some CSAs (Community Supported Agriculture) could not provide tomatoes to their members. In response, many questions emerged: How did it happen? What was unusual about this event compared to previous late blight epidemics? What is the current situation in 2012 and what can be done? It's easiest to answer these questions, and to understand the recent epidemics of late blight, if one knows a bit of the history of the disease and the biology of the causal agent, Phytophthora infestans.

Guidelines on obtaining consent for systemic anti-cancer therapy in adults

This guideline, initially drawn up for use in the UK, is essentially based on ethical principles and should be applicable across other jurisdictions. The document specifically addresses the issues which surround obtaining consent from adults for the administration of systemic anti-cancer therapy in the haemato-oncology setting. Consenting to a treatment or procedure is a complex medical, ethical, and legal issue. The process of obtaining consent and the general steps that should be taken by the healthcare professional involved in obtaining consent from a patient are discussed, and the potential legal and ethical pitfalls which can be encountered are outlined. Of fundamental importance are the requirements that agreement must be given voluntarily, based on adequate information, and the patient must have the ability to understand and retain the information given and be in a position to use it in order to reach a decision. The consenting process should include an explanation of the expected outcomes and possible side effects of treatment even if these are unlikely to occur, and the nature of the consenting process undertaken should be clearly documented. Obtaining consent in an emergency situation is also discussed, as is the process of consenting in individuals with impaired capacity or special needs. Withdrawal of consent and refusal of treatment are also considered.

Fissure Scab, a New Symptom Associated with Potato Common Scab Caused by a Streptomyces sp. in South Africa

Common scab caused by Streptomyces spp. is one of the major factors limiting successful potato (Solanum tuberosum) production in South Africa. Most potato cultivars are susceptible to the disease and huge losses are incurred due to a reduction in cosmetic value. Common scab symptoms that have been reported worldwide are variable, with circular, raised, tan-to-brown, corky lesions being the most common symptoms. However, a distinct atypical symptom was observed in isolated production regions (Western Free State and Mpumalanga) in South Africa since early 2010. Deep longitudinal fissures (3 to 12 mm) containing scab-like lesions were observed on the surface area of tubers from several potato cultivars (Mondial, BP1, and Buffelspoort). Lesions on Mondial were interesting since this cultivar, but not the susceptible BP1 and Buffelspoort cultivars, is tolerant to typical common scab in South Africa. Isolations were made from tuber lesions obtained from the two production regions and were plated onto yeast malt extract medium. Several pure culture strains were obtained that were positively identified as Streptomyces spp. based on morphology. Species identity of four strains was investigated using PCR primers targeting the 16S rRNA region of known species (3), which showed that the strains did not belong to any of the known pathogenic reference strains (S. scabiei, S. europascabiei, S. turgidiscabies, S. acidiscabies). Species identity of the strains was further investigated through sequencing of the 16S rRNA region (1.2 kb). The four strains had 100% sequence similarity (GenBank Accession. No. JQ241439) to each other and to 15 GenBank sequences that included several unknown Streptomyces spp., S. vinaceus, S. malachiticus, S. werraensis, S. cyaneus (the only published sequenced), and S. pseudogriseolus. The sequence of the isolates had only 95.5% identity to the most prevalent common scab pathogen, S. scabiei (GI154707840, [3]). The pathogenicity of the four strains, along with an S. scabiei reference isolate, was investigated using BP1 potato tubers and the double pot methodology (1). Fifteen-centimeter pots containing silica sand were each planted with one potato tuber and placed on top of a rectangular planting box (15 × 1.5 × 0.4 m) filled with native Hutton soil. The 15-cm pots were irrigated until the roots grew into the Hutton soil. Subsequently, irrigation was only applied to the Hutton soil, thus creating dry conditions in the tuber development area (15-cm pot), which is conducive for common scab development. The potato plants were inoculated with 10- to 14-day-old Streptomyces strains during the tuber initiation stage at a concentration of 1 × 10⁶ spores/ml of sterile water, 10 ml per plant, and six replicates per strain. Ten weeks after inoculation, each of the four strains caused cracking and scabbing, similar to initial symptoms observed, on more than 90% of the tubers. The S. scabiei reference isolate caused typical circular, raised, brown, corky common scab lesions. Streptomyces was reisolated from the lesions, fulfilling Koch's postulates. To our knowledge, these results indicate that a previously unreported Streptomyces sp. is the causal agent of a new lesion type, fissure scab, on potato in South Africa that may lead to serious losses to the local potato industry. References: (1) L. Marais and R. Vorster. Potato Res. 31:401, 1988. (2) D. J. Theron. Page 1 in: Guide to Potato Production in South Africa, 2003. (3) L. Wanner. Phytopathology 96:1363, 2006.

Resistance in Maize Inbred Lines to Fusarium verticillioides and Fumonisin Accumulation in South Africa

Fusarium ear rot of maize, caused by Fusarium verticillioides, is an important disease affecting maize production worldwide. Apart from reducing yield and grain quality, F. verticillioides produces fumonisins which have been associated with mycotoxicoses of animals and humans. Currently, no maize breeding lines are known with resistance to F. verticillioides in South Africa. The objective of this study, therefore, was to evaluate 24 genetically diverse maize inbred lines as potential sources of resistance to Fusarium ear rot and fumonisin accumulation in field trials at Potchefstroom and Vaalharts in South Africa. After artificial silk channel inoculation with F. verticillioides, Fusarium ear rot development was determined at harvest and fumonisins B₁, B₂, and B₃ quantified. A significant inbred line by location effect was observed for Fusarium ear rot severity (P ≤ 0.001), although certain lines proved to be consistently resistant across both locations. The individual inbred lines also differed considerably in fumonisin accumulation between Potchefstroom and Vaalharts, with differentiation between susceptible and potentially resistant inbred lines only being possible at Vaalharts. A greenhouse inoculation trial was then also performed on a subset of potentially resistant and highly susceptible lines. The inbred lines CML 390, CML 444, CML 182, VO 617Y-2, and RO 549 W consistently showed a low Fusarium ear rot (<5%) incidence at both Potchefstroom and Vaalharts and in the greenhouse. Two of these inbred lines, CML 390 and CML 444, accumulated fumonisin levels <5 mg kg^-1. These lines could potentially act as sources of resistance for use within a maize breeding program.

Unfractionated heparin for second trimester placental insufficiency: a pilot randomized trial

OBJECTIVE

To conduct a pilot randomized controlled trial of unfractionated heparin (UFH) in women considered at high risk of placental insufficiency in the second trimester.

METHODS

Women with either false-positive first trimester (pregnancy-associated placental protein-A [PAPP-A] < 0.35 MoM) or second trimester (alpha-fetoprotein [AFP] > 2.0 MoM, inhibin > 3.0 MoM, human chorionic gonadotropin > 4.0 MoM) serum screening tests or medical/obstetric risk factors were screened for placental insufficiency by sonographic evaluation of the placenta and uterine artery Doppler between 18 and 22 weeks. Thrombophilia screen-negative women with two or three abnormal test categories were randomized by 23+6 weeks to self-administration of subcutaneous unfractionated heparin (UFH) 7500 IU twice daily until birth or 34 weeks, or to standard care. Maternal anxiety and other maternal-infant outcomes were determined.

RESULTS

Thirty-two out of 41 eligible women consented, with 16 women randomized to UFH and 16 to standard care. There was no statistically significant difference identified between the two treatment groups (standard care vs. UFH) for the following: maternal anxiety score (mean [standard deviation]), 14.2 [± 1.6] vs. 14.0 [± 1.8]; birth weight (median [range]), 1795 [470-3295]g vs. 1860 [730-3050]g; perinatal death, 3 vs. 0; severe preeclampsia, 2 vs. 6; placental weight < 10th percentile, 7 vs. 4; or placental infarction, 4 vs. 3.

CONCLUSION

Our study design identified women at high risk of adverse maternal-infant outcomes attributable to placental insufficiency. Women with evidence of placental insufficiency were willing to undergo randomization and self-administration of UFH without increased maternal anxiety.

Uptake of hepatitis C antibody testing in patients with end-stage liver disease in Glasgow, 1993-2007

Individuals infected with hepatitis C virus (HCV) need to be diagnosed well before developing end-stage liver disease to benefit from treatment. We aimed to ascertain what proportion of cases had been tested for HCV to inform on the effectiveness of current guidelines. Record linkage between national databases of HCV tests, hospital discharges and deaths identified 10,645 persons who were hospitalized or had died with mention of end-stage liver disease in Glasgow, Scotland, between 1993 and 2007. We estimated HCV test uptake and prevalence of HCV infection within the study population. The associations between both HCV test uptake and HCV-antibody status and sex, age group and deprivation quintile were estimated using logistic regression. We found that 43% of those hospitalized (n = 9153) and 23% of those who otherwise died (n = 1492) with first-time mention of end-stage liver disease had been tested for HCV during this period. Test uptake in those hospitalized increased from 13 (95% CI: 12-14%) in 1993-1997 to 58% (56-59%) in 2003-2007. The adjusted odds of being tested for HCV were significantly higher for men (OR=1.3, 95% CI: 1.2-1.5), for ages 25-54 (25-34 years: 2.7, 95% CI: 2.1-3.4; 35-44 years: 2.3, 95% CI: 2.0-2.6; 45-54 years: 1.5, 95% CI: 1.4-1.7) compared with 55+ years, and for those residing in the two most deprived quintiles (1.1, 95% CI: 1.0-1.2). Twenty-eight per cent of the HCV testees aged 25-44 years were HCV infected. These results highlight the continuing need for raising awareness among medical professionals for comprehensive HCV testing in patients with liver disease.

Nonperturbative visualization of nanoscale plasmonic field distributions via photon localization microscopy

We demonstrate the nonperturbative use of diffraction-limited optics and photon localization microscopy to visualize the controlled nanoscale shifts of zeptoliter mode volumes within plasmonic nanostructures. Unlike tip- or coating-based methods for mapping near fields, these measurements do not affect the electromagnetic properties of the structure being investigated. We quantify the local field manipulation capabilities of asymmetric bowtie antennas, in agreement with theoretical calculations. The photon-limited localization accuracy of nanoscale mode positions is determined for many of the measured devices to be within a 95% confidence interval of +/-2.5 nm. This accuracy also enables us to characterize the effects of nm-scale fabrication irregularities on local plasmonic mode distributions.

Phytophthora taxa associated with cultivated Agathosma, with emphasis on the P. citricola complex and P. capensis sp. nov

Agathosma species, which are indigenous to South Africa, are also cultivated for commercial use. Recently growers experienced severe plant loss, and symptoms shown by affected plants suggested that a soilborne disease could be the cause of death. A number of Phytophthora taxa were isolated from diseased plants, and this paper reports their identity, mating type, and pathogenicity to young Agathosma plants. Using morphological and sequence data seven Phytophthora taxa were identified: the A1 mating type of P. cinnamomi var. cinnamomi, P. cinnamomi var. parvispora and P. cryptogea, the A2 mating type of P. drechsleri and P. nicotianae, and two homothallic taxa from the P. citricola complex. The identity of isolates in the P. citricola complex was resolved using reference isolates of P. citricola CIT groups 1 to 5 sensu Oudemans et al. (1994) along with multi-locus phylogenies (three nuclear and two mitochondrial regions), isozyme analyses, morphological characteristics and temperature-growth studies. These analyses revealed the isolates from Agathosma to include P. multivora and a putative novel species, P. taxon emzansi. Furthermore, among the P. citricola reference isolates the presence of a new species was revealed, described here as P. capensis. Findings of our study, along with some recent other studies, have contributed to resolving some of the species complexity within the P. citricola complex, resulting in the identification of a number of phylogenetically distinct taxa. The pathogenicity of representative isolates of the taxa from Agathosma was tested on A. betulina seedlings. The putative novel species, P. taxon emzansi, and P. cinnamomi var. parvispora were non-pathogenic, whereas the other species were pathogenic to this host.

Population Structure and Resistance to Mefenoxam of Phytophthora capsici in New York State

In 2006, 2007, and 2008, we sampled 257 isolates of Phytophthora capsici from vegetables at 22 sites in four regions of New York, to determine variation in mefenoxam resistance and population genetic structure. Isolates were assayed for mefenoxam resistance and genotyped for mating type and five microsatellite loci. We found mefenoxam-resistant isolates at a high frequency in the Capital District and Long Island, but none were found in western New York or central New York. Both A1 and A2 mating types were found at 12 of the 22 sites, and we detected 126 distinct multilocus genotypes, only nine of which were found at more than one site. Significant differentiation (F_ST) was found in more than 98% of the pairwise comparisons between sites; approximately 24 and 16% of the variation in the population was attributed to differences among regions and sites, respectively. These results indicate that P. capsici in New York is highly diverse, but gene flow among regions and fields is restricted. Therefore, each field needs to be considered an independent population, and efforts to prevent movement of inoculum among fields need to be further emphasized to prevent the spread of this pathogen.

Measuring and comparing constraints to improved biosecurity amongst GB farmers, veterinarians and the auxiliary industries

Constraints to the introduction of enhanced biosecurity systems are rarely considered in sufficient detail when population medicine specialists initiate new control schemes. The main objective of our research was to investigate and compare the different attitudes constraining improvement in biosecurity for cattle and sheep farmers, practising veterinary surgeons and the auxiliary industries in Great Britain (GB). This study was carried out utilizing farmer focus groups, a questionnaire survey of veterinary practitioners and a telephone survey of auxiliary industry representatives. It appears that farmers and veterinarians have their own relatively clear definitions for biosecurity in relation to some major diseases threatening GB agriculture. Overall, farmers believe that other stakeholders, such as the government, should make a greater contribution towards biosecurity within GB. Conversely, veterinary practitioners saw their clients' ability or willingness to invest in biosecurity measures as a major constraint. Veterinary practitioners also felt that there was need for additional proof of efficacy and/or the potential economic benefits of proposed farm biosecurity practices better demonstrated. Auxiliary industries, in general, were not certain of their role in biosecurity although study participants highlighted zoonoses as part of the issue and offered that most of the constraints operated at farm level.

A pilot study designed to acquaint medical educators with basic pedagogic principles

BACKGROUND

Faculty development activities in medical schools regularly target teaching behaviours but rarely address basic pedagogic principles underlying those behaviours. Although many teachers have an intuitive or tacit knowledge of basic pedagogic principles, overt knowledge of fundamental educational principles is rare.

AIMS

We conducted a short-term pilot study designed to transform teachers' tacit knowledge into explicit knowledge of pedagogic principles. We hypothesized that conscious awareness of these principles will positively influence their teaching effectiveness.

METHODS

The intervention included a workshop, provision of a workbook on pedagogic principles and free access to educational consultants. For the intervention, we chose a purposive sample of experienced teachers at our medical school.

RESULTS AND CONCLUSIONS

Evaluation of the impact of the intervention using questionnaires and semi-structured interviews revealed three notable findings; 1. Participants were surprised to discover the existence of an extensive body of pedagogic science underlying teaching and learning. 2. They were enthusiastic about the intervention and expressed interest in learning more about basic pedagogic principles. 3. The knowledge acquired had an immediate impact on their teaching.

Comparison of deaths related to Hepatitis C and AIDS in Scotland

In resource-rich countries, the incidence of and mortality from AIDS has fallen dramatically since the introduction of combination antiretroviral therapy. In contrast, developed countries have observed increases in the public health burden associated with the hepatitis C virus (HCV). We compared past and current trends in mortality related to HCV sequelae and HIV/AIDS in Scotland by linking death records with national databases of persons diagnosed with HCV and HIV/AIDS. AIDS-related deaths increased rapidly during the late-1980s to mid-1990s and declined dramatically after 1996. Deaths related to HCV (i.e., viral hepatitis, liver cancer, alcoholic liver disease, or non-alcoholic liver disease) surpassed the number of AIDS-related deaths in 1998 and increased at an average annual rate of 10.5% (95% confidence interval = 7-14%) during 1996-2005. The leading underlying cause of HCV-related deaths was alcoholic liver disease (50% of deaths during 2001-2005). This study highlights the increasing public health burden, vis-à-vis mortality, of HCV, when compared with HIV/AIDS in developed countries. Increased diagnosis and treatment of eligible HCV-infected individuals will be required if we wish to mitigate the future impact of HCV morbidity and mortality.

Iris yellow spot virus in Onion Seed Crops in South Africa

In December 2006, symptoms typical of iris yellow spot caused by Iris yellow spot virus (IYSV; genus Tospovirus, family Bunyaviridae) were observed on scapes (seed stalks) in an onion (Allium cepa L.) seed crop in the Klein Karoo of the Western Cape Province, South Africa. Symptoms included diamond-shaped chlorotic or necrotic lesions on the scapes, some of which had 'green-islands' with nested diamond-shaped lesions, as well as indistinct, circular to irregular, chlorotic or necrotic lesions of various sizes. At the time symptoms were observed, approximately 5% of the scapes had lodged as a result of extensive lesions resembling those caused by IYSV. The crop was 2 to 3 weeks from harvest. Symptomatic tissue from two plants (two samples from one plant and four samples from the other plant) was tested for IYSV by reverse-transcriptase (RT)-PCR. Total RNA was extracted from symptomatic scape tissue with the SV Total RNA Isolation System (Promega, Madison, WI) according to the manufacturer's instructions. First strand cDNA was synthesized with the RevertAid H Minus First Strand cDNA Synthesis kit (Fermentas Inc., Hanover, MD), followed by PCR amplification with primers IYSV-For (TGG YGG AGA TGY RGA TGT GGT) and IYSV-Rev (ATT YTT GGG TTT AGA AGA CTC ACC), which amplify the nucleocapsid (NP) gene of IYSV. An amplicon of expected size (approximately 750 bp) was observed for each of the symptomatic plants assayed and was sequenced. Comparison of the sequence (GenBank Accession No. EF579801) with GenBank sequences revealed 95% sequence identity with the NP gene of IYSV GenBank Accession No. EF419888, with eight amino acid differences. The known geographic distribution of IYSV in onion bulb or seed crops has increased rapidly in recent years in many areas of the world (1). To our knowledge, this is the first confirmation of IYSV in South Africa. Approximately 6,100 ha of onion bulb crops are grown annually in South Africa in the Western Cape, Kwazulu Natal, Limpopo, and Northern Cape provinces, and 600 ha of onion seed crops are grown primarily in the semi-arid regions of the Western Cape. Examination of an additional 10 onion seed crops in the Klein Karoo during January 2007 revealed the presence of iris yellow spot in three more crops at approximately 5% incidence in each crop. The four symptomatic crops had all been planted as bulb-to-seed crops, using vernalized bulbs produced on the same farm. This suggests that IYSV may have been disseminated into the seed crops on the vernalized bulbs, either as infected bulb tissue or in viruliferous thrips on the bulbs. Reference: (1) D. H. Gent et al. Plant Dis. 90:1468, 2006.

Economics of animal vaccination

This paper describes the steps that might be used in assessing the economic justification for using vaccination to control animal disease, and the way that vaccination is financed and administered. It describes decisions that have been taken with respect to preserving international trade, and issues related to protection of livelihoods. Regardless of the motivation for vaccination, its costs can usually be shared between the public and private sectors. Cost-effective vaccination requires methods of delivery to be adapted to livestock production systems. The paper concludes by suggesting questions around the use of vaccination that would merit further economic analysis.

First Report of Phytophthora cryptogea on Osteospermum spp. in South Africa

Osteospermum is the largest genus of the tribe Calendulea of the Compositae (Asteraceae) and has a center of diversity in South Africa with approximately 40 known species in the Cape Province (3). This indigenous plant genus is also a popular floricultural crop grown in South Africa because of drought and high temperature tolerance. Two diseased Osteospermum sp. samples were submitted by commercial nurseries to the Stellenbosch University Plant Disease Clinic. Both samples showed similar symptoms including black lesions on the lower stem, petioles, and the base of lower leaves. Isolations were made from roots, stems, and petioles following surface disinfestation of the lesions and plating on potato dextrose agar (PDA), water agar, PARP, and PARPH (1). The only microorganism that was consistently isolated from all lesions was a species of Phytophthora, from which single hyphal tip cultures were prepared. The cultures were identified morphologically as Phytophthora cryptogea Pethybridge & Lafferty. Morphological characteristics and cardinal growth temperatures followed Lévesque and de Cock (2). Distinctive morphological characteristics included abundant hyphal swellings in sterile soil extract and hemp seed water cultures, nonpapil-lated, persistent, internally proliferating, obpyriform sporangia having mean dimensions of 36 × 26 μm and mean length/breadth ratios that ranged from 1.30 to 1.53 (1). Cultures had a petaloid pattern on PDA and no growth at 35°C that distinguished it from Phytophthora drechsleri (1). Analyses and comparison of the internal transcribed spacer (ITS) regions of isolate STE-U 6133 (GenBank Accession No. GI DQ479410) supported the P. cryptogea identification. STE-U 6133 has been deposited in the Stellenbosch University culture collection. Pathogenicity of isolate STE-U 6133 was tested on six plants of Osteospermum jucundum (Phill.) T. Norl. and O. ecklonis (DC.) Norl. in individual containers. Inoculum was grown on V8 agar for 7 days, and 10-mm culture disks were incubated in a filter (0.2 μm) sterilized 1% soil extract solution (1). The disks were vortexed vigorously and filtered through miracloth (Calbiochem Corp., La Jolla, CA) to remove agar disks and excess mycelium. The inoculum concentration was adjusted to 10⁴ sporangia/ml and incubated at 4°C for 4 h. Six plants were inoculated with a 10-ml suspension of sporangia and zoospores by pipetting the suspension at the collar of each plant. Another six plants were treated with water as controls. The inoculated plants were kept at temperatures ranging from 22 to 25°C and were watered until saturation every second day. Initial symptoms were black lesions on the lower stem and petiole bases developing 14 to 18 days after inoculation, followed by wilting of some plants. Control plants remained healthy. Isolations from symptomatic plants yielded only P. cryptogea of which pure cultures were established, completing Koch's postulate. The experiment was repeated with similar results. To our knowledge, this is the first report of P. cryptogea as a pathogen of O. jucundum and O. ecklonis in South Africa. P. cryptogea has been reported as a pathogen on Osteospermum spp. in other countries (4). References: (1) D. C. Erwin et al. Phytophthora Diseases Worldwide. The American Phytopathological Society. St. Paul, MN, 1996. (2) C. A. Lévesque and A. W. A. M. de Cock. Stud. Mycol. 50:481, 2004. (3) B. Nordenstam. Edinb. J. Bot. 60:259, 2003. (4) D. J. Stamps. Phytophthora cryptogea. IMI Description of Fungi and Bacteria. No. 60:Sheet 592. CAB International, Wallingford, UK, 1978.

Studies of the Kinetics and Thermochemistry of the Forward and Reverse Reaction Cl + C6H6 = HCl + C6H5

The laser flash photolysis resonance fluorescence technique was used to monitor atomic Cl kinetics. Loss of Cl following photolysis of CCl4 and NaCl was used to determine k(Cl + C6H6) = 6.4 x 10(-12) exp(-18.1 kJ mol(-1)/RT) cm(3) molecule(-1) s(-1) over 578-922 K and k(Cl + C6D6) = 6.2 x 10(-12) exp(-22.8 kJ mol(-1)/RT) cm(3) molecule(-1) s(-1) over 635-922 K. Inclusion of literature data at room temperature leads to a recommendation of k(Cl + C6H6) = 6.1 x 10(-11) exp(-31.6 kJ mol(-1)/RT) cm(3) molecule(-1) s(-1) for 296-922 K. Monitoring growth of Cl during the reaction of phenyl with HCl led to k(C6H5 + HCl) = 1.14 x 10(-12) exp(+5.2 kJ mol(-1)/RT) cm(3) molecule(-1) s(-1) over 294-748 K, k(C6H5 + DCl) = 7.7 x 10(-13) exp(+4.9 kJ mol(-1)/RT) cm(3) molecule(-1) s(-1) over 292-546 K, an approximate k(C6H5 + C6H5I) = 2 x 10(-11) cm(3) molecule(-1) s(-1) over 300-750 K, and an upper limit k(Cl + C6H5I) < or = 5.3 x 10(-12) exp(+2.8 kJ mol(-1)/RT) cm(3) molecule(-1) s(-1) over 300-750 K. Confidence limits are discussed in the text. Third-law analysis of the equilibrium constant yields the bond dissociation enthalpy D(298)(C6H5-H) = 472.1 +/- 2.5 kJ mol(-1) and thus the enthalpy of formation Delta(f)H(298)(C6H5) = 337.0 +/- 2.5 kJ mol(-1).

Economic issues in vaccination against highly pathogenic avian influenza in developing countries

We consider the use of vaccination against highly pathogenic avian influenza (HPAI) in three contexts: as part of a stamping-out programme, as a government-led action for disease prevention and as private insurance by farmers. Poultry systems in developing countries cover all four of the poultry sectors defined by FAO and the OIE, each with particular economic aspects that might motivate farmers to take part in vaccination programmes or to initiate and finance them. Outbreaks in flocks of different types have different potential impacts in terms of disease spread and economic effects, which influence the potential benefits of vaccination as a means to prevent or control outbreaks. We use data from three countries to illustrate the costs of vaccination and discuss measures of cost-effectiveness and ways to improve it. We also consider the question of funding sources and their impact on the sustainability of vaccination programmes.

Disease intelligence for highly pathogenic avian influenza

A comprehensive approach to highly pathogenic avian influenza (HPAI) is crucial for identifying all the factors that contribute to its emergence, spread and persistence. Epidemiological understanding makes it possible to predict the evolution of the virus and to prevent and control the socioeconomic, environmental, institutional and policy consequences. At FAO, risk assessment and intelligence with regard to HPAI are based on lessons learnt from assisting countries to design strategies and on implementation of technical assistance programmes, which reveal important elements, such as the roles of ducks, live-bird markets and trade. Wild birds were found to contribute, by transporting the H5N1 virus over long distances. The contributions of different poultry farming systems and market chains in the epidemiology of HPAI are well recognized; however, the respective roles of smallholder systems and commercial farms are unclear. FAO considers that smallholders will continue to be an important factor and should be taken into account in control and prevention programmes. Changes in poultry farming are essentially driven by the private sector and market forces and could have negative consequences on the livelihoods of smallholders and on ecologically balanced production systems and agricultural biodiversity. Biosecurity can, however, be improved at the level of farms and markets. Institutional factors, such as the capacity of animal health systems to deliver control programmes, are also important, requiring strengthening and innovation in risk analysis and management.

First Report of Phytophthora infestans on Petunia × hybrida in South Africa

Phytophthora infestans is known worldwide as the destructive, late blight pathogen of potatoes and tomatoes. However, erratic reports dating back to 1856 also have shown it to be pathogenic on petunia (Petunia × hybrida), although it has not been regarded as an important pathogen on this host (4). Recently, reports from North America showed that P. infestans is of commercial importance in greenhouse-grown petunias (2), and that late blight-infected petunias may serve as inoculum to tomatoes growing in the same greenhouse (1,2). In the Western Cape Province of South Africa, two petunia samples were received at the Stellenbosch University Plant Disease Clinic in 2005 that showed symptoms resembling P. infestans infections. The two samples were from nurseries where petunias were either grown under shading nets or in a greenhouse. In the greenhouse-grown petunias, the presumptive late blight infections resulted in substantial losses to the grower. Symptoms included gray, slightly sunken leaf lesions with white sporulation mainly on the adaxial side of the leaves. Leaflets of the petunias were incubated in moist chambers, and sporangia sporulating from lesions were identified morphologically as being P. infestans (3). Subsequently, one isolate was cultured onto synthetic media by carefully transferring sporangia from a lesion with the tip of a bended glass rod onto wheat medium (120 g/L of crushed wheat seeds, blended, boiled and filtered through cheesecloth, plus 15 g of sucrose and agar). The identity of the culture was further confirmed through sequence analyses of the internal transcribed spacer regions (GenBank Accession No. DQ479409). The isolated P. infestans strain (STE-U 6134) has been submitted to the Stellenbosch University culture collection. Inoculum for the pathogenicity tests was produced by first flooding 14-day-old cultures with sterile distilled water to obtain a 2 × 10⁴/ml sporangial suspension, followed by zoospore induction at 4°C. A mixture of petunia cultivars (n = 24) were spray inoculated to runoff with the zoospore induced sporangial suspension. Control plants were sprayed with sterile distilled water. Inoculated plants were incubated at 22 to 25°C and high relative humidity (≥93%) within perspex humidity chambers (60 × 30 × 60 cm) lined with a wet sheet of chromatography paper. The experiment was repeated twice. The first late blight symptoms similar to those of the submitted samples appeared 5 to 7 days after inoculation, with some lesions containing profuse white mycelia and sporangiophores typical for P. infestans. The pathogen was reisolated from the leaf lesions, completing Koch's postulate. To our knowledge, this is the first report of P. infestans causing damage on petunias in South Africa. Future studies should be aimed at investigating whether late blight-infected petunias provide an important source of inoculum for potatoes and tomatoes, which are widely grown in the Western Cape Province of South Africa. References: (1) M. C. Becktell et al. Plant Dis. 89:1000, 2005. (2) K. L. Deahl and D. K. Farel. Plant Dis. 87:1004, 2003. (3) D. C. Erwin and O. K. Ribeiro, Phytophthora Diseases Worldwide. The American Phytopathological Society St. Paul, MN, 1996. (4) J. M. Hirst and W. C. Moore. Phytophthora infestans on petunia and datura. Page 76 in: Plant Pathology-A Record of Current Work on Plant Diseases and Pests. Vol. 6. Ministry of Agriculture, Fisheries and Food Plant Pathology Laboratory, Harpenden, England, 1957.

Characterization of Rhizoctonia spp. Recovered from Crop Plants Used in Rotational Cropping Systems in the Western Cape Province of South Africa

Isolates of Rhizoctonia spp. associated with barley, canola, clover, lucerne, lupin, annual Medicago spp. (medic), and wheat were recovered during the conduct of a 4-year (2000 to 2003) crop rotation trial in the Western Cape province of South Africa. These isolates were characterized by determining their anastomosis group (AG), in vitro optimum growth temperature, and pathogenicity toward emerging and 14-day-old seedlings of all the aforementioned crops. During the 4-year rotational trial, 428 Rhizoctonia isolates, in all, were obtained. The most abundant multinucleate AG was AG-4 HG-II (69%), followed by AG-2-1 (19%), AG-3 (8%), AG-2-2 (2%), and AG-11 (2%). The population of binucleate Rhizoctonia spp. comprised AG-K (53%), AG-A (10%), AG-I (5%), and unidentified AGs (32%). The optimal time for isolating Rhizoctonia spp. was found to be at the flowering or seedpod stage (20 to 22 weeks after planting). Temperature studies showed that isolates belonging to AG-2-2, AG-4 HG-II, and AG-K had significantly higher optimum growth temperatures than those from other AGs. In pathogenicity assays conducted on emerging as well as 14-day-old seedlings, isolates of AG-2-2 and AG-4 HG-II were the most virulent on all crops. Rhizoctonia solani AG-2-1 was highly virulent on canola, moderately virulent on medic and lupin, weakly virulent on lucerne and barley, and nonpathogenic on wheat. AG-11 isolates were moderate to weakly virulent on all crops, with the exception of barley and wheat. AG-3 was weakly virulent on canola, lupin, and medic. AG-K was the only binucleate Rhizoctonia sp. capable of inciting disease in our assays. This is the first comprehensive study to elucidate the identity and potential importance of Rhizoctonia spp. as a yield limiting factor in crop production systems in the Western Cape province of South Africa.

First Report of a Peronospora Species on Sweet Basil in South Africa

Sweet basil (Ocimum basilicum) is an herbaceous aromatic annual plant of the family Lamiaceae grown for its flavoring and fragrances that can be used fresh or dried. In South Africa, sweet basil is grown on a commercial scale. Downy mildew has recently been reported as one of the most destructive diseases of sweet basil in Switzerland, France, and Italy (1-3). The identity of the downy mildew species infecting sweet basil has been controversial and has been indicated as Peronospora lamii, a presumably undescribed (unnamed) Peronospora species, as well as a few species of which the status as distinct species is mostly unclear or doubtful (1). The distinction between P. lamii and the unnamed Peronospora species has been based on their sporangial dimensions, with P. lamii having sporangial dimensions with a length and width range of 16 to 26 × 15 to 23 μm (average 21 × 18 μm) and the unnamed Peronospora species having sporangial dimensions of 20 to 35 × 15 to 25 μm (average 28 × 22 μm) (1) or 23 to 36 × 18 to 29 μm (average 29 × 23 μm) (2). Additionally, internal transcribed spacer (ITS) sequence data has also been used to show that P. lamii and the unnamed Peronospora species on basil are not similar (1). In the Western Cape Province of South Africa, a sweet basil sample was received at the Stellenbosch University Plant Disease Clinic in 2005 from a grower in the region who experienced almost 50% crop failure under greenhouse-grown conditions. Initial symptoms were chlorotic leaves that subsequently developed a brown sporulation on the abaxial side. Microscopic observations of the brown sporulation were consistent with a Peronospora species. The sporangiophores branched two to five times with lengths ranging from 130 to 290 μm (average 194 μm). Sporangiophores terminated with dichotomously branched denticels bearing single detachable sporangia. Sporangia measured 26 to 34 × 20 to 28 μm (average 30 × 24 μm) and were elliptical and brown. The sporangia were similar in shape, color, and size range as that previously reported for a unnamed Peronospora species on sweet basil (1,2). Sequence analyses were also conducted on two isolates by first extracting DNA from spores that were washed from leaves using the Wizard SV genomic DNA purification system (Promega, Madison, WI), followed by polymerase chain reaction (PCR) amplification and sequencing of the ITS1, 5.8S, and ITS2 regions using primers ITS6 and ITS4 (4). The sequences of the two isolates were identical (GenBank Accession No. DQ479408). BLAST analyses of the sequences revealed a 99% similarity to the unnamed Peronospora species that was isolated from sweet basil in Switzerland and Italy (1). The sequences of the South African isolates only had low homology to P. lamii. To our knowledge, this is the first report of a Peronospora species on sweet basil in South Africa that on the basis of morphology and ITS sequence data is similar to the unnamed Peronospora species recently described in Switzerland and Italy on sweet basil (1). References: (1) L. Belbahri et al. Mycol. Res. 109:1276, 2005. (2) A. Garibaldi et al. Plant Dis. 88:312, 2004. (3) A. Garibaldi et al. Plant Dis. 89:683, 2005. (4) T. J. White et al. PCR Protocols: A Guide to Methods and Applications. M. A. Innis et al., eds., Academic Press, San Diego, 1990.

Potential Inoculum Sources of Phaeomoniella chlamydospora in South African Grapevine Nurseries

Petri disease of grapevine is primarily caused by Phaeomoniella chlamydospora. This pathogen affects mostly young grapevines, but is also implicated in esca disease of older grapevines. Little is known about the disease cycle of this fungus. Infected propagation material was identified as a major means of dissemination of the pathogen. Recently, the pathogen was also detected from soil in South Africa and airborne conidia have been found in vineyards. The aim of this study was to use a molecular detection technique to test different samples collected from nurseries in South Africa at different nursery stages for the presence of P. chlamydospora. A one-tube nested-PCR technique was optimised for detecting P. chlamydospora in DNA extracted from soil, water, callusing medium and grapevine wood. The one-tube nested-PCR was sensitive enough to detect as little as 1 fg of P. chlamydospora genomic DNA from water and 10 fg from wood, callusing medium and soil. PCR analyses of the different nursery samples revealed the presence of several putative 360 bp P. chlamydospora specific bands. Subsequent sequence analyses and/or restriction enzyme digestions of all 360 bp PCR bands confirmed that all bands were P. chlamydospora specific, except for five bands obtained from callusing media and one from water. Phaeomoniella chlamydospora was positively detected in 25% of rootstock cane sections collected from mother blocks, 42% of rootstock cuttings and 16% of scion cuttings collected during grafting, 40% of water samples collected after pre-storage hydration, 67% of water samples collected during grafting, 8% of callusing medium samples and 17% of soil samples collected from mother blocks. These media can therefore be considered as possible inoculum sources of the pathogen during the nursery stages.

Social, economic and policy issues in the long-term control of HPAI

Prevention and control of HPAI in Asia is a long term problem with important economic and policy consequences. The macro level impact of a single national outbreak is greatest for an exporting country, ranging in 2003-5 from dollars 65 million to over dollars 400 million. No estimates are available for the impact of market disruption if endemic disease changes the pattern of regional and international trade. In countries with minimal exports, the total financial impact may be much smaller, but there can be serious losses to vulnerable sectors of society at several stages of the market chain. The economies of the region are growing and some countries could finance recurrent costs of AI control, but substantial investment in veterinary services is required. National and regional financing structures need to be reviewed. AI control strategies should include a broad financial support system that addresses education, credit, compensation and social relief programmes. Some strategies may result in restructuring of the industry, or affect the wider development of rural areas and local food security.

Strategies, Effectiveness and Rationale of Vector-borne Disease Control in the Pastoralist System of South-western Uganda

In Uganda, control of vector-borne diseases is mainly in form of vector control, and chemotherapy. There have been reports that acaricides are being misused in the pastoralist systems in Uganda. This is because of the belief by scientists that intensive application of acaricide is uneconomical and unsustainable particularly in the indigenous cattle. The objective of this study was to investigate the strategies, rationale and effectiveness of vector-borne disease control by pastoralists. To systematically carry out these investigations, a combination of qualitative and quantitative research methods was used, in both the collection and the analysis of data. Cattle keepers were found to control tick-borne diseases (TBDs) mainly through spraying, in contrast with the control of trypanosomosis for which the main method of control was by chemotherapy. The majority of herders applied acaricides weekly and used an acaricide of lower strength than recommended by the manufacturers. They used very little acaricide wash, and spraying was preferred to dipping. Furthermore, pastoralists either treated sick animals themselves or did nothing at all, rather than using veterinary personnel. Oxytetracycline (OTC) was the drug commonly used in the treatment of TBDs. Nevertheless, although pastoralists may not have been following recommended practices in their control of ticks and tick-borne diseases, they were neither wasteful nor uneconomical and their methods appeared to be effective. Trypanosomosis was not a problem either in Sembabule or Mbarara district. Those who used trypanocides were found to use more drugs than were necessary.

The incidence of calf morbidity and mortality due to vector-borne infections in smallholder dairy farms in Kwale District, Kenya

An observational longitudinal study was carried out on 92 randomly selected smallholder farms in two coastal lowland zones of Kwale District in Kenya between December 1997 and November 1999. The objective was to estimate the incidence of the main vector-transmitted diseases in pre-weaned calves. From an initial 41 pure or cross-bred Bos taurus calves which were less than 2 months and whose birth and disease histories were known, study calves were recruited progressively and monitored until they were weaned at around 146 days. Overall, 130 calves in 67 farms were monitored and these contributed a total risk period of 30,062 days. Disease parameters were analysed and compared as true annual and age-specific incidence rates. The incidences of East Coast fever (ECF) (23.1%) and trypanosomosis (29.1%) were the highest among the vector-borne diseases. The corresponding mortality incidence rates of ECF and trypanosomosis were 10.9 and 3.6%, respectively. The annual incidence rates of anaplasmosis and babesiosis were 10.9 and 1.2%, respectively. There was no mortality arising specifically from anaplasmosis or babesiosis. Analysis of survival times to natural infection indicated that the field challenge resulting to cases of trypanosomosis was much higher compared to the risk of either ECF or anaplasmosis. It was concluded that these vector-borne diseases constrain production of replacement stock in this coastal lowlands region of Kenya.

Employment retention after moderate-severe traumatic brain injury (TBI) in the British Army 1989-98

AIMS

To examine retention in employment of subjects with moderate-severe traumatic brain injury (TBI) in the British Army.

METHODS

Comparative groups study of retention in Army employment after TBI using 564 TBI, 368 lower limb fracture, and 25 575 healthy subjects. Kaplan-Meier survival analysis was used to examine, stratifying for age, continuation in Army employment for six years after TBI.

RESULTS

Subjects in the younger groups (mean ages 23 years and 27 years respectively) with either TBI or lower limb fracture remained in employment longer than healthy peers (median time for TBI, 3.91 years, lower limb fracture, 4.39 years, and healthy, 1.74 years). This trend changed through age stratification and for older subjects the reverse pattern was seen. In group 4 (mean age 41 years), median retention time for TBI was 3.33 years, for lower limb fracture, 3.75 years, healthy 5.55 years. Older subjects also showed a marked drop out rate at one year after injury; 32.7% of those with TBI in group 3 (mean age 31 years) had left Army employment at the end of year one compared with 19% in age group 1 (mean age 23 years).

CONCLUSIONS

Younger soldiers with either TBI or lower limb fracture are retained in Army employment longer than their healthy peers. This may be due to sheltered employment, the availability of ongoing support, or transience of the healthy population. Since these results were drawn from incidence data on moderate and severe TBI it may be that those who serve on after TBI will do so with some degree of disability which affects occupational performance. There may be a significant unmet rehabilitation need for this group which is the focus of ongoing research.

Estimation of Milk Production from Smallholder Dairy Cattle in the Coastal Lowlands of Kenya

A study was carried out on 92 smallholder farms in Kwale district in Coast Province of Kenya to estimate the milk yield. The effect of concentrate feed supplementation on milk yield was also evaluated. Data were collected during a one-year observational longitudinal study. Analysis was done for 371 observations following 63 calving events. The mean annual milk offtake was estimated at 2021 kg/cow. Forty-nine (77.8%) of the lactating cows were supplemented with concentrate feeds at varying rates of 0.5-3.0 kg/cow per day. Supplementary feeding of lactating cows led to a significantly higher mean daily milk yield compared to non-supplemented cows throughout the year (p < 0.05). The mean annual milk offtake from supplemented cows (2195 kg/cow) was 18.6% more than offtake from non-supplemented cows, a difference that was statistically significant (p < 0.05). Therefore, supplementary feeding of commercial feed concentrates was a rational management practice. It was also concluded that milk production from smallholder dairy cows in the coastal lowlands of Kenya was comparable to that from similar production systems but lower than national targets.

Use of rapid rural appraisal and cross-sectional studies in the assessment of constraints in smallholder cattle production systems in the western Kenya highlands

Assessment of livestock production constraints in the smallholder dairy systems in the western Kenya highlands was carried out using both qualitative and quantitative epidemiological methods. Rapid rural appraisals (qualitative) were conducted in rural and peri-urban areas. A cross-sectional survey (quantitative) was then conducted on a random sample of farms in the study area. Diseases, poor communication, lack of marketing of livestock produce, lack of artificial insemination services, and feed and water shortages during the dry season were identified as the major constraints to cattle production in both areas. Tick borne diseases (especially East Coast fever) were identified as the major constraint to cattle production. Qualitative methods were found to be more flexible and cheaper than the quantitative methods by a ratio of between 2.19-2.0. The two methods were found to complement each other. Qualitative studies could be applied in preliminary studies before initiating more specific follow up quantitative studies.

Evaluation of mattresses using interface pressure mapping

OBJECTIVE

To compare the ranking of mattresses using several different performance indices, calculated from interface pressure-mapping data.

METHOD

Five mattresses were compared using interface pressure-mapping on 10 healthy volunteers. Mattresses were ranked in order, on the basis of several different specified performance indices.

RESULTS

Different performance indices ranked the mattresses in different orders.

CONCLUSION

Elaborate performance indices should be used with care, since it is possible to construct a 'tailor-made' performance index to make any chosen mattress rank as the best. Care should be taken to ensure that a performance index is validated, preferably by some demonstrated link to clinical outcomes.

Induction of hypoxia-inducible factor-1alpha and activation of caspase-3 in hypoxia-reoxygenated bone marrow stroma is negatively regulated by the delayed production of substance P

The bone marrow (BM), which is the major site of immune cell development in the adult, responds to different stimuli such as inflammation and hemorrhagic shock. Substance P (SP) is the major peptide encoded by the immune/hemopoietic modulator gene, preprotachykinin-1 (PPT-I). Differential gene expression using a microarray showed that SP reduced hypoxia-inducible factor-1alpha (HIF-1alpha) mRNA levels in BM stroma. Because long-term hypoxia induced the expression of PPT-I in BM mononuclear cells, we used timeline studies to determine whether PPT-I is central to the biologic responses of BM stroma subjected to 30-min hypoxia (pO(2) = 35 mm Hg) followed by reoxygenation. HIF-1alpha mRNA and protein levels were increased up to 12 h. At this time, beta-PPT-I mRNA was detected with the release of SP at 16 h. SP release correlated with down-regulation of HIF-1alpha to baseline. A direct role for SP in HIF-1alpha expression was demonstrated as follows: 1) transient knockout of beta-PPT-I showed an increase in HIF-1alpha expression up to 48 h of reoxygenation; and 2) HIF-1alpha expression remained baseline during reoxygenation when stroma was subjected to hypoxia in the presence of SP. Reoxygenation activated the PPT-I promoter with concomitant nuclear translocation of HIF-1alpha that can bind to the respective consensus sequences within the PPT-I promoter. SP reversed active caspase-3, an indicator of apoptosis and erythropoiesis, to homeostasis level after reoxygenation of hypoxic stroma. The results show that during reoxgenation the PPT-I gene acts as a negative regulator on the expression of HIF-1alpha and active caspase-3 in BM stroma subjected to reoxygenation.

Changing patterns of teenage pregnancy: population based study of small areas

OBJECTIVES

To measure the impact of socioeconomic deprivation on rates of teenage pregnancy and the extent of local variation in pregnancy rates in Scotland, and to examine how both have changed over time.

DESIGN

Population study using routine data from hospital records, aggregated for small areas.

SUBJECTS

Female teenagers resident in Scotland who were treated for pregnancy in an NHS hospital in either 1981-5 (62 338 teenagers) or 1991-5 (48 514) and who were aged 13-19 at the time of conception.

MAIN OUTCOME MEASURES

Pregnancy rates per 1000 in age group and the proportions of pregnancies resulting in a maternity (live birth or stillbirth) in teenagers aged 13-15, 16-17, and 18-19.

RESULTS

From the 1980s to the 1990s pregnancy rates increased differentially according to levels of local deprivation, as measured by the Carstairs index. Among teenagers aged less than 18 the annual pregnancy rate increased in the most deprived areas (from 7.0 to 12.5 pregnancies per 1000 13-15 year olds and from 67.6 to 84.6 per 1000 16-17 year olds), but there was no change, on average, among teenagers in the most affluent areas (3.8 per 1000 13-15 year olds and 28.9 per 1000 16-17 year olds). Among 18-19 year olds the pregnancy rate decreased in the most affluent areas (from 60.0 to 46.3 per 1000) and increased in the most deprived areas (from 112.4 to 116.0 per 1000). The amount of local variation explained by deprivation more than doubled from the 1980s to the 1990s. The proportion of pregnancies resulting in a maternity was positively associated with level of deprivation, but the effect remained similar over time.

CONCLUSION

From the 1980s to the 1990s the difference in rates of teenage pregnancy between more affluent and more deprived areas widened. This has implications for allocating resources to achieve government targets and points to important social processes behind the general increase in the number of teenage pregnancies in Scotland.