Disease and Yield Response of a Stem-rot-resistant and -Susceptible Peanut Cultivar under Varying Fungicide Inputs.

Peanut (Arachis hypogaea L.) producers rely on costly fungicide programs to manage stem rot, caused by Sclerotium rolfsii. Planting disease-resistant cultivars could increase profits by allowing for the deployment of less-expensive, lower-input fungicide programs. Field experiments were conducted to characterize stem rot and early and late leaf spot (caused by Passalora arachidicola and Nothopassalora personata, respectively), yield, and overall profitability of cultivars Georgia-06G (stem-rot-susceptible) and Georgia-12Y (stem-rot-resistant) as influenced by seven commercial fungicide programs. Stem rot incidence was consistently lower on Georgia-12Y for all fungicides when compared with Georgia-06G and was lowest for both cultivars in plots treated with prothioconazole plus a tank mixture of penthiopyrad and tebuconazole. Leaf spot severity was similar for both the resistant and susceptible cultivars, and the greatest reduction occurred in plots treated with prothioconazole plus a tank mixture of penthiopyrad and tebuconazole. Fungicide programs gave similar yield and net return on Georgia-12Y; however, plots of Georgia-06G treated with prothioconazole plus a tank mixture of penthiopyrad and tebuconazole had the greatest yield and net return. Yields and economic return from the highest level of fungicide inputs on Georgia-06G were numerically less than those of Georgia-12Y treated with only chlorothalonil. These results show the value of fungicides in peanut disease management with susceptible cultivars, as well as the benefits of planting stem-rot-resistant cultivars in high-risk situations.

The genus Atheris (Serpentes: Viperidae) in East Africa: phylogeny and the role of rifting and climate in shaping the current pattern of species diversity.

Past climatic and tectonic events are believed to have strongly influenced species diversity in the Eastern Afromontane Biodiversity Hotspot. We investigated the phylogenetic relationships and historical biogeography of the East African genus Atheris (Serpentes: Viperidae), and explored temporal and spatial relationships between Atheris species across Africa, and the impact of palaeoclimatic fluctuations and tectonic movements on cladogenesis of the genus. Using mitochondrial sequence data, the phylogeny of East African species of Atheris shows congruent temporal patterns that link diversification to major tectonic and aridification events within East Africa over the last 15million years (my). Our results are consistent with a scenario of a delayed direct west-east colonisation of the Eastern Arc Mountains of Atheris by the formation of the western rift. Based on the phylogenetic patterns, this terrestrial, forest-associated genus has dispersed into East Africa across a divided route, on both west-southeasterly and west-northeasterly directions (a C-shaped route). Cladogenesis in the Eastern Arc Mountains and Southern Highlands of Tanzania corresponds to late Miocene and Plio-Pleistocene climatic shifts. Taxonomically, our data confirmed the monophyly of Atheris as currently defined, and reveal four major East African clades, three of which occur in discrete mountain ranges. Possible cryptic taxa are identified in the Atheris rungweensis and A. ceratophora clades.

Report of the Obstetric APS Task Force: 13th International Congress on Antiphospholipid Antibodies, 13th April 2010.

The Obstetric APS Task Force of the 13th International Congress identified and discussed five general topics within 'Obstetric' Antiphospholipid Syndrome (APS) that contained areas of controversy or uncertainty: recurrent early miscarriage (REM), fetal death, delivery <34 weeks for severe preeclampsia or placental insufficiency, postpartum care, and long-term implications and care. The Task Force concluded that the frequency with which women with REM have a high titer of antiphospholipid antibodies (aPL) or lupus anticoagulant (LA) is somewhat controversial, especially with regard to the diagnostic titers required by the current international criteria for APS. Also, treatment trials involving heparin differ from one another with regard to the patients included and the outcomes achieved. Similarly, the frequency with which women with fetal death or delivery <34 weeks for severe preeclampsia or placental insufficiency have a high titer of aPL or LA is poorly defined, and there is no level I evidence to guide treatment in either group. Suggestions for future studies with regard to both REM and fetal death or delivery <34 weeks for severe preeclampsia or placental insufficiency were discussed and are outlined below. Postpartum and long-term care in women with APS diagnosed solely for obstetric criteria has been largely guided by expert opinion, and systematic evaluations of these populations would be welcome.

Prophylaxis of the antiphospholipid syndrome: a consensus report.

Hypothetical circumstances that may require prophylaxis for a potential antiphospholipid syndrome (primary prophylaxis), or in some instances when there already had been some manifestations ofthe syndrome (secondary prophylaxis), were presented to a panel of experts for their consideration on potential prophylactic intervention. These were subsequently presented to the participants in the First International Consensus on Treatment of the Antiphospholipid Syndrome. In most instances there was consensus in adding low dose aspirin, an exception being aspirin allergy when other antiaggregants could be used in nonpregnant subjects. General measures to prevent thrombosis and other vasoprotective actions should also be provided. Higher risk of fetal loss or thrombosis called for anticoagulation with coumadin in nonpregnant subjects or subcutaneous low molecular weight heparin in pregnant ones. When indicated, prophylaxis of the antiphospholipid syndrome should be provided in systemic lupus erythematosus patients who are being treated for their disease. In no instance should corticosteroids or immunosuppresants be given as prophylactic of an antiphospholipid syndrome.

Treatment of pregnant patients with antiphospholipid syndrome.

Antiphospholipid Syndrome (APS) has been widely recognized as a risk factor for the recurrence of both thrombosis and pregnancy losses; however the optimal treatment of patients is debatable. The aim of this paper was to establish a consensus among experts on the treatment of APS in pregnancy. A questionnaire that described possible different clinical situations was sent to the International Advisory Board of the 10th International Congress on Antiphospholipid Antibodies. Sixteen experts from different medical branches and different geographic areas sent their replies. The consensus was that treatment for APS pregnant patients should be low molecular weight heparin (LMWH) and low dose aspirin (LDA). The dosage, and frequency of LMWH depends on different situations, including the body weight and past history. Patients with previous thromboses usually receive two injections per day. Warfarin can also be used from 14 to 34 weeks, for patients with previous stroke or severe arterial thromboses. The use of intravenous immunoglobulin (IVIG) seems to be restricted to patients with pregnancy losses despite conventional treatment. The experts usually advised barrier methods of contraception, intrauterine device (if the patient is not taking corticosteroids) or progestins. Oral contraception with oestrogens was usually avoided.

Clinical inertia.

Medicine has traditionally focused on relieving patient symptoms. However, in developed countries, maintaining good health increasingly involves management of such problems as hypertension, dyslipidemia, and diabetes, which often have no symptoms. Moreover, abnormal blood pressure, lipid, and glucose values are generally sufficient to warrant treatment without further diagnostic maneuvers. Limitations in managing such problems are often due to clinical inertia-failure of health care providers to initiate or intensify therapy when indicated. Clinical inertia is due to at least three problems: overestimation of care provided; use of "soft" reasons to avoid intensification of therapy; and lack of education, training, and practice organization aimed at achieving therapeutic goals. Strategies to overcome clinical inertia must focus on medical students, residents, and practicing physicians. Revised education programs should lead to assimilation of three concepts: the benefits of treating to therapeutic targets, the practical complexity of treating to target for different disorders, and the need to structure routine practice to facilitate effective management of disorders for which resolution of patient symptoms is not sufficient to guide care. Physicians will need to build into their practice a system of reminders and performance feedback to ensure necessary care.

The patient-physician relationship. Teaching the human dimensions of care in clinical settings.

Despite repeated calls to emphasize the humanistic dimensions of care during medical education, these are few known techniques for effective teaching of humanism. We describe the barriers that inhibit humanistic teaching and suggest pragmatic teaching methods to overcome such barriers and teach humanistic care in clinical settings. We began by asking participants at a conference on patient-physician communications sponsored by the American Academy on Physician and Patient in June 1998, "What can we do in the patient's presence to improve and teach the human dimensions of care? Please provide one or more examples of approaches you found to be effective." We augmented this information with suggestions from a number of colleagues in other settings. In a series of iterations, we analyzed all their suggestions to identify key teaching methods. We found that barriers to teaching humanism largely consist of elements of the informal and hidden curricula in medical schools. We then defined methods to help teachers overcome these barriers. Specific methods fall into the 3 categories of taking advantage of seminal events, role modeling, and using active learning skills. We believe that formal courses and other well-motivated endeavors that take place away from patients fail to foster humanistic care. In contrast, we present pragmatic teaching methods that can be used in the fast-paced setting of the clinical environment.

Extraordinary case of matrotrophy in the African skink Eumecia anchietae.

The viviparous African skink, Eumecia anchietae, exhibits a matrotrophic fetal nutritional pattern. Until well after the limb bud stage, extravitelline nutritional provision is in the form of holocrine secretion originating from the stratified uterine epithelium of the uterine incubation chambers. Uterine secretions are absorbed by a specialized yolk sac ectoderm and chorioallantois through histotrophy. The yolk sac is not in close contact with the uterine lining from the limb bud stage onwards. The yolk sac ectoderm forms invaginations filled with uterine secretion and consists of a single layer of vacuolated hypertrophied cells bearing microvilli. The chorioallantois at the limb bud stage is extensive, well-vascularized, and not intimately associated with the uterine epithelium. Where the uterus is folded, the chorioallantois may interdigitate loosely. Chorionic cells are low to high columnar, clearly vacuolated, and bear microvilli. The allantoic layer consists primarily of squamous cells exhibiting villous projections. By the time embryos have well-defined digits, the specialized yolk sac ectoderm has regressed and the yolk sac lumen has been invaded by vitelline cells. The chorioallantois is very extensive and in areas greatly folded. Where it contacts the uterine epithelium, a proper chorioallantoic placenta is formed. Cell layers of the chorioallantois and uterine epithelium are thin and cuboidal to squamous in appearance. The chorioallantoic placenta is simple in structure, occurs throughout the incubation chamber, and is epitheliochorial in arrangement. It is unknown whether the placentome observed in other highly matrotrophic scincids is formed in late stage embryos of this species.

Inheritance of a Lutescent-Leaf color trait in peanut.

A Lutescent-Leaf color mutant was recently found in the cultivated peanut (Arachis hypogaea L.). Crosses involving the Lutescent-Leaf mutant were made both between and within subspecies of hypogaea and fastigiata to determine its inheritance. The F1, F2, and F3 data indicated that two duplicate recessive genes, designated lut1 and lut2, control the Lutescent-Leaf color trait. No maternal or cytoplasmic effects were detected among progenies from reciprocal hybridization.

Supporting the moral development of medical students.

Philosophers who studied moral development have found that individuals normally progress rapidly in early adulthood from a conventional stage in which they base behavior on the norms and values of those around them to a more principled stage where they identify and attempt to live by personal moral values. Available data suggest that many medical students, who should be in this transition, show little change in their moral development. Possibly, this relates to perceived pressures to conform to the informal culture of the medical wards. Many students experience considerable internal dissidence as they struggle to accommodate personal values related to empathy, care, and compassion to their clinical training. Educational interventions that positively influence this process have established regular opportunities for critical reflection by the students in small groups. Other interventions include faculty development to enhance role modeling and feedback by clinical faculty. The author espouses more widespread adoption of these educational interventions.

The ethics of caring and medical education.

The ethics of caring, though the subject of much recent discussion by philosophers, has hardly been applied to medical ethics and medical education. Based on receptivity (that is, empathy and compassion) toward and taking responsibility for other persons, the ethics of caring has particular relevance to medicine. Caring guides the physician always to remain the patient's advocate and to maintain the therapeutic relationship when dealing with and resolving ethical dilemmas. This article discusses the philosophy behind the ethics of caring and then explores three issues that arise within its context: receptivity, taking responsibility, and creating an educational environment that fosters caring.

Prediction and statistical evaluation of speech recognition test scores.

A speech test evaluation and presentation system is described. The test presentation subsystem has the flexibility and speed of live-voice testing while using recorded test materials. The speech test evaluation subsystem compares an individual subject's test performance on a monosyllabic word test with that of an average person with the same hearing loss. The elements needed to make such evaluations are discussed. Also, a trial of the procedure is described. The primary purpose of the trial was to obtain data that would provide a basis for statistical probability statements about individual monosyllabic word test results obtained in clinical settings. Data were collected from three audiology clinics in three different types of settings. Except for a few cases with highly asymmetric speech scores, all nonconductive hearing losses were included. Subject ages ranged from 8 to 92 years. Importance-weighted average pure-tone hearing losses ranged from 0.4 to 97.6 dB HL. Fifty-word recognition scores and audiograms for 2609 ears were included in the main analysis. Twenty-five-word recognition scores and audiograms for another 932 ears from one clinic were used in a subsidiary analysis. Results indicated that distributions of absolute speech recognition scores in hearing-impaired samples are highly skewed. However, after transformation of the scores into rationalized arcsine units (rau), the differences between individual subject scores and scores predicted from the audiogram were reasonably well described by the normal distribution. The standard deviation of this distribution of differences, for the data combined across the three audiology clinics, was approximately 13 rau.

Clinician-educators in academic medical centers: a two-part challenge.

As academic medical centers increasingly deliver care in primary care settings, a new category of faculty-clinician-educators-has emerged. Although the shift of education and patient care to outpatient settings makes the expanded role of clinician-educators necessary, it also presents challenges to clinician-educators themselves and to the institutions for which they work. This article examines these contemporary challenges (including financial constraints, undefined processes of promotion, and limited opportunities for professional development) and suggests strategies for meeting them. The number of clinician-educators joining the ranks of medical school faculties will probably continue to increase. As clinician-educators seek to provide the highest-quality education and patient care in the new medical marketplace, their success will be critical to the viability of the academic centers of the future.