A novel species of Microsphaeropsis causing cankers on Rafnia amplexicaulis in South Africa.

Cankers leading to branch, stem and plant death were observed on the South African endemic Rafnia amplexicaulis (Fabaceae) in the Cederberg Wilderness Area, South Africa, during September 2021. Conidiomatal pycnidia were found developing on the cankers, and isolations consistently yielded a Microsphaeropsis species. Phylogenetic analysis based on partial nucleotide sequences of the internal transcribed spacers (ITS), the nuclear large subunit (LSU) and RNA polymerase II second largest subunit (RPB2) regions showed that the fungus represented an undescribed species. Based on the multigene phylogeny and morphological characteristics, we describe the species here as M. rafniae sp. nov. Pathogenicity tests and the fulfilment of Koch's postulates confirmed that M. rafniae sp. nov. is the cause of the cankers of R. amplexicaulis. Presently, this disease is known from a single location in South Africa, and further surveys are required to determine its distribution and relative importance. Citation: Paap T, Marincowitz S, Pham NQ, Roets F, Basson RJ, Wingfield BD, Oberlander K, Wingfield MJ (2023). A novel species of Microsphaeropsis causing cankers on Rafnia amplexicaulis in South Africa. Fungal Systematics and Evolution 12: 73-80. doi: 10.3114/fuse.2023.12.05.

Guidelines for the selection of tooth whitening products amongst those available on the market.

BACKGROUND: Several tooth whiteners are available on the market, and the ideal choice should be determined by efficacy and optimal clinical results. OBJECTIVES: The purpose of this study was to compare the reported clinical success rates of different tooth whitening products. SEARCH STRATEGY: The relevant literature (1998 - 2011) was studied, using as sources the databases: Google Scholar, Science Direct, Medline and Pubmed. SELECTION CRITERIA: The material was clearly identified, the manufacturers' instructions were respected and the sample size stated. RESULTS AND CONCLUSIONS: This descriptive report on 49 papers focuses on the total colour change, measured with a calibrated shade guide and also numerically (colourimeter, chromameter or spectrophotometer), the relapse of the colour change and tooth sensitivity. In general, the dentist-supervised at-home bleaching and the in-office treatment gave approximately the same initial percentage improvement of tooth whitening. However, the relapse after a four week or longer period was significantly higher for the in-office treatment. The treatment of choice should be a dentist supervised at-home bleaching product which generally contains approximately 10% carbamide peroxide applied over about 14 days for about eight hours per night. Tooth sensitivity should not be a general problem although some subjects might choose to discontinue treatment as a result of sensitivity.

Women's sexual function and dysfunction: current uncertainties, future directions.

There is increasing evidence that women at the outset of sexual activity do not need to have sexual desire, as in 'drive', and that many do not distinguish desire from arousal. Multiple modes of investigation confirm poor correlation between women's subjective arousal and measured genital congestion. Suggested revisions to the DSM-IV definitions of sexual disorder have been published: there is now need to align interview assessments and screening questionnaires with contemporary understanding of women's sexual response. Whereas the psychological factors associated with women's sexual function and resilience to biological insults and external stressors are well documented, the role of biological factors is less clear. Variations in the rate of decline of adrenal and ovarian pro-hormones, activity of converting enzymes in peripheral cells, sensitivity of androgen and estrogen receptors and cerebral production of sex steroids may all be involved. Thus there is great complexity underlying the question of sex hormone supplementation, and in particular, little clarity as to which women have decreased brain and/or peripheral androgen activity. When psychosexual etiological factors appear to be minimal and investigational testosterone supplementation is considered, it would be appropriate to target women with disordered arousal and desire in keeping with the recently recommended revised definitions.

Hormones and sexuality: current complexities and future directions.

Complex correlations between women's sexual function and psychosexual variables confound the identification of any etiological role for estrogen and androgen deficiencies in sexual dysfunction. Although serum levels of androgens show minimal correlation with women's sexual function, the intracellular production of testosterone from adrenal and ovarian precursors may be relevant. Current research involves the detailed assessment of mid aged and older women, with and without sexual dysfunction, assessing medical and multiple psychosexual parameters, estrogen status, serum testosterone levels by mass spectrometry methods plus total androgen activity by means of androgen metabolites. Identification of any correlation between androgen activity and sexual function is one priority. A second is to confirm safety and efficacy of supplemental systemic estrogen and androgen from early menopause in sexually symptomatic women. Although local estrogen supplementation is effective therapy for loss of genital sexual sensitivity and vaginal elasticity, and reduced potential for lubrication, any systemic testosterone therapy requires concomitant systemic estrogen therapy. In the future, augmentation of estrogen and androgen sexual effects may be possible using certain selective estrogen and androgen receptor modulators.

Psychological profiles among women with vulvar vestibulitis syndrome: a chart review.

The purpose of this study was to assess the prevalence and type of psychological distress in women with vulvar vestibulitis syndrome (VVS). A retrospective chart review was conducted of all women receiving a diagnosis of VVS referred to a tertiary care facility during a two-year period. Brief psychological questionnaires, including the Personality Assessment Screener, Fear of Negative Evaluation Scale, Golombok-Rust Inventory of Sexual Satisfaction, and the Phobia Rating Scale were administered. Fifty-consecutive cases were reviewed along with 12-15 month follow-up data for 41 cases. Phobic anxiety to vaginal touch or entry was significantly higher in women with VVS than normative data. Fear of Negative Evaluation was a strong associated feature, and for 30% approached clinically significant levels. Twenty-six percent showed a moderate, while another 26% showed a mild clinically distressed profile. Negative affect and social withdrawal were among the most frequently endorsed variables. Improvement in allodynia and intercourse were both related to these psychological variables, and a multiple regression analysis supported the use of psychological instruments in addition to standard medical assessment. A subgroup of women with VVS display clinically significant broad based psychological distress that warrants additional assessment. The use of psychological questionnaires in addition to medical assessment of women with VVS may provide valuable information predictive of treatment needs and response.

Definitions of women's sexual dysfunction reconsidered: advocating expansion and revision.

In light of various shortcomings of the traditional nosology of women's sexual disorders for both clinical practice and research, an international multi-disciplinary group has reviewed the evidence for traditional assumptions about women's sexual response. It is apparent that fullfilment of sexual desire is an uncommon reason/incentive for sexual activity for many women and, in fact, sexual desire is frequently experienced only after sexual stimuli have elicited subjective sexual arousal. The latter is often poorly correlated with genital vasocongestion. Complaints of lack of subjective arousal despite apparently normal genital vasocongestion are common. Based on the review of existing evidence-based research, many modifications to the definitions of women's sexual dysfunctions are recommended. There is a new definition of sexual interest/desire disorder, sexual arousal disorders are separated into genital and subjective subtypes and the recently recognized condition of persistent sexual arousal is included. The definition of dyspareunia reflects the possibility of the pain precluding intercourse. The anticipation and fear of pain characteristic of vaginismus is noted while the assumed muscular spasm is omitted given the lack of evidence. Finally, a recommendation is made that all diagnoses be accompanied by descriptors relating to associated contextual factors and to the degree of distress.

Using a different model for female sexual response to address women's problematic low sexual desire.

An intimacy-based sex response cycle was used in the assessment of 47 women referred with low sexual desire. All could relate to the model and multiple breaks in the cycles were identified. Emotional intimacy to motivate the women to find sexual stimuli to elicit arousal was insufficient in 50%. Sexual stimuli and context were minimal in 53%. Psychological factors diminishing arousability were identified in 85%, depression contributing in 43%. Androgen deficiency (the cause suggested by referring doctors) contributed in 25%. Identifying missing components of their "normal" but currently problematic sex response cycles was itself therapeutic.

Female sexual response: the role of drugs in the management of sexual dysfunction.

A large component of women's sexual desire is responsive rather than spontaneous. Therefore, women's motivation and ability to find and respond to sexual stimuli to experience sexual arousal and subsequent sexual desire is crucial, but complex. In ongoing relationships, a woman's motivation appears to be largely influenced by her emotional intimacy with her partner and her wish to enhance it. Drugs (including androgen replacement therapy) aimed at increasing women's spontaneous sexual wanting (less characteristic of women in long-term relationships) or their arousability may have a role if other psychologic factors affecting arousability are addressed in tandem. A woman's sexual arousal is composite and complex, correlating well with how mentally exciting she finds the sexual stimulus and its context and poorly with objective genital blood flow changes. Drugs aimed at increasing the latter, including phosphodiesterase inhibitors, may have a role if there is prior careful enquiry as to whether genital engorgement is present but not attended to or is physically absent. Psychophysiologic studies to date suggest the former is common in women presenting with arousal disorder.

Commitment to change statements: a way of understanding how participants use information and skills taught in an educational session.

BACKGROUND: Commitment to change has gained increasing use in assessing short course effectiveness. This study examined the changes that learners intended to make in practice following an intensive day-long course offered at multiple sites, counted changes relative to the curriculum's focus, and analyzed which changes were implemented in practice. METHODS: Participants at a course on the management of male sexual dysfunction were asked to identify the changes to which they would commit. Six months after the course, they were asked to indicate which changes they implemented fully, partially, or not at all. RESULTS: A total of 352 physicians attended the courses held in 21 centers. A majority of attendees (344 or 97.7%) completed forms at the end of the course, providing 1,635 commitment statements. Six months later, 197 (57.3%) physicians provided follow-up data about 935 (55.4%) of the commitment statements originally submitted. Of these, 602 (66.52%) were completely implemented. Many of the changes related to two specific aspects of the course, namely, sexual history taking and medical intervention, accounting for 45.93% of the intended commitments and 47.67% of the changes completely implemented. Slightly over half (58%) of the course time was devoted to these two areas. There was a significant correlation between the number of changes and the amount of time allocated to that content within the course. FINDINGS: Commitment to change statements offered by course participants can be used to examine the impact of a course relative to its learning focus. Continuing medical education providers must take a critical look at commitment to change statements as an "intervention" in their own right and determine how the tool can best be used as a continuing medical education intervention.

Human sex-response cycles.

In order to better assess and explain the multiple factors contributing to our patients' sexual difficulties, we need to construct a reasonably simple model of human sexual response that illustrates, first, feedback to the mind as it orchestrates the sexual response and, second, the concept that sexual experiences can be undertaken for reasons that are not strictly sexual but intimacy-based. A simple model is presented that integrates responsive and "spontaneous" sexual desire, the subsequent creation of further stimuli in the form of the emotions experienced, subjective mental excitement, and accurate or inaccurate appreciation of physical, genital, and nongenital changes, all of which continue to modulate the sexual response.

Report of the international consensus development conference on female sexual dysfunction: definitions and classifications.

PURPOSE: Female sexual dysfunction is highly prevalent but not well defined or understood. We evaluated and revised existing definitions and classifications of female sexual dysfunction. MATERIALS AND METHODS: An interdisciplinary consensus conference panel consisting of 19 experts in female sexual dysfunction selected from 5 countries was convened by the Sexual Function Health Council of the American Foundation for Urologic Disease. A modified Delphi method was used to develop consensus definitions and classifications, and build on the existing framework of the International Classification of Diseases-10 and DSM-IV: Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, which were limited to consideration of psychiatric disorders. RESULTS: Classifications were expanded to include psychogenic and organic causes of desire, arousal, orgasm and sexual pain disorders. An essential element of the new diagnostic system is the "personal distress" criterion. In particular, new definitions of sexual arousal and hypoactive sexual desire disorders were developed, and a new category of noncoital sexual pain disorder was added. In addition, a new subtyping system for clinical diagnosis was devised. Guidelines for clinical end points and outcomes were proposed, and important research goals and priorities were identified. CONCLUSIONS: We recommend use of the new female sexual dysfunction diagnostic and classification system based on physiological as well as psychological pathophysiologies, and a personal distress criterion for most diagnostic categories.

The female sexual response: a different model.

Clarification of women's sexual response during long-term relationships is needed. I have presented a model that more accurately depicts the responsive component of women's desire and the underlying motivational forces that trigger it. The variety of arousal/orgasm responses is also acknowledged. The purpose is both to prevent diagnosing dysfunction when the response is simply different from the traditional human sex-response cycle and to more clearly define subgroups of dysfunction. The latter would appear to be necessary before progress in newer treatment modalities, including pharmacological, can be made.

Androgen replacement for women.

OBJECTIVES: To determine whether a postmenopausal syndrome comprising specific changes in sexual desire and response associated with low free testosterone exists. To determine whether this syndrome is ameliorated by testosterone replacement. QUALITY OF EVIDENCE: Literature documenting that replacement of physiological levels of testosterone is beneficial and safe is scant. Only one randomized prospective blinded study examines sexual outcome in detail. MAIN MESSAGE: Testosterone is an important metabolic and sex hormone produced by the ovary throughout life. The variable reduction in ovarian testosterone production coincident with menopause is sometimes associated with a syndrome of specific changes in sexual desire and sexual response. Estrogen deficiency also impairs sexual response, but its replacement will not improve and might exacerbate sexual symptoms from androgen loss. Diagnosis of androgen deficiency is clinical, based on accurate assessment of a woman's sexual status before and after menopause and only confirmed (rather than diagnosed) by a low level of free testosterone. Partial androgen replacement restores much of the sexual response and facilitates sexual desire that is triggered by external cues. Avoiding supraphysiological levels of testosterone lessens risk of masculinization. Avoiding alkylated testosterone lessens hepatic or lipid impairment. CONCLUSION: Further prospective randomized studies of replacement of physiological levels of testosterone in women with androgen deficiency syndrome are needed, using formulations of testosterone available in Canada. The consistency of sexual changes, the associated personal and relationship distress, together with our clinical experience of the gratifying response to physiological replacement, make further studies urgently needed.

Why rate of absorption inferences in single dose bioequivalence studies are often inappropriate.

PURPOSE: Peak drug concentration (Cmax) measures the extremity of drug exposure and is a secondary indicator of the extent of absorption after area under the concentration time curve (AUC). Cmax serves as the indicator of absorption rate in bioequivalence (BE) studies in the US (1). The use of Cmax, not the time to Cmax (Tmax), as the metric to assess absorption rate causes erratic inferences in BE studies, and incorrect conclusions for some. We can improve BE efficiency (i.e., get the answer right the first time), by properly analyzing the time to Cmax (Tmax) instead of Cmax. METHODS: We have previously redirected attention to Tmax as the unconfounded absorption rate variable, instead of Cmax, and have called for equally spaced sampling times during the suspected absorption phase to improve the performance of the rate metric (2). Equal spacing converts Tmax easily into a count variable and we illustrated an appropriate statistical analysis for counts. This paper provides some measurement theory concepts to help judge which is the more appropriate analysis, and also provides parametric confidence limits for Tmax treatment differences. Three separate BE studies are then analyzed by both methods. RESULTS: By focusing on the differences in conclusions, or inferences, this paper identifies three major issues with the current FDA "recommended" analysis of BE studies. First, Cmax, a continuous variable peak-height or extent measure has usurped Tmax's function and performs erratically as a substitute measure for the rate of absorption. Second, Tmax, should be analyzed as a discrete attribute, not as a continuous variable. Third, since several extent measures (AUC, Cmax), not one, are actually being analyzed, an adjustment for multiple testing is mandatory if we are to maintain the size of the test at the desired alpha level (13), and not inadvertently use a narrower bioequivalence window than is intended. These actions all can have serious unintended consequences on inferences, including making inappropriate ones.

[Nurses' knowledge of aspects of the trade union system]. / Verpleegkundiges se kennis omtrent aspekte van die vakbondwese.

The democratisation of the work place has implications for the nursing profession where conflict exists between the registered nurse as employee and professional practitioner with related professional-ethical responsibilities, and membership of a trade union with access to industrial action. It appears as if trade unions have recruited a significant number of nurses as members over the last few years. The aim with this research is to determine the knowledge of registered nurses with regard to aspects related to trade unions. An exploratory and descriptive research design was followed, utilising a structured questionnaire in a survey to determine the knowledge of registered nurses on certain aspects related to trade unions, within the context of hospitals in Gauteng and in the Free State. The study reveals inadequate knowledge of registered nurses regarding aspects related to trade unions (average percentage of knowledge is 33.8%) and empowerment through education in this regard seems necessary.

Sexuality and parkinson's disease.

This article is a clinical description of the sexual concerns of 25 people with idiopathic parkinsonism referred for sexual help to a tertiary, university-affiliated sexual medicine department. In this paper the author attempts to identify pathophysiology and psychosexual factors that underlie changes in the areas of sexual desire, sexual function, sexual selfesteem, partnership, mood, energy, mobility, bowel and bladder continence and fertility. Strategies used in management are discussed with emphasis on attempting to help both partners, each of whom suffers sexually but often in different ways as a result of idiopathic parkinsonism.