Improving Hypertension Control in Primary Care With the Measure Accurately, Act Rapidly, and Partner With Patients Protocol.

Better blood pressure (BP; mm Hg) control is a pivotal national strategy for preventing cardiovascular events. Measure accurately, Act rapidly, and Partner with patients (MAP) with practice facilitation improved BP control (<140/<90 mm Hg) from 61.2% to 89.8% during a 6-month pilot study in one primary care clinic. Current study objectives included evaluating the 6-month MAP framework in 16 Family Medicine Clinics and then withdrawing practice facilitation and determining whether better hypertension control persisted at 12 months since short-term improvements often decline by 1 year. Measure accurately included staff training in attended (intake) BP measurement and unattended automated office BP when intake BP was ≥140/≥90 mm Hg. Act rapidly (therapeutic inertia) included protocol-guided escalation of antihypertensive medications when office BP was ≥140/≥90 mm Hg. Partner with patients (systolic BP decline/therapeutic intensification) included shared decision making, BP self-monitoring, and affordable medications. Study data were obtained from electronic records. In 16 787 hypertensive adults (mean, 61.2 years; 54.1% women; 46.0% Medicare) with visits at baseline and first 6 months, BP control improved from 64.4% at baseline to 74.3% ( P<0.001) at 6 and 73.6% ( P<0.001) at 12 months. At the first MAP visit, among adults with uncontrolled baseline BP and no medication changes (n=3654), measure accurately resulted in 11.1/5.1 mm Hg lower BP. During the first 6 months of MAP, therapeutic inertia fell (52.0% versus 49.5%; P=0.01), and systolic BP decreased more per therapeutic intensification (-5.4 to -12.7; P<0.001). MAP supports a key national strategy for cardiovascular disease prevention through rapid and sustained improvement in hypertension control, largely reflecting measuring accurately and partnering with patients.

Periconia variicolor sp. nov., a new species from Puerto Rico.

Periconia variicolor was isolated from water of an evaporation pond used for salt production on the southwestern coast of Puerto Rico. On the basis of cultural and morphological characteristics and ITS sequence it is describe as a new species of Periconia.

Global health public-private partnerships: IAVI, partnerships and capacity building.

New developments in biotechnology and the need to overcome the lack of incentive for investment in vaccines for diseases affecting Africa have led to the promotion of product development public-private partnerships (PPP). Our work at the ESRC INNOGEN Research Centre assesses the way in which these collaborative mechanisms approach their mission of getting science to work for the poor and what they contribute to broader development objectives, particularly in relation to capacity building. Case study research of the International AIDS Vaccine initiative (IAVI) and their work on the ground in Africa and India has highlighted two legal related issues. First, by working as a PPP the organisation has changed the 'ownership' of science, making the process more flexible and emphasising a bottom-up dialogue process while advocating a private sector ethos. Second--whether intentionally or not--the partnership's emphasis on advocacy and communications has increased the importance of knowledge generation and management activities within the partnership and its availability to stakeholders. This paper attempts to ascertain the impact of these issues for the building of health research capacity.

Perithecial ascomycetes from the 400 million year old Rhynie chert: an example of ancestral polymorphism.

We describe a perithecial, pleomorphic ascomycetous fungus from the Early Devonian (400 mya) Rhynie chert; the fungus occurs in the cortex just beneath the epidermis of aerial stems and rhizomes of the vascular plant Asteroxylon. Perithecia are nearly spherical with a short, ostiolate neck that extends into a substomatal chamber of the host plant; periphyses line the inner surface of the ostiole. The ascocarp wall is multilayered and formed of septate hyphae; extending from the inner surface are elongate asci interspersed with delicate paraphyses. Asci appear to be unitunicate and contain up to 16 smooth, uniseriate-biseriate ascospores. The method of ascospore liberation is unknown; however, the tip of the ascus is characterized by a narrow, slightly elevated circular collar. Ascospores appear 1-5 celled, and germination is from one end of the spore. Also present along the stems and interspersed among the perithecia are acervuli of conidiophores that are interpreted as the anamorph of the fungus. Conidiogenesis is thallic, basipetal and probably of the holoarthric-type; arthrospores are cube-shaped. Some perithecia contain mycoparasites in the form of hyphae and thick-walled spores of various sizes. The structure and morphology of the fossil fungus is compared with modern ascomycetes that produce perithecial ascocarps, and characters that define the fungus are considered in the context of ascomycete phylogeny.

One-year vestibular and balance outcomes of Oklahoma City bombing survivors.

This multisite investigation assessed subjective, behavioral, and objective balance function in 30 blast survivors. Subjects with vertigo, dizziness, or imbalance were screened (n = 6) or evaluated (n = 27) during 1 year. Tests included a questionnaire, electronystagmography (ENG), and computerized dynamic posturography (CDP). Ninety-seven percent of subjects were located inside a building during the blast, and 63 percent of subjects experienced dysequilibrium within 48 hours. Forty-three percent of symptoms could not be attributed to head injury. Sixty percent of subjects had abnormal ENG and/or CDP; ENG abnormalities mostly were peripheral or nonlocalizing, whereas CDP patterns were "vestibular," "surface dependent," and "physiologically inconsistent." At 1-year postblast, 55 percent of initially abnormal CDP results were normal, and 72 percent of subjects said symptoms were unchanged or occurred intermittently. A serial, test battery approach is recommended to assess symptoms. Blast-related dysequilibrium had clinically significant manifestations and should be considered a valid component of aural blast injury.

The morphology of Cercophora palmicola (Lasiosphaeriaceae).

A detailed study of ascomal morphology and development in Cercophora palmicola showed that ontogeny is ascohymeniaceous, giving rise to an ostiolate perithecium. Ascomal initials consist of a coiled ascogonium surrounded by several layers of hyphae whose cells become pseudoparenchymatous. The centrum of the young ascoma is composed of a few rows of large, thin-walled pseudoparenchymatous cells that line the ascomal wall, with the central region filled by tightly packed, filamentous paraphyses. The ascogenous system forms along the inside of the layer of pseudoparenchymatous cells at the base of the paraphyses and gives rise to unitunicate asci that grow up among the paraphyses. The wall of the mature perithecium is greatly thickened. It is composed of three regions: a thin outer region of darkly pigmented, angular cells with thickened walls; a broad central region of cells with gelatinized walls; and a thin inner region of flattened cells. Ascomal ontogeny in C. palmicola conforms well to the Sordaria type of development, as defined by Huang.

One-year audiologic monitoring of individuals exposed to the 1995 Oklahoma City bombing.

This longitudinal study evaluated subjective, behavioral, and objective auditory function in 83 explosion survivors. Subjects were evaluated quarterly for 1 year with conventional pure-tone and extended high-frequencies audiometry, otoscopic inspections, immittance and speech audiometry, and questionnaires. There was no obvious relationship between subject location and symptoms or test results. Tinnitus, distorted hearing, loudness sensitivity, and otalgia were common symptoms. On average, 76 percent of subjects had predominantly sensorineural hearing loss at one or more frequencies. Twenty-four percent of subjects required amplification. Extended high frequencies showed evidence of acoustic trauma even when conventional frequencies fell within the normal range. Males had significantly poorer responses than females across frequencies. Auditory status of the group was significantly compromised and unchanged at the end of 1-year postblast.

Identification and retting efficiencies of fungi isolated from dew-retted flax in the United States and europe.

Seven strains of filamentous fungi and one yeast were isolated from flax that was dew retted in the United States. These filamentous fungi were subcultured to purity and identified, and six appear not to have been reported earlier as isolates from dew-retted flax. Five of the purified U.S. strains, two fungi isolated from flax that was dew retted in Europe, and a laboratory culture of Aspergillus sojae were tested for their ability to ret flax stems. The monocultures were evaluated for the degree of retting, fiber strength, dry weight loss, and tactile response (i.e., feel of softness) as reflected in the retted fiber. Structural modifications of representative samples of the retted flax were assessed by scanning electron microscopy. All of the filamentous fungi were able to carry out some retting, whereas the isolated yeast could not. All organisms produced pectinases when they were cultivated in shake flasks on ball-milled flax as the sole carbon source. Some fungi also produced cellulases, mannanases, and xylanases. Rhizomucor pusillus and Fusarium lateritium were noteworthy as retting organisms by their high level of pectinase activity, ability to attack noncellulosic cell types without attacking cellulose, capacity to penetrate the cuticular surface of the stem, and efficient fiber release from the core. The results indicated that these organisms deserve further study as potential organisms for retting of bast fibers in industrial applications.

Pioneer Leaders in Plant Pathology: ES Luttrell.

ES Luttrell was a mycologist who spent 42 of his 44 professional years at the University of Georgia, first at the Georgia Experiment Station in Griffin and later at the main campus in Athens. He is best known for his innovative classification scheme for the perithecial ascomycetes, in which orders were based on patterns of ascomal ontogeny and mode of ascus dehiscence. This work established him as an authority on ascocarp development. His later studies on the classification of the Helminthosporium complex, in which he showed that small differences in conidium germination and structure could be correlated with distinct teleomorphs, brought him recognition from plant pathologists as well. These studies were notable for his attention to detail and the quality of his work. His contributions to mycology and plant pathology were numerous and varied and brought him various awards later in his career. To his colleagues he served as administrator, teacher, mentor and friend.

Unusual cause of hemoptysis. Hickman-induced cava-bronchial fistula.

A 56-year-old man with metastatic prostatic carcinoma underwent placement of a Hickman catheter. Approximately two months after the procedure, he was admitted to the hospital with hemoptysis and in respiratory distress. A contrast computed tomographic (CT) scan confirmed the diagnosis of a cava-bronchial fistula. The fistula was surgically repaired, and the patient made a satisfactory recovery.

Production of aflatoxins B1 and G1 by Aspergillus flavus and Aspergillus parasiticus isolated from market pecans.

One hundred and forty-eight isolates of Aspergillus flavus and A. parasiticus were isolated from 5,608 pecans obtained from Chicago and Georgia markets. The percentage of internal contamination by these species was 7.3% in the Chicago market pecans and 1.7% in those from markets in Georgia. Of the 148 isolates, 93% of the A. parasiticus, but only 54% of the A. flavus, were capable of producing aflatoxin. Overall, 57% of the isolates were potentially aflatoxigenic. A. parasiticus isolates generally produced a greater amount of aflatoxins than A. flavus.

Effect of propylene oxide treatment on the microflora of pecans.

Studies were conducted to determine the effectiveness of propylene oxide (PO) treatment in controlling the microflora of pecans. As used commercially, PO has little effect on internal bacteria and fungi in pecan halves. Tests of surface washings of commercially treated pecans showed a reduction of 96% in coliform bacteria following PO treatment. Under controlled laboratory conditions, PO gave 80 to 92% reduction of surface microflora and at least 64% reduction of internal flora, but neither bacteria nor fungi could be eliminated completely, even with high dosages. Current assay methods for determining bacterial content of nutmeats were shown to be inadequate because they utilize only surface washings and thus do not give an accurate picture of the total bacterial population of the nutmeat. Consequently, such assays do not permit an accurate assessment of any potential health hazard related to these organisms.

Aflatoxigenic isolates of Aspergillus flavus from pecans.

Of 120 isolates of the Aspergillus flavus group from pecans used in bakery products, 85 were shown to produce aflatoxin on yeast extract sucrose medium. Extracts from moldy sections of raw pecans obtained commercially at the retail level showed aflatoxin-like spots on thin-layer chromatography. Cooked (autoclaved) pecans inoculated with toxigenic isolates of A. flavus were also good substrates for aflatoxin production.

Investigation of reported aflatoxin production by fungi outside the Aspergillus flavus group.

A screening study of 121 fungus isolates, representing 29 species, for aflatoxin synthesis demonstrated this property only in Aspergillus flavus and A. parasiticus. Eight of the organisms found negative were isolates reported by other investigators to produce aflatoxin. Since similar negative reports have come from several other workers, it is concluded that only the A. flavus group of Aspergillus can presently be certified as sources of these toxins. Reasons for possible false-positive findings are discussed along with precautionary measures and differential analytical procedures useful in aflatoxin screening studies.