Knockdown of ecdysteroid synthesis genes results in impaired molting and high mortality in Bactericera cockerelli (Hemiptera: Triozidae).

BACKGROUND: RNA-mediated interference (RNAi) has become a promising biopesticide technology with which to direct sequence-specific gene knockdown of key targets in the potato psyllid (PoP) Bactericera cockerelli, resulting in significant mortality. In this study, three strategically selected target genes, ATF4, C7 and D24, essential for the biosynthesis and regulation of ecdysteroids, were evaluated for knockdown and mortality using oral delivery of individual, paired and all three double-stranded RNAs (dsRNAs), in five replicated experiments. Knockdown was determined as the fold-change in gene expression using a quantitative polymerase chain reaction. RESULTS: Knockdown of the D24 target, at 39%-45%, resulted in 51% PoP mortality by 10 days post-ingestion (dpi) of dsRNA. Knockdown of C7, at 38%-61%, resulted in 53% mortality by 10 dpi, whereas dsD24 ingestion resulted in 65% mortality by 10 dpi when dsD24 and dsC7 were co-delivered. Three phenotypes, INCOMEC, PREMEC and SWOLLEN, were observed at a frequency of 4%-12%, and are consistent with incomplete ecdysis in immature and/or adult PoP. Adult PoP exhibiting INCOMEC survived for several days but were unable to mate or fly, whereas SWOLLEN and PREMEC were lethal to the immature instars. Knockdown of ATF4 did not result in the mortality or malformations in immature and adult PoP. CONCLUSIONS: Compared with knockdown of individual D24 and C7 targets, significantly greater RNAi penetrance was achieved following delivery of combined dsRNAs. The highest knockdown that resulted in incomplete ecdysis and/or mortality was obtained for targets with predicted involvement in the same or interacting pathway(s). Knockdown of ATF4 was apparently "rescued" by uncharacterized compensatory gene(s) or effects. © 2022 Society of Chemical Industry.

Primary care teams' experiences of delivering mental health care during the COVID-19 pandemic: a qualitative study.

BACKGROUND: Integrated primary care teams are ideally positioned to support the mental health care needs arising during the COVID-19 pandemic. Understanding how COVID-19 has affected mental health care delivery within primary care settings will be critical to inform future policy and practice decisions during the later phases of the pandemic and beyond. The objective of our study was to describe the impact of the COVID-19 pandemic on primary care teams' delivery of mental health care. METHODS: A qualitative study using focus groups conducted with primary care teams in Ontario, Canada. Focus group data was analysed using thematic analysis. RESULTS: We conducted 11 focus groups with 10 primary care teams and a total of 48 participants. With respect to the impact of the COVID-19 pandemic on mental health care in primary care teams, we identified three key themes: i) the high demand for mental health care, ii) the rapid transformation to virtual care, and iii) the impact on providers. CONCLUSIONS: From the outset of the COVID-19 pandemic, primary care quickly responded to the rising mental health care demands of their patients. Despite the numerous challenges they faced with the rapid transition to virtual care, primary care teams have persevered. It is essential that policy and decision-makers take note of the toll that these demands have placed on providers. There is an immediate need to enhance primary care's capacity for mental health care for the duration of the pandemic and beyond.

Characterization of the Complete Genome and P0 Protein for a Previously Unreported Genotype of Cotton Leafroll Dwarf Virus, an Introduced Polerovirus in the United States.

Virus-like disease symptoms consisting of leaf cupping, shortened internodes, and overall stunting were observed in commercial cotton fields in Alabama in 2017 to 2018. To determine the complete genome sequence of the suspected causal polerovirus, symptomatic leaf samples were collected in Macon County, Alabama, and subjected to Illumina RNA sequencing. Based on BLASTn analysis, the Illumina contig of 5,771 nt shared the highest nucleotide identity (approximately 95%) with members of the species Cotton leafroll dwarf virus (CLRDV) (genus Polerovirus; family Luteoviridae) from Argentina and Brazil. The full-length viral genome sequence was verified by reverse transcription (RT)-PCR amplification, cloning, and Sanger sequencing. The complete CLRDV genome of 5,865 nt in length shared 94.8 to 95.2% nucleotide identity with six previously reported CLRDV isolates. The genome of the CLRDV isolate amplified from Alabama samples (CLRDV-AL) has seven predicted open reading frames (ORFs). Viral proteins 1 to 5 (P1 to P5) shared 91.9 to 99.5% amino acid identity with the six CLRDV isolates from Argentina and Brazil. However, P0, the suppressor of host gene silencing, shared 82.4 to 88.5% pairwise amino acid identity with the latter CLRDV isolates. Phylogenetic analysis of the seven full-length CLRDV genomes resolved three sister clades: CLRDV-AL, CLRDV-typical, and CLRDV-atypical, respectively. Three recombination events were detected by the recombination detection program among the seven CLRDV isolates with breakpoints occurring along the genome. Pairwise nucleotide identity comparisons of ORF0 sequences for the three CLRDV-AL field isolates indicated that they were >99% identical, suggesting that this previously unknown CLRDV genotype represents a single introduction to Alabama.

Role of age and health in perceptions of returning to work: a qualitative study.

BACKGROUND: People aged over 50 years form a growing proportion of the working age population, but are at increased risk of unemployment compared to other age groups. It is often difficult to return to work after unemployment, particularly for those with health issues. In this paper, we explored the perceptions, attitudes, and experiences of returning to work after a period of unemployment (hereafter RTW) barriers among unemployed adults aged over 50 years. METHOD: In-depth semi-structured interviews were conducted with a diverse sample of 26 unemployed individuals aged 50-64 years who were engaged with the UK Government's Work Programme. Data were thematically analysed. RESULTS: Age alone was not discussed by participants as a barrier to work; rather their discussions of barriers to work focused on the ways in which age influenced other issues in their lives. For participants reporting chronic health conditions, or disabilities, there was a concern about being unfit to return to their previous employment area, and therefore having to "start again" in a new career, with associated concerns about their health status and managing their treatment burden. Some participants also reported experiencing either direct or indirect ageism (including related to their health status or need to access healthcare) when looking for work. Other issues facing older people included wider socio-political changes, such as the increased pension age, were felt to be unfair in many ways and contradicted existing expectations of social roles (such as acting as a carer for other family members). CONCLUSION: Over-50s experienced multiple and interacting issues, at both the individual and societal level, that created RTW barriers. There is a need for employability interventions that focus on supporting the over-50s who have fallen out of the labour market to take a holistic approach, working across healthcare, employability and the local labour market, providing treatment and skills training for both those out of work and for employers, in order to create an intervention that that helps achieve RTW and its associated health benefit.

Colonization and Intrusive Invasion of Potato Psyllid by 'Candidatus Liberibacter solanacearum'.

Previous studies have shown that the fastidious bacterial plant pathogen 'Candidatus Liberibacter solanacearum' (CLso) is transmitted circulatively and propagatively by the potato psyllid (PoP) Bactericera cockerelli. In this study, the temporal and spatial interrelationships between CLso PoP were investigated by scanning electron microscopy of the digestive system of PoP immature and adult instars and salivary glands of adults post CLso ingestion. CLso biofilms were not detectable on the outer midgut surface of the first and second instars; however, for third to fifth instars and teneral and mature adults, biofilms were observed in increasing numbers in each successive developmental stage. In adult PoP midguts, CLso cells were observed between the basal lamina and basal epithelial cell membranes; in basal laminar perforations, on the outer basal laminar surface, and in the ventricular lumen, epithelial cytosol, and filter chamber periventricular space. CLso were also abundantly visible in the salivary gland pericellular spaces and in the epidermal cell cytosol of the head. Collectively, these results point to an intrusive, systemic invasion of PoP by CLso that employs an endo/exocytosis-like mechanism, in the context of a propagative, circulative mode of transmission.

Asking patients about their religious and spiritual beliefs: Cross-sectional study of family physicians.

OBJECTIVE: To examine family physicians' practices in and opinions on asking patients about their religious and spiritual beliefs, as well as physicians' comfort levels in asking. DESIGN: Cross-sectional study using self-administered questionnaires. SETTING: Kitchener-Waterloo, Ont. PARTICIPANTS: A total of 155 family physicians with office practices. MAIN OUTCOME MEASURES: Frequency of asking patients about their religious and spiritual beliefs and physicians' comfort levels in asking. Separate multiple linear regression analyses were conducted for each of these outcomes. RESULTS: A total of 139 questionnaires were returned for a response rate of 89.7 %. Of the respondents, 51.8 % stated that they asked patients about their religious and spiritual beliefs sometimes. Physician opinion that it was important to ask patients about religious and spiritual beliefs (P = .001) and physician comfort level with asking (P < .001) were significantly associated with physicians' frequency of asking patients about their religious and spiritual beliefs. Comfort level with asking patients about their religious and spiritual beliefs was significantly associated with the opinions that it was important to ask (P = .004) and that it was their business to ask (P = .003), as well as with lack of training as the reason for not asking (P = .007). CONCLUSION: This study found that family physicians were more likely to ask patients about their religious and spiritual beliefs if they had higher comfort levels in asking or if they believed that asking was important. Further, this study found that family physicians' comfort level with asking was higher if they believed that it was important to ask and that it was their business to ask about religious and spiritual beliefs. Physician comfort levels with asking patients about religious and spiritual beliefs can be addressed through adequate training and education.

A novel approach to early sickness absence management: The EASY (Early Access to Support for You) way.

BACKGROUND: Sickness absence (SA) is multi-causal and remains a significant problem for employees, employers and society. This makes it necessary to concurrently manage a particular disabling condition and consider the working environment and employee-employer relationship. OBJECTIVE: To describe and examine the components of a novel SA management service Early Access to Support for You (EASY) and discuss their potential influence on the intervention. METHODS: A new sickness absence model, starting from day one of absence, was created called EASY. EASY is planned to support both employees and managers and comprises elements already found to be associated with reduction of SA, such as maintaining regular contact; early biopsychosocial case-management; physiotherapy; mental-health counselling; work modification; phased return-to-work; and health promotion activities. RESULTS: During the EASY implementation period, the SA rate at a health board reversed its trend of being one of the highest rates in the Scottish National Health Service (NHS) and EASY was considered helpful by both managers and employees. CONCLUSIONS: This paper describes an innovative occupational health intervention to sickness absence management based on the bio-psychosocial model to provide early intervention, and discusses the pros and cons of applying cognitive behavioural principles at an early stage in sickness-absence events, in order to improve return-to-work outcomes.

The EASY (Early Access to Support for You) sickness absence service: a four-year evaluation of the impact on absenteeism.

OBJECTIVES: In May 2008, the National Health Service (NHS) Lanarkshire (NHSL) implemented a unique telephone-based sickness absence management service entitled "EASY" (Early Access to Support for You). The EASY service supplements existing absence policies and enables telephone communication between the absentee, their line manager, and the EASY service from the first day of absence and referral to occupational health services at day ten. The aim of this study was to determine if the EASY service was effective between May 2008 and May 2012 in reducing sickness absence in NHSL compared to normal occupational healthcare in NHS Scotland and is, as such, a cost-saving intervention. METHODS: This study included time-series analysis of health board sickness absence data and analyses of the EASY service database (survival analyses and Cox's proportional hazards model). RESULTS: The EASY service was effective in reducing sickness absence by 21% in NHSL, whereas the nonspecific tightening of the sickness absence policies across the rest of Scottish NHS health boards reduced sickness absence by approximately 9%. The richness of the EASY database gave detailed information on absentees by cause, duration, job family, and reporting compliance. The mean duration of musculoskeletal absences was significantly shorter in years 2, 3, and 4 compared to year 1. Those absentees contacted by phone on the first day of absence were more likely to return to work than those contacted on subsequent days. The EASY service improves economic efficiency; the value of the hours saved from the reduced sickness absence exceeds the cost of operating the service. CONCLUSION: The study highlights the importance of an early telephone-based intervention for sickness absence management.

Understanding physiotherapists' roles in ontario primary health care teams.

PURPOSE: To understand physiotherapists' roles and how they are enacted within Ontario primary health care (PHC) teams. METHODS: Following a pragmatic grounded theory approach, 12 physiotherapists practising within Ontario PHC teams participated in 18 semi-structured in-depth in-person interviews. All interviews were audiotaped and transcribed verbatim, then entered into NVIVO-8. Coding followed three progressive analytic stages and was iterative in nature, guided by grounded theory. An explanatory scheme was developed. RESULTS: Physiotherapists negotiate their place within the PHC teams through five interrelated roles: (1) manager; (2) evaluator; (3) collaborator; (4) educator; and (5) advocate. These five roles are influenced by three contextual layers: (1) inter-professional team; (2) community and population served; and (3) organizational structure and funding. Canada's PHC mandate (access, teams, information, and healthy living) frame the contexts that influence role enactment. CONCLUSIONS: To fulfill the PHC mandate, physiotherapists carry out multiple roles that are based on a broad holistic perspective of health, within the context of a collaborative inter-professional team and the community, through an evidenced-informed approach to care. There appear to be multiple ways of successfully integrating physiotherapists within PHC teams, provided that role enactment is context sensitive and congruent with the mandate of PHC.

Objectif : Comprendre les rôles des physiothérapeutes et comment ils sont appliqués au sein des équipes de fournisseurs de soins de santé primaires en Ontario. Méthodes : Suivant une méthode théorique à base empirique pratique, 12 physiothérapeutes pratiquant dans des équipes de soins de santé primaires de l'Ontario ont participé à 18 entrevues personnelles détaillées semi-structurées. Toutes les entrevues ont été enregistrées, transcrites verbatim et entrées ensuite dans NVIVO-8. Le codage a suivi trois stades analytiques progressifs et était de nature répétitive, guidé par une théorie à base empirique. On a créé un système explicatif. Résultats : Les physiothérapeutes négocient leur place au sein des équipes de soins de santé primaires en jouant cinq rôles interdépendants : (1) gestionnaire; (2) évaluateur; (3) collaborateur; (4) éducateur; (5) représentant. Ces cinq rôles subissent l'influence de trois strates contextuelles : (1) équipe interprofessionnelle; (2) communauté et population desservies; (3) structure organisationnelle et financement. Le mandat du Canada au niveau des soins de santé primaires (accès, équipe, information et vie saine) circonscrit les contextes qui agissent sur les rôles joués. Conclusions : Pour s'acquitter du mandat relatif aux soins de santé primaires, les physiothérapeutes jouent de multiples rôles qui reposent sur une perspective holistique générale de la santé dans le contexte d'une équipe interprofessionnelle basée sur la collaboration et de la communauté, en suivant une approche des soins éclairée par des éléments probants. Il semble y avoir de multiples façons d'intégrer avec succès les physiothérapeutes dans les équipes de soins de santé primaires, à condition que les rôles joués soient contextualisés et conformes au mandat relatif aux soins de santé primaires.

Intergeneric recombination between a new, spinach-infecting curtovirus and a new geminivirus belonging to the genus Becurtovirus: first New World exemplar.

A novel curtovirus, spinach severe curly top virus (SSCTV), was associated with symptomatic spinach plants collected from a commercial field in south-central Arizona during 2009. In addition, a second viral molecule of about 2.9 kb from the same spinach plants was amplified, cloned and sequenced. The latter isolate, herein named spinach curly top Arizona virus (SCTAV), was found to share 77 % pairwise sequence identity with beet curly top Iran virus (BCTIV), a leafhopper-transmitted geminivirus that has been assigned to the new genus Becurtovirus. The SCTAV genome encodes three viral-sense genes, V1, V2, and V3, and two complementary-sense genes, C1 and C2. There was no evidence for the presence of either a C3 or C4 ORF in the genome sequence. The genome organization of SCTAV is not like that of New World curtoviruses but instead is similar to that of BCTIV, which, to date, is only known to be present in Iran. Consistent with this observation, SCTAV and BCTIV both contain the unusual nonanucleotide TAAGATT/CC and a replication-associated protein, Rep (or C1), that is more closely related to the mastrevirus Rep than to those of curtoviruses reported to date. Both SSCTV and SCTAV were found to have a recombinant genome containing sequences (AY548948) derived from ancestral SCTV sequences in the virion-sense portions of the genome. Agroinoculation of Nicotiana benthamiana (Domin) plants with the cloned genome of SCTAV resulted in infection of 95 % of the plants and the development of severe curling symptoms, whereas only 20 % of the SSCTV-inoculated plants were infected, developing only mild curling symptoms. When plants were co-inoculated with both viruses, the frequency of infection remained higher for SCTAV than for SSCTV (80 % vs. 20 %), indicating no evidence of synergistic effects between the two viruses with respect to efficiency of infection.

Palliative care making a difference in rural Uganda, Kenya and Malawi: three rapid evaluation field studies.

BACKGROUND: Many people live and die in pain in Africa. We set out to describe patient, family and local community perspectives on the impact of three community based palliative care interventions in sub-Saharan Africa. METHODS: Three palliative care programmes in Uganda, Kenya and Malawi were studied using rapid evaluation field techniques in each country, triangulating data from three sources: interviews with key informants, observations of clinical encounters and the local health and social care context, and routine data from local reports and statistics. RESULTS: We interviewed 33 patients with advanced illness, 27 family carers, 36 staff, 25 volunteers, and 29 community leaders and observed clinical care of 12 patients. In each site, oral morphine was being used effectively. Patients valued being treated with dignity and respect. Being supported at home reduced physical, emotional and financial burden of travel to, and care at health facilities. Practical support and instruction in feeding and bathing patients facilitated good deaths at home.In each country mobile phones enabled rapid access to clinical and social support networks. Staff and volunteers generally reported that caring for the dying in the face of poverty was stressful, but also rewarding, with resilience fostered by having effective analgesia, and community support networks. CONCLUSIONS: Programmes were reported to be successful because they integrated symptom control with practical and emotional care, education, and spiritual care. Holistic palliative care can be delivered effectively in the face of poverty, but a public health approach is needed to ensure equitable provision.

Impact of spirituality on palliative care physicians: personally and professionally.

BACKGROUND: Modern palliative care defines four key domains fundamental to a patients' holistic care: physical, emotional, social, and spiritual. Regardless of the symptom being addressed, all four domains of care may need to be addressed to reduce suffering and encourage healing. Yet, despite the spiritual domain consistently being asserted as an integral part of palliative care, more is written on how to provide the physical, emotional, and social aspects of care than on how to provide spiritual care. OBJECTIVE: The objective of this study was to explore the perspectives and experiences of palliative care physicians regarding the spiritual domain of care and to identify the role of this domain both personally and professionally. DESIGN: This study recruited a purposeful sample of palliative care physicians and utilized the qualitative method of phenomenology to elicit palliative care physician's perspectives and experiences regarding the importance of spirituality in providing palliative care to patients. RESULTS: Themes that emerged from the study in relation to palliative care physicians' perspectives and experiences regarding the spiritual domain of care included the concept of spirituality and the difference between spirituality and religion. The overarching theme was the concept of how the participant's own spirituality impacted their practice and their practice impacted their spirituality. These were inextricably woven together. CONCLUSION: Addressing spirituality was fundamental to a palliative care physician providing compassionate and holistic care. The impact of a physician's personal spirituality on practice and practice on spirituality were inextricably woven together.

Ontario care providers' considerations regarding models of maternity care.

OBJECTIVE: There is currently a crisis in the delivery of maternity care in Canada, in part due to the significant decline in the number of professionals who provide intrapartum care. This study was undertaken (1) to elicit care providers' opinions regarding seven proposed models of maternity care, (2) to explore barriers to collaborative interprofessional practice, and (3) to identify factors that would encourage the practice of intrapartum care. METHODS: A survey seeking opinions about models of care, perceived barriers to interprofessional collaboration, and factors that might encourage practising intrapartum care was mailed to all registered midwives (N = 322) and obstetricians (N = 647) in Ontario and to a stratified random sample of family physicians (N = 750) in Ontario. RESULTS: Completed questionnaires were received from 80% of midwives, 64% of obstetricians, and 66% of family physicians. Midwives and obstetricians endorsed uniprofessional models and indicated an interest in multiprofessional practice. Family physicians were reluctant to choose any models that would have them practising intrapartum care. However, family physicians currently providing intrapartum care would consider the uniprofessional model in which they delivered the babies of the women they were caring for unless they were signed out. Midwives identified different philosophies of care as the main barrier to collaborative interprofessional maternity care (60.7%); obstetricians and family doctors identified liability and insurance issues (60.3% and 38.7%, respectively). An adequate on-call arrangement was the key factor potentially encouraging midwives and obstetricians to provide intrapartum care (70.3% and 70.0%, respectively). For family physicians, good medical and obstetrical back-up was the first priority (70.8%), followed by on-call arrangements. CONCLUSION: A variety of models for providing intrapartum care must be available, as no single model meets the needs of all maternity providers. Attention must be given to eliminating barriers to collaborative interprofessional practice, coupled with enhancing factors that facilitate the delivery of intrapartum care.

Men with prostate cancer: making decisions about complementary/alternative medicine.

PURPOSE: The purpose of this study was to explore prostate cancer patients 'perceptions, feelings, ideas, and experiences regarding making decisions to use (or not use) complementary/alternative medicine (CAM). METHODS: Five focus groups were conducted with 29 men diagnosed with prostate cancer. Content analysis of the verbatim transcripts was used to identify key themes in the data. FINDINGS: Decision making about CAM treatments appears to depend on both fixed (e.g., disease characteristics, demographic characteristics, and medical history) and flexible (e.g., perceptions of CAM and conventional medicine, experiences with the health care system and health care practitioners, and perceptions about the need for control or action) decision factors. CONCLUSIONS: The participants in this study appeared more likely to be "pushed" toward using CAM by negative experiences with the health care system than to be "pulled" toward CAM by perceptions about its safety or congruence with their beliefs about health and illness.

Use of complementary/alternative medicine by men diagnosed with prostate cancer: prevalence and characteristics.

OBJECTIVES: To ascertain the prevalence of the use of complementary/alternative medicine (CAM) among a random sample of Ontario (Canadian) men diagnosed with prostate cancer and to explore in what way users of CAM differ from nonusers. METHODS: A questionnaire was mailed to a random sample of 696 men diagnosed with prostate cancer. RESULTS: The final response rate was 78.8%. Almost one third (29.8%) reported using CAM for their prostate cancer care. Natural health products (most commonly vitamin E, saw palmetto, and selenium) were used by 26.5% of the respondents. CAM therapies were used by 17.0% of the men (most commonly dietary changes), and only 9.1% visited CAM practitioners. Three characteristics appear to differentiate CAM users from nonusers. Men who had attended support groups were much more likely to use CAM. Men who had more advanced disease, and those who believed in the efficacy of CAM, but were not concerned about potential adverse effects of CAM, were also more likely to use CAM. CAM use was not related to education, income, or geographic location. CONCLUSIONS: The data suggest that CAM use is no longer a phenomenon restricted to a unique segment of the population that is highly educated and enjoys a high family income. CAM use appears to be more related to other factors such as support group attendance, disease characteristics, and beliefs about CAM. Our findings highlight the need for urologists to ask all their patients about their use of CAM.

Women's decision-making about their health care: views over the life cycle.

This paper describes a compilation and further analysis of three qualitative studies, conducted independently, on women's health care decisions. Key areas regarding women's health, which span the life cycle, were examined including prenatal genetic screening, hormone replacement therapy and the use of complementary/alternative medicine in the treatment of breast cancer. Common themes were evident across all the focus groups in each of the three studies including: women's information seeking behavior; reliance on trusted information sources; the desire for information sharing; active involvement in the decision-making process; and accepting the consequences of the final decision. The findings have important implications for health care professionals as they engage women in the decision-making process about health concerns.