The benefits of index telephone consultations in patients referred on the two-week wait colorectal cancer pathway.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic led to hospitals in the UK substituting face-to-face (FtF) clinics with virtual clinic (VC) appointments. We evaluated the use of virtual two-week wait (2-ww) lower gastrointestinal (LGI) clinic appointments, conducted using telephone calls at a district general hospital in England. METHODS: Patients undergoing index outpatient 2-ww LGI clinic assessment between 1 June 2019 and 31 October 2019 (FtF group) and 1 June 2020 and 31 October 2020 (VC group) were identified. Relevant data were obtained using electronic patient records. Compliance with national cancer waiting time targets was assessed. Environmental and financial impact analyses were performed. RESULTS: In total, 1,531 patients were analysed (median age=70, male=852, 55.6%). Of these, 757 (49.4%) were assessed virtually via telephone; the remainder were seen FtF (n=774, 50.6%). Ninety-two (6%, VC=44, FtF=48) patients had malignant pathology and 64 (4.2%) had colorectal cancer (CRC); of these, 46 (71.9%, VC=26, FtF=20) underwent treatment with curative intent. The median waiting times to index appointment, investigation and diagnosis were significantly lower following VC assessment (p<0.001). The cancer detection rates (p=0.749), treatments received (p=0.785) and median time to index treatment for CRC patients (p=0.156) were similar. A significantly higher proportion of patients were seen within two weeks of referral in the VC group (p<0.001). VC appointments saved patients a total of 9,288 miles, 0.7 metric tonnes of CO2 emissions and £7,482.97. Taxpayers saved £80,242.00 from VCs. No formal complaints were received from patients or staff in the VC group. CONCLUSION: Virtual 2-ww LGI clinics were effective, safe and were associated with tangible environmental and financial benefits.

Solving the Puzzles of the Decay of the Heaviest Known Proton-Emitting Nucleus

Two long-standing puzzles in the decay of ^{185}Bi, the heaviest known proton-emitting nucleus are revisited. These are the nonobservation of the 9/2^{-} state, which is the ground state of all heavier odd-A Bi isotopes, and the hindered nature of proton and α decays of its presumed 60-µs 1/2^{+} ground state. The ^{185}Bi nucleus has now been studied with the ^{95}Mo(^{93}Nb,3n) reaction in complementary experiments using the Fragment Mass Analyzer and Argonne Gas-Filled Analyzer at Argonne National Laboratory's ATLAS facility. The experiments have established the existence of two states in ^{185}Bi; the short-lived T_{1/2}=2.8_{-1.0}^{+2.3} µs, proton- and α-decaying ground state, and a 58(2)-µs γ-decaying isomer, the half-life of which was previously attributed to the ground state. The reassignment of the ground-state lifetime results in a proton-decay spectroscopic factor close to unity and represents the only known example of a ground-state proton decay to a daughter nucleus (^{184}Pb) with a major shell closure. The data also demonstrate that the ordering of low- and high-spin states in ^{185}Bi is reversed relative to the heavier odd-A Bi isotopes, with the intruder-based 1/2^{+} configuration becoming the ground, similar to the lightest At nuclides.

Constraining the Neutron Star Compactness: Extraction of the

The ^{23}Al(p,γ)^{24}Si reaction is among the most important reactions driving the energy generation in type-I x-ray bursts. However, the present reaction-rate uncertainty limits constraints on neutron star properties that can be achieved with burst model-observation comparisons. Here, we present a novel technique for constraining this important reaction by combining the GRETINA array with the neutron detector LENDA coupled to the S800 spectrograph at the National Superconducting Cyclotron Laboratory. The ^{23}Al(d,n) reaction was used to populate the astrophysically important states in ^{24}Si. This enables a measurement in complete kinematics for extracting all relevant inputs necessary to calculate the reaction rate. For the first time, a predicted close-lying doublet of a 2_{2}^{+} and (4_{1}^{+},0_{2}^{+}) state in ^{24}Si was disentangled, finally resolving conflicting results from two previous measurements. Moreover, it was possible to extract spectroscopic factors using GRETINA and LENDA simultaneously. This new technique may be used to constrain other important reaction rates for various astrophysical scenarios.

Phytophthora Species Are Common on Nursery Stock Grown for Restoration and Revegetation Purposes in California.

Phytophthora tentaculata was detected for the first time in North America in 2012 in a nursery on sticky monkeyflower plant (Diplacus aurantiacus) and again in 2014 on outplanted native plants. At that time, this species was listed as a federally actionable and reportable pathogen by the USDA. As a result of these detections, California native plant nurseries were surveyed to determine the prevalence of Phytophthora species on native plant nursery stock. A total of 402 samples were collected from 26 different native plant nurseries in California between 2014 and 2016. Sampling focused on plants with symptoms of root and crown rot. Symptomatic tissue was collected and tested by immunoassay, culture, and molecular techniques (PCR). Identifications were made using sequences from the internal transcribed spacer (ITS) rDNA region, a portion of the trnM-trnP-trnM, or the atp9-nad9 mitochondrial regions. Phytophthora was confirmed from 149 of the 402 samples (37%), and from plants in 22 different host families. P. tentaculata was the most frequently detected species in our survey, followed by P. cactorum and members of the P. cryptogea complex. Other species include P. cambivora, P. cinnamomi, P. citricola, P. hedraiandra, P. megasperma, P. multivora, P. nicotianae, P. niederhauserii, P. parvispora, P. pini, P. plurivora, and P. riparia. A few Phytophthora sequences generated from mitochondrial regions could not be assigned to a species. Although this survey was limited to a relatively small number of California native plant nurseries, Phytophthora species were detected from three quarters of them (77%). In addition to sticky monkeyflower, P. tentaculata was detected from seven other hosts, expanding the number of associated hosts. During this survey, P. parvispora was detected for the first time in North America from symptomatic crowns and roots of the nonnative Mexican orange blossom (Choisya ternata). Pathogenicity of P. parvispora and P. nicotianae was confirmed on this host. These findings document the widespread occurrence of Phytophthora spp. in native plant nurseries and highlight the potential risks associated with outplanting infested nursery-grown stock into residential gardens and wildlands.

Superallowed α Decay to Doubly Magic

We report the first observation of the ^{108}Xe→^{104}Te→^{100}Sn α-decay chain. The α emitters, ^{108}Xe [E_{α}=4.4(2) MeV, T_{1/2}=58_{-23}^{+106} µs] and ^{104}Te [E_{α}=4.9(2) MeV, T_{1/2}<18 ns], decaying into doubly magic ^{100}Sn were produced using a fusion-evaporation reaction ^{54}Fe(^{58}Ni,4n)^{108}Xe, and identified with a recoil mass separator and an implantation-decay correlation technique. This is the first time α radioactivity has been observed to a heavy self-conjugate nucleus. A previous benchmark for study of this fundamental decay mode has been the decay of ^{212}Po into doubly magic ^{208}Pb. Enhanced proton-neutron interactions in the N=Z parent nuclei may result in superallowed α decays with reduced α-decay widths significantly greater than that for ^{212}Po. From the decay chain, we deduce that the α-reduced width for ^{108}Xe or ^{104}Te is more than a factor of 5 larger than that for ^{212}Po.

Putting patients at the center of kidney care transitions: PREPARE NOW, a cluster randomized controlled trial.

Care for patients transitioning from chronic kidney disease to kidney failure often falls short of meeting patients' needs. The PREPARE NOW study is a cluster randomized controlled trial studying the effectiveness of a pragmatic health system intervention, 'Patient Centered Kidney Transition Care,' a multi-component health system intervention designed to improve patients' preparation for kidney failure treatment. Patient-Centered Kidney Transition Care provides a suite of new electronic health information tools (including a disease registry and risk prediction tools) to help providers recognize patients in need of Kidney Transitions Care and focus their attention on patients' values and treatment preferences. Patient-Centered Kidney Transition Care also adds a 'Kidney Transitions Specialist' to the nephrology health care team to facilitate patients' self-management empowerment, shared-decision making, psychosocial support, care navigation, and health care team communication. The PREPARE NOW study is conducted among eight [8] outpatient nephrology clinics at Geisinger, a large integrated health system in rural Pennsylvania. Four randomly selected nephrology clinics employ the Patient Centered Kidney Transitions Care intervention while four clinics employ usual nephrology care. To assess intervention effectiveness, patient reported, biomedical, and health system outcomes are collected annually over a period of 36 months via telephone questionnaires and electronic health records. The PREPARE NOW Study may provide needed evidence on the effectiveness of patient-centered health system interventions to improve nephrology patients' experiences, capabilities, and clinical outcomes, and it will guide the implementation of similar interventions elsewhere. TRIAL REGISTRATION: NCT02722382.

Risk factors and indicators of reduced welfare of grazing dairy cows from selected smallholder dairy farms in Midlands Province, Zimbabwe.

Zimbabwe's smallholder dairying faces many challenges that affect the welfare of dairy cows; however, the status of this welfare has not yet been determined. A cross-sectional study was conducted in Midlands Province on 41 active smallholder dairy farms with 86 cows in winter and summer to determine the risk factors and indicators to impaired cow welfare. These objectives were achieved using farmer questionnaires and direct observations. Eleven percent of the observed cows were severely lame in summer while only 5% were severely lame in winter. Lameness was significantly associated with season, absence of shade, breed, and low dipping frequency; 58% of the cows had low body condition scores (BC < 3) and this low BC was associated with low frequency of protein (p = 0.002) and vitamin (p = 0.012) supplementation recorded in more than 52% of the farms visited. In winter, only 11% of the observed cows were heavily soiled (score 3), while in summer 64% of the cows were heavily soiled and this was associated with slurry accumulation in more than 80% of the observed cattle pens as well as the study season (p < 0.001). A quarter (26%) of the studied animals had visible teat lesions on the teat skin and this was associated with the type of lubricant used (p = 0.011). Only 34% of the cows allowed an approaching stockman to touch them and this was associated with shouting (p = 0.012) and whipping of cows (p = 0.002). The study concluded that welfare of dairy cows was poor in most of the smallholder dairy farms studied.

Downregulation of estrogen receptor and modulation of growth of breast cancer cell lines mediated by paracrine stromal cell signals.

PURPOSE: Breast cancers have a poorer prognosis if estrogen receptor expression was lost during recurrence. It is unclear whether this conversion is cell autonomous or whether it can be promoted by the microenvironment during cancer dormancy. We explored the ability of marrow-derived stromal cell lines to arrest co-cultured breast cancer cells and suppress estrogen receptor alpha (ER) expression during arrest, facilitating the emergence of estrogen-independent breast cancer clones. METHODS: Cancer cell growth, ER protein, microRNA, and mRNA levels were measured in breast cancer cell lines exposed to conditioned medium from marrow stromal lines in the presence and absence of estrogen and of signaling pathway modulators. RESULTS: We demonstrate that paracrine signaling from the stromal cell line HS5 downregulated ER in T47D and MCF7 breast cancer cells. This occurred at the mRNA level and also through decreased ER protein stability. Additionally, conditioned medium (CM) from HS5 arrested the breast cancer cells in G0/G1 in part through interleukin-1 (IL1) and inhibited cancer cell growth despite the activation of proliferative pathways (Erk and AKT) by the CM. Similar findings were observed for CM from the hFOB 1.19 osteoblastic cell line but not from two other fibroblastic marrow lines, HS27A and KM101. HS5-CM inhibition of MCF7 proliferation could not be restored by exogenous ER, but was restored by the IL1-antagonist IL1RA. In the presence of IL1RA, HS5-CM activation of AKT and Erk enabled the outgrowth of breast cancer cells with suppressed ER that were fulvestrant-resistant and estrogen-independent. CONCLUSIONS: We conclude that marrow-derived stromal cells can destabilize estrogen receptor protein to convert the ER status of growth-arrested ER+ breast cancer cell lines. The balance between stromal pro- and anti-proliferative signals controlled the switch from a dormant phenotype to estrogen-independent cancer cell growth.

Inverse Kinematic Study of the (26g)Al(d,p)(27)Al Reaction and Implications for Destruction of (26)Al in Wolf-Rayet and Asymptotic Giant Branch Stars.

In Wolf-Rayet and asymptotic giant branch (AGB) stars, the (26g)Al(p,γ)(27)Si reaction is expected to govern the destruction of the cosmic γ-ray emitting nucleus (26)Al. The rate of this reaction, however, is highly uncertain due to the unknown properties of key resonances in the temperature regime of hydrogen burning. We present a high-resolution inverse kinematic study of the (26g)Al(d,p)(27)Al reaction as a method for constraining the strengths of key astrophysical resonances in the (26g)Al(p,γ)(27)Si reaction. In particular, the results indicate that the resonance at E(r)=127 keV in (27)Si determines the entire (26g)Al(p,γ)(27)Si reaction rate over almost the complete temperature range of Wolf-Rayet stars and AGB stars.

Half-life systematics across the N=126 shell closure: role of first-forbidden transitions in the ß decay of heavy neutron-rich nuclei.

This Letter reports on a systematic study of ß-decay half-lives of neutron-rich nuclei around doubly magic (208)Pb. The lifetimes of the 126-neutron shell isotone (204)Pt and the neighboring (200-202)Ir, (203)Pt, (204)Au are presented together with other 19 half-lives measured during the "stopped beam" campaign of the rare isotope investigations at GSI collaboration. The results constrain the main nuclear theories used in calculations of r-process nucleosynthesis. Predictions based on a statistical macroscopic description of the first-forbidden ß strength reveal significant deviations for most of the nuclei with N<126. In contrast, theories including a fully microscopic treatment of allowed and first-forbidden transitions reproduce more satisfactorily the trend in the measured half-lives for the nuclei in this region, where the r-process pathway passes through during ß decay back to stability.

First measurements of a carbon dioxide plume from an industrial source using a ground based mobile differential absorption lidar.

The emission of carbon dioxide (CO2) from industrial sources is one of the main anthropogenic contributors to the greenhouse effect. Direct remote sensing of CO2 emissions using optical methods offers the potential for the identification and quantification of CO2 emissions. We report the development and demonstration of a ground based mobile differential absorption lidar (DIAL) able to measure the mass emission rate of CO2 in the plume from a power station. To our knowledge DIAL has not previously been successfully applied to the measurement of emission plumes of CO2 from industrial sources. A significant challenge in observing industrial CO2 emission plumes is the ability to discriminate and observe localised concentrations of CO2 above the locally observed background level. The objectives of the study were to modify our existing mobile infrared DIAL system to enable CO2 measurements and to demonstrate the system at a power plant to assess the feasibility of the technique for the identification and quantification of CO2 emissions. The results of this preliminary study showed very good agreement with the expected emissions calculated by the site. The detection limit obtained from the measurements, however, requires further improvement to provide quantification of smaller emitters of CO2, for example for the detection of fugitive emissions. This study has shown that in principle, remote optical sensing technology will have the potential to provide useful direct data on CO2 mass emission rates.

A survey of post-amputation pains in serving military personnel.

INTRODUCTION: Amputation is a common injury in survivors of current military conflicts. The primary aim of this study was to establish the prevalence rate of phantom limb pain (PLP) in military personnel undergoing rehabilitation at the UK's Defence Medical Rehabilitation Centre. The secondary aims were to establish treatment failure rates and prevalence rates of phantom limb sensations (PLS) and residual limb pains (RLP). METHOD: A questionnaire survey was developed from that used in a previous study of pains in veterans. Questions were asked of the intensity of PLP, RLP and PLS over the previous month and the entire time since amputation. Treatment failure was defined as greater than 'mild' pain. A literature review for similar studies was undertaken. RESULTS: There were 48 responders with 65 amputations. PLP in the previous month was reported by 49% of respondents and 20% were classed as treatment failures; 76% had PLP at some point and 56% were analgesic failures. PLS was commoner with 70% reported over the previous month and 66% at any time. 65% had RLP over the previous month, 31% were treatment failures and 80% had experienced RLP at some point and 63% of these were failures of treatment. Eight other papers were found for comparison. CONCLUSIONS: This is the first paper that describes prevalence of pains associated with amputation in a serving military population. It also describes the use of analgesic failure as a concept and provides an encouraging rate of as low as 20% in this population.

First Detection of Puccinia ballotiflora on Salvia greggii.

Salvia greggii, autumn sage, is grown for its bright red to white flowers that bloom in late summer and fall. In February of 2008, a rust sample was sent to the CDFA plant pathology diagnostics laboratory in Sacramento from a nursery in Santa Barbara County, CA. Pustules were abundant on older leaves causing moderate defoliation of containerized stock. Only the varieties with entirely red or pink flowers were affected. S. greggii 'Hotlips,' a popular white/red bicolor, was unaffected. Amphigenous uredinia were cinnamon brown, round, powdery, and sometimes surrounded by yellow halos. Pustules were found primarily on the leaves, although a few were on the stems. Urediniospores were broadly obovoid, subglobose to broadly ellipsoid, echinulate, and 22 to 27 × 24 to 32 µm (24.9 × 26.9 µm average) with one apical pore and 2 to 3 equatorial pores. Urediniospore walls were cinnamon brown in color and measured 1.0 to 2.0 µm (1.5 µm average). No telia were observed. After the initial detection, this rust was found in additional nursery sites in Santa Cruz, Santa Clara, Santa Barbara, and Ventura counties in 2008 and 2009. In November of 2011, a sample from a landscape planting in Santa Barbara County of a similar rust with telia and teliospores was submitted. Urediniospores and teliospores were present in the same lesions. Lesions with teliospores were located primarily on the stems. Mature teliospores were two-celled, verrucose, chocolate brown, and 25 to 31 × 32 to 40 µm (28.6 × 35.3 µm average) with a pedicel ranging from 8 to 12 × 38 to 104 µm, sometimes attached obliquely. The rust matched the morphological characteristics of Puccinia ballotiflora (Syn = P. ballotaeflora Long) (2). To confirm pathogenicity, three 20-cm-tall plants of S. greggii 'Navajo Red' in 3.8-liter pots were spray inoculated with 10 ml of a 2.5 × 103 urediniospores per ml suspension and incubated in a dew chamber at 23°C for 2 days in the dark. Plants were transferred to a growth chamber maintained at 22°C with a 12-h photoperiod. Three plants were sprayed with sterile distilled water as controls. Uredinial pustules (1 to 2 mm) appeared on the abaxial surface of the leaves after 3 weeks. The pathogenicity test was repeated with similar results. The internal transcribed spacer region of rDNA and a portion of the 28S rDNA were amplified with primer pairs ITS5 (5'-GGAAGTAAAAGTCGTAACAAGG-3'), Rust1 (5'-GCTTACTGCCTTCCTCAATC-3'), and Rust2inv (5'-GATGAAGAACACAGTGAAA-3'), LR6 (5'-CGCAGTTCTGCTTACC-3') as described by Aime (1) and sequenced using the amplification primers, Rust2 (5'-TTTCACTGTGTTCTTCATC-3') and Rust3 (5'-GAATCTTTGAACGCACCTTG-3'). BLAST query of the assembled sequence, GenBank KF381491, was 91% identical to P. acroptili, JN204194, its closest match of similar length. P. ballotiflora has been found in Colombia on S. cataractarum, S. petiolaris, and S. mayori (3), and in Texas and Mexico on S. ballotiflora (4). To the best of our knowledge, this is the first detection of P. ballotiflora on S. greggii worldwide. P. ballotiflora is already widespread in the nursery trade in California and frequent fungicide applications are necessary to keep plants marketable. References: (1) M. C. Aime. Mycoscience 47:112, 2006. (2) J. W. Baxter and G. B. Cummins. Lloydia 14:201, 1951. (3) D. F. Farr and A. Y. Rossman. Fungal Databases. Systematic Botany and Mycology Laboratory, Online publication http://nt.ars-grin.gov/fungaldatabases ARS, USDA, 2014 (4) F. D. Kern et al. Mycologia 25:448, 1933.

First Report of Bacterial Fruit Blotch on Melon Caused by Acidovorax citrulli in California.

In July 2013, a melon plant sample (Cucumis melo cv. Saski) with disease symptoms resembling bacterial fruit blotch (BFB), was collected from a 10-acre field located in Yolo County, California, and submitted to the Plant Pest Diagnostics Center of the CDFA. Melon leaves had small (5 to 10 mm in diameter), tan to dark reddish-brown, angular lesions surrounded by yellow halos, and larger V-shaped lesions that extended from the leaf margins to the midrib. Bacterial streaming was observed at 400× magnification. The bacterium isolated from a leaf tissue wet mount formed smooth, round, cream-colored, non-fluorescent colonies on Pseudomonas F agar, was gram-negative, rod-shaped, aerobic, and oxidase-positive. The strain grew at 41°C and produced a strong hypersensitive response on tobacco (Nicotiana tabacum) 24 h after tissue infiltration. Based on a positive immunoassay test for Acidovorax citrulli (Eurofins STA Lab, Inc., Longmont, CO) and positive real-time PCR assays using species-specific primer sets, BX-L1/BX-S-R2 (1) and ZUP2436/2437 (4), the strain was identified as A. citrulli. A 360-bp fragment of the 16S ribosomal RNA gene was amplified using conventional PCR with primers WFB1 and WFB2 (3). The fragment, GenBank Accession No. KJ531595, showed 100% identity with the corresponding regions of A. citrulli (CP000512) strain AAC00-1 by BLAST query. Pathogenicity tests were performed by injecting 0.5 to 1 ml suspensions of the bacteria (106 CFU/ml) under the rind of three mature honeydew fruit (Cucumis melo var. indorus), three watermelon fruit (Citrullus lanatus cv. Sugar Baby), and into the cotyledons of ten, 10-day-old watermelon seedlings (cv. Sugar Baby). The fruit and seedlings were incubated in plastic bags at 30°C and similar treatments with sterile water served as negative controls. After 4 days, the seedlings inoculated with the suspect strain exhibited dark brown necrotic lesions with yellow halos that later coalesced, causing the cotyledons to collapse. Seven days after inoculation, the honeydew fruit exhibited dry, rotten gray cavities (4 to 6 cm in diameter) in the pericarp tissue below the rind. In contrast, the watermelon fruit had completely collapsed in a watery rot after 7 days. No symptoms were observed on the negative control fruits and seedlings treated with water. The pathogen was re-isolated from the inoculated fruit and seedlings and confirmed as A. citrulli by species-specific PCR and immunoassay as described above. The melon seed lot used to plant the field in Yolo County, CA, also tested positive for A. citrulli using species-specific real-time PCR assays (1,4). DNA fingerprinting by pulse field gel electrophoresis of Spe I-digested whole cell genomic DNA showed that all of the California A. citrulli strains were members of subgroup II (haplotype C strain) (3). These haplotypes normally occur on watermelon. BFB is a seed-transmitted disease of cucurbits and a major concern for national and global seed trade. First observed in United States commercial watermelon fields in 1989, BFB can cause economic losses up to 90% for commercial watermelon, cantaloupe, and honeydew growers (1,2). While BFB routinely occurs in the southeastern United States, this is the first official record of the disease in California. References: (1) O. Bahar et al. Plant Pathol. 57:754, 2008. (2) R. Walcott et al. J. Phytopathol. 152:277, 2004. (3) R. Walcott et al. Plant Dis. 84:470, 2000. (4) B. Woudt et al. Phytopathology 99:S143, 2009.

First Published Report of Rust on White Alder Caused by Melampsoridium hiratsukanum in the United States.

White alder (Alnus rhombifolia) is a fast-growing tree native to the western United States and is planted frequently in landscapes. In September 2010, mature leaves of white alder with small, orange-yellow pustules were collected in a commercial nursery in Santa Cruz County, CA. Approximately 25 white alder trees were affected. Collected leaves were sent to the California Department of Food and Agriculture Plant Pest Diagnostics Laboratory. Young uredinial pustules were bullate, with urediniospores emerging from a single pore in the pustule. Spiny cells lined the ostiole. With age, pustules broke open to release more spores. Urediniospores were obovate to oval and measured from 14 to 20 × 27 to 41 µm (17.1 × 32.2 µm average, n = 62). Spores were uniformly echinulate and contained a nearly hyaline cell wall measuring from 1 to 2 µm (1.5 µm average) in thickness. A portion of the 28S ribosomal subunit (GenBank Accession No. KC313888) and the internal transcribed spacer regions (KC313889) were amplified and sequenced from DNA extracted from urediniospores using primers LR6 and rust2inv (1) and ITS1-F and ITS4-B (2), respectively. Our ITS sequence had 99% identity to GenBank accession EF564164, Melampsoridium hiratsukanum. In September 2011, white alder leaves with similar symptoms were collected from a commercial nursery in Santa Barbara County, CA. The spore morphology matched the white alder sample previously collected in Santa Cruz County, CA, in 2010. At that time, pathogenicity assays were conducted on three 1-year-old, 61-cm white alder trees planted in 3.8-liter pots. Six detached leaves with visible rust pustules were rubbed gently onto both the apical and distal side of moistened leaves of the healthy alders. Each infected leaf was used to inoculate a total of 6 to 10 healthy leaves by rubbing two leaves per tree before moving to the next tree. Leaves on three additional white alder trees were rubbed with healthy leaves as controls. Trees were incubated in a dew chamber for 3 days in darkness at 24°C, then placed in a growth chamber at 22°C with a 12-h photoperiod. Twelve days after inoculation, small lesions were visible on a few of the leaf undersides of each inoculated tree. Not all inoculated leaves developed pustules. No lesions developed on the control trees. M. hiratsukanum has been reported in Canada, Europe, and eastern Asia (3). There are no published reports of this rust in the United States, but there is an unpublished specimen from white alder in the USDA Systematic Mycology Herbarium (BPI 028048) collected from California in 1931, which was identified as M. hiratsukanum by G. B. Cummins using morphological criteria. We are unaware if older specimens of this rust exist because we were unable to search other herbaria in the United States. To the best of our knowledge, this rust has been present in California since 1931, but has only recently been found causing disease in nursery plants. There have been no reports of the serious foliar disease symptoms on trees in California wild lands as have been reported in Europe, presumably due to dry summer and fall seasons in white alder's natural habitat. References: (1) M. C. Aime. Mycoscience 47:112, 2006. (2) M. Gardes and T. D. Bruns. Mol. Ecol. 2:113, 1993. (3) J. Hatula et al. Mycologia 101:622, 2009.

Resource polymorphism and diversity of Arctic charr Salvelinus alpinus in a series of isolated lakes.

Morphological, dietary and life-history variation in Arctic charr Salvelinus alpinus were characterized from three geographically proximate, but isolated lakes and one large lake into which they drain in south-western Alaska. Polymorphism was predicted to occur in the first three lakes because S. alpinus tend to become polymorphic in deep, isolated lakes with few co-occurring species. Only one morph was evident in the large lake and two of the three isolated lakes. In the third isolated lake, Lower Tazimina Lake, small and large morphs were found, the latter including two forms differing in growth rate. The small morph additionally differed from the two large forms by having more gill rakers and a deeper body than same-sized individuals of the large morph, consuming more limnetic and fewer benthic resources, having a greater gonado-somatic index and maturing at a smaller size. The two large forms consumed only slightly different foods (more terrestrial insects were consumed by the medium-growth form; more snails by the high-growth form). Trends in consumption of resources with body shape also differed between lakes. Variability in life history of S. alpinus in these Alaskan lakes was as broad as that found elsewhere. This variability is important for understanding lake ecosystems of remote regions where this species is commonly dominant.

Risk assessment and management approaches on mental health units.

This exploratory and descriptive study took place in one Canadian province. The study aimed to: (1) to identify and describe the nature and extent of current risk assessment and management approaches used in the adult inpatient mental health and forensic units; and (2) to identify good practice and shortfalls in the nature and extent of the approaches currently utilized. Data were collected from 48 participants through nine focus groups. Participants reported that they used a clinical approach to risk assessment. They had also not considered risk assessment and management as a proactive structured process. Education and training was also limited and skills were developed over time through practice. Five keys issues are discussed as important: reliance on clinical judgement alone is not the best choice to make; the need to consider risk as a whole concept; risk management being more reactive than proactive; education and training; and client involvement in risk assessment.

Non-linear relationship between serum 25-hydroxyvitamin D concentration and subsequent hip fracture.

UNLABELLED: Serum 25-OH vitamin D levels were compared in 254 hip fracture subjects and 2,402 matched control subjects. There was a significant inverse association between 25-OH vitamin D and hip fracture only between 0 and 70 nmol/L. INTRODUCTION: Vitamin D is integral to bone metabolism, however the utility of serum 25-OH vitamin D as a risk marker for hip fractures is controversial. METHODS: We conducted a case-control study of patients admitted to the hospitals with hip fractures in Calgary, Alberta, (catchment population 1.4 million) between January 1, 2007 and August 31, 2011. We searched the laboratory information system of Calgary Laboratory Services for serum 25-OH vitamin D levels within 6 months prior to admission on patients admitted to hospital with hip fractures. Cases were identified through the Calgary Laboratory Services laboratory information system and were matched to controls for age, sex, and month of testing. The hip fracture-25-OH vitamin D association was examined using multiple linear and spline regression. RESULTS: Of 305 subjects initially identified with hip fractures, serum 25-OH vitamin D levels were available for 254 (83 %). These were matched to 2,402 control subjects. We observed a significant (p < 0.01) non-linear relationship such that 25-OH vitamin D was inversely associated with hip fracture only below 70 nmol/L (odds ratio = 0.81 per 10 nmol/L increase; 95 % CI 0.86-0.93). CONCLUSIONS: The utility of 25-OH vitamin D level as a risk marker for hip fracture depends on the cut-off level used and was of potential use only for lower levels of 25-OH vitamin D.

First Report of Candidatus Liberibacter asiaticus Associated with Citrus Huanglongbing in California.

Huanglongbing (HLB), also known as citrus greening, is one of the most destructive citrus diseases worldwide and is seen as a major threat to the multimillion dollar citrus industry in California. The vector of the two bacterial species associated with this disease, Candidatus Liberibacter asiaticus and Ca. L. americanus, is the Asian citrus psyllid (ACP), Diaphorina citri (4). ACP was detected in California in August of 2008 and has since been detected in nine counties in southern California. As part of a long term survey and testing program for the ACP carrying the HLB associated bacteria, groups of ACP nymphs and adults were submitted to the Jerry Dimitman Citrus Research Board/Citrus Pest and Disease Prevention Program Laboratory in Riverside, CA. In March 2012, DNA extracted using the Qiagen MagAttract 96 DNA plant kit (QIAGEN Inc., 27220 Turnberry Lane, Suite 200, Valencia, CA 91355) from a group of three ACP adults tested positive for Ca. L. asiaticus with the real-time PCR assay developed by Li et al. (4). ACP adults were collected from a residential citrus tree located in the Hacienda Heights area of Los Angeles County, California. The approximately 1.8 meter tall lemon tree had 23 graft unions, primarily of lemon (Citrus × meyeri) and pomelo (Citrus maxima) varieties. The tree was unthrifty, with yellow shoots and chlorotic leaves. Symptoms on the lemon and pomelo leaves included asymmetrical blotchy mottling, yellowing, and corking of the leaf veins, with the blotchy mottle more prominent in the pomelo leaves. Pomelo leaves appeared crinkled along the thickened veins. Lemon leaves had yellow veins and a few had islands of green tissue completely surrounded by yellow tissue. The entire tree was removed, cut into sections, bagged, and transported to the CDFA Plant Pest Diagnostics Lab for analysis. Two hundred milligrams of petiole and midrib tissue from leaves apical to each graft union was collected, and DNA from each sample was extracted using the Qiagen DNeasy plant mini kit. DNA extracted from both lemon and pomelo leaves tested positive for Ca. L. asiaticus using real-time PCR (4). A 1,160-bp fragment of the 16S ribosomal RNA gene was amplified from the insect and plant DNA extracts using conventional PCR with primers Ol1 and OI2c (2). A 703-bp fragment of the ß-operon gene was amplified from the insect and plant extracts with primers A2 and J5 (1). The 16S rDNA fragments from the insect and plant respectively (GenBank Accession Nos. JX430434 and JX455745) and the ß-operon fragments (JX430435 and JX455746) showed 100% identity with the corresponding regions of Ca. L. asiaticus (CP001677) strain psy 62. Our 16S rDNA sequence showed 98% identity with Ca. L. africanus (EU921620), 97% identity with Ca. L. solanacearum (HM246509), and 96% with Ca. L. americanus (FJ036892). In response to the detection of HLB, a 241 km2 quarantine area around the detection site was established. Surveys for ACP and symptomatic host plants within the HLB quarantine area are ongoing. To date, there have been no additional positive detections. In the United States, HLB was first detected in Florida in 2005 (4) and in Texas in January of 2012 (3). To our knowledge, this is the first confirmed report of Ca. L. asiaticus associated with HLB in California. References: (1) A. Hocquellet et al. Mol. Cell. Probes 13:373, 1999. (2) S. Jagoueix et al. Mol. Cell. Probes 10:43, 1996. (3) M. Kunta et al. Phytopathology 102:S4.66, 2012. (4) W. Li et al. J. Microbiol. Methods 66:104, 2006.

Measurement of the 18Ne(α,p0) 21Na reaction cross section in the burning energy region for x-ray bursts.

The 18Ne(α,p) 21Na reaction provides one of the main HCNO-breakout routes into the rp process in x-ray bursts. The 18Ne(α,p0) 21Na reaction cross section has been determined for the first time in the Gamow energy region for peak temperatures T∼2 GK by measuring its time-reversal reaction 21Na(p,α) 18Ne in inverse kinematics. The astrophysical rate for ground-state to ground-state transitions was found to be a factor of 2 lower than Hauser-Feshbach theoretical predictions. Our reduced rate will affect the physical conditions under which breakout from the HCNO cycles occurs via the 18Ne(α,p) 21Na reaction.