Medical student knowledge and concern regarding mental health disclosure requirements in medical licensing.

OBJECTIVE: Two-thirds of United States medical boards require disclosure of mental health treatment or diagnosis during licensure, with negative influence on physician well-being but unknown impact on medical students. This study sought to understand whether medical students perceive mental health treatment to be a threat to their future medical license. METHOD: Students at an American medical school in a state without disclosure questions completed an anonymous fourteen question survey. Analysis with univariate and multivariate statistics explored knowledge, opinion, and impact of disclosure questions. RESULTS: Data was obtained from 327 medical students, a 53% response rate. The majority-91% (299)-were unsure or incorrect as to whether their state licensing board requires mental health disclosure. 33% (86) reported disclosure questions substantially discourage them from seeking mental health treatment. Of the 32% (105) who accessed mental health treatment during medical school, half-52% (74)-would not disclose during licensing. Those who believe that disclosure could impact their license were more likely to be discouraged from seeking care (OR, 5.23 [95% CI, 1.97-15.99]; P = 0.002). Most students-75% (245)-opposed mandatory disclosure. CONCLUSIONS: Concern about mandatory mental health disclosure discourages medical students from seeking care, despite uncertainty about disclosure questions.

Understanding sunscreen and photoprotection misinformation on parenting blogs: A mixed-method study.

BACKGROUND/OBJECTIVES: Sun exposure during childhood is a modifiable risk factor for skin cancer. Social media (including parenting blogs) represent promising platforms for understanding misinformation about pediatric photoprotection. This study's objective was to qualitatively and quantitatively evaluate the digital social context of parenting blogs that shape parents' decisions about children's photoprotection. METHODS: Mixed-method analysis was conducted of the 25 most popular parenting blogs in the USA, including 56 blog posts addressing photoprotection and 2661 comments. An inductive method was used to code and identify key themes associated with blog post categorization as sunscreen-encouraging, -discouraging, and -ambivalent. The qualitative analysis program NVivo was used to calculate descriptive statistics for comment codes based on co-occurrence with blog post category. RESULTS: Sunscreen-discouraging posts addressed natural remedies, sunscreen recipes, and vitamin D. Sunscreen-encouraging posts focused on skin cancer and protective clothing. Sunscreen-ambivalent posts were associated with scientific studies. Sunscreen-discouraging posts received more comments (mean 124) than encouraging (31) or ambivalent posts (8). Discouraging (65%) and ambivalent posts (75%) cited scientific literature more often than encouraging posts (14%). Comments were twice as likely to discourage photoprotection as to encourage it (1340 vs 447 comments). CONCLUSIONS: Parenting blogs are a substantial resource of both information and misinformation on pediatric photoprotection. However, misinformation receives substantially more engagement. The themes revealed in this study may help physicians and public health officials in developing interventions to target misinformation around pediatric photoprotection.

Traditional use of the native medicinal plant resource of Mt. Rtanj (Eastern Serbia): ethnobotanical evaluation and comparison.

ETHNOPHARMACOLOGICAL RELEVANCE: This study reports on the uses of medicinal plants and ethnobotanical significance of Mt. Rtanj, Eastern Serbia. The aim of the study was collecting information on plant utilization and creating the list of medicinal plants collected by local community in the region of Rtanj Mt. in Serbia. METHODOLOGY: A group of generally elderly people from the region were interviewed, asked to identify a certain number of plant taxa used against various human ailments. A quantitative ethnobotanical comparison has been performed in relation to other studies concerning the central Balkan Peninsula. RESULTS: There is an inventory of 45 plant species recorded. At the family level, the most common in traditional usage were species of Labiatae (22%), Rosaceae (20%) and Compositae (13%). The results of the survey suggested that Hypericum perforatum was the most popular medicinal plant. Among the 7 different recorded types of preparation, the aerial parts of plants were the most popular (47.3%). The most frequently reported medicinal uses of herbal drugs include remedies for immune system (22.97%), respiratory system (15.77%) and digestive system disorders (15.32%). However, a comparatively small number of available plant species was used for medicinal purposes while the level of ethnobotanical diversity was lower when compared to adjacent regions. CONCLUSIONS: Ethnobotanical knowledge in this area is decreasing due to high emigration rates during the last period. The historically developed ethnobotanical heritage should be preserved and promoted on the larger level, getting the special position in the future management plans for this area.

Risk factors for crop health under global change and agricultural shifts: a framework of analyses using rice in tropical and subtropical Asia as a model.

Plant disease epidemiology requires expansion of its current methodological and theoretical underpinnings in order to produce full contributions to global food security and global changes. Here, we outline a framework which we applied to farmers' field survey data set on rice diseases in the tropical and subtropical lowlands of Asia. Crop health risks arise from individual diseases, as well as their combinations in syndromes. Four key drivers of agricultural change were examined: labor, water, fertilizer, and land availability that translate into crop establishment method, water shortage, fertilizer input, and fallow period duration, respectively, as well as their combinations in production situations. Various statistical approaches, within a hierarchical structure, proceeding from higher levels of hierarchy (production situations and disease syndromes) to lower ones (individual components of production situations and individual diseases) were used. These analyses showed that (i) production situations, as wholes, represent very large risk factors (positive or negative) for occurrence of disease syndromes; (ii) production situations are strong risk factors for individual diseases; (iii) drivers of agricultural change represent strong risk factors of disease syndromes; and (iv) drivers of change, taken individually, represent small but significant risk factors for individual diseases. The latter analysis indicates that different diseases are positively or negatively associated with shifts in these drivers. We also report scenario analyses, in which drivers of agricultural change are varied in response to possible climate and global changes, generating predictions of shifts in rice health risks. The overall set of analyses emphasizes the need for large-scale ground data to define research priorities for plant protection in rapidly evolving contexts. They illustrate how a structured theoretical framework can be used to analyze emergent features of agronomic and socioecological systems. We suggest that the concept of "disease syndrome" can be borrowed in botanical epidemiology from public health to emphasize a holistic view of disease in shifting production situations in combination with the conventional, individual disease-centered perspective.

A Bayesian approach to meta-analysis of plant pathology studies.

Bayesian statistical methods are used for meta-analysis in many disciplines, including medicine, molecular biology, and engineering, but have not yet been applied for quantitative synthesis of plant pathology studies. In this paper, we illustrate the key concepts of Bayesian statistics and outline the differences between Bayesian and classical (frequentist) methods in the way parameters describing population attributes are considered. We then describe a Bayesian approach to meta-analysis and present a plant pathological example based on studies evaluating the efficacy of plant protection products that induce systemic acquired resistance for the management of fire blight of apple. In a simple random-effects model assuming a normal distribution of effect sizes and no prior information (i.e., a noninformative prior), the results of the Bayesian meta-analysis are similar to those obtained with classical methods. Implementing the same model with a Student's t distribution and a noninformative prior for the effect sizes, instead of a normal distribution, yields similar results for all but acibenzolar-S-methyl (Actigard) which was evaluated only in seven studies in this example. Whereas both the classical (P = 0.28) and the Bayesian analysis with a noninformative prior (95% credibility interval [CRI] for the log response ratio: -0.63 to 0.08) indicate a nonsignificant effect for Actigard, specifying a t distribution resulted in a significant, albeit variable, effect for this product (CRI: -0.73 to -0.10). These results confirm the sensitivity of the analytical outcome (i.e., the posterior distribution) to the choice of prior in Bayesian meta-analyses involving a limited number of studies. We review some pertinent literature on more advanced topics, including modeling of among-study heterogeneity, publication bias, analyses involving a limited number of studies, and methods for dealing with missing data, and show how these issues can be approached in a Bayesian framework. Bayesian meta-analysis can readily include information not easily incorporated in classical methods, and allow for a full evaluation of competing models. Given the power and flexibility of Bayesian methods, we expect them to become widely adopted for meta-analysis of plant pathology studies.

Explaining loss caused by tomato spotted wilt virus on tobacco with boreal winter weather: a Bayesian approach.

In North Carolina, Tomato spotted wilt virus (TSWV) has regularly been reported since 1997, with incidence being the highest in 2002. At the end of each season, a questionnaire is sent to the county agents to report disease losses. TSWV reported losses in 1993 to 2007 from 58 counties were available. A county-year combination was considered a case and, in total, 494 cases were analyzed. The winter months' temperature and precipitation significantly explained the reported TSWV loss (R(2) = 0.82). Specifically, the monthly average air temperature for December to February had a positive association with TSWV loss (P < 0.0001) whereas the total precipitation for the same months had a negative effect (P < 0.0001). Bayesian hierarchical models were implemented to include spatial and nonspatial random effects to investigate if there were significant spatial correlations or unexplained variability, respectively, and, thus, other significant variables that were ignored in the model development. The spatial random effects were not significant but the nonspatial random effects were significant in 36 cases. The importance of spring weather to dispersal of thrips and TSWV has been previously identified. Winter weather also may be a good indicator of potential available TSWV inoculum for the upcoming season.

Preparation and characterisation of fried chicken as a laboratory reference material for the analysis of heterocyclic amines.

The preparation of a laboratory reference material (LRM) for the determination of naturally occurring heterocyclic amines (HAs) in processed foods is presented in this work. A LRM was prepared from raw chicken breast meat, which was fried under controlled cooking temperature and time. The cooked meat was ground, lyophilised, sieved, homogenised, bottled, and labelled. The HAs DMIP, PhIP, MeIQx, 4,8-DiMeIQx, Norharman and Harman were analysed in the LRM. Homogeneity and stability studies of the bulk LRM were carried out and no statistical differences were observed in the content of the studied HAs in between-bottle and within-bottle comparisons at different storage temperatures (-18, +4, +25 and +40 degrees C) and times (1, 3, 6 and 9 months) by means of HAs determination and analysis of the results. Consequently, the material can be considered homogeneous and stable and can be used in intercomparison exercises for the determination of HAs as well as for quality control purposes in the routine analysis of HAs in foodstuffs. This is the first LRM for the analysis of HAs where these analytes were naturally formed in the material.

Curcumin structure-function, bioavailability, and efficacy in models of neuroinflammation and Alzheimer's disease.

Curcumin can reduce inflammation and neurodegeneration, but its chemical instability and metabolism raise concerns, including whether the more stable metabolite tetrahydrocurcumin (TC) may mediate efficacy. We examined the antioxidant, anti-inflammatory, or anti-amyloidogenic effects of dietary curcumin and TC, either administered chronically to aged Tg2576 APPsw mice or acutely to lipopolysaccharide (LPS)-injected wild-type mice. Despite dramatically higher drug plasma levels after TC compared with curcumin gavage, resulting brain levels of parent compounds were similar, correlating with reduction in LPS-stimulated inducible nitric-oxide synthase, nitrotyrosine, F2 isoprostanes, and carbonyls. In both the acute (LPS) and chronic inflammation (Tg2576), TC and curcumin similarly reduced interleukin-1beta. Despite these similarities, only curcumin was effective in reducing amyloid plaque burden, insoluble beta-amyloid peptide (Abeta), and carbonyls. TC had no impact on plaques or insoluble Abeta, but both reduced Tris-buffered saline-soluble Abeta and phospho-c-Jun NH(2)-terminal kinase (JNK). Curcumin but not TC prevented Abeta aggregation. The TC metabolite was detected in brain and plasma from mice chronically fed the parent compound. These data indicate that the dienone bridge present in curcumin, but not in TC, is necessary to reduce plaque deposition and protein oxidation in an Alzheimer's model. Nevertheless, TC did reduce neuroinflammation and soluble Abeta, effects that may be attributable to limiting JNK-mediated transcription. Because of its favorable safety profile and the involvement of misfolded proteins, oxidative damage, and inflammation in multiple chronic degenerative diseases, these data relating curcumin dosing to the blood and tissue levels required for efficacy should help translation efforts from multiple successful preclinical models.

Effects of Fluctuating Soil Temperature and Water Potential on Sclerotia Germination and Apothecial Production of Sclerotinia sclerotiorum.

The effects of fluctuating soil temperature and water potential on sclerotial germination and apothecial production by Sclerotinia sclerotiorum were investigated in growth chamber experiments. In the temperature experiments, temperature fluctuations of 4, 8, 12, and 16°C around a median of 20°C, and a constant of 20°C, were tested. Daily temperature fluctuations of 8°C resulted in highest levels of sclerotial germination and apothecial production. The earliest appearance of apothecia occurred in the 8°C fluctuation treatment, 24 days after the start of the experiment. Sclerotia in the 12°C fluctuation treatment germinated last; its first sclerotium germinated 44 days after experiment initiation. For the soil water potential experiments, constant saturation (approximately -0.001 MPa) and three levels of soil water potential fluctuation from saturation-"low" (-0.03 to -0.04 MPa), "medium" (-0.06 to -0.07 MPa), and "high" (-0.09 to -0.1 MPa)-were tested. Constant saturation yielded the highest number of germinated sclerotia and apothecia. All soil water potential fluctuations were detrimental to sclerotial germination and apothecial production, with sclerotial germination under fluctuating moisture conditions less than a tenth of that occurring under constant saturation. The first sclerotium in the constant saturation treatment germinated in 35 days; however, 76 days were required in the high soil water potential fluctuation treatment.

Effects of latent infection, temperature, precipitation, and irrigation on panicle and shoot blight of pistachio in california.

ABSTRACT Panicle and shoot blight, caused by a Fusicoccum sp., is an economically important disease of pistachio in California. Between 1999 and 2001, the disease severity was monitored throughout the growing season in 10 pistachio orchards, irrigated with drip, microsprinklers, low-angled (12 degrees ) sprinklers, or flood. The effect of temperature, precipitation pattern, irrigation system, and incidence of Fusicoccum sp. latent infection on panicle and shoot blight severity was quantified with a generalized linear model for repeated measures. The number of continuous rainy days in April and May and the cumulative daily mean temperatures from June to early September had a significant positive effect on panicle and shoot blight of pistachio leaves and fruit. Drip irrigation significantly decreased disease risk. Other factors, such as the number of discontinuous rainy days in April and May, the cumulative deviation from the 30-year average temperature during the dry days of April and May, the incidence of latent infection (only on leaves), and irrigation with microsprinklers or lowangled (12 degrees ) sprinklers were weak explanatory variables of panicle and shoot blight severity. Knowledge of panicle and shoot blight risk may contribute significantly to decisions regarding the appropriate application of fungicides, especially in years or fields of low risk.

Nurses' voices: policy, practice and ethics.

This article deals with nurses' ethical concerns raised by the consequences of changes in governmental and institutional policies on nursing practice and patient care. The aims of this project were to explore perspectives of registered nurses who provide or manage direct patient care on policies that affect nursing and patient care, and to provide input to policy makers for the development of more patient-centred policies. Four focus groups were conducted with a total of 36 registered nurse participants. The project team identified major themes that emerged in the analysis of transcripts of the focus group discussions. The four major themes were: effects of policy focused on cost containment, effects on quality of care, effects on patient education and access to needed services, and effects on nurses and nursing. The participants identified primarily negative effects of changes in national health policy and legislation that influence institutional policies on patient care and nursing practice. The effects of identified policy changes raised concerns about meeting nurses' ethical obligations to patients and families. Participants specified key points for consideration by legislators and other policy makers. They viewed nurses who are involved in direct patient care as a critical resource for legislators and other policy makers in the development of public and institutional policies that affect nursing and patient care.

Bayesian analysis in plant pathology.

ABSTRACT Bayesian methods are currently much discussed and applied in several disciplines from molecular biology to engineering. Bayesian inference is the process of fitting a probability model to a set of data and summarizing the results via probability distributions on the parameters of the model and unobserved quantities such as predictions for new observations. In this paper, after a short introduction of Bayesian inference, we present the basic features of Bayesian methodology using examples from sequencing genomic fragments and analyzing microarray gene-expressing levels, reconstructing disease maps, and designing experiments.

Logistic regression modeling of prevalence of soybean sclerotinia stem rot in the north-central region of the United States.

ABSTRACT Regional prevalence of soybean Sclerotinia stem rot (SSR), caused by Sclerotinia sclerotiorum, was modeled using tillage practices, soil texture, and weather variables (monthly air temperature and monthly precipitation from April to August) as inputs. Logistic regression was used to estimate the probability of stem rot prevalence with historical disease data from four states of the north-central region of the United States. Potential differences in disease prevalence between states in the region were addressed using regional indicator variables. Two models were developed: model I used spring (April) weather conditions and model II used summer (July and August) weather conditions as input variables. Both models had high explanatory power (78.5 and 77.8% for models I and II, respectively). To investigate the explanatory power of the models, each of the four states was divided into small geographic areas, and disease prevalence in each area was estimated using both models. The R(2) value of the regression analysis between observed and estimated SSR prevalence was 0.65 and 0.71 for models I and II, respectively. The same input variables were tested for their significance to explain the within-field SSR incidence by using Poisson regression analysis. Although all input variables were significant, only a small amount of variation of SSR incidence was explained, because R(2) of the regression analysis between observed and estimated SSR incidence was 0.065. Incorporation of available site-specific information (i.e., fungicide seed treatment, weed cultivation, and manure and fertilizer applications in a field) improved slightly the explained amount of SSR incidence (R(2) = 0.076). Predicted values of field incidence generally were overestimated in both models compared with the observed incidence. Our results suggest that preseason prediction of regional prevalence would be feasible. However, prediction of field incidence would not, and a different site-specific approach should be followed.

Bayesian logistic regression of soybean sclerotinia stem rot prevalence in the u.s. North-central region: accounting for uncertainty in parameter estimation.

ABSTRACT Bayesian ideas have recently gained considerable ground in several scientific fields mainly due to the rapid progress in computing resources. Nevertheless, in plant epidemiology, Bayesian methodology is not yet commonly discussed or applied. Results of a logistic regression analysis of a 4-year data set collected between 1995 and 1998 on soybean Sclerotinia stem rot (SSR) prevalence in the north-central region of the United States were reexamined with Bayesian methodology. The objective of this study was to use Bayesian methodology to explore the level of uncertainty associated with the parameter estimates derived from the logistic regression analysis of SSR prevalence. Our results suggest that the 4-year data set used in the logistic regression analysis of SSR prevalence in the north-central region of the United States may not be informative enough to produce reliable estimates of the effect of some explanatory variables on SSR prevalence. Such confident estimations are necessary for deriving robust conclusions and high quality predictions.

Impact of Management Practices on Prevalence of Soybean Sclerotinia Stem Rot in the North-Central United States and on Farmers' Decisions Under Uncertainty.

Regional prevalence of soybean Sclerotinia stem rot (SSR), caused by Sclerotinia sclerotiorum, was modeled using management practices (tillage, herbicide, manure and fertilizer application, and seed treatment with fungicide) and summer weather variables (mean monthly air temperature and precipitation for the months of June, July, August, and September) as inputs. Logistic regression analysis was used to estimate the probability of stem rot prevalence with disease data from four states in the north-central region of the United States (Illinois, Iowa, Minnesota, and Ohio). Goodness-of-fit criteria indicated that the resulting model explained well the observed frequency of occurrence. The relationship of management practices and weather variables with soybean yield was examined using multiple linear regression (R 2 = 0.27). Variables significant to SSR prevalence, including average air temperature during July and August, precipitation during July, tillage, seed treatment, liquid manure, fertilizer, and herbicide applications, were also associated with high attainable yield. The results suggested that SSR occurrence in the north-central region of the United States was associated with environments of high potential yield. Farmers' decisions about SSR management, when the effect of management practices on disease prevalence and expected attainable yield was taken into account, were examined. Bayesian decision procedures were used to combine information from our model (prediction) with farmers' subjective estimation of SSR incidence (personal estimate, based on farmers' previous experience with SSR incidence). MAXIMIN and MAXIMAX criteria were used to incorporate farmers' site-specific past experience with SSR incidence, and optimum actions were derived using the criterion of profit maximization. Our results suggest that management practices should be applied to increase attainable yield despite their association with high disease risk.

Apendicitis aguda. Estudio de la morbilidad y la mortalidad / Acute appendicitis. Study of morbidity and mortality

Se realiza una breve reseña sobre la importancia del diagnóstico y el tratamiento quirúrgico precoz en la apendicitis aguda. Se presentan 112 pacientes egresados. Se analizan los factores que intervienen en la morbilidad y la mortalidad. Se exponen las características del cuadro clínico y los resultados obtenidos en el curso posoperatorio(AU)