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Kentucky bluegrass (Poapratensis L.) is a widely used, facultatively apomictic, cool season turf and forage grass, with many known cultivars. Previously these have been classified on the basis of morphological traits in field tests. However, these determinations are lengthy, sensitive to environmental variations, and there are few traits that can be tested. Molecular markers provide an alternative way to classify these cultivars. Important advantages of molecular markers include lack of sensitivity to changes in environmental conditions, as well as a nearly unlimited potential number of markers and speed of the marker assays as compared with field tests. They can also provide additional information such as the amount of genetic divergence between Kentucky bluegrass cultivars and other genotypes, the amount of agreement between morphological and marker-based classification, and the amount of genetic variability between seedling replicates of genotypes. Random amplified polymorphic DNA (RAPD) marker data was collected from three replicates each of 123 Kentucky bluegrass cultivars, plant introductions (PIs), experimental breeding lines, and interspecific hybrids between Kentucky and Texas bluegrass (Poa arachnifera Torr.). From these data multidimensional scaling (MDS) plots were created, and ANOVA tests of significant differences between germplasm sources were performed. The Pis were the most genetically divergent from the cultivars, while the interspecific hybrids were not as distinct. Members of two morphological trait-based types were found to be genetically similar, and there was a wide range of genetic variability among germplasm sources. The genetic divergence of the PIs, combined with their potentially high turf utility reported in earlier studies, indicates their potential as a genetic resource. All but two of the morphological trait-based types contained genetically diverse individuals, so that cultivar blends of all but these two types would be morphologically similar yet genetically diverse. The rather high within-cultivar genetic variability could be due to a relatively high proportion of potentially sexually produced off-types. Thus, this study provides further evidence for the utility of RAPD markers for turfgrass genetics, as well as important genetic information for turf breeders and managers. [ABSTRACT FROM AUTHOR]

Typhula incarnata, the causal agent of gray snow mold, is an important winter pathogen of turfgrasses in the northern United States. The relative susceptibility of cultivars of three bent-grass species (creeping, colonial, and velvet bentgrass) to Typhula incarnata and the aggressiveness of 15 T incarnata isolates obtained from infected turfgrasses on golf courses in Michigan, Minnesota, and Wisconsin were evaluated under controlled conditions. A hypersensitive type of resistance response to T incarnata was not observed in any cultivar. Disease severity increased with higher inoculum concentration of T. incarnata. Colonization by gray snow mold gradually decreased with increasing plant age from 11 weeks after seeding in most cultivars tested, suggesting that age-related resistance was expressed over time. There were significant differences in disease severity among the three bentgrass species, particularly between tetraploid (creeping and colonial) and diploid (velvet) species, and among cultivars within each species, indicating varying levels of susceptibility to T. incarnata. All 15 isolates were pathogenic on bentgrass and were significantly different in aggressiveness, but aggressiveness was not related to geographic origin. Therefore, turfgrass breeders should be able to use one or a few virulent representative isolates of the pathogen to screen for resistance. [ABSTRACT FROM AUTHOR]

Snow molds are psychrophilic fungi that grow under snow cover by taking advantage of carbohydrate-depleted, dormant plants. Typhula snow molds caused by Typhula incarnata, T. phacorrhiza, and T. ishikariensis are the most important winter diseases of perennial grasses and winter cereals in the United States. Colonized turfgrass samples with sclerotia were collected from 135 golf courses in Wisconsin, Utah, Michigan, and Minnesota in spring 2001 and 2002. Species and varieties from a total of 2,864 samples were identified using Typhula spp.-specific polymerase chain reaction markers. All three species were found throughout the states sampled, except T. phacorrhiza, which was not found in Minnesota. T. incarnata was distributed in areas of shorter snow cover duration and higher mean temperature than T. ishikariensis. Canonical correspondence analysis indicated that snow cover days and mean temperature were significantly correlated with frequency of Typhula spp. and T. ishikariensis varieties infecting turfgrasses on golf courses in Wisconsin, and that T. incarnata, T. phacorrhiza, and T. ishikariensis were ecologically distinct based on the 2001 data. However, because these two variables accounted for a relatively small proportion of total variation, other environmental variables also may be important in characterizing the distribution of these pathogens and require further study. [ABSTRACT FROM AUTHOR]

Importance: Physicians who belong to minoritized racial and ethnic groups remain underrepresented and underpromoted. Serving as a chief resident is an important position of leadership and prestige, and indicates a benchmark for future professional success. However, it is unknown if disparities in race and/or sex exist in the chief resident selection process., Objective: To describe race, ethnicity, and sex of emergency medicine (EM) chief residents and determine the association of racial identity and the intersectionality of race and sex for selecting chief residents in US emergency medicine departments., Design, Setting, and Participants: This cohort study analyzed data collected from the Association of American Medical Colleges and the Electronic Residency Application Service in the graduating classes of 2017 and 2018. Data were analyzed between December 2021 and January 2023., Main Outcomes and Measures: Relative risk (RR) of selection for chief residency for Black, Asian, and Hispanic EM residents in comparison with White counterparts., Results: Among 3408 studied residents, 738 (21.7%) served as chief resident (2253 male [66.1%]; 451 Asian [13.2%], 144 Black [4.2%], 158 Hispanic [4.6%], 239 more than 1 race [7.0%], 46 other [1.3%], and 2370 White [69.5%]). Of chiefs, 81 (11.0%) identified as Asian, 17 (2.3%) as Black, and 26 (3.5%) Hispanic. Asian residents were 78% (95% CI, 63%-96%) as likely to be promoted to chief resident compared with White peers, and Black residents were 51% (95% CI, 32%-80%) as likely as White residents. In our fully adjusted model, racial differences remained significant for Black residents, who were half as likely as white residents to be selected for chief residency (adjusted risk ratio [aRR], 0.55; 95% CI, 0.36-0.82). Overall, White women were most likely to be selected for chief residency and 20% more likely to be selected than White men counterparts (aRR, 1.20; 95% CI, 1.03-1.39). In comparison, women underrepresented in medicine (a category that included residents identified as Black, Hispanic, American Indian or Alaskan Native, and Native Hawaiian or Other Pacific Islander) were least likely to be selected for chief promotion, and 50% as likely to be selected for chief resident compared with White men (aRR, 0.50; 95% CI, 0.06-0.66)., Conclusions and Relevance: In this 2024 nationally representative study of EM residents, chief promotion was lower among residents identifying as Asian or Black, and in particular, women underrepresented in medicine. This study's findings suggest further review of chief resident selection process by residency programs and accreditation bodies is needed to ensure workforce equity for promotion and opportunities for leadership.

Abstract: The complexity of improving health in the United States and the rising call for outcomes-based physician training present unique challenges and opportunities for both graduate medical education (GME) and health systems. GME programs have been particularly challenged to implement systems-based practice (SBP) as a core physician competency and educational outcome. Disparate definitions and educational approaches to SBP, as well as limited understanding of the complex interactions between GME trainees, programs, and their health system settings, contribute to current suboptimal educational outcomes elated to SBP. To advance SBP competence at individual, program, and institutional levels, the authors present the rationale for an integrated multilevel systems approach to assess and evaluate SBP, propose a conceptual multilevel data model that integrates health system and educational SBP performance, and explore the opportunities and challenges of using multilevel data to promote an empirically driven approach to residency education. The development, study, and adoption of multilevel analytic approaches to GME are imperative to the successful operationalization of SBP and thereby imperative to GME's social accountability in meeting societal needs for improved health. The authors call for the continued collaboration of national leaders toward producing integrated and multilevel datasets that link health systems and their GME-sponsoring institutions to evolve SBP., (Copyright © 2023 the Association of American Medical Colleges.)

Background: Graduate medical education (GME) program leaders struggle to incorporate quality measures in the ambulatory care setting, leading to knowledge gaps on how to provide feedback to residents and programs. While nationally collected quality of care data are available, their reliability for individual resident learning and for GME program improvement is understudied., Objective: To examine the reliability of the Healthcare Effectiveness Data and Information Set (HEDIS) clinical performance measures in family medicine and internal medicine GME programs and to determine whether HEDIS measures can inform residents and their programs with their quality of care., Methods: From 2014 to 2017, we collected HEDIS measures from 566 residents in 8 family medicine and internal medicine programs under one sponsoring institution. Intraclass correlation was performed to establish patient sample sizes required for 0.70 and 0.80 reliability levels at the resident and program levels. Differences between the patient sample sizes required for reliable measurement and the actual patients cared for by residents were calculated., Results: The highest reliability levels for residents (0.88) and programs (0.98) were found for the most frequently available HEDIS measure, colorectal cancer screening. At the GME program level, 87.5% of HEDIS measures had sufficient sample sizes for reliable measurement at alpha 0.7 and 75.0% at alpha 0.8. Most resident level measurements were found to be less reliable., Conclusions: GME programs may reliably evaluate HEDIS performance pooled at the program level, but less so at the resident level due to patient volume., Competing Interests: Conflict of interest: Dr Holmboe is an employee of the Accreditation Council for Graduate Medical Education and has written a clinical competency textbook published by Elsevier.

Objectives: The purpose of this study was to understand COVID-19 information seeking among Korean immigrant women in comparison to their flu/cold information seeking. In particular, the study aimed to examine: (1) the levels of information sought regarding both COVID-19 and the flu/cold, and (2) the content of information discussed at each level. Methods: We analyzed the posts on Missy USA--one of the largest Korean online communities for married Korean immigrant women. Two sets of data, one for COVID-19 (n=726) and the other for the flu/cold (n=50), were analyzed with codes at different levels, which were adapted from the social-ecological model. Results: Applying the social-ecological model, we found that about 80% of information regarding the flu/cold and about 60% of COVID-19 information was concentrated at individual, interpersonal, and organizational levels. Information seeking at the community level was more frequent for COVID-19 than for the flu/cold. Conclusions: Our finding that Korean immigrant women primarily sought information regarding COVID-19 serves as a theoretical contribution at the transnational level, which might be relevant for immigrant women during the unprecedented COVID-19 pandemic.

Purpose: Despite the importance of training in ambulatory care settings for residents to acquire important competencies, little is known about the organizational and environmental factors influencing the relative amount of time primary care residents train in ambulatory care during residency. The authors examined factors associated with postgraduate year 1 (PGY-1) residents' ambulatory care training time in Accreditation Council for Graduate Medical Education (ACGME)-accredited primary care programs., Method: U.S.-accredited family medicine (FM) and internal medicine (IM) programs' 2016-2017 National Graduate Medical Education (GME) Census data from 895 programs within 550 sponsoring institutions (representing 13,077 PGY-1s) were linked to the 2016 Centers for Medicare and Medicaid Services Cost Reports and 2015-2016 Area Health Resource File. Multilevel regression models examined the association of GME program characteristics, sponsoring institution characteristics, geography, and environmental factors with PGY-1 residents' percentage of time spent in ambulatory care., Results: PGY-1 mean (standard deviation, SD) percent time spent in ambulatory care was 25.4% (SD, 0.4) for both FM and IM programs. In adjusted analyses (% increase [standard error, SE]), larger faculty size (0.03% [SE, 0.01], P < .001), sponsoring institution's receipt of Teaching Health Center (THC) funding (6.6% (SE, 2.7), P < .01), and accreditation warnings (4.8% [SE, 2.5], P < .05) were associated with a greater proportion of PGY-1 time spent in ambulatory care. Programs caring for higher proportions of Medicare beneficiaries spent relatively less time in ambulatory care (< 0.5% [SE, 0.2], P < .01)., Conclusions: Ambulatory care time for PGY-1s varies among ACGME-accredited primary care residency programs due to the complex context and factors primary care GME programs operate under. Larger ACGME-accredited FM and IM programs and those receiving federal THC GME funding had relatively more PGY-1 time spent in ambulatory care settings. These findings inform policies to increase resident exposure in ambulatory care, potentially improving learning, competency achievement, and primary care access., (Copyright © 2020 by the Association of American Medical Colleges.)

Dollar spot, caused by Sclerotinia homoeocarpa, is one of the most significant diseases of cool-season turfgrass on golf courses. Resistance to the benzimidazole, dicarboximide, and succinate dehydrogenase inhibitor (SDHI) classes and reduced sensitivity to the sterol-demethylation inhibitor (DMI) in S. homoeocarpa populations have been widely reported in the United States. Moreover, the occurrence of S. homoeocarpa populations with multiple fungicide resistance (MFR) is a growing problem on golf courses. The present study was undertaken to evaluate the efficacy of DMI, dicarboximide, and SDHI against a S. homoeocarpa population with MFR on a Connecticut golf course fairway from 2014 to 2016. Also, because the S. homoeocarpa population consisted of four different phenotypes with differing resistance profiles to benzimidazole, dicarboximide, and DMI, in vitro sensitivity assays were used to understand the dynamics of the MFR population in the presence and absence of fungicide selection pressures. Results indicated that boscalid fungicide (SDHI) was able to provide an acceptable control of the MFR dollar spot population. Propiconazole or iprodione application selected isolates with both DMI and dicarboximide resistance (DMI-R/Dicar-R). In the absence of fungicide selection pressures, the percent frequency of DMI-R/Dicar-R or DMI and benzimidazole resistance (DMI-R/Ben-R) isolates declined in the population. Out of the four phenotypes, the percent frequency of isolates with DMI, dicarboximide, and benzimidazole resistance (DMI-R/Dicar-R/Ben-R) was the lowest in the population regardless of fungicide selection pressures. Our first report of MFR population dynamics will help develop effective strategies for managing MFR and potentially delay the emergence of future resistant populations in S. homoeocarpa.

Objective: To investigate associations between survival and use of psychological and spiritual activities practiced over 1 year in HIV-positive (HIV+) patients., Method: Nine hundred one HIV+ adults living in the United States using at least 1 form of complementary and alternative medicine (CAM) completed a questionnaire 3 times between 1995 and 1998. Information on specific mind-body therapies included psychotherapy (group therapy, support groups, individual therapy) and spiritual therapies (self-defined "spiritual" activities, prayer, meditation, affirmations, psychic healing, visualizations). Subsequent death was ascertained from the National Death Index (NDI). Cox proportional-hazards regression assessed risk of death through 1999., Results: Use of any psychological therapy reported in both the 6-month and 12-month follow-up questionnaires (1 year continuous use) was associated with a reduced risk of death (hazard ratio [HR]: 0.5, 95% CI: 0.3-0.9) adjusted for income, clinical acquired immune deficiency syndrome, CD4 count, smoking, alcohol use, and use of antiretroviral therapy or highly active antiretroviral therapy (HAART). The relationship between spiritual activities and survival was modified by use of HAART, which may reflect severity of illness. Individuals not currently using HAART and who participated in spiritual activities over the previous year were found to be at a reduced risk of death (HR: 0.4, 95% CI: 0.2-0.9) compared to those not practicing spirituality., Conclusions: Participation in spiritual and psychological therapies may be related to beneficial clinical outcomes in HIV+ individuals, including improved survival. Due to the self-selection of therapies in this observational cohort, it is not possible to distinguish use of the therapies from other characteristics or activities of the people participating in them.

Context: Complementary and alternative medicine (CAM) use is on the rise in the United States, especially for breast cancer patients. Many CAM therapies are delivered by licensed naturopathic physicians using individualized treatment plans., Objective: To describe naturopathic treatment for women with breast cancer., Design: Cross-sectional mail survey in 2 parts: screening form and 13-page survey., Setting: Bastyr University Cancer Research Center, Kenmore, Wash., Participants: All licensed naturopathic physicians in the United States and Canada (N=1,356) received screening forms; 642 (47%) completed the form. Of the respondents, 333 (52%) were eligible, and 161 completed the survey (48%)., Main Outcome Measures: Demographics of naturopathic physicians, development of treatment plans, CAM therapies used, perceived efficacy of therapeutic interventions., Results: Of those respondents screened, 497 (77%) had provided naturopathic care to women with breast cancer, and 402 (63%) had treated women with breast cancer in the previous 12 months. Naturopaths who were women were more likely than men to treat breast cancer (P < or = .004). Of the survey respondents, 104 (65%) practiced in the United States, and 57 (35%) practiced in Canada; 107 (66.5%) were women, and 54 (33.5%) were men. To develop naturopathic treatment plans, naturopathic physicians most often considered the stage of cancer, the patient's emotional constitution, and the conventional therapies used. To monitor patients clinically, 64% of the naturopathic physicians used diagnostic imaging, 57% considered the patient's quality of life, and 51% used physical examinations. The most common general CAM therapies used were dietary counseling (94%), botanical medicines (88%), antioxidants (84%), and supplemental nutrition (84%). The most common specific treatments were vitamin C (39%), coenzyme Q-10 (34%), and Hoxsey formula (29%).

The aims of this analysis are to characterize the incidence and types of malignancies and tumor-specific mortality in our institution. Retransplantation, rejection episodes, and OKT3 use were evaluated. Our single-institution prospective database of 1,570 liver transplantations in 1,421 patients was analyzed. Data were statistically analyzed regarding sex, age at transplantation, time from transplantation to diagnosis of tumor, tumor type, and follow-up time. One hundred twenty-five patients (8.8%) developed de novo tumors; 69 patients were men, 56 patients were women. Seventeen patients received more than one allograft. De novo tumors were as follows: skin, 41; lymphomas, 35; lung, 11; colon, 6; anal, 2; rectal, 1; breast, 7; thyroid, 3; oropharyngeal squamous cell, 3; metastatic without primary tumor identified, 4; renal cell, 3; Kaposi's sarcoma, 1; angiosarcoma, 1; uterine, 1; ovarian, 1; pituitary, 1; pancreatic, 2; cholangiocarcinoma, 1; and esophageal, 1. These tumors developed in a statistically significant chronological sequence. Lung cancers and lymphomas showed shorter mean survival times, as well as greater mortality. OKT3 use and rejection did not show significance in tumor development. De novo tumors post-liver transplantation affected our population in a distribution similar to that of the general non-transplantation population. Intense short courses of immunosuppression for rejection were not as important as chronic immunosuppression in the development of tumors. The risk for development was not enough to preclude transplantation. We found that tumors developed in chronological fashion. Therefore, directed surveillance, patient education, and early detection may facilitate earlier treatment.

The article reports on a study of 22 suicides which occurred between 1972 and 1978 during inpatient treatment of patients of the Psychiatric Clinic of Hanover Medical College, partly within the premises of the clinic and partly without. The group of patients who committed suicide in the clinic itself is characterised on the basis of the individual social, personal and disease-relevant data and compared with the overall patient population of the clinic. It is found that there was an increase in the suicidal rate following a change in the organisational and therapeutical skeleton concept of the clinic, but the question whether there is a causal relationship must remain unsettled. It is also discussed whether a higher proportion of suicidal risk patients is being admitted to the clinic due to greater emphasis on the care for residents in nearby areas, patients who would otherwise not have been treated on an inpatient basis. Another problem which is considered worth discussing is whether and to what extent rehabilitation activities overtax the facilities and possibilities of some hospitals and to what extent the new - basically favourably rated - clinical concept for suicide-risk patients entails additional burdens which could be met by suitable suicide-preventive measures.