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Brown JP, Amaechi BT, Bader JD, Shugars D, Vollmer WM, Chen C, Gilbert GH, Esterberg EJ, for the X-ACT Collaborative Research Group. The dynamic behavior of the early dental caries lesion in caries-active adults and implications. Community Dent Oral Epidemiol 2015. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Abstract - Objective: To describe the full range of behavior of the visible, noncavitated, early caries lesion in caries-active adults with substantial fluoride exposure, and to consider implications. Methods: The data were from the Xylitol for Adult Caries Trial (X-ACT) collected annually for 33 months using condensed ICDAS caries threshold criteria. Individual tooth surfaces having a noncavitated caries lesion were included, and the patterns of transition to each subsequent annual clinical examination to sound, noncavitated or cavitated, filled or crowned were determined. The resulting sets of patterns for an individual tooth surface, looking forward from its first appearance as a noncavitated lesion, were combined into one of four behavior profiles classified as reversing, stable, oscillating, or continuously progressing, or were excluded if not part of the caries continuum. The distributions of profile types were assessed using the Rao-Scott chi-square test, which adjusts for clustering of tooth surfaces within teeth. Results: Inter- and intra-examiner kappa scores demonstrated acceptable calibration at baseline and annually. 8084 tooth surfaces from 543 subjects were included. The distribution of profile types differed significantly between coronal and root surfaces. Overall, two-thirds of all coronal noncavitated lesions were first seen at baseline, half reversed, over a fifth were stable, 15% oscillated, and only 8.3% progressed to cavitation, filled, or crowned in 33 months or less (6.3% consistently Progressed plus 2.0% inconsistently, a subset of oscillating, which oscillated before progressing to cavitation). Approximal, smooth, and occlusal coronal surfaces each were significantly different in their individual distributions of profile types. Xylitol showed no significant and consistent effect on this distribution by tooth surface type. This was in keeping with the X-ACT's lack of effect of xylitol at the noncavitated plus cavitated lesion thresholds combined. Conclusions: This study demonstrated the full dynamic range of early caries lesion behavior. The great majority were not progressive, and few (8.3%) became cavitated over 33 months in caries-active adults using fluorides. Important caries management implications favoring recorded longitudinal monitoring, prevention of active risks, and minimal restoration only after direct visual determination of cavitation are discussed.

To determine the association of parental use of integrated personal health records (PHRs) with children's adherence to immunization and well-child care (WCC) visit recommendations.For the immunization and WCC visit measures, we retrospectively analyzed, respectively, 766 and 639 matched pairs at Kaiser Permanente (KP) Hawaii and 2795 and 2448 pairs at KP Northwest who were ≤ 31 days old at enrollment and continuously enrolled for 2 years between January 2007 and July 2011. The independent variable (≥ 1 PHR feature used vs none) was matched using propensity scores on parental and children characteristics. The dependent variables were 2 measures from the 2010 Healthcare Effectiveness Data and Information Set: combination 2 immunization (all immunizations vsall) and number of WCC visits through 15 months old (≥ 6 vs6). We conducted multivariate logistic, propensity score-matched regression adjusting for parents' education and child's continuity of care.Children whose parents used ≥ 1 PHR feature (vs none) had higher odds of adhering to the recommended immunizations only at KP Northwest (KP Hawaii: OR 1.1, 95% CI 0.8-1.4, P.05; KP Northwest OR 1.2, 95% CI 1.0-1.3, P.05). PHR use was associated with better adherence to WCC visit recommendations for both KP Hawaii (OR 1.9, 95% CI 1.3-2.9, P.001) and KP Northwest (OR 2.5, 95% CI 2.1-2.9, P.001).Young children whose parents used a PHR were more likely to adhere to the recommended WCC visits in both regions but immunizations in only 1 region.

Purpose: Accurate and reliable measurement of physical activity plays an important role in assessing effective lifestyle interventions for obesity. This study examined reliability of accelerometer-based estimates of physical activity levels of overweight and obese adults before and after a lifestyle weight loss program. Methods: Participants were overweight and obese (body mass index = 25-45 kg[middle dot]m-2) members (n = 1592; 67% female, 42% African American) of the multicenter weight loss maintenance trial. They wore RT3 accelerometers during waking hours for 7 d at baseline and after a 6-month weight loss intervention that included diet and physical activity recommendations. Moderate-to-vigorous physical activity (MVPA) and MVPA occurring in bouts >=10 min (bout MVPA) were assessed. Results: At baseline, wear time minimums of 10 and 6 h[middle dot]d-1 resulted in similar average minutes per day of MVPA (18.3 and 18.0 min) and MVPA bout minutes per day (6.9 and 6.7 min). Similar wear times occurred after the weight loss intervention for MVPA (27.0 and 26.8 min) and bout MVPA (15.1 and 15.0 min). Reliability measurements by intraclass correlation (ICC) were larger for 4 versus 2 d[middle dot]wk-1 minimum wear time for both MVPA and bout MVPA (4-d ICC = 0.27-0.44 and 2-d ICC = 0.19-0.38), but there was little increase in ICC comparing 4 (ICC = 0.27-0.44) and 7 d[middle dot]wk-1 (ICC = 0.30-0.46). Conclusions: Longer wear time requirements did not result in significant increases in reliability. Using 4 d of data with >=6 h[middle dot]d-1 of wear time optimized the balance between ICC and participant burden in overweight and obese adults before and after a weight loss intervention. Future investigations using accelerometers to estimate MVPA in overweight and obese samples can consider requiring less monitor wear time

OBJECTIVES: The U.S. Office of Management and Budget (OMB) guidelines for collecting and reporting race and ethnicity information recently divided the "Asian or Pacific Islander" category into "Asian" and "Native Hawaiian or Other Pacific Islander". The OMB's decision to disaggregate the "Asian or Pacific Islander" category was the first step toward providing these communities with information to better serve their needs. However, whether individuals who formerly made up the combined group categorize themselves as the new guidelines intend is a question analyzed in this report. METHODS: A subset of adults participating in the Hemochromatosis and Iron Overload Screening Study completed both the OMB-minimum and the expanded race and ethnicity measure used in the National Health Interview Survey. We compared responses on the expanded measure contained within the OMB "Asian" definition (Filipino, Korean, Vietnamese, Japanese, Asian Indian, Chinese, and/or Other Asian) to "Asian" responses on the OMB-minimum measure. RESULTS: Mixed heritage Asians less often marked "Asian". Among mixed heritage Japanese, Chinese, and Filipinos, 27%, 49%, and 52% did not mark "Asian" on the OMB measure, respectively. Eleven percent of single-heritage Filipinos did not mark "Asian." CONCLUSIONS: Many individuals formerly making up the combined "Asian or Pacific Islander" group do not categorize themselves as the revised OMB guidelines intend. This is particularly evident among Filipinos and among Asians of mixed heritage. This research illuminates the reliability and utility of the broad "Asian" category and points to possible consequences of collapsing groups into a single category, i.e., missed information and/or erroneous generalization.

To examine the relationship between patient characteristics and medication adherence trajectories for patients with congestive heart failure (CHF).Historical prospective study.We conducted a secondary analysis of data assembled for the Practice Variation and Care Outcomes (PRAVCO) study, which examined patterns of cardiovascular care. We used group based trajectory modeling to define medication adherence trajectories, and then modeled factors associated with belonging to a trajectory group during the 6year period from 2005 to 2010 (n = 10,986). We focused on the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) for secondary prevention of CHF.Four trajectory groups were optimal in characterizing adherence level patterns: 1) low adherence group, with an initial average adherence rate of 62% that dropped to between 40% and 50%; 2) increasing adherence group, with an initial average adherence rate of 55% that increased to 90%; 3) decreasing adherence group, with an initial average adherence rate above 90% that decreased to 60%; 4) high adherence group, with an average adherence rate consistently above 90%. Age, region, education, smoking, and race were all significantly associated with the likelihood of belonging to a particular trajectory. Nonwhites were less likely to be in the high adherence group, and smoking was more common in the low adherence group (22%) than in the high group (10%); increasing body mass index and Charlson Comorbidity Index (CCI) scores were also associated with being in the low adherence group.Population characteristics associated with sustained low adherence might be used to target interventions and improve vulnerable patients' prospects of heart health.

OBJECTIVES: Osteoporosis treatment rates after a fracture are low. This study evaluated methods to increase guideline-recommended osteoporosis care postfracture. DESIGN: Participants were randomly assigned to usual care or one of two interventions. Analysis of primary outcomes used electronic data and linear regression. SETTING: A Pacific Northwest nonprofit health maintenance organization. PARTICIPANTS: Female patients aged 50 to 89 who suffered a fracture in 1999 and had not received bone mineral density (BMD) measurement or medication for osteoporosis (n=311) and their primary care providers (n=159). INTERVENTION: Patient-specific clinical guideline advice to the primary care provider delivered by electronic medical record (EMR) message or electronic reminder to the provider plus an educational letter mailed to the patient. MEASUREMENTS: BMD measurement and osteoporosis medication. RESULTS: At 6 months, provider reminder resulted in 51.5% of patients receiving BMD measurement or osteoporosis medication, provider reminder plus patient education resulted in 43.1%, and usual care resulted in 5.9% (P

Managed care organizations and others reaching out to underscreened women seek strategies to encourage mammogram and Pap screening.Female HMO members aged 50-69 years and overdue for a mammogram and a Pap test (n = 501) were followed for 24 months after interventions began. An Outreach intervention (tailored letters and motivational telephone interviews), an Inreach intervention (motivational interview delivered in clinics), and a Combined Inreach/Outreach intervention were compared to Usual Care at 24 months. Logistic regression and Cox hazard models examined predictors of obtaining screening services and time-to-service, respectively.Compared with Usual Care, the odds of Outreach women aged 50-64 obtaining a mammogram (OR = 2.06; 95% CI = 1.59-5.29), a Pap test (OR = 1.97; 95% CI = 1.12-3.53), or both (OR = 2.53; 95% CI = 1.40-4.63) remained significantly increased at 24 months. The average time-to-service for Outreach women was reduced by 4 months. Outreach effects persisted despite intensive, ongoing health plan efforts to improve screening of all women.This brief, tailored outreach intervention was an effective strategy for encouraging cervical and breast cancer screening among women overdue for both screening services. It also shortened time-to-service, an important benefit for early detection and treatment. Alternative strategies are needed for women who remain unscreened.

Objectives To better understand the effectiveness of xylitol in caries prevention in adults and to attempt improved clinical trial efficiency. Methods As part of the Xylitol for Adult Caries Trial (X-ACT), non cavitated and cavitated caries lesions were assessed in subjects who were experiencing the disease. The trial was a test of the effectiveness of 5 g/day of xylitol, consumed by dissolving in the mouth five 1 g lozenges spaced across each day, compared with a sucralose placebo. For this analysis, seeking trial efficiency, 538 subjects aged 21-80, with complete data for four dental examinations, were selected from the 691 randomized into the 3-year trial, conducted at three sites. Acceptable inter- and intra-examiner reliability before and during the trial was quantified using the kappa statistic. Results The mean annualized noncavitated plus cavitated lesion transition scores in coronal and root surfaces, from sound to carious favoured xylitol over placebo, during the three cumulative periods of 12, 24, and 33 months, but these clinically and statistically nonsignificant differences declined in magnitude over time. Restricting the present assessment to those subjects with a higher baseline lifetime caries experience showed possible but inconsistent benefit. Conclusions There was no clear and clinically relevant preventive effect of xylitol on caries in adults with adequate fluoride exposure when non cavitated plus cavitated lesions were assessed. This conformed to the X-ACT trial result assessing cavitated lesions. Including non cavitated lesion assessment in this full-scale, placebo-controlled, multisite, randomized, double-blinded clinical trial in adults experiencing dental caries did not achieve added trial efficiency or demonstrate practical benefit of xylitol. Trial registration ClinicalTrials.Gov NCT00393055.

Molecular data, essential for genomics research, can be captured more efficiently in large-scale, population-based biobanks of genetic material rather than by individual studies. Biobanks also offer improved quality and reliability of genetic samples and access through automated sample retrieval. However, it is challenging to adequately inform participants of the broad nature of the research and participation risks and benefits. In addition, recent studies suggest concerns about data sharing and return of research results, or future research topics (eg, stereotypical or potentially stigmatizing traits). We evaluated the interest in participating in a biobank and reasons for nonparticipation.

Gene fusions between the ERG transcription factor and the androgen-regulated gene TMPRSS2 occur in a subset of prostate cancers and contribute to transformation of prostatic epithelial cells. Prior reports have used fluorescence in situ hybridization (FISH) or quantitative PCR (QPCR) to determine the presence of TMPRSS2-ERG fusions or ERG expression, respectively. Recently, several groups have reported on immunohistochemistry (IHC) to measure ERG expression, which is much more readily performed in clinical practice. However, the prior studies examining ERG expression by IHC had small sample sizes or they failed to clarify the association of ERG protein expression with important clinico-pathological features or prostate cancer-specific mortality.To address these deficits, we evaluated ERG expression by IHC in 208 radical prostatectomy samples from the Kaiser Permanente Molecular Epidemiology of Fatal Prostate Cancer (MEFPC) study, a case-control study of prostate cancer-specific mortality.Nuclear ERG expression was seen in neoplastic prostate epithelia in 49 of the samples (23.7%). ERG expression in tumor cells was associated with higher tumor stage (OR = 2.0, 95% confidence interval 1.0-4.0, P value = 0.04). ERG immunoreactivity was positively associated with prostate cancer-specific mortality, although the confidence interval was wide (OR = 1.9, 95% confidence interval 0.88-4.0, P value = 0.10).Our results demonstrate that ERG protein expression is readily quantifiable with an existing commercial antibody. Evaluating ERG protein expression may improve our ability to identify the subset of more aggressive, invasive prostate cancers.

Background Immigration to the United States has been associated with obesity, yet the relationship of acculturation to obesity and energy balance (ie, physical activity/dietary intake) in adults is a complex issue. Limited longitudinal data are available on immigrant Asians and Pacific Islanders. Design Analyses were conducted on baseline data and change data from baseline to 24 months in the hotel-based cluster-randomized Work, Weight and Wellness trial involving 15 control and 15 intervention hotels on the island of Oahu, Hawaii. Sample Participants were adult employees of predominantly Asian and Pacific Islander ancestry who were assessed one or more times over the course of 24 months. The full sample consisted of 4,236 hotel workers (about 40% of hotel workforce) at baseline, 3,502 hotel workers at Year 1 and 2,963 hotel workers at the 24-month follow up. One thousand one hundred fifteen hotel workers had at least two measurements, and were included in the analysis. Intervention The Work, Weight, and Wellness trial was designed to promote weight loss via motivation and support for increases in physical activity and increased access to and consumption of healthy low-fat/low-energy foods. The measure of acculturation consisted of a score that was a compilation of a participant's age when he or she immigrated to the United States, country of birth, language spoken at home, and years of education. Statistical analyses We used mixed effect regression models for cross-sectional baseline models and longitudinal multilevel regression analysis of change in diet and physical activity behaviors and obesity over time using a random intercept. Estimates of the intervention effect are expressed as an annual rate of change for all study outcomes. Results At baseline acculturation was positively associated with body mass index; physical activity level; and fruit, meat, and sweetened drink intake level. In analyses of change across 24 months, acculturation did not significantly influence change in dietary intake or indexes of obesity (ie, body mass index or waist-to-height ratio). However physical activity increased significantly more in the intervention group during the course of the intervention compared with the control group, which decreased activity, when sociodemographic factors (including acculturation) and food intake behavior were controlled for.

Background:Accelerometers measure intensity, frequency, and duration of physical activity. However, the scarcity of reports on data reduction makes comparing accelerometer results across studies difficult.Methods:Participants were asked to wear a triaxial accelerometer (RT3) for ≥10 hours for at least 4 days, including one weekend day. We summarize our data-cleaning procedures and assess the impact of defining a usable day of measurements as at least 6, 8, or 10 hours of wear time, and of standardizing data to a 12-hour day.Results:Eighty-two percent of participants met wear time requirements; 93% met requirements when we defined a day as 8-or-more hours of wear time. Normalization of data to a 12-hour day had little impact on estimates of daily moderate-to-vigorous physical activity (MVPA; 16.9 vs. 17.1 minutes); restricting MVPA to activities occurring in bouts of 10 minutes or longer had greater impact (16.9 vs. 6.3 minutes per day).Conclusion:Our account of accelerometry quality-control and data-cleaning procedures documents the small impact of variations in daily wear time requirements on MVPA estimates, and the larger impact of evaluating total MVPA vs. MVPA occurring in extended bouts. This paper should allow other researchers to duplicate or revise our methods as needed.

The spacer promoter of the rat rDNA repeat consists of two functional domains: a core (proximal) element that is sufficient for transcription in vitro, and an upstream (distal) promoter element that increases the efficiency of transcription. Two of the transcription factors that interact with the 45S promoter also interact with the spacer promoter. Rat SL-1, is required for transcription of the spacer promoter by heterologous extracts, e.g. human, and rat SF-1 is required for efficient transcription in vitro. Order-of-addition experiments demonstrated that the preinitiation complex formed by these factors on the spacer promoter is not as stable as the complex formed on the 45S promoter. DNase 1 footprinting experiments demonstrated binding sites for rat SL-1 and SF-1 on the distal element of the spacer promoter. The topology of the domains of the spacer promoter may explain both the reduced stability of the preinitiation complex formed on that promoter and the lower efficiency of transcription of that promoter when compared to the 45S promoter.

Objective To examine the influence of the PREMIER study lifestyle interventions on dietary intakes and adherence to the Dietary Approaches to Stop Hypertension (DASH) dietary pattern and the Dietary Reference Intakes (DRI). Design An 18-month multicenter, randomized controlled trial comparing two multicomponent lifestyle intervention programs to an advice only control group. Subjects/setting A total of 810 participants were recruited from local communities and randomized into the study. Individuals were eligible if they were aged 25 years or older, had body mass index between 18.5 and 45.0, not taking antihypertensive medication, and had prehypertension or stage 1 hypertension (systolic blood pressure 120 to 159 mm Hg and diastolic blood pressure 80 to 95 mm Hg). Intervention The two active intervention programs were a behavioral lifestyle intervention that implements established recommendations, and an established intervention plus the DASH dietary pattern. Both interventions consisted of intensive group and individual counseling sessions. The control group received a brief advice session after randomization and again after 6 months of data collection. Dietary intakes were collected by two random 24-hour recalls at baseline, 6 months, and 18 months. Main outcome measures The primary outcome of the PREMIER study was change in systolic blood pressure at 6 months. The main outcomes examined here include dietary variables collected by 24-hour recall at each time point. Statistical analyses Nutrient intakes were calculated and compared among the time points and the three intervention groups using mixed models with repeated measures at 6 and 18 months. Proportion of participants who met or achieved the original DASH nutrient intake levels and the DRIs were calculated and compared among the three intervention groups. P Results Participants in both the established intervention and established intervention plus DASH dietary pattern groups substantially reduced energy, total fat, saturated fat, and sodium intake and these reductions persisted throughout the study. Established intervention plus DASH dietary pattern group participants increased intakes of fruits, vegetables, dairy, and many vitamins and minerals; these increases were significantly greater than that of the control and established intervention groups. A majority of established intervention plus DASH dietary pattern group participants achieved at least two thirds of the DRI recommendations for most nutrients at 6 months, despite their reduction in total energy intake. Some but relatively small recidivism occurred at 18 months. Conclusions Both the established intervention and established intervention plus DASH dietary pattern group intervention were effective in helping participants follow established recommendations to control blood pressure. The advice-only control group also made some behavior changes, mainly decreasing energy and sodium intake. Only the established intervention plus DASH dietary pattern group significantly increased intakes of DASH-specific food groups, including fruits, vegetables, and dairy products, and nutrients, including protein, fiber, calcium, potassium, and magnesium. Most of the increases did not reach the levels consumed in the original DASH feeding studies. Whereas the established intervention plus DASH dietary pattern group intervention provides a useful platform to achieve the DASH dietary pattern and current DRI recommendations, intervention enhancements, including a greater emphasis on nutrient-dense foods, would likely improve this intervention.

Objective To examine the merits of the Asthma Therapy Assessment Questionnaire (ATAQ) control index together with prior asthma health-care utilization from administrative data in predicting future acute asthma health-care utilization. Design Prospective cohort study. Population A total of 4,788 adult asthma patients aged 17 to 93 years who completed a baseline evaluation and had at least 6 months of follow-up data. Statistical methods Classification and regression tree methodology to predict future risk of acute health-care utilization events. Results These results show that the ATAQ control index and administrative data are jointly useful for predicting future health-care utilization. The utility of the ATAQ control index in the presence of information about prior health-care utilization is to further stratify risk among the subset of younger individuals who did not have any prior acute health-care utilization. While administrative health-care utilization data served as the strongest predictor of future health-care utilization, the ATAQ control index helped to identify 1% of individuals without recent acute care that had approximately a sixfold elevated risk (95% confidence interval, 4.2 to 8.4) of future acute health-care utilization. This is an important result since only a small fraction of individuals with acute events in a given year will have had acute events in the previous year. Conclusion These findings should assist the practicing clinician and organizations interested in population-based asthma disease management.

Osteoporosis treatment rates after a fracture are low. This study evaluated methods to increase guideline-recommended osteoporosis care postfracture.Participants were randomly assigned to usual care or one of two interventions. Analysis of primary outcomes used electronic data and linear regression.A Pacific Northwest nonprofit health maintenance organization.Female patients aged 50 to 89 who suffered a fracture in 1999 and had not received bone mineral density (BMD) measurement or medication for osteoporosis (n=311) and their primary care providers (n=159).Patient-specific clinical guideline advice to the primary care provider delivered by electronic medical record (EMR) message or electronic reminder to the provider plus an educational letter mailed to the patient.BMD measurement and osteoporosis medication.At 6 months, provider reminder resulted in 51.5% of patients receiving BMD measurement or osteoporosis medication, provider reminder plus patient education resulted in 43.1%, and usual care resulted in 5.9% (P.001). The effect of provider advice combined with patient education was not significantly different from provider advice alone (P=.88). Patients aged 60 to 69 were 18% (95% confidence interval=3-34) more likely to receive BMD measurement or an osteoporosis medication than those aged 80 to 89.Patient-specific postfracture advice to the provider through an EMR message significantly increased BMD measurement and osteoporosis medication. As EMRs become more widespread, this intervention could improve osteoporosis management for many postfracture patients. Future research should identify barriers to and facilitators of care for older, high-risk patients.

Background: The clinical significance of glycemic index (GI) and glycemic load (GL) is inconclusive. Objective: This study was conducted to examine the association of GI and GL with clinical cardiovascular disease (CVD) risk factors including body weight, blood pressure (BP), serum lipids, fasting glucose, insulin and homocysteine over time among the PREMIER participants. Design: PREMIER was an 18-month randomized lifestyle intervention trial, conducted from 2000 to 2002, designed to help participants reduce BP by following the Dietary Approaches to Stop Hypertension (DASH) dietary pattern, losing weight, reducing sodium and increasing physical activity. GI and GL were estimated from 24 h diet recall data at baseline, 6 and 18 months after intervention. PROC MIXED model was used to examine the association of changes in GI or GL with changes in CVD risk factors. Results: A total of 756 randomized participants, 62% females and 34% African Americans and who averaged 50.0±0.3 years old and 95.3±0.7 kg, were included in this report. Neither GI nor GL changes was associated with changes in any risk factors at 6 months. At 18 months, however, the GI change was significantly and positively associated with total cholesterol (TC) change only ( p

Background and Aims: Despite the proliferation of care guidelines, widespread practice variation is common. Longitudinal electronic health records (EHR) provide an opportunity to observe how care variations are related to care outcomes. This study uses blood pressure management to illustrate the uses of the Disease Management Index (DMI) to relate care quality to cardiovascular outcomes. Methods: The Blood Pressure Disease Management Index (BP-DMI) incorporates the level of control of BP and the time out of control into a single index scored from 0 to 100. The practice level DMI for a given year is the average DMI for all diagnosed hypertensive patients in the practice. We observed practice level BP-DMI scores for 199 to 374 primary care physician (PCP) practices for the years 1998–2007 (Oregon) and 2005–2007 (Hawaii) and related those scores to annual incidence rates of myocardial infarction (MI), stroke, and congestive heart failure (CHF) hospital days. Results: Systolic BP (SBP) control was much worse than diastolic BP (DBP) control, particularly before 2005, but improved steadily from that point on. Practice variations in BP control were substantial. Propensity scores were used to adjust for the substantial differences in patient risk across practices. On average, clinicians treating elevated DBP had patients who were younger and healthier than those treating elevated SBP. Propensity adjusted incidence rates of MI, stroke, and CHF hospital days were strongly associated with both systolic (S) and diastolic (D) BP-DMI scores (p

The two test sites paired perennially cold-damaged portions of field vs. controls were monitored and assessed the same as last season. The winter of 1996–97 did not produce the same level of winter injury as the previous winter, thus this season was an opportunity to evaluate the effects of a “recovery” year. The overall cane lengths and bud number per cane were higher in the previously winter injured plots of both fields compared to the control. It showed the previous injured plants with a reduced crop load in 1996 were able to devote more energy into developing the 1997 crop. However, damaged plots still had higher cane dieback, percentage of cane dieback, number of dead or dormant buds per cane, and percentage of dead or dormant buds in both sites, especially at site 2, even in a mild 1996–97 winter. The control plots had greater average lateral length, total lateral length, and higher berry numbers per lateral, especially in laterals from primary buds at both sites. Thus, a mild winter reduced productivity of the floricanes and its laterals in the cold damaged plots. The differences in fruit yield and its components between the check and the cold-damaged ones were not significant this season. Leaves on the cold damaged floricanes had greater photosynthetic activity after harvesting than the control. The winter-injured plants with a reduced leaf area may show higher demand for photosynthate.

A field experiment was conducted in Lynden, Wash., to assess the combined bud damage to raspberry caused by cold injury, clay colored weevil (CCW) and spur blight disease last year. The CCW treatments included 3 and 6 weeks of continuous feedings and a minimal feeding in a nearby planting with no CCW infestation. Two other sets of field experiments evaluated cold injury to raspberry alone. Cold injury caused significant bud damage and moderate yield losses last winter. The large compensatory ability of raspberry makes yield loss due to cold injury alone insignificant in most years. Cold injury reduced berry yield mainly through a drop in lateral number/cane due to bud damage and cane die back. The combined damage of cold injury with infestations of CCW and spur blight, to the buds and fruit yield were devastating, and 60% bud damage and 61% yield loss were recorded. The combined damage was well over the compensatory ability of raspberry, and resulted in not only lower lateral number/cane, but also lower fruit number/lateral and fruit weight. The bud damage by CCW in the spring left little time for the secondary laterals to initiate flowers. An integrated pest management system is highly recommended to avoid the cumulative damage to the buds and has special importance in areas, where cold injury occurs frequently. Bud damage counted as cold injury was higher in the control plots (18%) than in the weevil-infested plots (6% to 9%). This was likely due to undercount of some cold damaged buds in the infested plots, which also suffered CCW feeding. All plots had similar levels of spur blight bud infection numbering from low to mid-teens. Spur blight-infected buds are often capable of producing normal fruiting laterals.

In 1999, yield of the split (ST) vs. conventional trellis (CT) was again compared in “Meeker” red raspberry. Field-testing was repeated at four sites in north (Lynden) and southwest (Woodland, Ridgefield, WSUV REU) Wash. A variety of widths, crossarm styles, and machine harvesters were tested in fields with varied cultural practices. Topped and tied-over canes were compared at two locations. In previous years, estimated yield potentials have been 20% to 60% greater for ST, but actual yields have only been 10% to 13% greater because of harvester damage to laterals and premature pick of green fruit. This year, Littau Harvester suggested minor machine adjustments that addressed these problems, resulting in a 19.4% yield increase for a 51-cm ST (Lynden). Lateral damage was minimized by spreading the picking heads to begin harvest, and then moving them closer after every three harvests. Excessive green fruit was controlled by reducing beater rod speed. A rough cost/benefit analysis indicates that there would be substantial economic gain (15% more $/acre in this case, assuming $0.50/lb fruit) for ST vs CT at this level of yield increase. There was no difference in harvest efficiency between treatments at WSUV. More fruit was lost to drop in the row center for ST in Lynden. Topped canes in CT and ST had reduced yields of 11 and 19% respectively compared to their tied-over counterparts. Topped ST canes had 11% greater yield than topped CT canes. ST canopies were larger, and had more leaves than CT. No differences were seen on a leaf-area basis between treatments for leaf: CO2 assimilation, fluorescence, and chlorophyll or in primocane leaf total nitrogen. Increased ST yields were recorded for a 2nd year at two locations, which supports yield sustainability for ST.

In 1998, yield of the split (ST) vs. conventional trellis was again compared in `Meeker' red raspberry with work at Vancouver focusing on advanced trellis development and technology transfer. Field testing was expanded from two to five sites in northern (Lynden) and southwestern (Woodland, Ridgefield, WSUV REU) Washington, with a total of eight trials. These tested a variety of widths (28–51 cm), crossarm styles, and machine harvesters in fields with varied cultural practices. Four trials were machine-picked, and, in Vancouver, harvest efficiency was studied. For widths >43 cm, yields were 10% to 13% greater for ST in four trials, while widths less than 43 cm showed no increase. As in previous years, estimated yield potential was 20% to 59% higher for ST in three of four trials. Differences between actual/estimated yields were due to several factors, including damage to laterals, harvest inefficiency, and poor early fruit release. Yield potential was greater (28%) for ST in a second-year trial, suggesting sustainability. In various trials, numerous data were collected including canopy and primocane measurements, aboveground biomass, light interception and leaf: area, gas exchange, chlorophyll content, fourth derivative spectra, fluorescence, N content, and tissue for anatomical analysis. Results were similar to last year. Increased light within ST causes earlier and larger canopy growth and fruit development. There was a large increase in leaf number, leaf area and berry number. Increases in yield were again associated with higher number of lateral/cane. There was no difference in leaf physiological measurements/leaf area between treatments.

Two test sites pairing perennially cold-damaged portions of fields vs. controls for a 3rd year were assessed. Winter 1997-1998 was very mild and produced less winter injury than the previous winters. We evaluated continued recovery of the raspberry canopy and cane productivity. In contrast to the last 2 years, the previously cold-damaged plots did not show higher levels of cane dieback, percentage of cane dieback, number of dead or dormant buds per cane, and percentage of dead buds at either site. Very few secondary laterals were produced at either site, which supports previous observations that raspberry compensates for winter injury with increased production of secondary laterals. For the first time, the damaged plots actually produced higher yields mainly through a significantly increased berry number per cane at both sites. Floricane leaves in the damaged plots showed higher photosynthetic rates at the green fruit stage and after harvest at site 2. Cane size was similar across sites, although the previously cold-damaged plants had higher berry numbers per lateral. It seems the newly recovered plants in the previously damaged plots had a renewed vigor, working harder to achieve a higher yield. No differences between treatments was detected in leaf nitrogen for a third year, suggesting this may not be a factor in winter injury here. A high population of weevils was observed at one injured site, suggesting a possible interaction with cold damage.

After promising results were obtained with an open-style split trellis (two top wires) in its initial year, two new trials were established in 1997 in northwest (Lynden) and southwest (Woodland) Washington. For the split trellis, actual yields were 33% (machine-picked 1/2 season) and 17% (hand-picked) greater, respectively, for the two locations compared to the conventional trellis (one top wire). In Woodland, canes from the split trellis had 33% more berries, 55% more laterals, 69% more leaves, and 25% greater leaf area compared with the conventional trellis. Greatest enhancement of these components was in the upper third of the canopy. Laterals were also shorter in this area of the split canopy, but there was no difference in average total length of lateral/cane between trellis types. Total dry weight/cane was 22% greater in the split trellis, but component partitioning/cane was consistent between the two systems with fruit + laterals (43%) having the greatest above-ground biomass, followed by the stem (30% to 33%) and the leaves (21% to 22%). Measurement of canopy width, circumference, and light interception showed that the split-trellis canopy filled in more quickly, and was larger from preanthesis through postharvest. Light interception near the top of the split canopy was 30% greater 1 month before harvest with 98% interception near the top and middle of that canopy. There was no difference between the trellis types in leaf CO2 assimilation, spectra, or fluorescence through the fruiting season, or in total nitrogen of postharvest primocane leaves.

With the advent of new rotary-head mechanical harvesters, it is now possible to machine-harvest a wider raspberry canopy. In Spring 1996, a trial was established in a grower's field in Lynden, Wash., comparing raspberries trained to two top wires with a 70-cm spread (split trellis) to the conventional single top wire system. Within the split trellis, increases in leaf number per cane (97%), and leaf area per cane (55%) were not reflected in a concomitant increase in total leaf dry weight per cane (35%). Leaf dry weight per fruit weight was 11% less within the split trellis. These data suggest that the canopy is more efficient with this type of trellis. Increases in estimated yield per cane (49%) and projected yield per acre (50%) associated with the split trellis were due to increases in berry number per cane (47%). Fruit number per meter of lateral was 35% greater within the split trellis. Greatest enhancements to yield components were in the upper parts of the canopy where canes were tied over. Since there were no differences in lateral numbers or lateral lengths between the two systems, this increased productivity was due to increased floral expression, enhanced fruit set, increases through Spring bud initiation or any combination thereof. In both trellis systems, the longest laterals occurred on the middle third of the cane and decreased in length progressively towards the tip of the cane. Primocane lengths were shorter (20%) and diameters were smaller (10%) and more uniform in the split trellis system.

Two sets of field experiments have been set up in Lynden, Wash., to evaluate cold damage to red raspberry `Meeker'. The locations represent newly established crops (fi eld 1) and a field that suffered reoccurring cold damages in recent years (fi eld 2), respectively. Temperature and moisture HOBOs were set up in the check and colddamaged treatments of both of the fields to record the air and soil temperatures and air moisture. The cold-damaged treatments in both fields had significantly higher cane dieback and dead buds. Cold injury significantly reduced berry yield in field 1, but not in field 2, through an steep drop in berry number per cane, mainly due to a significant reduction in lateral number/cane. Cold damage reduced primary lateral number/cane, and increased secondary lateral number/cane in both fields. Secondary laterals were shorter in length and had lower berry number/lateral than the primary ones. It proved that cold damage also delayed initiation and development of secondary laterals, and resulted in more yield loss to the plant. The cold-damaged fruiting cane had lower gas exchange rates, leaf and stomatal conductance, and transpiration rates during fruit development in both fields. It also significantly reduced fluorescence parameters Fo, Fm, Fv, T1/2, and Fq of the cold injury treatment in field 1. On a few cold days this spring, the HOBOs recorded a lower daily low temperature in the cold damaged area than in the check area.

Leaf water potential (LWP), relative water content (RWC), gas exchange characteristics, and specific leaf weight (SLW) were measured six hours before, during, and after water stress treatment in F. chiloensis and F. ×ananassa grown in growth chambers. The leaves of both species showed significantly lower LWP and RWC as water stress developed. F. ×ananassa had consistency lower LWP under stressed and nonstressed conditions than F. chiloensis. F. ×ananassa had higher RWC under nonstressed conditions, and its RWC decreased more rapidly under water stress than F. chiloensis. In comparison to F. ×ananassa, F. chiloensis had significantly higher CO2 assimilation rate (A), leaf conductance (LC), and SLW, but not transpiration rate (Tr), under stressed and nonstressed conditions. LC was the most sensitive gas exchange characteristic to water stress and decreased first. Later, A and stomatal conductance were reduced under more severe water stress. A very high level of Tr was detected in F. ×ananassa under the most severe water stress and did not regain after stress recovery, suggesting a permanent damage to leaf. The Tr of F. chiloensis was affected less by water stress. Severe water stress resulted in higher SLW of both species.

The effect of mechanical stress from sources such as wind on the physiology of higher plants has been documented in many species. Some of these reported changes, such as decreased photosynthetic activity, are not well-documented and bear closer examination. Mechanical stress has been reported to decrease the productivity of some crop plants. In both field and greenhouse trials, high-speed blown air was used as a thigmic stress for the temporary, nonchemical suppression of primocane growth in red raspberry. Field trials with the cultivar Meeker in 1993–94 have shown that high-speed blown air can be used to adequately control primocane height for mechanical harvest, while increasing yield through greater numbers of fruit per cane. In both field and greenhouse experiments, photosynthetic activity or red raspberry leaves was not affected by 273 km/h of wind applied twice daily, 5 days per week. Anatomical analysis demonstrated changes in the cross-sectional anatomy of mechanically stressed canes. Stressed canes had increased callose deposition and greater numbers of secondary xylem cells.

The red raspberry industry of the Pacific Northwest depends upon chemical primocane suppression to temporarily reduce competing vegetation during fruit development. This practice increases yield and harvest efficiency, but can reduce cane vigor, number and diameter over time. Few chemicals are available for this purpose and thus the potential of nonchemical alternatives is being explored. The purpose of this project was to evaluate the potential of blown air as a thigmic stress to temporarily suppress primocane growth. Blown air treatments were applied once (12 PM) or twice (12\4pm) per day, five days per week using a portable leaf blower generating winds of 273 km per hr. Treatments also included several rates of three experimental herbicides and an untreated control. All treatments were applied when primocanes were 10-15 cm in length and blown air treatments continued through fruit development. Primocane development was monitored over the course of the season. Blown air reduced primocane length by 15-30% prior to harvest giving control equivalent to current chemical methods. Blown air increased cane diameter but reduced yield by reducing fruit numbers. Reductions in fruit numbers are likely due to flowering\fruiting points removed by blown air.

Leaf water potential (LWP). relative water content (RWC), gas exchange rates and 4th-derivative spectra were measured in water-stressed and normally Irrigated plank of Totem' strawberry (Fragaria × ananassa) grown in a growth chamber. CO2 assimilation rate (A) dropped sharply when LWP decreased from -0.5 to -1.2 MPa and almost ceased as LWP fell below -1.5 MPa. There was a significant but more gradual decline of A as RWC decreased form 90% to 55%. An exponential relationship with A was observed across a wide range of LWP and RWC (Rz= 0.64, 0.86, respectively). LWP was more closely related with transpiration and leaf and stomatal conductances than with A and water use efficiency. RWC was highly correlated with all gas exchange parameters. Under moderate water stress, younger leaves maintain higher RWC and A than older leaves. There was no relationship between LWP and leaf age. RWC and A were both negatively correlated with peak amplitudes of Ca 684 and Ca 697 and positively correlated with Ca 693 in their 4th-derivative spectra of chlorophyll. LWP had a negative correlation with Cb 640.

On four dates during the 1991 growing season, gas exchange rates were measured on the same middle leaflets every 3 h from 7am-10pm from deflowered (DF) and fruiting (F) red raspberry (Rubus idaeus L. cv. “Meeker”) canes. Concurrently, the adjacent side leaflets were sampled for anatomical starch determination. The dates corresponded to the late anthesis/early green fruit, early red fruit, late red fruit, and post fruit maturity stages of the growing season. For all dates, CO2 assimilation (A) was highest from 7-10am, lowest at 4pm, and increased at 7pm. Overall A peaked during fruit development. Leaves of F canes had greater A than leaves of DF canes during fruit development, but rates were similar after fruit maturity. Starch accumulation in leaf cross-sections generally followed the diurnal pattern observed for A. Starch appeared heaviest from 7am-lpm and often showed an increase from 7-10pm. Leaves from DF canes generally had a greater accumulation of starch. Seasonally, leaf starch from F canes appeared greatest at late anthesis, decreased during fruit development and was very low post fruit maturity. Leaf starch in DF canes appeared greatest at the late anthesis and late red fruit stages. DF leaves had greater dry weight accumulation than F leaves during the red fruit stages. A Western blot showed that Rubisco levels as a percentage of total soluble protein were higher during fruit development and decreased after fruit maturity.

After anthesis, date of leaf emergence was recorded in fruited plants (F) and deflowered plants (DF) of `Totem' strawberry (Fragaria × ananassa), which were grown in a randomized block design with four blocks in a greenhouse. Two different regression models were fitted to describe leaf emergence rate (LER) after anthesis for F and DF (R2 = 0.826 and 0.916, respectively). The LER of F decreased during the fruit development, and accelerated and exceeded DF after fruit maturity, then both dropped when the growth season was ending. Physiological and photosynthetic characteristics were measured on leaves from F and DF at green fruit, red fruit, and after fruit maturity stages. Newly expanded leaves had significantly higher gas exchange rates, specific leaf weight, chlorophyll a and b contents but lower a/b ratio than the older leaves both during and after fruit development. They also had higher amplitudes of Ca 693 but lower peaks at Ca 684 and Cb 649 in their fourth-derivative chlorophyll spectra. Leaf chlorophyll a content and CO2 assimilation rate decreased after fruit maturity. Plants at red fruit stage had higher chlorophyll b content than at green fruit and after fruit maturity stages. The LERs of the second and third leaves emerged after anthesis were most seriously affected by fruit development. They showed greater photosynthetic activity than other leaves in the canopy during fruit development and were thus important to fruit yield.

Gas exchange rates were measured in the field on middle leaflets of Fragaria chiloensis (L.) trifoliates which were then used for Rubisco quantity and activity assays. Side leaflets of the same leaf were utilized for fourth-derivative spectroscopy, chlorophyll extraction, and specific leaf weight data. Differences of CO2 assimilation (A) rates were highly significant between genotypes ranging from 16.2 to 27.6 μmol CO2·s·m. Chlorophyll a and b, and total chlorophyll per unit area were positively correlated to A (r = 0.48**, 0.45**, and 0.49**, respectively). Total chlorophyll per unit dry weight had a correlation coefficient with A of 0.6**. Fourth-derivative analysis of in vivo leaf attenuance spectra showed a positive correlation between A and Ca693 peak amplitude and a negative correlation of A and Ca677 peak amplitude. Peak amplitude of Ca693 was also correlated with chlorophyll content. Activity per unit Rubisco was not a significant factor influencing A, but Rubisco quantity on either a leaf area or a dry weight basis was positively linked to A (r = 0.40** and 0.44**, respectively).

In the early spring, 300 canes of `Meeker' red raspberry were tagged and 150 were deflowered at anthesis. During a 12-week period beginning at anthesis, leaves were sampled for anatomical sectioning and determination of chlorophyll content and dry weight per leaf unit area, Comparisons of leaf cross-sections from fruiting (F) and deflowered (DF) canes demonstrated high levels of starch accumulation in the latter. This accumulation of starch was layered throughout the cross section, and size of starch crystals varied by location. Dry weight per leaf unit area increased in all leaves during the season, but was consistently greater in leaves of DF canes throughout the season. Total leaf chlorophyll and chlorophyll a content increased until reaching a maximum three weeks after anthesis, Both decreased slightly until nine weeks after anthesis and sharply thereafter as leaves began to senesce. Chlorophyll b content remained nearly constant until eight weeks after anthesis at which time levels declined during the onset of senescence.

Accumulated attendance and fourth-derivative spectra were measured using intact leaf samples at mom temperature for 80 genotypes of four Fragaria species. Attendance peak wavelength and amplitude data of all samples was pooled and yielded 25 common bands for Fragaria. Of these, 14 chlorophyll bands and two phototransformed bands were consistent with French's (1972) model.Peak wavelengths and amplitudes which represent major bands in F. chiloensis and F. × ananassa spectra were also determined separately. While peak wavelengths of the two species were identical, variation was noted in peak amplitude. The signals of the bands at Cb640, Cb649, Ca670, Ca673, Ca675-676, Ca684 and Ca693 in F. chiloensis were significantly stronger than those in F. × ananassa. Ca677 and Ca695 were stronger in F. × ananassa.The greatest difference among Fragaria species was found in the amplitude of Ca693. The amplitude of this peak was greatest in F. chi/oensis (0.0025) and smallest in F. virginiana (-0.0005), The cultivated hybrid of these two species, F. × ananassa, was intermediate (0.0008), Preliminary evidence suggests that certain genotype-specific spectral characteristics may relate directly to observed differences in photosynthetic biology among these species.