Search

OBJECTIVE: Patient use of online electronic medical records (EMR) holds the potential to improve health outcomes. The purpose of this study is to discover how patients living with chronic inflammatory bowel disease (IBD) value Internet-based patient access to electronic patient records. DESIGN: This was a qualitative, exploratory, descriptive study using in-depth interviews and focus groups of a total of 12 patients with IBD of at least one-year duration at University Health Network, a tertiary care center in Toronto, Ontario. RESULTS: Four themes have been elucidated that comprise a theoretical framework of patient-perceived information and communication technology usefulness: promotion of a sense of illness ownership, of patient-driven communication, of personalized support, and of mutual trust. CONCLUSIONS: For patients with chronic IBD, simply providing access to electronic medical records has little usefulness on its own. Useful technology for patients with IBD is multifaceted, self-care promoting, and integrated into the patient's already existing health and psychosocial support infrastructure. The four identified themes can serve as focal points for the evaluation of information technology designed for patient use, thus providing a patient-centered framework for developers seeking to adapt existing EMR systems to patient access and use for the purposes of improving health care quality and health outcomes. Further studies in other populations are needed to enhance generalizability of the emergent theory. [ABSTRACT FROM AUTHOR]

There are constraints embedded in medical record structure that limit use by patients in self-directed disease management. Through systematic review of the literature from a critical perspective, four characteristics that either enhance or mitigate the influence of medical record structure on patient utilization of an electronic patient record (EPR) system have been identified: environmental pressures, physician centeredness, collaborative organizational culture, and patient centeredness. An evaluation framework is proposed for use when considering adaptation of existing EPR systems for online patient access. Exemplars of patient-accessible EPR systems from the literature are evaluated utilizing the framework. From this study, it appears that traditional information system research and development methods may not wholly capture many pertinent social issues that arise when expanding access of EPR systems to patients. Critically rooted methods such as action research can directly inform development strategies so that these systems may positively influence health outcomes. [ABSTRACT FROM AUTHOR]

Differences among clinical care units in social dynamics and social organization are associated with differences in the clinical course of patients with a range of chronic illness. These differences are also associated with well-being of staff members. Recent attention has focused on understanding these differences among units with an eye towards correcting deficiencies and enhancing strengths of clinical care units. The current study sought to delineate the effect of social and organizational dynamics unique to each unit on staff perceptions of the security of their relationships with other staff and their perceived work pressure. The unit as a major source of differences among staff subjects was compared with the impact of ethnic identity, of work in the morning shift vs other shifts, and of professional role. Results confirmed that unit membership was, by far, the most important correlate of staff perceptions of the unit, particularly those concerning security of relationships with others and perceived work pressure. Moreover, the results suggested that unit differences in perceived security were due to differences among units in long standing turmoil within the unit or long standing problematic ties between the unit and the larger institution which controls it. However, perceived work pressure seems more transient and may reflect the challenge of shorter-temm fluctuations in the demands of patient care. [ABSTRACT FROM AUTHOR]

Stainless steel is a ubiquitous structural material and one that finds extensive use in core-internal components in nuclear power plants. Stainless steel features superior corrosion resistance (e.g., as compared to ordinary steel) due to the formation of passivating iron and/or chromium oxides on its surfaces. However, the breakdown of such passivating oxide films, e.g., due to localized deformation and slip line formation following exposure to radiation, or aggressive ions renders stainless steel susceptible to corrosion-related degradation. Herein, the effects of alkali cations (i.e., K + , Li + ) and the interactions between the passivated steel surface and the solution are examined using 304L stainless steel. Scanning electrochemical microscopy and atomic force microscopy are used to examine the inert-to-reactive transition of the steel surface both in the native state and in the presence of applied potentials. Careful analysis of interaction forces, in solution, within ≤10 nm of the steel surface, reveals that the interaction between the hydrated alkali cations and the substrate affects the structure of the electrical double layer (EDL). As a result, a higher surface reactivity is indicated in the presence of Li + relative to K + due to the effects of the former species in disrupting the EDL. These findings provide new insights into the role of the water chemistry not only on affecting metallic corrosion but also in other applications, such as batteries and electrochemical devices., Competing Interests: The authors declare no competing financial interest.

Background: The use of expert systems to generate automated alerts and patient instructions based on telemonitoring data could enable increased self-care and improve clinical management. However, of great importance is the development of the rule set to ensure safe and clinically relevant alerts and instructions are sent. The purpose of this work was to develop a rule-based expert system for a heart failure mobile phone-based telemonitoring system, to evaluate the expert system, and to generalize the lessons learned from the development process for use in other healthcare applications., Methods: Semi-structured interviews were conducted with 10 heart failure clinicians to inform the development of a draft heart failure rule set for alerts and patient instructions. The draft rule set was validated and refined with 9 additional interviews with heart failure clinicians. Finally, the clinical champion of the project vetted the rule set. The concerns voiced by the clinicians during the interviews were noted, and methods to mitigate these concerns were employed. The rule set was then evaluated as part of a 6-month randomized controlled trial of a mobile phone-based heart failure telemonitoring system (n=50 for each of the telemonitoring and control groups)., Results: The developed expert system generated alerts and instructions based on the patient's weight, blood pressure, heart rate, and symptoms. During the trial, 1620 alerts were generated, which led to various clinical actions including 105 medication changes/instructions. The findings from the trial indicated the rule set was associated with improved quality of life and self-care., Conclusions: A rule set was developed with extensive input by heart failure clinicians. The results from the trial indicated the rule set was associated with significantly increased self-care and improved the clinical management of heart failure. The developed rule set can be used as a basis for other heart failure telemonitoring systems, but should be validated and modified as necessary. In addition, the process used to develop the rule set can be generalized and applied to create robust and complete rule sets for other healthcare expert systems., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Background: Previous trials of telemonitoring for heart failure management have reported inconsistent results, largely due to diverse intervention and study designs. Mobile phones are becoming ubiquitous and economical, but the feasibility and efficacy of a mobile phone-based telemonitoring system have not been determined., Objective: The objective of this trial was to investigate the effects of a mobile phone-based telemonitoring system on heart failure management and outcomes., Methods: One hundred patients were recruited from a heart function clinic and randomized into telemonitoring and control groups. The telemonitoring group (N = 50) took daily weight and blood pressure readings and weekly single-lead ECGs, and answered daily symptom questions on a mobile phone over 6 months. Readings were automatically transmitted wirelessly to the mobile phone and then to data servers. Instructions were sent to the patients' mobile phones and alerts to a cardiologist's mobile phone as required., Results: Baseline questionnaires were completed and returned by 94 patients, and 84 patients returned post-study questionnaires. About 70% of telemonitoring patients completed at least 80% of their possible daily readings. The change in quality of life from baseline to post-study, as measured with the Minnesota Living with Heart Failure Questionnaire, was significantly greater for the telemonitoring group compared to the control group (P = .05). A between-group analysis also found greater post-study self-care maintenance (measured with the Self-Care of Heart Failure Index) for the telemonitoring group (P = .03). Brain natriuretic peptide (BNP) levels, self-care management, and left ventricular ejection fraction (LVEF) improved significantly for both groups from baseline to post-study, but did not show a between-group difference. However, a subgroup within-group analysis using the data from the 63 patients who had attended the heart function clinic for more than 6 months revealed the telemonitoring group had significant improvements from baseline to post-study in BNP (decreased by 150 pg/mL, P = .02), LVEF (increased by 7.4%, P = .005) and self-care maintenance (increased by 7 points, P = .05) and management (increased by 14 points, P = .03), while the control group did not. No differences were found between the telemonitoring and control groups in terms of hospitalization, mortality, or emergency department visits, but the trial was underpowered to detect differences in these metrics., Conclusions: Our findings provide evidence of improved quality of life through improved self-care and clinical management from a mobile phone-based telemonitoring system. The use of the mobile phone-based system had high adherence and was feasible for patients, including the elderly and those with no experience with mobile phones., Trial Registration: ClinicalTrials.gov NCT00778986.

Background: Previous trials of heart failure telemonitoring systems have produced inconsistent findings, largely due to diverse interventions and study designs., Objectives: The objectives of this study are (1) to provide in-depth insight into the effects of telemonitoring on self-care and clinical management, and (2) to determine the features that enable successful heart failure telemonitoring., Methods: Semi-structured interviews were conducted with 22 heart failure patients attending a heart function clinic who had used a mobile phone-based telemonitoring system for 6 months. The telemonitoring system required the patients to take daily weight and blood pressure readings, weekly single-lead ECGs, and to answer daily symptom questions on a mobile phone. Instructions were sent to the patient's mobile phone based on their physiological values. Alerts were also sent to a cardiologist's mobile phone, as required. All clinicians involved in the study were also interviewed post-trial (N = 5). The interviews were recorded, transcribed, and then analyzed using a conventional content analysis approach., Results: The telemonitoring system improved patient self-care by instructing the patients in real-time how to appropriately modify their lifestyle behaviors. Patients felt more aware of their heart failure condition, less anxiety, and more empowered. Many were willing to partially fund the use of the system. The clinicians were able to manage their patients' heart failure conditions more effectively, because they had physiological data reported to them frequently to help in their decision-making (eg, for medication titration) and were alerted at the earliest sign of decompensation. Essential characteristics of the telemonitoring system that contributed to improved heart failure management included immediate self-care and clinical feedback (ie, teachable moments), how the system was easy and quick to use, and how the patients and clinicians perceived tangible benefits from telemonitoring. Some clinical concerns included ongoing costs of the telemonitoring system and increased clinical workload. A few patients did not want to be watched long-term while some were concerned they might become dependent on the system., Conclusions: The success of a telemonitoring system is highly dependent on its features and design. The essential system characteristics identified in this study should be considered when developing telemonitoring solutions.

A brief personal history illustrates how fortunate I was to have stumbled into a career in plant pathology, which turned out to be the ideal job for me. Several of the people who steered me or facilitated my development in research on plant diseases are mentioned. Starting with my PhD research, I have had the good fortune to indulge a career-long fascination with epidemiology and genetics of disease resistance in plants, particularly coevolution of gene-for-gene host-pathogen systems. I hope that my example may inspire others of like minds to consider a research career in plant pathology.

Adolescent substance abuse is a criminal behavior; however, not all criminal behaviors result in criminal justice involvement. This study examined disparities among adolescents aged 12 to 17 admitted to substance abuse treatment nationwide. Findings indicate significant disparities in patterns and determinants of criminal justice involvement between White and minority adolescents. Minorities were significantly more likely to be involved with the criminal justice system, even after controlling for criminal behaviors, substance abuse, mental health problems, and socioenvironmental risk. Findings reveal that connections to the educational system may be especially important for minority groups. The importance of developing systems of treatment for adolescents in the community and correctional system that are part of the same continuum of care is highlighted.

Background: Multidisciplinary heart function clinics aim to improve self-care through patient education and to provide clinical management., Objective: The objectives of the present study were to investigate the self-care and quality of life of patients attending a multidisciplinary heart function clinic and to explore the relationship between self-care and quality of life., Methods: One hundred outpatients attending a multidisciplinary heart function clinic were asked to complete a questionnaire. The questionnaire included the Self-care of Heart Failure Index (SCHFI) and the Minnesota Living With Heart Failure Questionnaire, which were used to assess self-care behavior and quality of life, respectively. Self-care practices and perceived barriers were also assessed through semistructured interviews with each patient., Results: : The returned questionnaires (n = 94) were used to compute the following SCHFI maintenance, management, and confidence scores: 60.8 (SD, 19.3), 62.0 (SD, 20.7), and 55.9 (SD, 19.7), respectively. Higher SCHFI scores indicate better self-care. None of the self-care dimensions reached the self-care adequacy cut point of 70. The average score on the Minnesota Living With Heart Failure Questionnaire was 49.9 (SD, 25.4), indicating a moderate health-related quality of life. Lower ejection fraction, older age, and better quality of life were associated with better self-care. Determinants of better quality of life were older age, better functional capacity, higher self-care confidence, and fewer comorbidities. The patient interviews revealed that better quality of life is associated with higher self-care confidence and barriers to self-care caused anxiety to the patients. The self-care barriers were found to include lack of self-care education, financial constraints, lack of perceived benefit, and low self-efficacy., Conclusions: Patients attending a large multidisciplinary Canadian heart failure clinic do not perform adequate self-care as measured with the SCHFI and report only a moderate quality of life. Increasing self-care through education and tools that target self-care barriers are required and may help improve quality of life.

In this article, we elaborate on the cost-effectiveness of eHealth solutions and the need to evaluate the return on investment as is done routinely with all other major expenditures. To this end, we discuss the theory that exists today to explain some of the usage principles affiliated with information technology implementation in healthcare; namely, we reflect on the Technology Adoption Criteria in Health (TEACH) model and Wagner's Chronic Disease Management model. The basic premise of the TEACH model is that adoption requires work; this work must be recognized at the outset, and the progress to overcome the workload increase must be measured for the adoption to continue. Furthermore, both of these models have emphasized that the trade-off between cost and work and the benefits realized (as seen through measurement) must first be applied to patients that use the system frequently and on an ongoing basis (ie, the chronically ill). We refer to these ongoing users as consumers of healthcare resources-Consumers with Chronic Conditions (the 3C patients). In this article, we show that the benefits outweigh the costs only when we do, in fact, apply the analysis to 3C patients. Once an effective eHealth system has been developed for the 3C patients, then it can be straightforwardly extended to include all patients and other stakeholders.

Background: Mobile phone-based remote patient monitoring systems have been proposed for heart failure management because they are relatively inexpensive and enable patients to be monitored anywhere. However, little is known about whether patients and their health care providers are willing and able to use this technology., Objective: The objective of our study was to assess the attitudes of heart failure patients and their health care providers from a heart function clinic in a large urban teaching hospital toward the use of mobile phone-based remote monitoring., Methods: A questionnaire regarding attitudes toward home monitoring and technology was administered to 100 heart failure patients (94/100 returned a completed questionnaire). Semi-structured interviews were also conducted with 20 heart failure patients and 16 clinicians to determine the perceived benefits and barriers to using mobile phone-based remote monitoring, as well as their willingness and ability to use the technology., Results: The survey results indicated that the patients were very comfortable using mobile phones (mean rating 4.5, SD 0.6, on a five-point Likert scale), even more so than with using computers (mean 4.1, SD 1.1). The difference in comfort level between mobile phones and computers was statistically significant (P< .001). Patients were also confident in using mobile phones to view health information (mean 4.4, SD 0.9). Patients and clinicians were willing to use the system as long as several conditions were met, including providing a system that was easy to use with clear tangible benefits, maintaining good patient-provider communication, and not increasing clinical workload. Clinicians cited several barriers to implementation of such a system, including lack of remuneration for telephone interactions with patients and medicolegal implications., Conclusions: Patients and clinicians want to use mobile phone-based remote monitoring and believe that they would be able to use the technology. However, they have several reservations, such as potential increased clinical workload, medicolegal issues, and difficulty of use for some patients due to lack of visual acuity or manual dexterity.

Background: Personal health records (PHRs) provide patients with access to personal health information (PHI) and targeted education. The use of PHRs has the potential to improve a wide range of outcomes, including empowering patients to be more active participants in their care. There are a number of widespread barriers to adoption, including privacy and security considerations. In addition, there are clinical concerns that patients could become anxious or distressed when accessing complex medical information. This study assesses the implementation of a PHR, and its impact on anxiety levels and perceptions of self-efficacy in a sample of breast cancer patients., Methods: A quasi-experimental pre-test/post-test design was used to collect data from participants to evaluate the use of the PHR. Study participants completed background and pre-assessment questionnaires and were then registered into the portal. By entering an activation key, participants were then able to review their lab results and diagnostic imaging reports. After six weeks, participants completed post-assessment questionnaires and usability heuristics. All data were collected using an online survey tool. Data were cleaned and analyzed using SAS v9.1., Results: A total of 311 breast cancer patients completed demographic and pre-assessment questionnaires, 250 registered to use the online intervention, and 125 participants completed all required study elements. Matching the pre- and post-anxiety scores demonstrated a decrease in mean anxiety scores (-2.2, p = 0.03); the chemotherapy sub-group had a statistically insignificant mean increase (1.8, p = .14). There was no mean change in self-efficacy scores., Conclusions: Participants generally found the portal easy to use; however, the perceived value of improved participation was not detected in the self-efficacy scores. Having access to personal health information did not increase anxiety levels. While these results suggest that the use of this PHR may be of benefit for informing patients, further research is required to investigate the impact on the patients experiences, their participation in their care, their relationships with the health care team, and their health outcomes.

This study explores the basis for providing effective access to electronic medical record data as a reference source for patients with early-stage testicular cancer undergoing surveillance follow-up programs.

Background: Black youth are disproportionately affected by the HIV/AIDS epidemic. This study examined disparities in patterns and determinants of sexual risk behaviors among black and white adolescents in substance abuse treatment programs., Methods: We used pooled clinical data collected from 4,565 sexually active 12-17-year-old black (29.7%) and white (70.3%) adolescents entering outpatient and residential substance abuse treatment programs nationally. Multivariate logistic regression analyses were used to examine racial differences in patterns of sexual risk behaviors and the associations of these behaviors with demographic, socioenvironmental and psychosocial risk factors, including substance use and abuse, symptoms of mental disorders and criminal behaviors., Results: Blacks were significantly more likely than whites to have had sex with multiple partners, purchased or traded sex and used substances to enhance their sexual experiences, even after adjusting for demographic, socioenvironmental and psychosocial risk factors. Substance use and abuse, internalizing symptoms and drug-related crimes were significantly associated with engaging in > or =2 sexual risk behaviors in both groups. Disparities in determinants of HIV risk were also found. For instance, male gender, single-parent custody and history of criminal justice involvement were associated with having had sex with multiple partners among blacks but not among whites. Demographic, socioenvironmental and psychosocial risk factors accounted for up to 30% of the variance in sexual risk in both groups., Conclusions: Black adolescents with substance use problems are at greater risk for HIV infection than their white peers because of their higher rates of sexual risk behaviors. Differences in co-occurring psychosocial problems did not fully explain racial disparities in sexual risk behaviors. HIV prevention programs for black adolescents in treatment should consider both individual and broader contextual factors that co-occur with sexual risk behaviors.

Background: Providing patients with access to their electronic health records offers great promise to improve patient health and satisfaction with their care, as well to improve professional and organizational approaches to health care. Although many benefits have been identified, there are many questions about best practices for the implementation of patient accessible Electronic Health Records (EHRs)., Objectives: To develop recommendations to assist health care organizations in providing patients with access to EHRs in a meaningful, responsible, and responsive manner., Methods: A Patient Accessible Electronic Health Record (PAEHR) Workshop was held with nationally and internationally renowned experts to explore issues related to providing patient access to the EHR and managing institutional change., Results: The PAEHR Workshop was attended by 45 participants who discussed recommendations for the implementation of patient accessible EHRs. Recommendations were discussed under four subject domains: (1) providing patient access to the EHR, (2) maintaining privacy and confidentiality related to the PAEHR, (3) patient education and navigation of the PAEHR, and (4) strategies for managing institutional change. The discussion focused on the need for national infrastructure, clear definitions for privacy, security and confidentiality, flexible, interoperable solutions, and patient and professional education. In addition, there was a strong call for research into all domains of patient accessible EHRs to ensure the adoption of evidence-based practices., Conclusions: Patient access to personal health information is a fundamental issue for patient engagement and empowerment. Health care professionals and organizations should consider the potential benefits and risks of patient access when developing EHR strategies. Flexible, standardized, and interoperable solutions must be integrated with outcomes-based research to activate effectively patients as partners in their health care.

Background: Access to personal health information through the electronic health record (EHR) is an innovative means to enable people to be active participants in their own health care. Currently this is not an available option for consumers of health. The absence of a key technology, the EHR, is a significant obstacle to providing patient accessible electronic records. To assess the readiness for the implementation and adoption of EHRs in Canada, a national scan was conducted to determine organizational readiness and willingness for patient accessible electronic records., Methods: A survey was conducted of Chief Executive Officers (CEOs) of Canadian public and acute care hospitals., Results: Two hundred thirteen emails were sent to CEOs of Canadian general and acute care hospitals, with a 39% response rate. Over half (54.2%) of hospitals had some sort of EHR, but few had a record that was predominately electronic. Financial resources were identified as the most important barrier to providing patients access to their EHR and there was a divergence in perceptions from healthcare providers and what they thought patients would want in terms of access to the EHR, with providers being less willing to provide access and patients desire for greater access to the full record., Conclusion: As the use of EHRs becomes more commonplace, organizations should explore the possibility of responding to patient needs for clinical information by providing access to their EHR. The best way to achieve this is still being debated.

The world has evolved into "The Informed Society" where consumers from all types of businesses and industries play larger roles in both the purchase and the development of products and services. But in health care, such " grass roots" contributions have been slower to come to the fore. The first step in the evolution is access to their own health information--providing patients access to their own health information within electronic health records. As this information becomes available, additional education programs will have to be developed to safely activate and empower patients as partners in their care.

3C have a constant need to manage their own personal healthcare. This requires managing information related to their conditions. Given that the nature of healthcare is information intensive, effective management requires much more than simply providing patients with access to their electronic health record within a hospital-based system. This practice has been followed with little ongoing success. 3C will need a health recording system specifically designed and implemented for them, with essential decision-support capabilities built in. Furthermore, while non-3C may experience peaks and valleys of increased consumption of healthcare services, which alter their contextual environment, 3C are constantly engaged through either the consumption of information to improve self-management or the consumption of health services to treat the underlying condition and all of the associated comorbidities. As a result, 3C will not only demand information within effectively designed PHRs, but they will do so in ways and in frequencies that we have not yet imagined. This has been the experience from many industries once the primary end-users have been empowered. We conclude with a single yet most important recommendation: that the healthcare system recognize 3C as powerful active participants with the ability to drive change and the adoption of PHRs. Opportunities must be provided to involve 3C in system design, testing and development.

This paper describes the objectives of a collaborative initiative that attempts to provide the evidence that increased information technology (IT) capabilities, availability, and use lead directly to improved clinical quality, safety, and effectiveness within the inpatient hospital setting. This collaborative network has defined specific measurement indicators in an attempt to examine the existence, timing, and level of improvements in health outcomes that can be derived from IT investment. These indicators are in three areas: (1) IT costs (which includes both initial and ongoing investment), (2) IT infusion (ie, system availability, adoption, and deployment), and (3) health performance (eg, clinical efficacy, efficiency, quality, and effectiveness). Herein, we outline the theoretical framework, the methodology employed to create the metrics, and the benefits that can be obtained.

ABSTRACT To determine how exposure to heat effects their survival, oospores of Aphanomyces cochlioides isolate C22 were exposed in water to 35, 40, 45, or 50 degrees C for prescribed times and then examined for viability. The Weibull model was modified to represent the effects of temperature on survival of oospores. The final fitted model gave lethal doses for 50% of the oospores of 251, 49.8, 9.8, and 1.9 h at 35, 40, 45, and 50 degrees C, respectively. To determine if alternating high and low temperatures resulted in (i) recovery from heat damage during low temperature periods, (ii) increased susceptibility to heat damage, or (iii) if effects of heat damage were cumulative, oospores were examined after each of four 24-h cycles at 45 degrees C for 4 h and 21 degrees C for 20 h. Survival of oospores exposed to alternating high and low temperatures fit the cumulative effects model. Significant variability in heat tolerance among five isolates was observed (P< 0.001) but model parameters successfully accommodated this variability (R(2) = 0.96, P < 0.001). This research shows that under wet conditions, there are predictable patterns to mortality for A. cochlioides oospores exposed to continuous or fluctuating high temperatures.

Measures of diversity within populations, and distance between populations, are compared for organisms with an asexual or mixed mode of reproduction. Examples are drawn from studies of plant pathogenic fungi based on binary traits including presence/absence of DNA bands or virulence/avirulence to differential hosts. Commonly used measures of population diversity or genetic distance consider either genotype frequencies or allele frequencies. Kosman's diversity and distance measures are the most suitable for populations with an asexual or mixed mode of reproduction, because by considering genetic patterns of all individuals they take into account not just the genotype frequencies but also the genetic similarities between genotypes in the populations. The Kosman distance and diversity measures for populations can be calculated using different measures of dissimilarity between individuals (the simple mismatch, Jaccard and Dice coefficients of dissimilarity). Kosman's distances based on the simple mismatch and Jaccard dissimilarities are metrics. Comparisons of diversity indices for hypothetical examples as well as for actual data sets are presented to demonstrate that inferences from diversity analysis of populations can be driven by techniques of diversity and distance assessments and not only data driven.

Patients must be able to access their own personal health information in order, ultimately, to partner with providers in the management of their health and wellness care. Just as customers accessing their information have reduced costs in other industries, such as banking, the same may hold true in healthcare.

Proportions of formae speciales of Puccinia graminis in collections of aeciospores from barberry were determined from cereal rust survey records from 1912 to 2002 in Minnesota. The frequency of P. graminis f. sp. avenae in aeciospore collections fluctuated between 0 and 10% from 1920 to 2002, even though oat was the dominant small grain crop in Minnesota until 1970. In early years, P. graminis f. sp. tritici was common, but the frequency of P. graminis f. sp. tritici in aeciospore collections declined to a low of 4% in the 1980s, whereas P. graminis f. sp. secalis increased to 96%. After 1990, the frequency of P. graminis f. sp. tritici increased and P. graminis f. sp. secalis declined in aecial collections, possibly indicating a changing proportion of P. graminis f. sp. secalis and tritici on wild grasses near barberry bushes. Diversity of races among uredinial collections of P. graminis f. sp. tritici from wheat in Minnesota declined sharply from 1912 to 1930 and remained low to 2002. Although the races of P. graminis f. sp. tritici most common in uredinial collections also were most common in the aecial collections in five of nine decades from 1912 to 1999 as well in the years 2000 to 2002, the diversity of races was greater among aecial than uredinial collections. Diversity in aecial collections remained nearly constant for 90 years, indicating a continuing contribution of the sexual stage to diversity of P. graminis f. sp. tritici.

Virulence of isolates of Puccinia coronata collected during 1992 to 1998 from Sonora, Chihua-hua, Nuevo Leon, and five states in Central Mexico were compared on a set of 27 differential oat (Avena sativa) lines with different genes for race-specific resistance. Frequencies of virulence and the presence of specific pathogenic races were compared among the four regions of Mexico and between Mexico and the adjoining states of California and Texas in the United States. The P. coronata populations in Mexico were highly diverse even though the sexual stage of the fungus is not known to occur there. Overall virulence frequencies were most similar between Chihuahua and Nuevo Leon, but there were more races in common between Central Mexico and Chihuahua than between any other pair of regions of Mexico. No races found in Sonora were found in other regions of Mexico. More races found in Texas also occurred in Nuevo Leon than in any other region of Mexico. Mean virulence complexity was lowest in isolates from central Mexico; greatest in Sonora, California, and Texas; and intermediate in Chihuahua and Nuevo Leon. Significant (P < 0.05) associations of virulences occurred for 24 pairs of virulence genes in at least three of the four regions of Mexico. Virulences to 19 of the 24 pairs were also significantly associated in Texas; virulences to 13 were also significantly associated in California.

Race-specific resistance to crown rust, the most important disease of oat (Avena sativa) in Bra-zil, often fails within a few years of use in Brazilian cultivars. Virulence of 144 isolates of Puccinia coronata from cultivated oat in Brazil in 1997 to 1999 and 36 isolates from Uruguay in 1994-95 and 1998 was tested on a set of 27 oat crown rust differentials lines, each with a different Pc gene for race-specific resistance. Frequencies of virulence and mean virulence complexity were compared among these five collections from Brazil and Uruguay as well as with mean virulence complexity for a collection of 17 isolates from cultivated oat in western Siberia in Russia. Virulence-avirulence for each of the 27 Pc genes was polymorphic in both Brazil and Uruguay. Virulence frequencies were similar for collections from Brazil in 1998 and 1999 and for the collection from Uruguay from 1998, but there were large differences between the 1997 collection and the 1998 and 1999 collections from Brazil. Mean virulence complexity in both Brazil and Uruguay was greater than reported in the United States and much greater than in the Russian collection of P. coronata. A large number of races of P. coronata were found, with no more than five isolates of any race found in a single year in Brazil or Uruguay. The high virulence complexity and great diversity of virulence polymorphisms in Brazil and Uruguay make it unlikely that race-specific resistance can be effective there even though the South American populations of P. coronata are apparently entirely asexual.

To facilitate the detection of quantitative trait loci (QTLs) for partial resistance to oat crown rust, Puccinia coronata f. sp. avenae Eriks., a genetic map was generated in a population of 158 F(6)-derived oat recombinant inbred lines from a cross of a partial resistance line MN841801-1 by a susceptible cultivar selection 'Noble-2'. The map, developed using 230 marker loci, mostly restriction fragment length polymorphism and amplified fragment length polymorphism markers, spanned 1,509 cM (Haldane) arranged into 30 linkage groups of 2-18 markers each. Four consistently detected major QTLs for partial rust resistance, Prq1a, Prq1b, Prq2, and Prq7, and three minor QTLs, Prq3, Prq5, and Prq6, were found in tests involving three field and two greenhouse environments. In addition, two major QTLs for flowering time, Ftq1 and Ftq7, and five weaker QTLs, Ftq2, Ftq3, Ftq4, Ftq5, and Ftq6, were revealed. Overlapping of the map segments of Ftq1 and Prq1 and of Ftq7 and Prq7 suggested either linkage between the flowering time QTLs and resistance QTLs or a pleiotropic effect of the Ftq QTLs on rust resistance. Relatively low heritability estimates (0.30) obtained for partial resistance to crown rust in the field indicate a potential value for marker-assisted selection.

In all, 1,323 single plant accessions of Aegilops bicornis, A. kotschyi, A. longissima, A. ovata, A. searsii, A. sharonensis, A. speltoides, and A. variabilis collected from 18 regions in Israel and 2 adjacent regions in Lebanon and Egypt were evaluated for leaf rust (Puccinia triticina) and stripe rust (P. striiformis) resistance in field plots and for seedling resistance to leaf rust and stem rust (P. graminis f. sp. tritici) in greenhouse tests. Nearly all accessions of A. speltoides were highly resistant to leaf rust, stripe rust, and stem rust. A. longissima and A. ovata were highly resistant to stripe rust, whereas A. bicornis and A. kotschyi were highly susceptible. A. searsii was highly susceptible to stem rust, but 24 to 51% of accessions of A. bicornis, A. longissima, A. ovata, and A. variabilis were resistant to stem rust. Except for A. ovata and A. speltoides, more than 95% of the Aegilops accessions were susceptible to leaf rust caused by P. recondita alternating on Anchusa spp. Only Aegilops ovata was susceptible to P. recondita from Echium spp. A. bicornis, A. koschyi, and A. searsii were highly susceptible as seedlings to common wheat leaf rust caused by P. triticina. Most accessions of A. variabilis and about half of the accessions of A. longissima had good seedling resistance to P. triticina. Few accessions of A. ovata showed seedling resistance to the P. triticina population in Israel, but 30% were resistant to U.S. isolates. In field tests, A. bicornis showed high susceptibility to common wheat leaf rust, but more than 90% of the accessions of the other Aegilops spp. developed little or no leaf rust on adult plants. The Aegilops spp. in Israel and adjoining countries provide a rich and varied source of rust resistance for wheat breeding.

Unlabelled: SUMMARY Stem rust has been a serious disease of wheat, barley, oat and rye, as well as various important grasses including timothy, tall fescue and perennial ryegrass. The stem rust fungus, Puccinia graminis, is functionally an obligate biotroph. Although the fungus can be cultured with difficulty on artificial media, cultures grow slowly and upon subculturing they develop abnormal ploidy levels and lose their ability to infect host plants [Bushnell and Bosacker (1982) Can. J. Bot. 60, 1827-1836]. P. graminis is a typical heteroecious rust fungus with the full complement of five distinct spore stages that occur during asexual reproduction on its gramineous hosts and sexual reproduction that begins in the resting spore stage and culminates on the alternate host, barberry (Berberis spp.). There appears to be little polymorphism for resistance/susceptibility in Berberis species, but complex polymorphisms of resistance/susceptibility and matching virulence/avirulence exist in gene-for-gene relationships between small grain species and the forms of P. graminis that infect them., Taxonomy: Puccinia graminis is a rust fungus in the phylum Basidiomycota, class Urediniomycetes, order Uredinales, and family Pucciniaceae, which contains 17 genera and approximately 4121 species, of which the majority are in the genus Puccinia[Kirk et al. (2001) Ainsworth and Bisby's Dictionary of the Fungi. Wallingford, UK: CAB International]. Various subdivisions of P. graminis into subspecies, varieties and formae speciales have been proposed based on spore size and host range. Crossing studies and DNA sequence comparisons support the separation of at least two subspecies, but not the proposed separation based on spore size., Host Range: The host range of P. graminis is very broad compared with that of most Puccinia spp.; it includes at least 365 species of cereals and grasses in 54 genera [Anikster (1984) The Cereal Rusts. Orlando, FL: Academic Press, pp. 115-130]. Wheat stem rust, P. graminis f. sp. tritici, was shown to infect 74 species in 34 genera in artificial inoculations of seedlings, but only 28 of those species belonging to eight genera were known to be natural hosts of the fungus. Other formae speciales of P. graminis have narrower host ranges than P. graminis f. sp. tritici. Disease symptoms: Infections in cereals or grasses occur mainly on stems and leaf sheaths, but occasionally they may be found on leaf blades and glumes as well. The first macroscopic symptom is usually a small chlorotic fleck, which appears a few days after infection. About 8-10 days after infection, a pustule several millimetres long and a few millimetres wide is formed by rupture of the host epidermis from pressure of a mass of brick-red urediniospores produced in the infection. These uredinial pustules are generally linear or diamond shaped and may enlarge up to 10 mm long. The powdery masses of urediniospores appear similar to rust spots on a weathered iron surface. With age, the infection ceases production of brick-red urediniospores and produces a layer of black teliospores in their place, causing the stems of heavily infected plants to appear blackened late in the season.

A federal and state program operated from 1918 until the 1980s to eradicate common barberry (Berberis vulgaris), the alternate host of Puccinia graminis, from the major areas of cereal production in the United States. Over 500 million bushes were destroyed nationally during the program, approximately 1 million in Minnesota. Some sites in Minnesota where barberry bushes were destroyed remained in the "active" class when eradication was phased out in the 1980s. Active sites were defined as those on which there was still a possibility of emergence of barberry seedlings or sprouts arising from the parent bush. In the present study, from 1998 to 2002, 72 of the approximately 1,200 active sites in Minnesota were surveyed. Areas within 90 m of mapped locations of previously destroyed bushes were searched carefully at each site. Reemerged barberry plants were found on 32 sites. The reproductive status and GPS coordinates were recorded for each reemerged bush. More than 90% of the barberry bushes were found in counties with less than 400 ha of wheat per county, mostly in southeastern Minnesota, but one bush was found in a major wheat-producing county in northwestern Minnesota. Reemergence of barberry may serve as a source of new wheat stem rust races in future epidemics.

Determining true genetic dissimilarity between individuals is an important and decisive point for clustering and analysing diversity within and among populations, because different dissimilarity indices may yield conflicting outcomes. We show that there are no acceptable universal approaches to assessing the dissimilarity between individuals with molecular markers. Different measures are relevant to dominant and codominant DNA markers depending on the ploidy of organisms. The Dice coefficient is the suitable measure for haploids with codominant markers and it can be applied directly to (0,1)-vectors representing banding profiles of individuals. None of the common measures, Dice, Jaccard, simple mismatch coefficient (or the squared Euclidean distance), is appropriate for diploids with codominant markers. By transforming multiallelic banding patterns at each locus into the corresponding homozygous or heterozygous states, a new measure of dissimilarity within locus was developed and expanded to assess dissimilarity between multilocus states of two individuals by averaging across all codominant loci tested. There is no rigorous well-founded solution in the case of dominant markers. The simple mismatch coefficient is the most suitable measure of dissimilarity between banding patterns of closely related haploid forms. For distantly related haploid individuals, the Jaccard dissimilarity is recommended. In general, no suitable method for measuring genetic dissimilarity between diploids with dominant markers can be proposed. Banding patterns of diploids with dominant markers and polyploids with codominant markers represent individuals' phenotypes rather than genotypes. All dissimilarity measures proposed and developed herein are metrics.

A total of 742 single plant accessions of Triticum dicoccoides were collected from 26 locations in Israel. All accessions were evaluated for leaf rust (Puccinia triticina) resistance in field plots at Tel Aviv, and subsets of 284 and 468 accessions were tested in the greenhouse in Tel Aviv and St. Paul, MN, respectively, for seedling resistance to leaf rust; 460 accessions were also tested for seedling resistance to stem rust (Puccinia graminis f. sp. tritici) in St. Paul. One accession was highly resistant to leaf rust in seedling tests in Tel Aviv, and 21 others had moderately susceptible to moderately resistant seedling resistance. Four accessions were highly resistant to leaf rust in seedling tests in St. Paul, and 11 were resistant to at least one stem rust race. Adult resistance to leaf rust was more common than seedling resistance among the accessions; 21 accessions had less than 25% leaf rust severity in field plots compared with 80 to 90% severity for highly susceptible accessions. Most of the accessions with effective adult plant resistance came from two nearby locations in Upper Galilee, a region where populations of T. dicoccoides are most extensive and genetically diverse. These accessions may provide valuable new partial resistance genes for durable protection against leaf rust in cultivated wheat.

ABSTRACT Isolates of Puccinia coronata obtained from natural populations of Avena sterilis in Israel, winter oat (A. sativa) cultivars in Texas, and spring oat cultivars in the Northern Plains states of Minnesota, North Dakota, and South Dakota were analyzed for significance of pairwise virulence associations. Isolates from all three regions were tested on 25 oat lines with single P. coronata (Pc) genes for crown rust resistance from A. sterilis and one line with a Pc gene from A. sativa. Isolates from Israel were tested also on 11 Iowa backcross lines with undesignated crown rust resistance genes from A. sterilis. Four associated virulence groups were identified from significant positive virulence associations that were consistent across all three regions. Group 38 included virulence to Pc-38, Pc-39, Pc-55, Pc-63, and Pc-71; group 45 included virulence to Pc-45, Pc-46, Pc-48, Pc-52, Pc-54, and Pc-57; group 58 included virulence to Pc-35, Pc-40, Pc-58, and Pc-59; and group 61 included virulence to Pc- 36, Pc-51, Pc-56, Pc-60, and Pc-61. Virulence to Pc-70 showed the strongest association to virulences in group 38 but also showed significant association with virulence to Pc-45, Pc-35, and Pc-58. Virulences in group 61 were consistently negatively associated with virulences in group 38 in each region. In Israel, virulences to five of the Iowa lines showed positive associations to virulences in group 61 and negative associations to virulences in groups 38 and 45. Close similarity of reactions of nearly all isolates to Pc-39, Pc-55, and Pc-71 suggest that these genes may be identical or nearly identical alleles.

One overall objective of Electronic Patient Records (EPRs) is to improve patient education and to enhance the patient experience through the use of information technology (IT) so as to facilitate the sharing of information between providers and their patients. The research project reported on herein took place at University Health Network (UHN) in Toronto (Canada), which is a large academic health science center with multiple hospital sites in the city. As a first step in this process, we examined the literature to investigate the human factors issues related to healthcare as well as other settings. Subsequently, we interviewed a number of interested stakeholders from two groups: the physicians (both family and attending) and the patients themselves. Finally, using a simulation environment, we explored the content that UHN lung-transplant patients would be interested in having within their own EPRs. In this paper, we report on the research, the methodology and the findings pertaining to the both the content and the design of an electronic patient record.

ABSTRACT Crown rust (Puccinia coronata) in indigenous populations of Avena sterilis has been cited as an example of stability of wild pathosystems that consist of natural mixtures of resistance and virulence. This study confirmed that virulence/avirulence polymorphisms in P. coronata on A. sterilis in Israel are highly diverse and that super races do not dominate. Isolates of P. coronata from Israel in 1991 to 1996 were polymorphic for virulence to 35 of 36 differential oat lines with resistance genes from A. sterilis. On average, isolates of P. coronata were more highly virulent to differentials with Pc genes from A. sterilis accessions from Israel than to differentials with Pc genes from other countries. Isolates from Israel also were more virulent on average to 10 additional differentials with Pc genes derived from A. sativa than to differentials with Pc genes from A. sterilis. Frequencies of virulence were usually higher in collections of P. coronata from Israel than in collections from cultivated oat in the United States, even though several of the Pc genes in the differentials have been used extensively in American oat cultivars. Mean virulence complexity of P. coronata from eight regions of Israel was not correlated with the distribution of resistance among collections of A. sterilis from previous surveys in the same areas, probably because pathogen migration between regions within Israel is sufficient to obscure effects of selection locally.

Frequent epidemics of leaf rust in Egypt have been attributed to the appearance of new races virulent on commonly grown wheat cultivars. In 1998, 1999, and 2000, 726 isolates of Puccinia triticina collected in Egypt were tested on a set of 20 single Lr gene differential wheat lines, and 160 races were identified. Three races, MBDLQ, MCDLQ, and TCDMQ, were found in Egypt in all 3 years. Race MCDLQ occurred at >20% frequency each year. Virulences to wheat lines with Lr1, 3, 10, 14b, 15, 17, 23, and 26 occurred at >45% each year. Seven races found in Egypt also were found in either Israel, Sudan, Turkey, or Romania in 1998 or 1999, although the one race common to Sudan and Egypt was rare in Egypt (only 1 year, <1%). Four races found in Israel also were found in Egypt, and the similarity of virulence frequencies in Israel and Egypt indicate at least some exchange of inoculum. Romania and Turkey did not appear to be major sources of inoculum for leaf rust epidemics in Egypt. The level of genetic diversity in leaf rust collections in Egypt in 1998 to 2000 was similar to that of collections from the Southern and Central Plains of the United States in 1998 to 2000. The high diversity of races and the recurrence of common races in each year in Egypt as in the Southern and Central Plains of the United States is consistent with oversummer survival of P. triticina within Egypt or in a neighboring country. The buildup of races virulent on cultivars with the most commonly used Lr genes for resistance in Egypt also is consistent with year-round survival within Egypt or cyclical exchange of inoculum between Egypt and a neighboring country.

More than 2,000 isolates of Puccinia coronata f. sp. avenae collected in national virulence surveys were analyzed to determine regional patterns of virulence on 28 single-gene oat lines. From 1990 to 2000, frequencies of virulence to eight differentials increased significantly in Texas, and virulence frequencies of four of the eight also increased in the northern Great Plains. No significant changes occurred for the other 20 differentials. Isolates from northern states from the Dakotas to New York had similar patterns of virulence frequencies on these 20 differentials. The pattern of virulence frequencies in the north differed from that of southern states from Texas to the Carolinas. There was a gradient of similarity values in state by state comparisons from Texas to the Atlantic Coast. Isolates from California were distinctly different from those elsewhere in the United States. Isolates from the South and from California had greater mean virulence complexity than isolates from northern states. Collections from the central Great Plains were intermediate between northern and southern isolates. Uredinial isolates from oat and aecial isolates from the alternate host Rhamnus cathartica in Minnesota had similar frequencies of virulence, as did isolates from cultivated oat and wild Avena fatua in North Dakota. Maintenance of large numbers of stable virulence polymorphisms with different regional allele frequencies is consistent with the operation of some form of stabilizing selection.

ABSTRACT In our previous report, quantitative trait loci (QTL) for field adult plant resistance to crown rust were identified in an oat population of 152 F(5:6) recombinant inbred lines from the cross of 'Ogle' (susceptible)/MAM17-5 (resistant). The objectives of the present study were to identify in the same population, the number, genomic location, and effect of QTL and digenic QTL epistasis associated with greenhouse seedling resistance to isolates of Puccinia coronata to determine if the QTL detected are isolate-specific and to compare them with previously detected QTL for field resistance. Reaction type was scored on greenhouse seedlings inoculated with three isolates. Composite interval mapping was conducted to identify genomic regions associated with resistance using a framework map of 272 molecular markers. Two QTL, Pcq1 and Pcq2, were identified for resistance to each of the three isolates. Pcq1, the major QTL controlling field resistance, did not confer detectable greenhouse seedling resistance when present singly; however, Pcq1 did serve as an enhancer of seedling resistance when it was combined with Pcq2. The final model explained 76.5, 77.9, and 79.3% of total phenotypic variation for resistance to isolates MNB248, MNB249, and MNB251, respectively. Race-specificity of quantitative resistance remains to be further examined.

Digital image analysis is an objective and nondestructive method potentially capable of providing accurate and precise estimates of disease resistance components. This study was conducted to quantify components of partial resistance to crown rust through the analysis of sequential digital images of inoculated leaves of adult oat plants, and to compare components found in two sources of resistance unrelated genetically. Uredinium density, relative infection frequency, latent period, days to first pustule appearance, uredinium size, and disease progress rates were assessed on three oat lines (RS-line 3W-C2R-9-3b, MN-841801, Starter) in two greenhouse experiments. Resistant lines had fewer and smaller uredinia, and these appeared later than in the susceptible check. Relative infection frequency, latent period, and uredinium size were equally important components in the expression of the partial resistance to crown rust, and the two sources of resistance could not be differentiated by any of the variables studied. The analysis of sequential digital images of diseased leaves produced precise estimates of partial resistance components and disease progress rates.

This paper compares two different funding policies for inpatients, the case-based approach in Austria versus the global budgeting approach in Canada. It examines the impact of these funding policies on length of stay of inpatients as one key measure of health outcome. In our study, six major clinical categories for inpatients are selected in which the day of the week for admission is matched to the particular day of the week of discharge for each individual case. The strategic statistical analysis proves that funding policies have a significant impact on the expected length of stay of inpatients. For all six clinical categories, Austrian inpatients stayed longer in hospitals compared to Canadian inpatients. Moreover, inpatients were not admitted and discharged equally throughout the week. We also statistically prove for certain clinical categories that more inpatients are discharged on certain days such as Mondays or Fridays depending on the funding policy. Our study is unique in the literature and our conclusions indicate that, with the right incentives in place, the length of stay can be decreased and discharge anomalies can be eliminated, which ultimately leads to a decrease in healthcare expenditures and an increase in healthcare effectiveness.

A new morphotype of Puccinia coronata, pathogenic to Bromus inermis, a common roadside and pasture grass in the northern United States, was discovered in the 1990s and described as P. coronata f. sp. bromi by Delgado et al in 2001. Puccinia coronata f. sp. bromi does not require fertilization of pycnia to produce aecia on its alternate host, whereas fertilization is required in all other varieties or formae speciales of P. coronata with aecial hosts in the family Rhamnaceae and for which life cycles have been described. Promycelia of P. coronata f. sp. bromi produce only two basidiospores, and each receives a pair of nuclei from the promycelium. The nuclei divide again so that mature basidiospores each contain four nuclei. Puccinia coronata f. sp. bromi has smaller teliospores than P. coronata var. avenae, and its substomatal vesicles are non-septate and distinctly shaped compared to those of P. coronata var. avenae. In addition, nuclei of P. coronata f. sp. bromi contain less DNA than those of P. coronata var. avenae. Puccinia coronata f. sp. bromi is further distinguished from P. coronata var. avenae and P. coronata var. hordei in being avirulent on both oat and barley, whereas neither P. coronata var. avenae nor P. coronata var. hordei are virulent on Bromus inermis.

Collections of Puccinia triticina were obtained from rust infected wheat leaves by cooperators throughout the United States and from surveys of wheat fields and nurseries in the Great Plains, Ohio Valley, Gulf Coast, and Atlantic Coast States in order to determine the virulence of the wheat leaf rust fungus in 2000. Single uredinial isolates (1,120 in total) were derived from the wheat leaf rust collections and tested for virulence phenotype on 16 lines of Thatcher wheat that are near-isogenic for leaf rust resistance genes. In the United States in 2000, 54 virulence phenotypes of P. triticina were found. Virulence phenotypes MBDS and MCDS, which are virulent to resistance gene Lr17, were the first and third most common phenotypes in the United States and were found in the Great Plains and the Ohio Valley regions. MCRK, which is virulent to Lr26, was the second most common phenotype and was found primarily in the Southeast, Ohio Valley, and Northeast regions. In the northern area of the Great Plains, phenotypes with virulence to Lr16 increased in frequency from 1998 and 1999. The Southeast and Great Plains regions had different predominant virulence phenotypes, which indicates that populations of P. triticina in those areas are not closely connected. The northern and southern areas of the Great Plains region had the same predominant virulence phenotypes, indicating movement of virulence phenotypes of P. triticina within this region.

Race-specific resistance in oat does not provide adequate protection against crown rust because new virulent races of the pathogen often arise within a few years after cultivars with race-specific resistance are released. This study assessed levels of partial resistance in a series of experimental oat lines that showed reduced crown rust severity over 30 years of exposure to a diverse crown rust population. Oat breeding lines with putative adult plant slow-rusting resistance to Puccinia coronata were evaluated in small isolated field plots for crown rust severity in natural epidemics and in controlled inoculations in the greenhouse for infection efficiency with a single virulent P. coronata isolate. Lines were also tested as seedlings against isolates from a local P. coronata population to detect race-specific resistance. In field tests, areas under the disease progress curves for all 14 experimental lines tested were significantly less than for cv. Starter, the susceptible check, and values for nine of the lines were significantly less than for Portage, a standard slow-rusting cultivar. Four lines with good field resistance were susceptible as seedlings to >85% of the local P. coronata population. One of the lines, MN841801, remained relatively free of rust in field plots over 7 years of tests, even in the 3 years when Starter was destroyed by crown rust. In greenhouse inoculations, adult plants of MN841801 developed only 7% as many uredinia as Starter. MN841801 can be an excellent source of effective, durable adult plant resistance to crown rust.

Isolates of Puccinia triticina were obtained from wheat leaf collections made by cooperators throughout the United States and from surveys of wheat fields and nurseries in the Great Plains, Ohio Valley, and Gulf Coast states in 1999. Pathogenic races were determined from virulence/avirulence phenotypes on 14 host lines that are near-isogenic for leaf rust resistance. We found 58 races among 1,180 isolates in 1999. As in previous surveys, regional race distribution patterns showed that the central United States is a single epidemiological unit distinct from the eastern United States. The distinctive racial composition of collections from the Southeast, Northeast, and Ohio Valley indicates that populations of P. triticina in those areas are not closely connected, suggesting epidemics originate from localized overwintering sources.

In the summer of 1997, the Department of Health Administration decided to incorporate on-line learning into its professional graduate program. This paper describes this two-year process from original discussion through to full implementation across the entire first year course curriculum by the summer of 1999, with an emphasis on faculty experience and evaluation, the existence of barriers, and critical success factors for implementation.

Isolates of Puccinia triticina were obtained from wheat leaf collections made by cooperators throughout the United States and from surveys of wheat fields and nurseries in the Great Plains, Ohio Valley, and Gulf Coast states in 1996, 1997, and 1998. Virulence-avirulence phenotypes were determined on 14 host lines that are near-isogenic for leaf rust resistance. We found 31 phenotypes among 277 single uredinial isolates in 1996, 56 phenotypes among 989 isolates in 1997, and 43 phenotypes among 989 isolates in 1998. As in previous surveys, regional race distribution patterns showed that the central United States is a single epidemiological unit distinct from the eastern United States. The distinctive racial composition of collections from the southeast, northeast, and Ohio Valley indicate that populations of P. triticina in those areas are not closely connected, suggesting that epidemics originate from localized overwintering sources.

ABSTRACT Random amplified polymorphic DNA (RAPD) and amplified fragment length polymorphism (AFLP) are widely used in studies of genetic variation. Although it is recognized that contamination should be avoided in DNA samples, little is known about the potential hazards of low level bacterial contamination of samples from which DNA is extracted for RAPD or AFLP analyses. We found that contamination of Aphanomyces cochlioides cultures with a prokaryote at visibly undetectable levels markedly altered the results of RAPD and AFLP analyses. The contamination resulted in seven contaminant-specific RAPD products and in the suppression of eight products characteristic of uncontaminated A. cochlioides cultures. Prokaryote contamination resulted in 39 contaminant-specific AFLP products, but did not cause suppression of AFLP products. Comparing A. cochlioides samples with outgroup A. euteiches did not clearly indicate the presence of contaminant DNA, because uneven product suppression in RAPD analysis increased the apparent similarity between contaminated samples and A. euteiches and because a high proportion of the contaminant-specific amplified products comigrated with products from A. euteiches in both RAPD and AFLP analyses. Work with organisms that are prone to contamination should employ techniques such as restriction fragment length polymorphism or DNA sequence comparisons rather than relying solely on RAPD or AFLP analyses.

In the fall of 1997, a team of faculty members from the Department of Health Administration (University of Toronto) began work on the introduction of Distance Education Technology (DET) into the MHA/MHSc course curriculum. This paper describes the almost three-year process from original discussion through to full implementation across the entire first year course curriculum by the fall semester of 1999. In fact, the final course assignment in one of the courses was to write a paper critiquing DET, outlining both the good and bad components. Consequently, we conclude with a detailed student evaluation of the advantages and drawbacks of such technology.

A nomenclature system for designating virulence phenotypes of Puccinia coronata f. sp. avenae, the causal agent of oat crown rust, is proposed. Sixteen single gene oat (Avena sativa) lines, with seedling resistance genes Pc38, 39, 40, 45, 46, 48, 50, 51, 52, 54, 56, 58, 59, 62, 64, and 68, are the primary differentials. The host lines are arranged into groups of four (subset 1 = Pc40, 45, 46, 50; subset 2 = Pc38, 39, 48, 68; subset 3 = Pc51, 52, 58, 59; subset 4 = Pc54, 56, 62, 64). Avirulence and virulence of Puccinia coronata f. sp. avenae isolates on each line are indicated by low and high infection types, respectively. A letter from the 16 consonants B through T is assigned to each of the 16 possible combinations of low and high infection types on the four differentials of each subset. Designations for P. coronata f. sp. avenae virulence phenotypes are indicated by a four-letter code for the virulence combinations on all four subsets, one letter for each subset. Local differential series are separated from the four-letter code by a dash, followed by an additional letter code describing the virulence combinations of the isolates on the local supplemental differentials. When fewer than four differentials are used in the supplemental series, virulence combination on these differentials for each isolate is described by a listing of the Pc gene(s) to which the isolate was virulent, following the four-letter code and a dash. This nomenclature system for P. coronata f. sp. avenae is similar to the nomenclature system in use for P. graminis f. sp. tritici and P. triticina.