Different Levels Of Disease Severity Research Articles

Capturing the Diagnosis: An Internal Medicine Education Program to Improve Documentation

BackgroundSpecific and accurate documentation of patient diagnoses and comorbidities in the medical record is critical to drive quality improvement and to ensure accuracy of publicly reported data. Unfortunately, inpatient documentation is taught to internal medicine trainees and practitioners sporadically, if at all. At Harbor-UCLA Medical Center, a public, tertiary care, academic medical center, we implemented an educational program to enhance documentation of diagnoses and comorbidities by internal medicine resident and attending physicians. MethodsThe program consisted of a series of lectures and the creation of a pocket card. These were designed to guide providers in accurate documentation of common diagnoses that group to different levels of disease severity, achieved by capturing Centers for Medicare and Medicaid Services complication codes and major complication codes. We started the educational program in January 2010 and used a pre-post design to compare outcomes. The program's impact on complication codes and major complication codes capture rates, mortality index, and case mix index was evaluated using the University Health Consortium database. ResultsThe median quarterly complication codes and major complication codes capture rate for inpatients on the internal medicine service was 42% before the intervention versus 48% after (P = .003). Observed mortality did not change but expected mortality increased, resulting in a 30% decline in median quarterly mortality index (P = .001). The median quarterly case mix index increased from 1.27 to 1.36 (P = .004). ConclusionsThus, implementation of an internal medicine documentation curriculum improved accuracy in documenting diagnoses and comorbidities, resulting in improved capture of complication codes.

An application of item response theory to fMRI data: Prospects and pitfalls

When using functional brain imaging to study neuropsychiatric patients an important challenge is determining whether the imaging task assesses individual differences with equal precision in healthy control and impaired patient groups. Classical test theory (CTT) requires separate reliability studies of patients and controls to determine equivalent measurement precision with additional studies to determine measurement precision for different levels of disease severity. Unlike CTT, item response theory (IRT) provides estimates of measurement error for different levels of ability, without the need for separate studies, and can determine if different tests are equivalently difficult when investigating differential deficits between groups. To determine the potential value of IRT in functional brain imaging, IRT was applied to behavioral data obtained during a multi-center functional MRI (fMRI) study of working memory (WM). Average item difficulty was approximately one standard deviation below the ability scale mean, supporting the task's sensitivity to individual differences within the ability range of patients with WM impairment, but not within the range of most controls. The correlation of IRT estimated ability with fMRI activation during the task recognition period supported the linkage of the latent IRT scale to brain activation data. IRT can meaningfully contribute to the design of fMRI tasks.

Aggressiveness variation of Fusarium graminearum isolates from Argentina following point inoculation of field grown wheat spikes

Aggressiveness variation among isolates of Fusarium graminearum from Argentina was analyzed by following disease development on point inoculated spikes of field grown wheat. Two aspects of the capacity of the isolates to induce disease were observed: (i) the infection efficiency reflected by the ability to produce symptoms and evaluated as the number of symptomatic spikes over the inoculated ones; and (ii) the size of the lesion provoked, which is reflected by the number of symptomatic spikelets over its total number. One hundred and twelve isolates were found to induce significantly different levels of disease severity, reflecting variation in aggressiveness. Differences were also found between the isolates for the thousand kernel weight (TKW) and the area under the disease progress curve (AUDPC) and the correlations between disease severity, AUDPC, and TKW were highly significant. Based on disease severity, isolates were clustered as low, medium and highly aggressive and both lesion size and infection efficiency were significantly different between these groups. The movement of the pathogen in the spike occurred primarily downwards the point of inoculation. Movement toward the upper portion was related with the aggressiveness of the isolates and the premature ripening of the spike appeared to be a function of isolate aggressiveness. In this work point inoculation allowed us to study not only the aggressiveness of a large collection of F. graminearum isolates but also to analyze the development of Fusarium head blight symptoms in large numbers of spikes under conditions similar to those in which this disease naturally occurs.

Haemophilia and Exercise

One of the most important objectives of intervention programs for persons with haemophilia (PWH) is to improve their quality of life. Regular physical activity has been recommended as an adjunct to conventional treatment, with positive results in the prevention of joint problems and bleeding, in addition to the improvement in cardiovascular function, muscle strength, and body composition. The objective of the present review was to present the benefits of aerobic and resistance training programs in PWH, as well to discuss the best exercise dose-response in the different levels of disease severity. We considered randomized controlled trials, study cases and literature reviews from MEDLINE and Highwire databases. After a detailed analysis of the studies involving exercise for PWH, it can be concluded that this intervention elicits some benefits for physical fitness and blood coagulation mechanisms, suggesting the application of physical training as a non pharmacological treatment in association with conventional treatment. Adequate and periodized resistance training considering the disease severity, accompanied by physical education professionals could improve muscle strength, balance and proprioception. In addition, aerobic training could reduce the risks of obesity and several metabolic and cardiovascular diseases. Exercise can improve several outcomes of quality in PWH.

Examining the relationships among health-related quality-of-life indicators in cancer patients participating in clinical trials: a pooled study of baseline EORTC QLQ-C30 data

Aims: Cancer patients experience multiple and concurrent health-related problems and symptoms due to their illness and therapies. The first objective of this analysis was to identify how health-related quality-of-life (HRQoL) indicators cluster among cancer patients and how possible clusters change across patients with different sociodemographic and clinical characteristics. The second objective of this study was to identify which HRQoL indicators are linked to patients’ perception of overall quality of life. Methods: Retrospective pooling of 30 closed randomized European Organisation for Research and Treatment of Cancer (EORTC) clinical trials yielded baseline EORTC Quality of Life Core Questionnaire (QLQ-C30) HRQoL data for a total of 7417 patients. A cluster analysis was performed to determine how the 15 HRQoL indicators obtained with the QLQ-C30 cluster overall and by patient characteristics. Results: Three main clusters emerged from the overall dataset: a physical cluster, a psychological cluster and a gastrointestinal cluster. The same clusters were found in subgroups defined according to sociodemographic and clinical characteristics, while some differences emerged among cancer sites. The Global Health scale was found to be part of the physical cluster in the overall dataset. This result was consistent across different levels of disease severity, while divergent results were seen across some cancer sites. Conclusion: Our findings suggest that HRQoL indicators are interrelated. Understanding these relationships may aid clinicians in managing the symptom burden experienced by patients, as well as policy-makers, in defining psychosocial support plans.

Adaptation and validation of the Osteoarthritis Knee and Hip Quality of Life (OAKHQOL) questionnaire for use in patients with osteoarthritis in Spain

This study aims to adapt and validate the Spanish version of the Osteoarthritis Knee and Hip Quality of Life (OAKHQOL) questionnaire. The OAKHQOL was adapted into Spanish using a forward-backward translation methodology. The Spanish version was then validated in a prospective, mixed-design study of 759 patients with hip or knee osteoarthritis (OA). Patients completed the OAKHQOL, Short Form 36 (SF-36), Western Ontario and McMaster Universities Osteoarthritis Index, and the EQ-5D. The internal consistency was evaluated using Cronbach's alpha. Convergent validity was assessed by examining correlations between the OAKHQOL and other patient-reported instruments; known groups' validity was assessed by determining the capacity of the OAKHQOL to discriminate between patients with different levels of disease severity measured using the Lequesne Index. Test-retest reliability was evaluated by calculating the intraclass correlation coefficient (ICC) for all OAKHQOL domains in 409 stable patients with OA. Responsiveness was evaluated by calculating effect sizes among 129 patients undergoing hip or knee replacement. Cronbach's alpha for the five domains of the OAKHQOL ranged from 0.60 to 0.93 while ICCs ranged from 0.75 to 0.81 for all domains except the two social domains. Statistically significant differences (p < 0.001) were observed between patients with different degrees of disease severity on all domains except "social support". The instrument showed convergent validity among hypothesized domains (p < 0.001). Results of the study supported that the Spanish version OAKHQOL questionnaire was a valid instrument to measure health-related quality of life in patients with OA of the lower limb.

A review of the methods used to estimate the cost of Alzheimer's disease in the United States.

BACKGROUN/RATIONALE: To determine the suitability of published estimates of the US cost of Alzheimer's disease (AD) for use in cost-effectiveness models for new AD treatments. A systematic literature review of published information on direct medical, direct nonmedical, indirect, and informal care costs for different levels of disease severity. Nineteen studies were included in the review. In studies presenting mean costs by disease severity, the change in different types of costs with increasing disease severity varied, depending on the data sources and characteristics of patients with AD. In studies presenting the results of regression analyses, costs were shown to be independently associated with cognition, functional status, behavioral symptoms, and dependence. Published US studies (1) did not include all the types of costs and AD populations, and (2) generally did not include all the measures of disease severity that are needed for cost-effectiveness models.

A new short and simple health-related quality of life measurement for paediatric rheumatic diseases: initial validation in juvenile idiopathic arthritis

To develop and validate a new short and simple measure of health-related quality of life (HRQL) in children with juvenile idiopathic arthritis (JIA). The Paediatric Rheumatology Quality of Life Scale (PRQL) is a 10-item questionnaire that explores HRQL in two domains: physical health (PhH) and psychosocial health (PsH). Validation of the parent proxy report and child self-report versions of the instrument was accomplished by evaluating 472 JIA patients and approximately 800 healthy children. Validation analyses included assessment of feasibility, face and content validity; construct and discriminative ability; internal structure and consistency; test-retest reliability; responsiveness to clinical change; and minimal clinically important difference. The PRQL was found to be feasible and to possess both face and content validity. The PRQL score correlated in the predicted range with most of the other JIA outcome measures, thereby demonstrating good construct validity, and discriminated well between different levels of disease severity. Assessment of internal structure (factor analysis) revealed that the PhH and PsH subscales identify two unambiguously separated domains. The internal consistency (Cronbach's alpha) was 0.86. The intraclass correlation coefficient for test-retest reliability was 0.91. The PRQL revealed fair responsiveness, with a standardized response mean of 0.67 in improved patients. Overall, the PRQL appeared to be more able to capture physical HRQL than psychosocial HRQL. The PRQL was found to possess good measurement properties and is, therefore, a valid instrument for the assessment of HRQL in children with JIA. This tool is primarily proposed for use in standard clinical care.

Differential Expression of Tissue Repair Genes in the Pathogenesis of Chronic Obstructive Pulmonary Disease

The airflow limitation that defines severity of chronic obstructive pulmonary disease (COPD) is caused by a combination of small airway obstruction and emphysematous lung destruction. To examine the hypothesis that small airway obstructive and emphysematous destructive lesions are produced by differential expression of genes associated with tissue repair. The expression of 54 genes associated with repair of repetitively damaged tissue was measured in 136 paired samples of small bronchioles and surrounding lung tissue separated by laser capture microdissection. These samples were collected from 63 patients at different levels of disease severity who required surgery for either lung cancer or lung transplantation for very severe COPD. Gene expression was measured by quantitative polymerase chain reaction in these paired samples and compared with the FEV(1) by linear regression analysis. After corrections for false discovery rates, only 2 of 10 genes (serpin peptidase inhibitor/plasminogen activator inhibitor member 2 and matrix metalloproteinase [MMP] 10) increased, whereas 8 (MMP2, integrin-alpha1, vascular endothelial growth factor, a disintegrin and metallopeptidase domain 33, scatter factor/hepatocyte growth factor, tissue inhibitor of matrix metalloproteinase-2, fibronectin, and collagen 3alpha1) decreased in small airways in association with FEV(1). In contrast, 8/12 genes (early growth response factor 1, MMP1, MMP9, MMP10, plasminogen activator urokinase, plasminogen activator urokinase receptor, tumor necrosis factor, and IL13) increased and 4/12 (MMP2, tissue inhibitor of matrix metalloproteinase-1, collagen 1alpha1, and transforming growth factor-beta3) decreased in the surrounding lung tissue in association with progression of COPD. The progression of COPD is associated with the differential expression of a cluster of genes that favor the degradation of the tissue surrounding the small conducting airways.

Relationship between the EQ-5D index and measures of clinical outcomes in selected studies of cardiovascular interventions

BackgroundThe EuroQoL 5D (EQ-5D) has been widely used in studies of cardiac disease, but its measurement properties in this group are not well established. The study aimed to quantify the relationship between measures commonly used in studies of cardiac disease and the EQ-5D index across different levels of disease severity.MethodsPatient-level data from 7 studies of cardiac interventions were used, which included randomised trials and observational studies. Relationships between the EQ-5D index and commonly used cardiac measures, Canadian Cardiovascular Society (CCS) angina severity class, treadmill exercise time (ETT) and scales of the Seattle Angina Questionnaire (SAQ) were examined. Mixed effects linear regression was used to assess these relationships, with the EQ-5D index as the response.ResultsStudy sample sizes ranged from 68 to 2419. Mean baseline EQ-5D index ranged from 0.77 in patients at diagnosis (95% CI 0.75, 0.78) to 0.43 in patients with advanced disease (95% CI 0.39, 0.48) and differed significantly across studies (p < 0.001). There was evidence of a ceiling effect in patients at diagnosis. The minimum clinically important difference of a one minute increase in ETT was associated with a 0.019 (95% CI 0.014, 0.025) increase in EQ-5D index. One class increase in CCS was associated with a 0.11 (95% CI 0.09, 0.13) decrease in EQ-5D index. A 10 unit increase in SAQ scales was associated with increases between 0.04 and 0.07 in EQ-5D index (95% CIs 0.03, 0.05 and 0.05, 0.08). Tests of heterogeneity indicated the EQ-5D-covariate relationships were consistent across levels of disease severity for ETT and the treatment satisfaction scale of the SAQ, but heterogeneous for age, gender, CCS angina class and other scales of the SAQ.ConclusionThe EQ-5D index varies with coronary disease severity. The relationship between the EQ-5D index and an outcome measure used in cardiac intervention studies, ETT, was consistent across disease severity levels, but the relationship between demographic variables, CCS angina class and most of the SAQ scales and the EQ-5D index was heterogeneous for patients with different levels of coronary disease. Differences in the EQ-5D index associated with clinically important differences in cardiac measures can be quantified and vary between three important examples - angina class, ETT and SAQ.

Avaliação da reação varietal de cebola à antracnose foliar

A antracnose foliar (Colletotrichum gloesporioides) é uma das principais doenças na cultura da cebola no sul do Brasil, manifestando-se como síndrome, conforme o estádio de desenvolvimento e variedade utilizada. Com a finalidade de melhor esclarecer esse quadro sintomatológico e selecionar variedades resistentes, avaliaram-se as reações à antracnose e sua taxa de progresso da doença em vinte e uma variedades de cebola, sob condições de casa-de-vegetação em 2004/05. As plantas foram inoculadas no estádio H (todas as folhas verdadeiras emitidas), pulverizando-se uma suspensão de 1,2 x 10(6) conídios/mL. Plantas inoculadas nunca morreram, mas apresentaram diferentes níveis de severidade. Nenhuma variedade testada revelou resistência completa ao isolado Cg 103. Metade das variedades, como Alfa Tropical, Alfa Tropical II, Belém IPA 9, Crioula Hortec, Crioula Roxa, Epagri 304, IPA 6, Régia, Rosada Empasc 358, Roxa IPA 3 e Super Precoce, tiveram as menores taxas de progresso da doença, sugerindo a existência de muitas fontes de resistência parcial.

What does dengue disease surveillance contribute to predicting and detecting outbreaks and describing trends?

To review the evidence on the application of tools for dengue outbreak prediction/detection and trend monitoring in passive and active disease surveillance systems in order to develop recommendations for endemic countries and identify research needs. Systematic review of literature in the Cochrane Database of Systematic Reviews, PubMed, EMBASE, Lilacs, WHO library database, manual reference search and grey literature. Two reviewers independently applied pre-defined inclusion and exclusion criteria and assessed the level of evidence. Studies describing the outcome of dengue disease surveillance with respect to trend monitoring and outbreak prediction/detection based on empirical data were included. Twenty-four studies (of 1804 references) met the eligibility criteria. Different indicators and their respective threshold values were identified as potential triggers for outbreak alerts through retrospective analysis of data from passive and/or active surveillance systems. Some indicators are potentially useful for predicting imminent outbreaks in the low transmission season and others for detecting outbreaks at an early stage. However, the information collected is mainly retrospective and often site-specific and appropriate levels of sensitivity and specificity of the outbreak indicators/triggers could not be determined. Retrospective and prospective virus surveillance studies were not conclusive regarding the question of whether a newly introduced serotype is an outbreak predictor, but contributed additional indicators for outbreak prediction/detection. Under-reporting was a major concern. Taking cost and feasibility issues into account, it remains an open question whether dengue surveillance should be passive (based on routine reporting) or active (based on more costly sentinel or other active population based surveillance systems). Adding active surveillance elements to a well-functioning passive surveillance system improves sensitivity; adding laboratory elements to the system improves specificity. In view of the lack of evidence about the most feasible and sustainable surveillance system in a country context, countries could use a stepwise approach to locally adapt their passive routine surveillance system into an improved combined active/passive surveillance approach. Prospective studies are needed to better define the most appropriate dengue surveillance system and trigger for dengue emergency response.

Infection by powdery mildew Erysiphe cruciferarum (Erysiphaceae) strongly affects growth and fitness of Alliaria petiolata (Brassicaceae)

Garlic mustard (Alliaria petiolata) is an invasive biennial that negatively impacts plant and animal communities throughout North America and lacks significant herbivory in its invasive range. Throughout Ohio, many garlic mustard populations support the powdery mildew fungus Erysiphe cruciferarum, although disease incidence varies among populations and environments. Effects of infection on plant growth, as well as both plant and fungal responses to drought and light conditions, were examined on greenhouse-grown, first-year garlic mustard plants. Also, the effects of the fungus on plant growth and fitness were studied in a naturally growing population of second-year plants in the field. Powdery mildew significantly reduced growth of first-year plants in the greenhouse, eventually causing complete mortality. Simulated drought slowed both plant growth and disease development, independent of light conditions. In the field, plants with little incidence of disease after their first year grew taller during their second year, producing significantly more siliques and twice as many seeds as heavily diseased plants did. Seed germination rates did not differ between plants with different levels of disease severity. Consistent reductions in survival, growth, and fitness caused by fungal infection may reduce populations of garlic mustard. These effects may be more evident in moist sites that favor fungal development.

Reliability and sensitivity to change of the Simple Erosion Narrowing Score compared with the Sharp–van der Heijde method for scoring radiographs in rheumatoid arthritis

Objective:To compare the performance of a simplified scoring method for structural damage on radiographs of patients with rheumatoid arthritis (the Simple Erosion Narrowing Score or SENS) with the Sharp–van der...

Evidence‐based management of anaphylaxis

For common diseases such as asthma and allergic rhinitis, many efficacious and safe interventions, both pharmacological and nonpharmacological, have been introduced in recent decades. Thousands of prospective, randomized, masked, controlled clinical trials of these interventions have been conducted in large numbers of patients with well-defined symptoms and symptom patterns, and with different levels of disease severity. Newer interventions have been compared with placebo and, increasingly, with more established treatments. The information obtained from these studies has been systematically identified, collated, critically appraised for its validity and usefulness, and summarized (with attention paid to the issue of potential bias) in Cochrane Collaboration reviews and other systematic reviews. Based on relatively abundant evidence, consistent, high-quality recommendations for management of asthma and allergic rhinitis have been promulgated in national and international guidelines (1–3). Most doctors now accept the concept that evidence-based interventions in these diseases are superior to traditionand opinion-based interventions (4). In contrast, the state of the evidence base for the treatment of anaphylaxis has not yet been as thoroughly examined, although recent attempts have been made in this regard (5–7). There are no universally accepted guidelines for pharmacological or nonpharmacological interventions in anaphylaxis; indeed, the definition of the disease continues to evolve (8–11). Anaphylaxis is still considered to be uncommon (12), although the rate of occurrence is increasing (13). Many of the pharmacologic agents available for use in anaphylaxis, for example, adrenaline, first-generation H1-antihistamines such as diphenhydramine, and glucocorticoids, are more than half a century old, and were therefore introduced long before the era of evidence-based medicine. Moreover, when the principles of evidence-based medicine are applied to interventions in anaphylaxis, other concerns become apparent. For a number of reasons, it is difficult to conduct prospective, randomized, double-masked, placebo-controlled trials in this disease. Most cases of anaphylaxis now occur unpredictably in community settings although they also still occur in healthcare settings despite vigilant preventive efforts. The clinical presentation of anaphylaxis is characterized by variability among patients, and variability in the same patient from one episode to another. For example, the time lag between exposure to the trigger and the onset of symptoms can vary from minutes to hours. The severity of symptoms can vary from mild and self-limited to fatal within minutes. The number of symptoms can vary from a few to many symptoms in virtually all body systems (11, 14). For over a decade, the Cochrane Collaboration has led the way in setting high standards for systematic reviews of the evidence base for diagnostic and therapeutic procedures. This approach is widely accepted as the gold standard, and has helped to identify the quality of the F. E. R. Simons, A. Sheikh Department of Pediatrics & Child Health, Department of Immunology, Canadian Institutes of Health Research National Training Program in Allergy & Asthma, Faculty of Medicine, University of Manitoba, Manitoba, Canada; Allergy & Respiratory Research Group, Division of Community Health Sciences: GP Section, University of Edinburgh, Edinburgh, UK

Detection of Glaucoma Using Scanning Laser Polarimetry with Enhanced Corneal Compensation

To evaluate and compare the diagnostic accuracies for glaucoma detection of scanning laser polarimetry (SLP) with enhanced corneal compensation (GDx ECC) and variable corneal compensation (GDx VCC; both by Carl Zeiss Meditec, Dublin, CA), according to different levels of disease severity and presence of atypical retardation patterns. The study included 102 eyes of 68 patients with glaucoma and 94 eyes of 55 normal subjects. All patients underwent SLP imaging with ECC and VCC methods on the same day. Severity of disease was based on the AGIS (Advanced Glaucoma Intervention Study) visual field score. An ROC regression model was fitted to evaluate the influence of disease severity and atypical retardation patterns (typical scan score [TSS]) on the diagnostic performance of the SLP parameters for both methods. GDx ECC performed significantly better than GDx VCC in glaucoma detection in patients with more severe atypical retardation patterns. For average disease severity and arbitrarily chosen TSS values of 20, 50, 70, and 100, the ROC curve areas for GDx ECC were 0.910, 0.935, 0.948, and 0.964. Corresponding values for GDx VCC were 0.684, 0.850, 0.920, and 0.975. For lower values of TSS and lower AGIS scores, GDx ECC performed significantly better than GDx VCC. GDx ECC performed significantly better than VCC for diagnosing glaucoma in patients with more severe atypical patterns of retardation and at earlier stages of disease.

Multi-temporal wheat disease detection by multi-spectral remote sensing

For the implementation of site-specific fungicide applications, the spatio-temporal dynamics of crop diseases must be well known. Remote sensing can be a useful tool to monitor the heterogeneity of crop vitality within agricultural sites. However, the identification of fungal infections at an early growth stage is essential. This study examines the potential of multi-spectral remote sensing for a multi-temporal analysis of crop diseases. Within an experimental field, a 6 ha plot of winter wheat was grown, containing all possible infective stages of the powdery mildew (Blumeria graminis) and leaf rust (Puccinia recondita) pathogens. Three high-resolution remote sensing images were used to execute a spatio-temporal analysis of the infection dynamics. A decision tree, using mixture tuned matched filtering (MTMF) results and the Normalized Difference Vegetation Index (NDVI), was applied to classify the data into areas showing different levels of disease severity. Classification results were compared to ground truth data. The classification accuracy of the first scene was only 56.8%, whereas the scenes from May 28th and June 20th achieved considerably higher accuracies of 65.9% and 88.6% respectively. The results showed that high-resolution multi-spectral data are generally suitable to detect in-field heterogeneities of crop vigour but are only moderately suitable for early detection of crop infections.

Costs and quality of life in multiple sclerosis in Europe: method of assessment and analysis

The objective of this observational study in nine European countries was to establish the current cost of MS at different levels of disease severity. The study used a prevalence-based bottom-up to estimate costs from a societal perspective. Patients were recruited via patient organizations and neurology centres and asked by mail to complete a detailed questionnaire concerning their resource consumption, work capacity, quality of life and current disease status. Resources included all health-care and social services, personal expenditures, informal care and temporary or definitive work absence. Quality of life was collected as utility and disease information collected related to functional capacity, relapses and fatigue. The data were analyzed separately for each country, using local unit costs but a fully standardized methodology. A total of 13 186 patients at all levels of disease severity participated in the survey, with an average response rate of around 40% (range 20-75%). This paper describes the methodology used for the study, while results are presented in the individual country reports.

Qigong exercise for the symptoms of Parkinson's disease: A randomized, controlled pilot study

Irrespective of limited evidence, not only traditional physiotherapy, but also a wide array of complementary methods are applied by patients with Parkinson's disease (PD). We evaluated the immediate and sustained effects of Qigong on motor and nonmotor symptoms of PD, using an add-on design. Fifty-six patients with different levels of disease severity (mean age/standard deviation [SD], 63.8/7.5 years; disease duration 5.8/4.2 years; 43 men [76%]) were recruited from the outpatient movement disorder clinic of the Department of Neurology, University of Bonn. We compared the progression of motor symptoms assessed by Unified Parkinson's Disease Rating Scale motor part (UPDRS-III) in the Qigong treatment group (n = 32) and a control group receiving no additional intervention (n = 24). Qigong exercises were applied as 90-minute weekly group instructions for 2 months, followed by a 2 months pause and a second 2-month treatment period. Assessments were carried out at baseline, 3, 6, and 12 months. More patients improved in the Qigong group than in the control group at 3 and 6 months (P = 0.0080 at 3 months and P = 0.0503 at 6 months; Fisher's exact test). At 12 months, there was a sustained difference between groups only when changes in UPDRS-III were related to baseline. Depression scores decreased in both groups, whereas the incidence of several nonmotor symptoms decreased in the treatment group only.

Relationship between common bacterial blight severity and bean yield loss in pure stand and bean?-?maize intercropping systems

Field experiments were conducted in the 1999 and 2000 seasons to determine the relationship between common bacterial blight (CBB) (caused by Xanthomonas campestris pv. phaseoli) and bean (Phaseolus vulgaris) yield in different cropping systems. Different levels of disease severity were created using natural epidemics by spraying copper hydroxide (Kocide 101) at 7-, 14- and 21-day intervals beginning at the first observation of CBB symptoms. The susceptible cultivar Red Wolaita was grown in broadcast, mixed and row bean - maize intercropping and pure stand. The bean growth stage at which the disease severity was correlated with seed yield varied among the cropping systems. In broadcast and mixed intercroppings, CBB appeared to be correlated with seed yield at later growth stages. In row intercropping, disease was correlated at preflowering to 50% flowering and in pure stand at 50% flowering to pod filling. In intercropping systems, both relative and predicted seed yield and 100-seed weight losses to CBB were, generally, less than in pure stand. Single-point regression models in 1999 predicted that for each per cent increase of CBB severity in broadcast and mixed intercropping, about 5.2 and 9.1 kg ha1 seed yield loss, respectively, occurred at physiological maturity. In pure stand, for each percentage increase in CBB at an earlier growth stage, 73 days after planting (DAP) in 2000, a yield loss of 38.8 kg ha1 occurred. Similarly, in row intercropping a 71.1 kg ha1, seed yield loss was estimated at 52 DAP in 1999. Decreasing seed weight was correlated with yield loss to CBB. The type of cropping system influenced CBB severity and the amount of loss in yield attributable to CBB. Variation in CBB and its relation to yield between years was influenced by difference in seasonal weather between years.