Integrated Disease Management Program Research Articles

Azelaic Acid Induces Resistance in Coffea arabica Against Infection by Hemileia vastatrix, the Causal Agent of Coffee Leaf Rust

ABSTRACTCoffee leaf rust (CLR), caused by the fungus Hemileia vastatrix, is a very devastating disease affecting coffee production in many countries worldwide and causing yield losses that range from 15% to 50%. High CLR intensity on coffee trees impairs photosynthesis and causes intense defoliation resulting in fewer and smaller fruit berries on trees. New control methods for CLR that will reduce the use of fungicides and production costs need to be investigated and used in an integrated disease management program. In this study, it was hypothesised that azelaic acid (AzA), a C9 dicarboxylic acid (oxylipin) known to be involved in systemic acquired resistance, could boost defence reactions on the leaves of coffee (Coffea arabica, cultivar Catuaí Vermelho—IAC44) against infection by H. vastatrix. In the in vitro assay, urediniospores germination was significantly reduced (81%–86%) by AzA with concentrations from 1 to 20 mM. Fungal sporulation was much more intense on the leaves from water‐sprayed plants compared to leaves from AzA‐sprayed plants at both 22 and 30 days after inoculation (dai). The area under CLR progress curve and the intensity of fungal sporulation were significantly lower by 82% and 83%, respectively, and the incubation period was higher by 31% for AzA‐sprayed plants compared to water‐sprayed ones. The AzA‐sprayed plants infected by H. vastatrix displayed less photosynthetic impairments considering the greater values for rate of net CO2 assimilation, internal CO2 concentration, transpiration rate, and maximum photochemical efficiency of photosystem II compared to water‐sprayed and infected ones. On top of that, these plants displayed higher concentrations of chlorophyll a + b and carotenoids and a more robust antioxidative metabolism (increased ascorbate peroxidase, catalase, and glutathione reductase activities at 12 dai). Interestingly, activities of chitinase, β‐1,3‐glucanase, phenylalanine ammonia‐lyase, peroxidase, and polyphenoloxidase were lower for AzA‐sprayed plants as a result of reduced colonisation and sporulation of H. vastatrix in contrast to water‐sprayed and infected ones. Higher concentration of superoxide anion radical for AzA‐sprayed plants and infected by H. vastatrix at 12, 22, and 30 dai may have helped to reduce the colonisation of coffee leaf tissues by H. vastatrix besides having a citotoxic fungistatic effect against the fungus. These results strongly support the potential of AzA to negatively affect the germination of urediniospores from H. vastatrix as well as to hamper the infection process of H. vastatrix on coffee leaves.

Cover crops are unlikely to pose a risk to the management of Neopestalotiopsis sp. of strawberry in Florida

An aggressive Neopestalotiopsis sp. has emerged causing leaf spot and fruit rot on strawberry. In Florida strawberry production, cover crops (CCs) are grown in the summer to maintain and enhance soil structure and properties. Although CCs can be used in integrated disease management programs, they could also serve as hosts and increase inoculum levels. Since Pestalotiopsis-like fungi are known for their endophytic ability and wide host range, we sought to determine the effect of CCs commonly used over the summer in Florida on Neopestalotiopsis sp. inoculum. Pathogenicity was tested on sunn hemp, iron clay cowpea, sorghum sudan, oats, sunflower, and ryegrass. Moreover, trials in strawberry fields with histories of disease outbreaks, were conducted using iron clay cowpea, sorghum sudan, and sunn hemp as CCs plus a fallow control. Plants were evaluated for presence of symptoms in the field or following incubation in the laboratory. Soil samples were collected from each treatment and processed using a semiselective medium. Strawberry isolates were pathogenic to all the inoculated CCs, but symptoms were subtle and did not progress over time. Symptoms were not observed on the CCs under field conditions. Neopestalotiopsis sp. was successfully isolated from a single sorghum plant at one trial site, a single clay pea plant at another site, and a single sunflower plant at a third trial site. This suggests that the risk might be more closely associated with the decomposition of strawberry plant material rather than the infection of alternate hosts. Colony-forming units per g soil varied from 0 to 125, and differences were not consistent among trials. Our data suggest that the CCs tested do not pose a risk of increasing pathogen levels on strawberry fields and should still be used to protect and enhance organic matter in the soil.

Systemic acquired resistance inducing chemicals mitigate black scurf disease in potato by activating defense-related enzymes.

The potato, being an underground vegetable crop, faces consistent threats from soil- and tuber-borne fungal and bacterial pathogens. Black scurf and stem canker disease caused by the fungal pathogen Rhizoctonia solani Kuhn is a critical global concern in the potato cultivation system. In this study, we evaluated the disease mitigation potential of five systemic acquired resistance-inducing chemicals viz., salicylic acid, jasmonic acid, β-aminobutyric acid, γ-aminobutyric acid and hydrogen peroxide (H2O2). Two common methods, tuber dipping and foliar spray, were utilized in this experiment to evaluate pathogen inhibition on inoculated tubers. The results revealed that all the systemic acquired resistance inducing chemicals were effective in disease suppression in a concentration-dependent manner compared to an inoculated control. Significant differences (P<0.005) were evident among the various treatment combinations, with salicylic acid being the most effective in alleviating black scurf disease. Maximum reduction in disease incidence compared to the control was observed with salicylic acid (57.89% and 73.68%), followed by jasmonic acid (52.63% and 65.78%) and H2O2 (49.99% and 60.52%) under the tuber dipping treatment combinations. Whereas, in the foliar application, the maximum reduction in disease incidence compared to the control was observed with salicylic acid (44.73 and 63.15%), followed by jasmonic acid (42.10 and 60.52%) and H2O2 (39.46 and 52.63%). The tuber dipping treatments were significantly more efficacious (P<0.005) compared to foliar spray for all treatment combinations. The biochemical analysis of defense-related enzymes and metabolites demonstrated the induced resistance activation under these treatments. The activity of peroxidase, polyphenol oxidase, and phenyl ammonia-lyase was significantly higher in treated tubers as compared to inoculated and uninoculated control. The total phenol content was also elevated in treated tubers as compared to the respective control. Altogether, these resistance-inducing chemicals can be successfully included in integrated disease management programs.

Impacts of a Commercially Available Horticultural Oil Biopesticide (EF-400) on the Tomato-Phytophthora infestans Pathosystem.

Biopesticide fungicides are naturally derived compounds that offer protection from plant diseases through various modes of action, including antimicrobial activity and upregulation of defense responses in host plants. These plant protectants provide a sustainable and safe alternative to conventional pesticides in integrated disease management programs and are especially salient in the management of high-risk and economically important diseases such as late blight of tomato and potato, for which host resistance options are limited. In this study, a commercially available biopesticide, EF400 comprised of clove (8.2%), rosemary (8.1%), and peppermint oils (6.7%) (Anjon AG, Corcoran, CA), was investigated for its effects on the Phytophthora infestans-tomato pathosystem. Specifically, we evaluated the impact of EF400 on P. infestans growth in culture, disease symptoms in planta, and activation of host defenses through monitoring transcript accumulation of defense-related genes. The application timing and use rate of EF400 were further investigated for managing tomato late blight. EF400 delayed the onset of tomato late blight symptoms, although not as effectively as the copper hydroxide fungicide Champ WG (Nufarm Americas Inc., Alsip, IL). Pathogen mycelial growth and sporangial quantity on late blight-susceptible tomato leaves were significantly reduced with EF400. The biopesticide also had an enhancing or suppressing effect on the transcript accumulation of three defense-related genes: Pin2, PR1a, and PR1b. Our work in exploring a commercially available horticultural oil biopesticide meaningfully contributed to the essential knowledge base for optimizing recommendations for the management of tomato late blight.

An Innovative Patient-Centred Approach to Heart Failure Management: The Best Care Heart Failure Integrated Disease-Management Program

BackgroundThe management of heart failure (HF) is challenging because of the complexities in recommended therapies. Integrated disease management (IDM) is an effective model, promoting guideline-directed care, but the impact of IDM in the community setting requires further evaluation. MethodsA retrospective evaluation of community-based IDM. Patient characteristics were described, and outcomes using a pre- and post-intervention design were HF-related health-service use, quality of life, and concordance with guideline-directed medical therapy (GDMT). Results715 patients were treated in the program (2016 to 2023), 219 in a community specialist–care clinic, and 496 in 25 primary-care clinics. The overall cohort was predominantly male (60%), with a mean age of 73.5 years (± 10.7), and 60% with HF with reduced ejection fraction. In patients with ≥ 6 months of follow-up (n = 267), pre vs post annualized rates of HF-related acute health-service use decreased from 36.3 to 8.5 hospitalizations per 100 patients per year, P < 0.0001, from 31.8 to 13.1 emergency department visits per 100 patients per year, P < 0.0001, and from 152.8 to 110.0 urgent physician visits per 100 patients per year, P = 0.0001. The level of concordance with GDMT improved; the number of patients receiving triple therapy and quadruple therapy increased by 10.1% (95% confidence interval [CI], 2.4%,17.8%) and 19.6% (95% CI, 12.0%, 27.3%), respectively. Within these groups, optimal dosing was achieved in 42.5% (95% CI, 32.0%, 53.6%) and 35.0% (95% CI, 23.1%, 48.4%), respectively. In patients with at least one follow-up visit (n = 286), > 50% experienced a clinically relevant improvement in their quality of life. ConclusionsA community-based IDM program for HF, may reduce HF-related acute health-service use, improve quality of life and level of concordance with GDMT. These encouraging preliminary outcomes from a real-world program evaluation require confirmation in a randomized controlled trial.

Real-World Cost-Consequence Analysis of an Integrated Chronic Disease Management Program in Saskatchewan, Canada.

An integrated disease management program otherwise called a clinical pathway was recently implemented in Saskatchewan, Canada for patients living with chronic obstructive pulmonary disease (COPD). This study compared the real-world costs and consequences of the COPD clinical pathway program with 2 control treatment programs. The study comprised adult COPD patients in Regina (clinical pathway group, N = 759) matched on propensity scores to 2 independent control groups of similar adults in (1) Regina (historical controls, N = 759) and (2) Saskatoon (contemporaneous controls, N = 759). The study measures included patient-level healthcare costs and acute COPD exacerbation outcomes, both tracked in population-based administrative health data over a one-year follow-up period. Analyses included Cox proportional hazards models and differences in means between groups. The bias-corrected and accelerated bootstrap method was used to calculate 95% confidence intervals (CI). The COPD pathway patients had lower risks of moderate (hazard ratio [HR] =0.57, 95% CI [0.40-0.83]) and severe (HR = 0.43, 95% CI [0.28-0.66]) exacerbations compared to the historical control group, but similar risks compared with the contemporaneous control group. The COPD pathway patients experienced fewer episodes of exacerbations compared with the historical control group (mean difference = -0.30, 95% CI [-0.40, -0.20]) and the contemporaneous control group (mean difference = -0.12, 95% CI [-0.20, -0.03]). Average annual healthcare costs in Canadian dollars were marginally higher among patients in the COPD clinical pathway (mean = $10 549, standard deviation [SD] =$18 149) than those in the contemporaneous control group ($8841, SD = $17 120), but comparable to the historical control group ($10 677, SD = $21 201). The COPD pathway provides better outcomes at about the same costs when compared to the historical controls, but only slightly better outcomes and at a marginally higher cost when compared to the contemporaneous controls.

HerzMobil Tirol – A telemedical, integrated disease management program for patients with heart failure

Heart failure (HF) is a global health problem with an increasing an increasing incidence and prevalence and thus a major impact on healthcare systems. The 1-year mortality is 23.6% in patients with acute HF. Hospitalization for acute HF is associated with higher mortality and recurrent hospitalization. The majority of readmissions occurs early after hospital discharge: about 25% of patients are readmitted within the first month with a 50% proportion of HF-related causes of readmissions.&#x0D; Therefore, in 2012 the Austrian province of Tyrol launched the HerzMobil Tirol (HMT) program, which is a multidisciplinary post-discharge disease management program for HF patients. It is supported by a telemedical monitoring system and embedded in a network of specialized nurses, resident physicians, and secondary/tertiary referral centers. After initial project phases, HMT reached its adolescence in 2017 and was adopted as regular service. This ensures reimbursement of the program by the social security system. &#x0D; HMT is based on: (1) patient education to improve patient empowerment, (2) nurse-led care for early detection of imminent decompensation, (3) patient-held mobile phone for daily data acquisition and transmission of blood pressure, heart rate, body weight, well-being and drug intake, including nurse and physician-controlled telemonitoring, (4) continuous optimization of guideline-based HF therapy for long-term stabilization, and (5) network communication to assure comprehensive HF management across venues;&#x0D; Patients enter HMT at the end of hospitalization for acute HF. Patient education is delivered by specialized HF nurses. On discharge, each patient is assigned to a resident network physician near his/her home. Network physicians supervise the management of the patient and optimize individualized guideline-directed medical therapy. Discharge information including a detailed treatment plan from the hospital is communicated to the HMT network. Within HMT, patients are supervised for 3 months. Telemedically transmitted patient data are reviewed daily by HF nurses and weekly by network physicians. Out-of-limit data are automatically signaled so that interventions, for example, adjustment of diuretics, can follow immediately. Face-to-face visits of the patient with the network physician are scheduled 1, 4, and 12 weeks after discharge. HF nurses monitor patients’ compliance with medication, maintain telephone contact with patients if necessary and adjust HF medication according to the network physicians’ instructions. Additionally, a home visit by the HF nurse is scheduled immediately after discharge to complete disease- and equipment-related education and to ensure that prescribed medication is available. At the end of the managed care program, structured transfer of patients to regular care is organized. Regular HF network meetings of physicians and nurses are scheduled every 3 months.&#x0D; A recently publication demonstrated the effectiveness of the program as indicated by a significant reduction of HF readmission and all-cause mortality within 6 months for patients in the HMT program compared to usual-care patients. &#x0D; HerzMobil was adopted in other provinces of Austria following the Tyrolean model. It is continuously further developed. In a next step, the coronary heart disease will be included in the HMT model. An extension of the program with physical activity aspects is planned.

Elicitor-Driven Defense Mechanisms: Shielding Cotton Plants against the Onslaught of Cotton Leaf Curl Multan Virus (CLCuMuV) Disease.

Salicylic acid (SA), benzothiadiazole (BTH), and methyl jasmonate (MeJA) are potential elicitors found in plants, playing a crucial role against various biotic and abiotic stresses. The systemic acquired resistance (SAR) mechanism was evaluated in cotton plants for the suppression of Cotton leaf curl Multan Virus (CLCuMuV) by the exogenous application of different elicitors. Seven different treatments of SA, MeJA, and BTH were applied exogenously at different concentrations and combinations. In response to elicitors treatment, enzymatic activities such as SOD, POD, CAT, PPO, PAL, β-1,3 glucanse, and chitinase as biochemical markers for resistance were determined from virus-inoculated and uninoculated cotton plants of susceptible and tolerant varieties, respectively. CLCuMuV was inoculated on cotton plants by whitefly (Bemesia tabaci biotype Asia II-1) and detected by PCR using specific primers for the coat protein region and the Cotton leaf curl betasatellite (CLCuMuBV)-associated component of CLCuMuV. The development of disease symptoms was observed and recorded on treated and control plants. The results revealed that BTH applied at a concentration of 1.1 mM appeared to be the most effective treatment for suppressing CLCuMuV disease in both varieties. The enzymatic activities in both varieties were not significantly different, and the disease was almost equally suppressed in BTH-treated cotton plants following virus inoculation. The beta satellite and coat protein regions of CLCuMuV were not detected by PCR in the cotton plants treated with BTH at either concentration. Among all elicitors, 1.1 mM BTH was proven to be the best option for inducing resistance after the onset of CLCuMuV infection and hence it could be part of the integrated disease management program against Cotton leaf curl virus.

In vitro and in vivo efficacy of Larrea divaricata extract for the management of Phytophthora palmivora in olive trees

Phytophthora palmivora is a ubiquitous pathogen responsible for “dry branch” disease, causing significant economic losses in olive trees. Synthetic chemical fungicides are currently used for the control of P. palmivora. The general concern about the negative consequences of using synthetic products prioritizes the search for eco-friendly alternatives. In this context, plant extracts have emerged as an interesting and promising alternative for crop protection. This work studies the inhibitory activity of Larrea divaricata extract on P. palmivora mycelial growth, sporangium and zoospore production. The extract showed fungicidal activity against P. palmivora mycelial growth at concentrations over 150 mg mL-1. Specifically, the extract at 50 mg mL-1 completely suppressed the production of P. palmivora sporangia and zoospores. The alkaloid piperine in L. divaricata extract showed antimicrobial activity against P. palmivora mycelial growth. Extract effectiveness was also evaluated on olive trees in a greenhouse, showing 63% of disease reduction. These results support the use of L. divaricata extract as another environmentally friendly tool to be included in an integrated disease management program for dry branch disease caused by P. palmivora. Highlights: L. divaricata extract showed an effective antimicrobial activity against P. palmivora. Piperine was identified in the divaricata extract by HPLC/MWD. The alkaloid piperine in divaricata extract showed antimicrobial activity on the mycelial growth of P. palmivora. L. divaricata extract could be included in an integrated management programme for dry branch disease caused by P. palmivora.

Estimating the Health and Economic Impact of Improved Management in Prevalent Chronic Obstructive Pulmonary Disease Populations in England, Germany, Canada, and Japan: A Modelling Study.

COPD is a leading cause of morbidity and mortality globally. Management is complex and costly. Although international quality standards for diagnosis and management exist, opportunities remain to improve outcomes, especially in reducing avoidable hospitalisations. To estimate the potential health and economic impact of improved adherence to guideline-recommended care for prevalent, on-treatment COPD populations in four high-income settings. A disease simulation model was developed to evaluate the impact of theoretical improvements to COPD management, comparing outcomes for usual care and policy scenarios for interventions that reduce avoidable hospitalisations: 1) increased attendance (50% vs 31-38%) of early follow-up review after severe exacerbation hospitalisation; 2) increased access (30% vs 5-10%) to an integrated disease management (IDM) programme that provides guideline adherent care. For cohorts of 100,000 patients, Policy 1 yielded additional life years (England: 523; Germany: 759; Canada: 1316; Japan: 512) and lifetime cost savings (-£2.89 million; -€6.58 million; -$40.08 million; -¥735.58 million). For Policy 2, additional life years (2299; 3619; 3656) and higher lifetime total costs (£38.15 million; €35.58 million; ¥1091.53 million) were estimated in England, Germany and Japan, and additional life years (4299) and cost savings (-$20.52 million) in Canada. Scenarios found that the cost impact depended on the modelled intervention effect size. Interventions that reduce avoidable hospitalisations are estimated to improve survival and may generate cost savings. This study provides evidence on the theoretical impact of policies to improve COPD care and highlights priority areas for further research to support evidence-based policy decisions.

Activity of volatiles induced by microbes and natural plants stifled the growth of Pythium aphanidermatum - the damping off in Tomato

BackgroundVolatilomes from natural plants and microbes imparts diverse antifungal properties to suppress the growth of plant pathogens and therefore can be a suitable alternative of chemical fungicides. The present experiment was to study effect of volatiles produced by natural plants and microbes on the fungal growth of Pythium aphanidermatum, which is a tomato seedling pathogen.ResultsIsolate of P. aphanidermatum, causing damping off in tomato were isolated and incubated at 25 ± 2 °C. The isolate was tested for the anti-oomycetes activities of volatiles in vitro. The volatiles produced by the leaves of Mentha spicata and Cymbopogon citratus showed the maximum inhibitory effect of 45.56 and 24.70 percent, respectively on the mycelial growth of P. aphanidermatum, whereas, the pathogen was not inhibited on exposure to the volatiles of macro-basidiomycetes fungi. The volatiles of T. asperellum showed the maximum inhibitory effect of 69.26 percent against P. aphanidermatum. The study also included the identification of Volatile Organic Compounds (VOCs) involved in the suppression of pathogens by Headspace Gas Chromatography Mass Spectrometry (HS GCMS). The results revealed the production of carvone by the leaves of M. spicata; citronellol and geraniol by C. citratus; isopentyl alcohol and limonene by T. asperellum with increased peak area percentage and these compounds possessed antifungal properties. The vaporous action of isopentyl alcohol completely suppressed the mycelial growth of P. aphanidermatum, which is highly correlated to the T. asperellum extract on pathogenic growth. While the compounds, carvone, and citronellol showed the maximum inhibitory effect of 89.02 and 85.49 percent, respectively when used at 500 ppm and also altered the sporulation behavior of P. aphanidermatum.ConclusionResults showed that volatiles of M. spicata and T. asperellum have anti-oomycetes action on pathogenic growth leading to a distortion of sporulation of P. aphanidermatum. High antifungal properties make VOCs suitable for incorporation as a new integrated plant disease management programs.

Antimycotic effects of synthetic fungicides and plant extracts on Aspergillus flavus

Aspergillus flavus contaminates the seeds of cowpea (Vigna unguiculata) and produces mycotoxins. This study was carried out to proffer solutions to the infection caused by A. flavus on cowpea seeds. The in vitro trial was set up using two rates (50 and 100%) of each potential control agent (mancozeb, COPMET (Copper-I-oxide + metalaxyl), and aqueous extracts of Eucalyptus and neem) and a control (0%). The botanical extracts and pesticides inhibited the fungus growth significantly (P≤0.05) at different times. Both concentrations of mancozeb gave 100% inhibition of the fungus at 24–168 hours after incubation (HAI). At 24 HAI, Eucalyptus extract (50 and 100%) completely inhibited the fungus growth similar to mancozeb. Eucalyptus extract was more effective than neem extract and COPMET throughout. Though the extracts of both botanicals inhibited the growth of A. flavus at 168 HAI, Eucalyptus (83.8-89.2%) was more potent than neem (20.3–28.4%). At 48-168 HAI, both concentrations of neem extract and COPMET had similar effect on the fungus. The early stage of the antimycotic intervention is critical to the control of the fungus. This can be achieved by dressing cowpea seeds with mancozeb or Eucalyptus. However, due to the high cost and toxicity of synthetic chemicals, Eucalyptus extract could be used as an alternative for management of the fungus or incorporated into integrated disease management programmes for A. flavus. Research on the effects of long-term storage of cowpea using these botanicals is highly admonished.

Diagnosis and integrated management of onion wilt caused by Fusarium sp.

Onion wilt is an endemic disease in producing farms of Michoacán, Mexico that can reduce yields up to 25-30%. From onion plants with wilting symptoms, a monosporic isolate of the fungus Fusarium spp. was obtained, and its pathogenicity was verified. The fungus was morphologically and molecularly identified as Fusarium sp. Also, Fusarium sp. susceptibility to biological, botanical, and chemical pesticides was determined through four different bioassays. In experiment I, Trichoderma spp. in vitro antibiosis was tested using the cellophane technique. In Trials II and III, the in vitro effect of botanical and chemical fungicides on the pathogen was evaluated through the amended potato dextrose agar (PDA) culture technique. In Study IV, the biological efficacy of the products previously selected during in vitro assays was evaluated under greenhouse conditions. During the antibiosis trials, the commercial strain of Trichoderma virens (PHC Root Mate®) inhibited 33.3% of Fusarium sp. mycelial growth. Among botanical pesticides, cinnamon-neem extract (NeemAcar®) at doses of 0.06, 0.08- and 0.10-mL L-1 inhibited 100% mycelial growth of Fusarium sp. The fungicides benomyl, prochloraz, and pyraclostrobin completely suppressed Fusarium sp. development. Under greenhouse conditions, the incidence of wilt of plants treated with Trichoderma spp. and botanical extracts applied individually and in combination did not present significant differences from chemical fungicides treated. These results will help to develop an integrated disease management program for onion wilt.

The impact of the duration of the integrated disease management program on COPD-related outcomes

BackgroundThe aim of this study is to assess the impact of the duration of the integrated disease management (IDM) program on COPD-related outcomes in real-world setting.MethodsA retrospective cohort study among 3771 patients with COPD who had regularly completed 4 visits of IDM program within 1 year between April 1, 2017 and December 31, 2018. CAT score as the primary outcome used to investigate the association between IDM intervention duration and improvement in CAT score. Change in CAT score from baseline to each follow-up visit determined by using least-squares means (LSMeans) approach. The cut-off value of IDM duration for improving the CAT score was determined by the Youden index. Logistic regression was used to analyze the relationship between IDM intervention duration and MCID (the minimal clinically important difference) improvement in CAT score and the factor associated CAT improvement. Risks of COPD exacerbation events (COPD-related ED visit and COPD-related hospitalization) were estimated by using the cumulative incidence curve and Cox proportional hazards models.ResultAmong 3771 enrolled COPD patients, the majority of the study cohort were males (91.51%) and 42.7% of patients had CAT score of ≥ 10 at baseline. The mean of age was 71.47 years and the mean CAT at baseline were 10.49. The mean change from baseline in CAT score was − 0.87, − 1.19, − 1.23 and − 1.40 at 3-, 6-, 9- and 12 month follow-up (p < 0.0001 for all visits), respectively. Statistically significantly lower likelihood of achieving MCID improvement in CAT were observed at 3- and 6 month compared to 9 month (at 3 month: OR: 0.720, 95% CI 0.655–0.791; at 6 month: OR: 0.905, 95% CI 0.825–0.922). And only a modest increase likelihood of achieving MCID improvement in CAT at 12 month (OR: 1.097, 95% CI 1.001–1.201) compared with 9-month follow-up. In logistic regression on the entire cohort, CAT MCID improvement was most associated with baseline CAT scores ≥ 10, followed by frequent exacerbation in previous year (> 2 episodes/year), wheezing, and GOLD B or D at baseline. In baseline CAT ≥ 10 group, patients were more likely to achieve CAT MCID improvement and had greater decreases from baseline in CAT score observed at 3-, 6-, 9-, and 12 month compared with baseline CAT score < 10 group (all p < 0.0001). Moreover, in CAT ≥ 10 groups, patients who achieved CAT MCID improvement had lower risk of subsequent COPD exacerbation events (COPD-related ED visit: aHR: 1.196, 95% CI 0.985–1.453, p = 0.0713; COPD-related hospitalization: aHR: 1.529, 95% CI 1.215–1.924, p = 0.0003) when compared to those without.ConclusionThis is the first real-world study indicating the association between COPD IDM intervention duration and COPD-related outcomes. From 3 to 12 month follow-up results showed that continued improvement over time in COPD-specific health status, particularly in patients with baseline CAT score of ≥ 10. Furthermore, a reduction of the risk of subsequent COPD exacerbations were observed in patients with CAT MCID improvement.

Use of Bacteria Isolated from Berry Rhizospheres as Biocontrol Agents for Charcoal Rot and Root-Knot Nematode Strawberry Diseases

Strawberry is a high-value crop in Spain, where fruits for fresh consumption are produced off-season and exported to central and northern European countries. Soil-borne pathogens (SBP), such as Macrophomina phaseolina and Meloidogyne hapla, are widely spread in strawberry crops in Spain. The prevalence of these pathogens is a significant barrier to producing strawberries of premium quality and at profitable yields. The current ban on fumigant pesticides drives the search for alternative SBP control methods that can simultaneously control both SBP. Twenty-nine bacterial strains were isolated and identified from strawberry and blueberry rhizospheres and screened for plant growth promotion activities as well as for biocontrol potential on M. phaseolina and M. hapla. Two of these bacterial strains (Bacillus velezensis FC37 and Pseudomonas aeruginosa AC17), together with Brevibacterium frigoritolerans Hvs8 coming from IFAPA’s bacterial collection, were selected and evaluated in planta for their biocontrol potential on strawberry SBP diseases caused by M. phaseolina and M. hapla. The three tested bacterial strains reduced charcoal rot disease severity, crown incidence and severity, and petiole colonization by M. phaseolina. Root-knot nematode (RKN) symptoms were reduced by P. aeruginosa AC17 and B. velezensis FC37, but RKN reproduction was only reduced in plants inoculated with P. aeruginosa AC17. Pseudomonas aeruginosa AC17 showed the greatest potential as a biocontrol agent candidate to be included in integrated disease management programs to control the two most prevalent soil-borne pathogens of strawberry in Spain.

Diverse environmental bacteria displaying activity against Phakopsora pachyrhizi, the cause of soybean rust.

The management of soybean rust (SBR) caused by the obligate fungus Phakopsora pachyrhizi mostly relies on the use of synthetic fungicides, especially in areas where the disease inflicts serious yield losses. The reliance on synthetic fungicides to manage this disease has resulted in resistance of P. pachyrhizi populations to most fungicides. In this study, bacteria isolated from diverse environments were evaluated for their biocontrol potential against P. pachyrhizi using soybean detached-leaf method and on-plant in the growth chamber, greenhouse, and field. Among 998 bacterial isolates evaluated using the detached-leaf method; 58% were isolated from plant-related materials, 27% from soil, 10% from insects, and 5% from other environments. Of the isolates screened, 73 were active (they had ⪖ 75% rust reduction) with an active rate of 7.3%. From the active isolates, 65 isolates were re-tested on-plant in the growth chamber for activity confirmation. In the confirmation test, 49 bacteria isolated from plant-related materials maintained their activity with a confirmation rate of 75%. The majority of bacteria with confirmed activity belonged to the taxonomic classes Bacilli and Gammaproteobacteria (70%). Active isolates were prioritized for greenhouse and field testing based on activity in the initial screen and confirmation test. Six bacterial isolates AFS000009 (Pseudomonas_E chlororaphis), AFS032321 (Bacillus subtilis), AFS042929 (Bacillus_C megaterium), AFS065981 (Bacillus_X simplex_A), AFS090698 (Bacillus_A thuringiensis_S), and AFS097295 (Bacillus_A toyonensis) were selected from those bacteria that maintained activity in the confirmation test and were evaluated in the greenhouse, and five among them were evaluated in the field. From the Alabama field evaluation, all bacterial isolates reduced rust infection as well as azoxystrobin (Quadris® at 0.3 L/ha) used as the fungicide control (P > 0.05). Moreover, the scanning electron micrographs demonstrated evidence of antagonistic activity of AFS000009 and AFS032321 against P. pachyrhizi urediniospores. Bacterial isolates that consistently showed activity comparable to that of azoxystrobin can be improved through fermentation and formulation optimization, developed, and deployed. These bacteria strains would provide a valuable alternative to the synthetic fungicides and could play a useful role in integrated disease management programs for this disease.

Micronutrients Foliar and Drench Application Mitigate Mango Sudden Decline Disorder and Impact Fruit Yield

Mango sudden death (MSD) or quick decline (QD) is the most destructive disease found in mango orchards of Pakistan and is characterized by collapse of the vascular system by Ceratocystis fimbriata and Lasiodiplodia theobromae. Cultural practices, chemicals, and biological control are the most valuable tools for the management of MSD, but the role of micronutrient deficiencies has remained an area that is heavily ignored by the farming community. To study the impact of micronutrients, four mango orchards were selected at different locations where different combinations of micronutrients, i.e., Zinc (Zn), Boran (B), and Copper (Cu) in the form of Zinc sulphate (ZnSO4), Borax/Boric acid (H3BO3), and Copper Sulphate (CuSO4), were applied both foliar and in drench along with the recommended doses of Nitrogen: Phosphorous: Potassium (NPK), and Farmyard manure (FYM), respectively. The quantities of micronutrients were determined from the soil and leaves before and after application of the treatments. The impact of micronutrients was measured in terms of reduction in disease severity and increase in fruit yield. The results revealed that the application of all three micronutrients both in soil drench and in foliar form significantly decreased the disease severity at three locations and increased the yield in all four mango orchards. Application of ZnSO4 (0.8%), +H3BO3 (0.8%), +CuSO4 (0.5%) and as soil drench ZnSO4 (400 g) + Borax (200 g) + CuSO4 200 g plant−1 proved to be the best treatments, with an average of 12.88 and 14.03% reduction in disease severity and with an average yield of 128 and 119 kg, respectively. The application of micronutrients would be a promising solution in an integrated disease management program used to tackle MSD.

Cost-effectiveness of integrated disease management for high risk, exacerbation prone, patients with chronic obstructive pulmonary disease in a primary care setting

BackgroundWe evaluate the cost-effectiveness of the ‘Best Care’ integrated disease management (IDM) program for high risk, exacerbation prone, patients with chronic obstructive pulmonary disease (COPD) compared to usual care (UC) within a primary care setting from the perspective of a publicly funded health system (i.e., Ontario, Canada).MethodsWe conducted a model-based, cost-utility analysis using a Markov model with expected values of costs and outcomes derived from a Monte-Carlo Simulation with 5000 replications. The target population included patients started in GOLD II with a starting age of 68 years in the trial-based analysis. Key input parameters were based on a randomized control trial of 143 patients (i.e., UC (n = 73) versus IDM program (n = 70)). Results were shown as incremental cost per quality-adjusted life year (QALY) gained.ResultsThe IDM program for high risk, exacerbation prone, patients is dominant in comparison with the UC group. After one year, the IDM program demonstrated cost savings and improved QALYs (i.e., UC was dominated by IDM) with a positive net-benefit of $5360 (95% CI: ($5175, $5546) based on a willingness to pay of $50,000 (CAN) per QALY.ConclusionsThis study demonstrates that the IDM intervention for patients with COPD in a primary care setting is cost-effective in comparison to the standard of care. By demonstrating the cost-effectiveness of IDM, we confirm that investment in the delivery of evidence based best practices in primary care delivers better patient outcomes at a lower cost than UC.

Characterisation of Trichoderma spp. and Assessment as Biocontrol Using Dual Culture Assay Against Fungi Associated with Black Pepper (Piper nigrum L.) Diseases in Sarawak

Black pepper (Piper nigrum L.) is one of the most widely used spices in food, beverage, cosmetics, and medicine. Black pepper production has suffered from various fungal diseases. Microbial biological control is an essential part of integrated disease management to reduce the heavy reliance on chemical fungicides. Trichoderma fungi comprise a large group of rhizocompetent filamentous fungi widely used in the biocontrol of plant pathogens. Three field surveys conducted on five black pepper farms in Belaga, Sarawak, identified three fungal diseases: yellowing, black berry, and foot rot. Based on the morphological and molecular characterisation, the identified fungal causal agents were Fusarium solani (yellowing disease), Colletotrichum gloeosporioides (black berry disease), and Phytophthora palmivora (foot rot disease). Twenty isolates of Trichoderma spp. were isolated from secondary forest and Biopark in Bintulu, Sarawak. Trichoderma isolates were characterised based on the morphological characteristics and molecular phylogenetic analysis using the rDNA internal transcribed spacer (ITS) region. Trichoderma isolates were separated into five distinct species, namely T. harzianum, T. virens, T. brevicompactum, T. tawa, and telomorphic Hypocrea lixii. Among the Trichoderma fungi, T. harzianum was the most frequently (65%) isolated species. Trichoderma harzianum (Isolates of TJ9, 10, and 16) showed antagonistic and inhibitory effects by 61 to 70% on in vitro mycelial growth against three common fungal pathogens of black pepper, P. palmivora, C. gloeosporioides, and F. solani. This study highlights the potential of using native Trichoderma fungi as biocontrol agents in the black pepper integrated disease management program.

Primary care-based integrated disease management for heart failure: a study protocol for a cluster randomised controlled trial

IntroductionHeart failure (HF) is a common chronic disease that increases in prevalence with age. It is associated with high hospitalisation rates, poor quality of life and high mortality. Management is...