The Cost-Effectiveness Analysis of Teleglaucoma Screening Device

Glaucoma is the leading cause of irreversible vision loss and costs the American economy $2.9 billion. Teleglaucoma remotely detects glaucoma improving access to ophthalmic care in rural areas. It helps manage glaucoma more efficiently to preserve vision and reduce healthcare costs. A cost-effectiveness analysis was conducted using healthcare provider or third-party payer perspective within rural Canada. The study population were patients at-risk of glaucoma which includes those with diabetes and/or hypertension, family history of glaucoma, adults older than 50 years, and concurrent ocular conditions in rural Alberta. Markov modelling was used to model glaucoma health states. Effectiveness was measured in Quality-Adjusted Life Years (QALYs) and costs were used in Canadian dollars. Using TreeAge Pro 2009, incremental cost-effectiveness ratios (ICER) were developed in dollars per QALYs. Deterministic and probabilistic sensitivity analyses were performed to assess the factors affecting cost-effectiveness. Teleglaucoma had a 20% increase in ophthalmologist-referral rate; it reduced patient travel times by 61 hours and physician wait times by 30% in comparison to in-person examination (standard of care). Teleglaucoma costs $872 per patient screened which was 80% less than in-person examination. Teleglaucoma had a greater incremental effectiveness providing an additional 0.12 QALY per patient examination. It was more sensitive (86.5%) and less specific (78.6%) than in-person examination. Teleglaucoma was more cost-effective than in-person examination with an ICER of-$27,460/QALY. This indicated that teleglaucoma will save $27, 460 for each additional QALY gained. Long term benefits showed teleglaucoma prevents 24% cases of glaucoma blindness after 30 years. Teleglaucoma demonstrated improved health outcomes, as well as, cost benefits. It increases access to ophthalmic care and improves healthcare service efficiency, specifically in rural areas. Teleglaucoma is more cost-effective than current in-person examination and can improve the quality of life in glaucoma patients.     

Who should decide? Qualitative analysis of panel data from public,patients, healthcare professionals,and insurers on priorities in health care.

OBJECTIVE: To explore the arguments underlying the choices of patients, the public, general practitioners, specialists, and health insurers regarding priorities in health care. DESIGN: A qualitative analysis of data gathered in a series of panels. Members were asked to economise on the publicly funded healthcare budget, exemplified by 10 services. RESULTS: From a medical point of view, both panels of healthcare professionals thought most services were necessary. The general practitioners tried to achieve the budget cuts by limiting access to services to those most in need of them or those who cannot afford to pay for them. The specialists emphasised the possibilities of reducing costs by increasing the efficiency within services and preventing inappropriate utilisation. The patients mainly economised by limiting universal access to preventive and acute services. The "public" panels excluded services that are relatively inexpensive for individual patients. Moreover, they emphasised the individual''s own responsibility for health behaviour and the costs of health care, resulting in the choice for copayments. The health insurers emphasised the importance of including services that relate to a risk only, as well as feasibility aspects. CONCLUSIONS: There were substantial differences in the way the different groups approached the issue of what should be included in the basic package. Healthcare professionals seem to be most aware of the importance of maintaining equal access for everyone in need of health care.     

Healthcare Service Utilization by Patients with Obstructive Sleep Apnea: A Population-Based Study

Objective

Although obstructive sleep apnea (OSA) is not a life-threatening disease, very few studies have compared differences in healthcare service utilization between patients with and those without OSA in an Asian population according to different age groups. This study attempted to investigate differences in healthcare service utilization between patients with and those without OSA in different age groups in Taiwan.

Methods

Sampled subjects and data on their health service utilization were retrieved from the Taiwan Longitudinal Health Insurance Database 2005. We included 568 patients with OSA and 2840 subjects without OSA. Each subject was followed for a 1-year period to evaluate their healthcare resource utilization. Wilcoxon-Mann-Whitney tests were performed to compare differences in healthcare utilization between patients with and those without OSA during the 1-year follow-up period.

Results

As to all healthcare service utilization, patients with OSA had significantly more outpatient visits (30.3 vs. 18.6), outpatient costs (US$1231.2 vs. US$764.8), inpatient days (1.8 vs. 1.2), inpatient costs (US$563.6 vs. US$276.7), and total costs (US$1794.8 vs. US$1041.5) than comparison subjects during the 1-year follow-up period. Moreover, patients with OSA aged 40~49 and 50~59 years respectively incurred 2.11- and 2.02-fold higher total costs compared to patients without OSA. However, patients with OSA aged over 70 years did not have higher total costs compared to those without OSA.

Conclusions

This study found that patients with OSA had greater healthcare service utilization than those without OSA. Additionally, patients with OSA in the 40~49- and 50~59-year age groups had about 2-fold higher total costs of healthcare services than those without OSA.     

Out-of-Pocket Payments,Health Care Access and Utilisation in South-Eastern Nigeria: A Gender Perspective

Out-of-pocket (OOP) payments have severe consequences for health care access and utilisation and are especially catastrophic for the poor. Although women comprise the majority of the poor in Nigeria and globally, the implications of OOP payments for health care access from a gender perspective have received little attention. This study seeks to fill this gap by using a combination of quantitative and qualitative analysis to investigate the gendered impact of OOPs on healthcare utilisation in south-eastern Nigeria. 411 households were surveyed and six single-sex Focus Group Discussions conducted. This study confirmed the socioeconomic and demographic vulnerability of female-headed households (FHHs), which contributed to gender-based inter-household differences in healthcare access, cost burden, choices of healthcare providers, methods of funding healthcare and coping strategies. FHHs had higher cost burdens from seeking care and untreated morbidity than male-headed households (MHHs) with affordability as a reason for not seeking care. There is also a high utilisation of patent medicine vendors (PMVs) by both households (PMVs are drug vendors that are unregulated, likely to offer very low-quality treatment and do not have trained personnel). OOP payment was predominantly the means of healthcare payment for both households, and households spoke of the difficulties associated with repaying health-related debt with implications for the medical poverty trap. It is recommended that the removal of user fees, introduction of prepayment schemes, and regulating PMVs be considered to improve access and provide protection against debt for FHHs and MHHs. The vulnerability of widows is of special concern and efforts to improve their healthcare access and broader efforts to empower should be encouraged for them and other poor households.     

Chronic Non-Communicable Disease and Healthcare Access in Middle-Aged and Older Women Living in Soweto,South Africa

The aim of the current study was to describe the healthcare access, beliefs, and practices of middle-aged and older women residing in Soweto. This is a cross-sectional study of the primary (female) caregivers of the Birth to Twenty Cohort, based in Soweto, South Africa. The study instrument was administered to 1 102 caregivers as part of routine annual data collection. Over half the respondents (50.7%) reported having at least one chronic non-communicable disease (CND), only a small portion (33.3%) of whom reported accessing a healthcare service in the last 6 months. Reported availability of private medical practice and government clinics was high (75.1% and 61.5% respectively). The low utilisation of healthcare services by women with CND is a concern in terms of healthcare management. There is a need to further investigate how healthcare beliefs are formed, as well as the feasibility of programmes to support the ongoing management of CND in Soweto.     

Indigenous knowledge is saving our iconic species

When a species’ last strong foothold occurs on Country, empowering Indigenous-led actions under the collaborative management of culturally significant species is key to species persistence. We examine how Indigenous Australians are using Indigenous knowledge to save the greater bilby, a highly valued species to Indigenous and non-Indigenous Australians.     

Ethnic Differences in the Quality of the Interview Process and Implications for Survey Analysis: The Case of Indigenous Australians

Comparable survey data on Indigenous and non-Indigenous Australians are highly sought after by policymakers to inform policies aimed at closing ethnic socio-economic gaps. However, collection of such data is compromised by group differences in socio-economic status and cultural norms. We use data from the Household, Income and Labour Dynamics in Australia Survey and multiple-membership multilevel regression models that allow for individual and interviewer effects to examine differences between Indigenous and non-Indigenous Australians in approximate measures of the quality of the interview process. We find that there are both direct and indirect ethnic effects on different dimensions of interview process quality, with Indigenous Australians faring worse than non-Indigenous Australians in all outcomes ceteris paribus . This indicates that nationwide surveys must feature interview protocols that are sensitive to the needs and culture of Indigenous respondents to improve the quality of the survey information gathered from this subpopulation.     

Hospital Utilisation in Indigenous and Non-Indigenous Infants under 12 Months of Age in Western Australia,Prospective Population Based Data Linkage Study

BackgroundIndigenous infants (infants aged under 12 months) have the highest hospital admission and emergency department presentation risks in Australia. However, there have been no recent reports comparing hospital utilisation between Indigenous and non-Indigenous infants.MethodsOur primary objective was to use a large prospective population-based linked dataset to assess the risk of all-cause hospital admission and emergency department presentation in Indigenous compared to non-Indigenous infants in Western Australia (WA). Secondary objectives were to assess the effect of socio-economic status (Index of Relative Socio-Economic Disadvantage [IRSD]) on hospital utilisation and to understand the causes of hospital utilisation.FindingsThere were 3,382 (5.4%) Indigenous and 59,583 (94.6%) non-Indigenous live births in WA from 1 January 2010 to 31 December 2011. Indigenous infants had a greater risk of hospital admission (adjusted odds ratio [aOR] 1.90, 95% confidence interval [95% CI] 1.77–2.04, p = <0.001) and emergency department presentation (aOR 2.15, 95% CI 1.98–2.33, p = <0.001) compared to non-Indigenous infants. Fifty nine percent (59.0%) of admissions in Indigenous children were classified as preventable compared to 31.2% of admissions in non-Indigenous infants (aOR 2.12, 95% CI 1.88–2.39). The risk of hospital admission in the most disadvantaged (IRSD 1) infants in the total cohort (35.7%) was similar to the risk in the least disadvantaged (IRSD 5) infants (30.6%) (aOR 1.04, 95% CI 0.96–1.13, p = 0.356).InterpretationWA Indigenous infants have much higher hospital utilisation than non Indigenous infants. WA health services should prioritise Indigenous infants regardless of their socio economic status or where they live.     

Trial-Based Cost-Utility Analysis of Icotinib versus Gefitinib as Second-Line Therapy for Advanced Non-Small Cell Lung Cancer in China

Background

Our objective is to compare the cost-utility of icotinib and gefitinib for the second-line treatment of advanced non-small cell lung cancer (NSCLC) from the perspective of the Chinese healthcare system.

Methods

Model technology was applied to assess the data of randomized clinical trials and the direct medical costs from the perspective of the Chinese healthcare system. Five-year quality-adjusted life years (QALYs) and incremental cost-utility ratios (ICURs) were calculated. One-way and probabilistic sensitivity analyses (PSA) were performed.

Results

Our model suggested that the median progression-free survival (PFS) was 4.2 months in the icotinib group and 3.5 months in the gefitinib group while they were 4.6 months and 3.4 months, respectively, in the trials. The 5-year QALYs was 0.279 in the icotinib group and 0.269 in the gefitinib group, and the according medical costs were $10662.82 and $13127.57. The ICUR/QALY of icotinib versus gefitinib presented negative in this study. The most sensitive parameter to the ICUR was utility of PFS, ranging from $-1,259,991.25 to $-182,296.61; accordingly the icotinib treatment consistently represented a dominant cost-utility strategy.

Conclusions

The icotinib strategy, as a second-line therapy for advanced NSCLC patients in China, is the preferred strategy relative to gefitinib because of the dominant cost-utility. In addition, icotinib shows a good curative effect and safety, resulting in a strong demand for the Chinese market.     

The Cost and Cost-Effectiveness of Scaling up Screening and Treatment of Syphilis in Pregnancy: A Model

Background

Syphilis in pregnancy imposes a significant global health and economic burden. More than half of cases result in serious adverse events, including infant mortality and infection. The annual global burden from mother-to-child transmission (MTCT) of syphilis is estimated at 3.6 million disability-adjusted life years (DALYs) and $309 million in medical costs. Syphilis screening and treatment is simple, effective, and affordable, yet, worldwide, most pregnant women do not receive these services. We assessed cost-effectiveness of scaling-up syphilis screening and treatment in existing antenatal care (ANC) programs in various programmatic, epidemiologic, and economic contexts.

Methods and Findings

We modeled the cost, health impact, and cost-effectiveness of expanded syphilis screening and treatment in ANC, compared to current services, for 1,000,000 pregnancies per year over four years. We defined eight generic country scenarios by systematically varying three factors: current maternal syphilis testing and treatment coverage, syphilis prevalence in pregnant women, and the cost of healthcare. We calculated program and net costs, DALYs averted, and net costs per DALY averted over four years in each scenario. Program costs are estimated at $4,142,287 – $8,235,796 per million pregnant women (2010 USD). Net costs, adjusted for averted medical care and current services, range from net savings of $12,261,250 to net costs of $1,736,807. The program averts an estimated 5,754 – 93,484 DALYs, yielding net savings in four scenarios, and a cost per DALY averted of $24 – $111 in the four scenarios with net costs. Results were robust in sensitivity analyses.

Conclusions

Eliminating MTCT of syphilis through expanded screening and treatment in ANC is likely to be highly cost-effective by WHO-defined thresholds in a wide range of settings. Countries with high prevalence, low current service coverage, and high healthcare cost would benefit most. Future analyses can be tailored to countries using local epidemiologic and programmatic data.     

Parasitic diseases of remote Indigenous communities in Australia

Indigenous Australians suffer significant disadvantage in health outcomes and have a life expectancy well below that of non-Indigenous Australians. Mortality rates of Indigenous Australians are higher than that of Indigenous populations in developed countries elsewhere in the world. A number of parasitic diseases which are uncommon in the rest of the Australian population contribute to the high burden of disease in many remote Indigenous communities. High rates of infection with enteric parasites such as Strongyloides stercoralis, hookworm and Trichuris have been recorded and infection of the skin with the ecto-parasitic mite Sarcoptes scabiei is also a substantial problem. Secondary infection of scabies lesions, including with Staphylococcus aureus and group A Streptococcus, can produce serious sequelae such as rheumatic fever and post-streptococcal glomerulonephritis. Transmission of many parasites in many remote communities is facilitated by overcrowded living conditions and infrastructure problems which result in poor sanitation and hygiene. Improvements in environmental health conditions must accompany medical initiatives to achieve sustainable improvement in the health of Indigenous Australians.     

The Costs of Preventing and Treating Chagas Disease in Colombia

Background

The objective of this study is to report the costs of Chagas disease in Colombia, in terms of vector disease control programmes and the costs of providing care to chronic Chagas disease patients with cardiomyopathy.

Methods

Data were collected from Colombia in 2004. A retrospective review of costs for vector control programmes carried out in rural areas included 3,084 houses surveyed for infestation with triatomine bugs and 3,305 houses sprayed with insecticide. A total of 63 patient records from 3 different hospitals were selected for a retrospective review of resource use. Consensus methodology with local experts was used to estimate care seeking behaviour and to complement observed data on utilisation.

Findings

The mean cost per house per entomological survey was $4.4 (in US$ of 2004), whereas the mean cost of spraying a house with insecticide was $27. The main cost driver of spraying was the price of the insecticide, which varied greatly. Treatment of a chronic Chagas disease patient costs between $46.4 and $7,981 per year in Colombia, depending on severity and the level of care used. Combining cost and utilisation estimates the expected cost of treatment per patient-year is $1,028, whereas lifetime costs averaged $11,619 per patient. Chronic Chagas disease patients have limited access to healthcare, with an estimated 22% of patients never seeking care.

Conclusion

Chagas disease is a preventable condition that affects mostly poor populations living in rural areas. The mean costs of surveying houses for infestation and spraying infested houses were low in comparison to other studies and in line with treatment costs. Care seeking behaviour and the type of insurance affiliation seem to play a role in the facilities and type of care that patients use, thus raising concerns about equitable access to care. Preventing Chagas disease in Colombia would be cost-effective and could contribute to prevent inequalities in health and healthcare.     

The anatomy, physiology, functional significance and evolution of specialized hearing organs of gerbilline rodents

Middle and inner ear anatomy correlates with neurophysiological responses to a wide range of sound frequencies for species of the Gerbillinae representing generalized, intermediate, and specialized anatomical conditions. Neurophysiological data were recorded from 81 specimens of 13 species representing six genera. Anatomical parameters involved in the process of hearing were correlated with the neurophysiological data to assess the effects of different degrees of anatomical specialization on hearing. The 13 species tested in this manner have graphic curves of auditory sensitivity of remarkably similar disposition over the frequencies tested and to those published for Kangaroo Rats. Ears with anatomical specializations show greater auditory sensitivity. The natural history of the Gerbillinae, particularly the kinds of predators, degree of predation, and habitat is reviewed and utilized to interpret the significance of the degree of auditory specialization in the forms studied and to evaluate the prevailing hypothesis that these specializations enhance the ability of these rodents to survive in open desert situations by detecting and evading predators. The middle ear anatomy of five additional genera and species was also studied. Thus, data on the entire spectrum of gerbilline middle ear morphology provide an evolutionary sequence. Certain anatomical parameters of the organ of Corti show a degree of specialization parallel to that of features of the middle ear. The morphological changes and possible functional roles of these features are considered. A very high correlation exists for degree of specialization and aridity of habitat, thus specialization increases with increasing aridity. This increased specialization may result from more effective predation in open xeric environments. Auditory acuity for a wide range of low frequency sounds augmented by auditory specialization is hence more advantageous here. There does not appear to be selection for hearing at particular frequencies in this range. The peaks of greatest auditory sensitivity appear to correspond to the resonant frequencies of the different components of the middle ear transformer and cavity.     

Binaural Fusion and Listening Effort in Children Who Use Bilateral Cochlear Implants: A Psychoacoustic and Pupillometric Study

Bilateral cochlear implants aim to provide hearing to both ears for children who are deaf and promote binaural/spatial hearing. Benefits are limited by mismatched devices and unilaterally-driven development which could compromise the normal integration of left and right ear input. We thus asked whether children hear a fused image (ie. 1 vs 2 sounds) from their bilateral implants and if this “binaural fusion” reduces listening effort. Binaural fusion was assessed by asking 25 deaf children with cochlear implants and 24 peers with normal hearing whether they heard one or two sounds when listening to bilaterally presented acoustic click-trains/electric pulses (250 Hz trains of 36 ms presented at 1 Hz). Reaction times and pupillary changes were recorded simultaneously to measure listening effort. Bilaterally implanted children heard one image of bilateral input less frequently than normal hearing peers, particularly when intensity levels on each side were balanced. Binaural fusion declined as brainstem asymmetries increased and age at implantation decreased. Children implanted later had access to acoustic input prior to implantation due to progressive deterioration of hearing. Increases in both pupil diameter and reaction time occurred as perception of binaural fusion decreased. Results indicate that, without binaural level cues, children have difficulty fusing input from their bilateral implants to perceive one sound which costs them increased listening effort. Brainstem asymmetries exacerbate this issue. By contrast, later implantation, reflecting longer access to bilateral acoustic hearing, may have supported development of auditory pathways underlying binaural fusion. Improved integration of bilateral cochlear implant signals for children is required to improve their binaural hearing.     

Healthcare Service Utilization for Practicing Physicians: A Population-Based Study

Background

Physicians are considered to be the most informed consumers in the use of medical services since they have more information about diseases or medical technology. However, although plenty of researchers have suggested that different medical seeking behavior exists among physicians, very few empirical studies have been conducted to investigate differences in medical utilization between physicians and the general population.

Objective

We explored differences in the utilization of healthcare services between physicians and the general population using a population-based dataset.

Design

A cross-sectional study.

Participants

Data for this study were sourced from the Taiwan Longitudinal Health Insurance Database 2000. We included 1426 physicians and 1426 sex- and age-matched comparison subjects.

Methods

We used Wilcoxon-Mann-Whitney tests to explore differences in variables of healthcare resource utilization between physicians and comparison subjects. We further used Kruskal-Wallis tests to examine differences in variables of healthcare resource utilization between physician practice location and comparison subjects.

Results

We found that physicians had significantly fewer outpatient visits (13.2 vs. 15.7, p<0.001) and significantly lower outpatient costs (US$477 vs. US$680, p<0.001) than comparison subjects. Furthermore, physicians had lower total health service costs than comparison subjects (US$643 vs. US$1066, p<0.001). This indicates that the mean total health service costs in the year 2010 was 1.66-fold greater for comparison subjects than for physicians. We also found that there were significant differences in the mean number of outpatient services (p<0.001), outpatient costs (p = 0.001), inpatients costs (p = 0.018), and total costs (p = 0.001) among office-based physicians, hospital-based physicians, and comparison subjects. Specifically, Scheffe contrast tests showed that office-based physicians had significantly more outpatient visits (19.3 vs.10.7, p<0.001) and significantly higher outpatient costs (US$656 vs. US$402, p<0.001) than hospital-based physicians.

Conclusions

Physicians had less healthcare utilization than comparison subjects. Furthermore, hospital-based physicians had higher inpatient costs and less outpatient services and costs than office-based physicians.     

Asthma-Like Symptoms in Homeless Children in the Greater Paris Area in 2013: Prevalence,Associated Factors and Utilization of Healthcare Services in the ENFAMS Survey

IntroductionAsthma remains poorly studied in homeless children. We sought to estimate the prevalence of asthma-like symptoms (ALS) and to identify the factors associated with ALS and healthcare service utilisation.ResultsThe prevalence of ALS among the children was 19.9%. Poor housing sanitation was significantly associated with ALS, as being born in the European Union. Most of the children with ALS had used healthcare services (85.4%). The main barriers to accessing such services were having lived in France for less than 49 months, having difficulties in French and living in poor housing conditions.ConclusionALS prevalence seemed lower than in the general child population, possibly because of the children''s origins. Environmental factors associated with ALS point to the need to improve the indoor environment of family shelters. The relatively high rate of healthcare service utilisation should not overshadow existing barriers.     

Addressing antimicrobial resistance by improving access and quality of care—A review of the literature from East Africa

Universal access to healthcare, including quality medicines, is a fundamental human right but is still out of reach for many in low- and middle-income countries (LMICs). An existing framework capturing variability of access to healthcare in low-resource settings includes the 5 dimensions: availability, accessibility, affordability, adequacy, and acceptability. This framework encompasses key components, including health infrastructure and means to access it as well as service organisation, costs, and factors that influence users’ satisfaction. However, in reality, the effectiveness of accessed healthcare is measured by the likelihood of a positive outcome. We therefore propose an expansion of this framework to include an additional dimension, “aspects of quality,” incorporating quality, which critically influences the ability of the accessed services to generate optimal health outcomes. Within this framework, we explore literature from East Africa likely relevant to a range of LMIC contexts, mainly focusing on the provision of widely used antimicrobials such as antimalarials and antibiotics. We argue that major inadequacies exist across all 6 dimensions of access and quality of drugs and their provision. While the global focus is on curbing excessive antimicrobial use to tackle the antimicrobial resistance (AMR) crisis, major constraints around access shape patients’ health-seeking decisions leading to potentially problematic practices that might exacerbate the AMR problem. We advocate for a holistic approach to tackling these inadequacies, encompassing all dimensions of access and quality of healthcare in order to improve health outcomes while simultaneously counteracting the AMR crisis.     

IN VITRO CULTURE OF EAR SHOOTS OF ZEA MAYS AND THE EFFECT OF KINETIN ON SEX EXPRESSION

Immature ear primordia of maize when cultured on a defined liquid medium grew and differentiated in response to two variables: 1) size of initial explants and 2) concentration of kinetin in the medium. Overall growth of primordia, less than 15 mm at explanting, reached an optimum fresh weight and ear length when kinetin was 10^–6m. Ears less than 10 mm, in the presence of kinetin, produced many male spikelets with well-developed stamens in both upper and lower flowers. Ears greater than 15 mm, at explanting, produced only female flowers regardless of the kinetin concentration. Different proportions of male and female and bisexual flowers were produced depending upon the initial size of inflorescences and the concentration of kinetin.     

Ear wax removal: a survey of current practice.

OBJECTIVE--To determine the methods of removing ear wax used by local general practitioners and the incidence of associated complications. DESIGN--Postal survey of 312 general practitioners serving a population of about 650,000; supplementary study of ear, nose, and throat outpatients to quantify the improvement in aural acuity after wax removal. SETTING--Catchment area of the Edinburgh otolaryngological unit. PARTICIPANTS--289 General practitioners who responded to the survey; 21 outpatients in the ear, nose, and throat department with occlusive wax. RESULTS--274 General practitioners removed wax by syringing, but only 53 (19%) always performed the procedure themselves; the remainder routinely delegated the task to practice nurses, some of whom had received no instruction. Ears were rarely examined again after the procedure. Complications had been experienced by 105 practitioners (38%) and included perforation, canal lacerations, and failure of wax removal. The removal of occlusive wax improved hearing by a mean of 5 dB over the frequencies analysed. CONCLUSIONS--About 44,000 ears are syringed each year in the area and complications requiring specialist referral are estimated to occur in 1/1000 ears syringed. The incidence of complications could be reduced by a greater awareness of the potential hazards, increased instruction of personnel, and more careful selection of patients.     

Some treatments affecting growth substances in developing wheat ears

Cytokinin, auxin and gibberellin-like substances were bio-assayed in extracts from developing ears of wheat plants grown in various conditions. Changes in cytokinin activity along the ears may be related to the earlier flowering in the middle of the ear. Ears on the main stems of plants from which all the tillers had been removed contained less cytokinin than the main-stem ears of normal tillered plants. When grain development was stopped by preventing fertilization of the ovules the ear contained more cytokinin than normal ears. With de-tillered plants, removing flag leaves before anthesis increased cytokinin, gibberellin and auxin in the ears; later removal of flag leaves did not affect cytokinin but decreased gibberellin in the ears. Conversely, removing ears before anthesis did not affect cytokinin or auxin in the flag leaves, but their gibberellin was less than that of flag leaves on intact plants. Treatment of wheat ears with zeatin did not affect grain weight or number per ear which supports the conclusion that the growth substances in the ear may be adequate for normal grain growth.