THE ASSOCIATION OF INCREASING RESILIENCE WITH POSITIVE HEALTH OUTCOMES AND QUALITY OF LIFE AMONG OLDER ADULTS

Background

Resilience has been recognized as a concept central to successful aging. Higher resilience has been associated with positive mental health while a direct impact on physical health outcomes has been less consistent. Objective: To investigate three levels of resilience (low, medium, and high), identify characteristics associated with medium and high resilience and measure the impact of increasing resilience on selected health outcomes: quality-of-life (QOL), and healthcare utilization and expenditures.

Methods

The study sample was identified from adults age ≥65, covered by an AARP® Medicare Supplement Insurance Plan from UnitedHealthcare, who had completed a health survey during May-June 2019 (N=3,573). Resilience was categorized to three levels: low, medium, and high. Other positive resources, including purpose-in-life, locus of control, social connections, and optimism, were dichotomized as high/low and counted with equal weighting as a continuous variable. Quality of life was measured from the health survey; healthcare utilization and expenditures from administrative databases.

Results

Among weighted survey respondents, the prevalence of low, medium, and high resilience levels were 27%, 29%, and 43%, respectively. The strongest predictors of medium and high resilience included increasing number of other positive resources, lower stress, and no depression. Individuals with medium and high resilience had significantly higher QOL, lower healthcare utilization and reduced healthcare expenditures.

Conclusions

Interventions promoting the maintenance and/or increase of resilience should include a focus on other positive resources and stress/depression management. Resilience strategies integrated into healthy aging programming could be associated with improved health outcomes.

IMPACT OF A SOCIAL CONNECTION PROGRAM ON OLDER ADULTS DURING THE COVID-19 PANDEMIC

Background

Research demonstrates social connections decrease loneliness and improves life satisfaction among older adults. However, the COVID-19 pandemic limited social connectedness, specifically for older adults. Thus, programs aimed to increase social connectedness among older adults are integral to their well-being. Purpose: The primary objective of this study was to determine if the telephonic Peer-to-Peer (P2P) program could improve social connectedness and reduce loneliness among older adults. A secondary objective was to improve life satisfaction and social support.

Methods

Eligible older adults (age 65+) were recruited via outbound calls and/or a mailer. Participants were mailed a T1 survey, completed intervention training, and matched into a dyad. The matched dyad engaged in weekly telephone calls for 12 weeks. Post 12 weeks, participants completed a T2 survey, and a T3 four weeks later.

Results

A total of 475 participants completed a T1, and 125 dyads (250 individuals) completed a T3. Older females were more likely to participate (77% female, 44% 75+ old). Individuals who were lonelier at baseline showed a significant improvement in loneliness throughout the program, as well as improvement in social support, life satisfaction, and subjective happiness.

Conclusion

Results from this program showed significant improvement in psychosocial well-being outcomes for lonely older adults. This program took place during the initial months of the COVID-19 pandemic and demonstrated success for lonely older adults with limited technology who may have been socially isolated during this time.

The association of physical activity with loneliness, social isolation, and selected psychological protective factors among older adults

The primary objectives were to investigate the association of physical activity levels with 1) loneliness and social isolation; 2) protective factors: resilience, purpose-in-life, and perception of aging; and 3) the impact of these factors on healthcare expenditure patterns across physical activity levels. The study sample was identified from adults age ≥65 who completed a health survey in 2018 or 2019 (N=6,652). Among survey respondents, the prevalence of low, moderate, and high physical activity levels was 29%, 31%, and 41%, respectively. Moderate and high physical activity were associated with 15%-30% lower likelihoods of loneliness and social isolation; and with 27% to 150% higher protective factors. In addition, physical activity was associated with the mitigation of increased healthcare expenditures associated with loneliness, social isolation, and low levels of protective factors. Thus, physical activity could serve as an intervention to reduce loneliness and social isolation, augment protective factors, and mitigate excess healthcare expenditures.

Stapler Malfunctions in Bariatric Surgery: An Analysis of the MAUDE Database

Background

Staple line leaks are a serious problem in bariatric surgery and a major cause of serious morbidity and mortality. Adverse events caused by medical devices are reported to the Food and Drug Administration which maintains the Manufacturer and User Facility Device Experience (MAUDE) database. We examined adverse stapler events reported to the MAUDE database, specifically with regards to bariatric surgery.

Methods

The MAUDE database was queried for adverse events caused by staplers between January 1, 2018 - December 31, 2020; events reported by Intuitive, Ethicon, and Medtronic/Covidien; and limited our search to "gastric bypass", "sleeve gastrectomy", "stapler malfunction" combined with each company.

Results

There were 883 adverse events reported for Medtronic, 353 for Ethicon, and 35 for Intuitive. Approximately 3.5 million staple reloads sold in the study period. The reported misfire rate for Medtronic was 0.04% and for Ethicon was 0.02%. Data for Intuitive was unavailable. The most common reported event for Medtronic was failure to fire (n = 349), followed by misfire (n = 186). For Ethicon, the most common event was failure to fire (n = 146), followed by mechanical problems (n = 27). The most common event with the Intuitive stapler was leak (n = 10) and bleeding from staple line (n = 8).

Conclusions

Stapler malfunction is a very rare event in metabolic and bariatric surgery. All of the major stapler producers have transitioned to powered staplers with excellent safety profiles. Open and honest reporting about stapler malfunction is essential to determine the true safety of these ubiquitous devices.

Older Adults’ Experiences Participating in Aging Strong 2020 Programs

User satisfaction assessments are integral to demonstrating intervention efficacy. Towards that end, older participants across the Aging Strong 2020 suite of offerings participated in semi-structured interviews (n = 248) to provide feedback about their experiences in the program and resulting satisfaction. Overall, most participants were satisfied with the Aging Strong 2020 interventions and reported gaining new skills, tools, or coping strategies. Participants endorsed program features that facilitated social interaction, community building, and social support. Program content specifically adapted for older adults and appropriate life stage concerns and/or areas of interest were considered especially helpful. Results demonstrate that the current test and learn model offers an opportunity for participant feedback to refine and improve future iterations of project offerings. Participant feedback led to key improvements in subsequent versions of the Aging Strong 2020 programs and their contributions to successful aging among older adults.

Older Adults’ Experiences in an Online Intervention for Managing Subjective Depressive Symptoms

Background: Many older adults struggle with late-life depression, stress, and anxiety, especially when facing age-related transitions including retirement, relocation, and the death of a spouse. Given the consequences of depression among older adults, which include higher rates of suicide, timely interventions that help to manage depressive symptoms are essential. Objective: The primary purpose of this study was to explore the perceived efficacy of an online program in improving subjective depressive feelings. Methods: Older adult participants were recruited for semi-structured interviews (n = 24) in a web-based intervention that included interactive games and activities undergirded by a cognitive behavioral therapy (CBT) approach. Participants were asked to provide feedback about program features, including weekly module content, games, interactive activities and community interactions, and any perceived effects on their health behaviors and/or emotional well-being. Participants’ responses were analyzed using qualitative content analysis. Results: Participants reported several gains, including developing the habit of forming ongoing, incremental goals, achieving wellness-related goals, and experiencing an overall positive shift in perspective. In addition, participants reported feeling greater gratitude, increased positivity, and improvement in mood. Featured games and activities helped to promote stress relief and entertainment, and mindfulness exercises were cited as the most helpful and/or enjoyable among participants. Participants expressed a preference for program content related to aging and aging-related transitions. Conclusions: This study demonstrated feasibility of an interactive web-based intervention for older adults with subjective depressive feelings, while also providing important findings about users’ preferences for personalized, aging-related feedback.

Preliminary Impact of a Social Connection Program on Older Adults

Half a century ago Lopata used the concept “society of widows” to describe the gendered reality of late life singlehood, where widowed women were excluded from coupled social life, depended on a community of other widows for social integration, and refrained from initiating new relationships due to “sanctification” of their former husbands. We use Swedish, American and EU census data and a national survey to Swedes 60-90 years old (n=1225; response rate 42%) to illustrate a substantial change in the demographic landscape of late life singlehood. More people enter later life as divorcees or become divorced at a high age. Among Swedes 60+ divorcees outnumber widowed people, and the incidence of late life divorce has more than doubled since the millennium in what has been called the “grey divorce revolution”. Many other Western countries follow the same demographical trend, posing important questions about the transformation of late life singlehood. Based on two Swedish studies we will show that the structure of the late life single community is becoming less gender skewed as a consequence of the emerging society of divorcees, and that in this society relationship careers are increasingly complex, attitudes to repartnering increasingly liberal and partner sanctification seldom an issue. We conclude by proposing the concept “society of divorcees” for this new demographic landscape of late life singlehood, argue that research is needed to capture this new reality, and discuss the implications of this change for access to social support later life.

Long Term Outcomes after Laparoscopic Assisted Trans-Gastric Endoscopic Retrograde Cholangiopancreatography

Background:

The gastric bypass is a commonly performed bariatric procedure. The stomach is divided into a small pouch as well as leaving a larger remnant that is bypassed by the gastrojejunal anastomosis. This makes access to the biliary system difficult as an endoscope cannot transverse the esophagus, roux limb, and biliopancreatic limb. Therefore, a transgastric approach (endoscopic retrograde cholangiopancreatography [t-ERCP]) through the abdominal wall and remnant stomach is necessary. This involves the surgical team providing access to the remnant stomach for the gastroenterologist to perform the t-ERCP. We have performed a number of these for biliary pathology that ranges from cancer to retained gallstones. We evaluated these patients with at least a 3-year follow-up to determine long term outcomes.

Methods:

We conducted a chart review of patients who underwent a t-ERCP with at least a 3-year follow-up. We collected de-identified data including demographics, operative details, complications, and postoperative courses.

Results:

There were 12 patients who underwent t-ERCP. Eleven patients had at least a 3-year follow-up with a mean follow-up of 68.1 months (excluding one death from pancreatic cancer). The most common pathology was benign biliary stricture (n = 6), followed by retained gallstones (n = 4), with one pancreatic cancer, and one normal examination. Two patients still had epigastric pain at long term follow-up after 3 years.

Conclusion:

T-ERCP is safe and efficacious with good long-term results.

Safety of liver biopsy at the time of bariatric surgery: an analysis of the MBSAQIP database

BACKGROUND

The majority of patients undergoing bariatric surgery have hepatic steatosis. Liver biopsy is not technically difficult to perform at the time of metabolic and bariatric surgery (MBS), but there may be concerns for bleeding complications. The safety of liver biopsy (LBx) at the time of MBS has been studied in single institutional studies but has not been studied on a national level.

METHODS

The MBSAQIP database for 2015-2018 was examined. The codes for Roux-en-Y gastric bypass (RYGB) of 43644 and sleeve gastrectomy (SG) 43775 were used along with 47000 (percutaneous liver biopsy), 47001 (percutaneous liver biopsy at time of other procedure), and 47379 (unlisted laparoscopic procedure, liver). Outcomes such as operative time, complications, and length of stay were examined. Propensity-matched analysis was performed to evaluate for adjusted associations.

RESULTS

There were 546,532 patients that met our inclusion criteria. Of those, 21,367 (3.9%) underwent LBx. Only 5.5% (8012) of patients undergoing RYGB had a LBx and 3.3% (13,355) of SG patients. Patients who underwent a LBx had a longer operative time before (103 min vs 84 min, p < 0.001) and after propensity matching [regression coefficient (RC): 10.7 (8.87, 12.5)]. There was no increase in length of stay. There was an increased risk in mortality in the unadjusted analysis (prevalence ratio = 1.61, p = 0.02), but when propensity-matched analysis was done, there was no statistically significant difference between the two groups. Concerning bleeding or transfusion, there was no difference in bleeding or rates of transfusion (p= 0.22, p = 0.21).

CONCLUSION

Liver biopsy at the time of MBS is safe. It adds operative time, but there is no increase in length of stay, bleeding complications, morbidity, or death.

The additive impact of multiple psychosocial protective factors on selected health outcomes among older adults

Our objective was to investigate the additive properties of five psychosocial protective factors: purpose-in-life, resilience, optimism, internal locus of control and social connections. Self-reported psychological (depression, stress) and physical (health status, functionality) health outcomes and measured healthcare utilization and expenditures were included. The study sample was identified from adults age ≥65 who completed a health survey during May-June 2019 (N = 3,577). Each of the five protective factors was dichotomized as high/low (1/0) and counted with equal weighting. The protective factors were additive such that significant improvements in psychological and physical health outcomes were evident across factor subgroups: as the number of factors increased, health outcomes improved. The magnitude of the improvements was greatest between 0 and 1 factor. In addition, a significant linear trend for reduced healthcare expenditures ($1,356 reduction per factor added) was evident. Interventions promoting at least one protective factor would be beneficial for older adult populations.

ONLINE MINDFULNESS PROGRAM FOR LONELY OLDER ADULTS

Mindfulness meditation is a cognitive state of self-awareness that promotes emotional regulation and change in self-perspective. Mindfulness has been applied to address loneliness, stress, and anxiety, demonstrating consistent health benefits. The purpose of this study was to test the feasibility of an online mindfulness program and to measure its impact on well-being among lonely older adults. The intervention consisted of seven one-hour weekly online modules led by a trained facilitator via WebEx. Engagement was high with 63% of participants attending four or more sessions. Pre/post survey data (N=42) found decreased anxiety, stress, and improvement in mindfulness, purpose in life, and resilience. This program demonstrates that online mindfulness programs may be of great benefit for lonely older adults. Future research will include larger samples to investigate further impacts.

LIFEBIO: PARTICIPANTS' EXPERIENCES IN A TELEPHONIC-BASED REMINISCENCE PROGRAM

Older adults facing age-related transitions are at increased risk for depression and loneliness. Reminiscence therapy has demonstrated positive outcomes for older adults, including improved socialization and reduced depression. A program known as LifeBio was designed as a group intervention to engage participants by capturing their life stories to positively impact wellness through reminiscence. This program was adapted to a telephonic format for the Aging Strong 2020 initiative. Semi-structured interviews eliciting feedback about participants’ experiences in the program were conducted with 24 participants. Respondent feedback indicated that those with limited mobility and fewer social connections reported the greatest benefit. Many identified the value of journaling as a form of recordkeeping for family members, but reported varying degrees of journal completion. Suggestions for improvement included future facilitation of two-way communication with other participants and opportunities for face-to-face interaction in group settings.

REDUCING LONELINESS AMONG OLDER ADULTS WITH ANIMATRONIC PETS

Pet ownership has been examined as a solution for loneliness. However, multiple challenges of pet ownership exist for older adults. Therefore, research efforts are considering the use of animatronic pets to reduce loneliness. The purpose of this study was to determine if ownership of animatronic pets would decrease loneliness and improve well-being among lonely older adults. Individuals were identified as lonely through a prior survey. Participants were provided with their choice of either an animatronic cat or dog and completed T1, T2, and T3 surveys. Response rates were high; 167 (63%) completed T1 and T2, and 125 (48%) also completed T3. T2 data indicated that loneliness decreased, while mental well-being, resilience, purpose in life, and optimism improved. At T3 mental well-being and purpose and life continued to improve. Animatronic pets appear to provide significant benefits for the well-being of lonely older adults.

Trends in Drain Utilization in Bariatric Surgery: an Analysis of the MBSAQIP Database 2015-2017

Background

Laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (SG) are the two most common bariatric operations. With the implementation of enhanced recovery protocols, the use of drains should decrease.

Methods

The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database was queried for the years 2015–2017. Our inclusion criteria included all patients undergoing a primary LRYGB, SG, and revisions. We examined demographics, operative characteristics, the use of drains, and postoperative complications. Continuous variables were summarized using means and standard deviations (SD). Categorical variables were summarized using frequencies and proportions. Student’s T test (Wilcoxon sum rank test in the case of skewed data) and chi-squared analysis were used to assess the baseline differences in drain utilization.

Results

From 2015 to 2017, there were 388,239 bariatric cases performed without drains and 100,221 performed with drains. Twenty-nine percent of LRYGB patients had a drain placed but only 16.7% of SG patients. The percentage of LRYGB that had a drain dropped from 33.1 to 24.6% during the study period and that of SG dropped from 20.3 to 13.6%. Patients that had drains placed were more likely to have a provocative test at the time of surgery (prevalence ratio (PR) 2.24) and to have a postoperative swallow study (PR 1.93).

Conclusions

Drains are still commonly used in bariatric patients. Over the study period, there was a decrease in the use of drains in both bypass and sleeve patients. Patients with a drain were more likely to have had a provocative test and a swallow study and have a higher rate of complications and mortality.

Electronic supplementary material

The online version of this article (10.1007/s11695-019-04215-6) contains supplementary material, which is available to authorized users.

Small bowel obstructions following the use of barbed suture: a review of the literature and analysis of the MAUDE database

BACKGROUND

Barbed suture has been adopted across all surgical specialties. One of the infrequent complications seen with the use of barbed suture is small bowel obstructions (SBOs). In this study, we perform a review of the literature and the Manufacturer and User Facility Device Experience Database (MAUDE) to characterize SBOs after the use of barbed sutures in a variety of operative procedures.

METHODS

A review of the literature was performed by searching PubMed and Ovid. We used the search terms: "barbed," "suture," "bowel," and "obstructions." For each case report, we examined the initial surgical procedure, type of barbed suture used, the type of complication, the time to complication, the presentation, and the type of operative interventions required. We did the same with the MAUDE database.

RESULTS

Our review of the literature revealed 18 different cases of SBO secondary to the use of barbed suture. The four most common procedures, with a total of four cases each, were inguinal hernia procedures, myomectomy, hysterectomy, and pelvic floor reconstructive procedures. The average time of presentation to SBO was found to be 26.3 days post-op (1-196 days). A total of 16 patients (88.9%) presented with abdominal pain. Other common complaints included vomiting (33.3%), abdominal distension (27.8%), oral intolerance (22.2%), and constipation (16.7%). A total of 5 cases were also found to have a possible volvulus on computed tomography (CT), and 2 cases were reported to have strangulation. The MAUDE database had 14 cases reporting on obstruction.

CONCLUSIONS

Surgeons should have a high index of suspicion for SBO if a patient presents with obstructive symptoms after a surgery that used barbed suture. This will often present as a mesenteric volvulus on CT. These particular SBOs require operative exploration, with laparoscopy being successful in the majority of cases.

Characteristics of New-Onset and Chronic Sleep Medication Users Among Older Adults: A Retrospective Study of a US Medigap Plan Population using Propensity Score Matching

Background

Prescription sleep medications are often utilized to manage sleep problems among older adults even though these drugs are associated with multiple risks.

Objective

The aim was to determine the prevalence and characteristics of new-onset compared to chronic sleep medication users and to examine factors associated with the conversion from new to chronic use. A secondary objective was to investigate the impact of sleep medications on health outcomes of injurious falls and patterns of healthcare utilization and expenditures.

Methods

A 25% random sample of adults ≥ 65 years with 3-year continuous AARP^® Medicare Supplement medical and AARP^® MedicareRx drug plan enrollment was utilized to identify new-onset and chronic sleep medication users. Prescription sleep medication drugs were defined using National Drug Codes (NDCs); falls or hip fractures were identified from diagnosis codes. New users had no sleep medication use in 2014, but initiated medication use in 2015; chronic users had at least one sleep medication prescription in 2014 and in 2015; both groups had follow-up through 2016. Characteristics associated with new users, new users who converted to chronic use, and chronic users were determined using multivariate logistic regression. Prevalence of falls, healthcare utilization and expenditures were regression adjusted.

Results

Among eligible insureds, 3 and 9% were identified as new-onset and chronic sleep medication users, respectively. New-onset sleep medication prescriptions were often associated with an inpatient hospitalization. The strongest characteristics associated with new users, those who converted to chronic use, and chronic users were sleep disorders, depression and opioid use. About 50% of new users had > 30 days’ supply; 25% converted to chronic use with ≥ 90 days’ supply. The prevalence of falls for new-onset users increased by 70% compared to a 22% increase among chronic users.

Conclusion

New-onset and chronic sleep medication users were characterized by sleep disorders, depression and pain. Addressing the underlying problems associated with sleep problems among older adults may decrease the need for sleep medications and thus reduce the risk of sleep medication-related adverse events.

A Pilot Online Mindfulness Intervention to Decrease Caregiver Burden and Improve Psychological Well-Being

Interventions to reduce caregiver burden are of great interest as the number of informal family caregivers continues to grow. The purpose of this study was to test the feasibility of an online mindfulness meditation intervention for community-dwelling older adult caregivers and to evaluate its impact on quality of life, caregiver burden, and psychological well-being. A total of 40 caregivers were recruited from 2 community center support groups to participate in an 8-week online mindfulness intervention. Pre and post surveys were administered. Retention rates were high with 55% completing the post surveys and attending at least 5 out of 8 sessions. Matched pairs t test indicated that the intervention reduced caregiver burden, perceived stress, anxiety, and loneliness and improved mental well-being. Online interventions offer flexibility for caregivers regardless of their responsibilities. Future research should expand this opportunity and explore the scalability of online mindfulness interventions.

Falls-Related Drug Use and Risk of Falls Among Older Adults: A Study in a US Medicare Population

Background

Approximately one-third of community-dwelling older adults fall each year, and approximately 10% have falls requiring medical services. Among other factors, research studies have linked certain medications with an increased risk of falls.

Objective

The aim of this study was to examine the risk of falls relative to use patterns among new and continuing falls-related drug (FRD) users.

Methods

A 10% random sample, insured in AARP^® Medicare Supplement and AARP Medicare Part D Rx plans, was utilized to define new and continuing FRD users. New users had a 12-month pre-period without FRD use, whereas continuing users had at least one FRD in the pre-period. Both groups had 12-month follow-up after initiating or continuing FRD use. Characteristics associated with the risk of falls for new and continuing users were determined using multivariate logistic regression models.

Results

Among insureds, 44% used at least one of the FRD classes. Of these, 29% were new users (N = 35,340) and 71% were continuing users (N = 121,488). Fall rates for the two subgroups were similar at 7 and 8%, respectively. Characteristics associated with the risk of falls were previous injurious fall, use of two or more classes of FRDs, older age, poorer health, and being female. New users were at higher risk than continuing users.

Conclusion

New users of FRDs were at highest risk of falls, and continuing users were at increased risk, especially with higher numbers of FRD classes. Both groups could benefit from falls awareness and prevention programs.

Purpose in Life and Positive Health Outcomes Among Older Adults

Purpose in life (PIL) is conceptualized as having goals, a sense of direction, and a feeling that there is meaning to present and past life. PIL has been associated with positive health outcomes among older adults, including fewer chronic conditions, less disability, and reduced mortality. The purpose of this study was to estimate the prevalence of PIL among AARP Medicare Supplement insureds, identify associated characteristics, and measure impact on selected health outcomes. In 2016, surveys were sent to a random stratified sample; PIL was measured using a 7-item scale with 5 responses. Scores were averaged across responses and categorized to PIL levels of low, medium, and high. Survey responses were weighted to adjust for nonresponse bias and to weight to a nationally representative population. Multivariate regression models, adjusting for confounding covariates, were utilized to determine characteristics associated with PIL levels and the impact on health care utilization and expenditures, preventive services compliance and quality of life (QOL). Among weighted survey respondents (N = 15,680), low, medium, and high PIL levels were 24.2%, 21.1%, and 54.7%, respectively. The strongest characteristics of medium and high PIL included social support, resilience, reliance on faith, high health literacy, and good health status. Individuals with medium and high PIL had significantly lower health care utilization and expenditures, increased preventive services compliance, and higher QOL. PIL is strongly associated with improved mental and physical health outcomes among older adults. Thus, interventions to improve and/or maintain higher levels of PIL over time may promote successful aging.

Diversity of Ralstonia solanacearum in French Guiana expands knowledge of the "emerging ecotype"

Although bacterial wilt remains a major plant disease throughout South America and the Caribbean, the diversity of prevalent Ralstonia solanacearum populations is largely unknown. The genetic and phenotypic diversity of R. solanacearum strains in French Guiana was assessed using diagnostic polymerase chain reactions and sequence-based (egl and mutS) genotyping on a 239-strain collection sampled on the families Solanaceae and Cucurbitaceae, revealing an unexpectedly high diversity. Strains were distributed within phylotypes I (46.9%), IIA (26.8%), and IIB (26.3%), with one new endoglucanase sequence type (egl ST) found within each group. Phylotype IIB strains consisted mostly (97%) of strains with the emerging ecotype (IIB/sequevar 4NPB). Host range of IIB/4NPB strains from French Guiana matched the original emerging reference strain from Martinique. They were virulent on cucumber; virulent and highly aggressive on tomato, including the resistant reference Hawaii 7996; and only controlled by eggplant SM6 and Surya accessions. The emerging ecotype IIB/4NPB is fully established in French Guiana in both cultivated fields and uncultivated forest, rendering the hypothesis of introduction via ornamental or banana cuttings unlikely. Thus, this ecotype may have originated from the Amazonian region and spread throughout the Caribbean region.

Genetic mapping of a major dominant gene for resistance to Ralstonia solanacearum in eggplant

Resistance of eggplant against Ralstonia solanacearum phylotype I strains was assessed in a F(6) population of recombinant inbred lines (RILs) derived from a intra-specific cross between S. melongena MM738 (susceptible) and AG91-25 (resistant). Resistance traits were determined as disease score, percentage of wilted plants, and stem-based bacterial colonization index, as assessed in greenhouse experiments conducted in Réunion Island, France. The AG91-25 resistance was highly efficient toward strains CMR134, PSS366 and GMI1000, but only partial toward the highly virulent strain PSS4. The partial resistance found against PSS4 was overcome under high inoculation pressure, with heritability estimates from 0.28 to 0.53, depending on the traits and season. A genetic map was built with 119 AFLP, SSR and SRAP markers positioned on 18 linkage groups (LG), for a total length of 884 cM, and used for quantitative trait loci (QTL) analysis. A major dominant gene, named ERs1, controlled the resistance to strains CMR134, PSS366, and GMI1000. Against strain PSS4, this gene was not detected, but a significant QTL involved in delay of disease progress was detected on another LG. The possible use of the major resistance gene ERs1 in marker-assisted selection and the prospects offered for academic studies of a possible gene for gene system controlling resistance to bacterial wilt in solanaceous plants are discussed.

So near and yet so far: the specific case of Ralstonia Solanacearum populations from Côte d'Ivoire in Africa

The genetic and phenotypic diversity of Côte d'Ivoire Ralstonia solanacearum strains was assessed on a 168-strain collection sampled on Solanaceae both in the southern lowlands and western highlands. Phylotypes I, II, and III were prevalent, though at unexpected frequencies. Phylotype I strains (87.5%) were genetically diverse and overrepresented in all agroecological areas, including highlands (AEZ III). Phylotype II strains (10.7%) only belonged to one tropical lowland-adapted broad host range lineage (IIA-35), whereas no highland-adapted potato brown rot (IIB-1) or Moko strains were detected. African phylotype III strains were rare (1.8%). They originated from a single Burkina Faso lineage (III-23) and were only found in lowlands. Three phylotype I strains were found harboring pRSC35, a plasmid identified in phylotype III strains in Cameroon. From pathogenicity tests performed on commercial varieties and tomato/eggplant/pepper references, the virulence diversity observed was high, with five pathoprofiles described. Eggplant accessions MM152 and EG203 and tomato HW7996 displayed the largest resistance spectrum and highest level. Two highly virulent phylotype I strains were able to bypass resistance of HW7996 and the eggplant reference AG91-25. Collectively, these points lead to the conclusion that the situation in Côte d'Ivoire is specific towards other African countries, and specifically from the Cameroon reference, and that within phylotype I can exist a high virulence diversity. This calls for similar studies in neighboring West African countries, linking R. solanacearum pathogen genetic diversity to strain virulence at the regional level, for the rationalization of regional resistance deployment strategies and future resistance durability studies.

Extensive settlement of the invasive MEAM1 population of Bemisia tabaci (Hemiptera: Aleyrodidae) in the Caribbean and rare detection of indigenous populations

Bemisia tabaci populations belonging to Middle East-Asia Minor one (MEAM1) and Mediterranean (MED) groups (formerly biotype B and Q, respectively) have spread throughout the world. Although the introduction of MEAM1 is documented from several Caribbean islands, it is generally not known whether MED has also been introduced; whether indigenous populations have survived; and if in the affirmative, to which group(s) they belonged. Whiteflies were collected from seven islands on various plant species. The prevalence of MEAM1 and non-MEAM1 individuals was assessed using a microsatellite approach validated with sequences of the mitochondrial cytochrome oxidase I (mtCOI) gene. Of the 262 samples tested, 247 exhibited the MEAM1 pattern, whereas none showed the MED pattern. The mtCOI gene was partially sequenced from a sample of individuals exhibiting MEAM1 (n = 15) and non-MEAM1 patterns (n = 8) and compared with type sequences. The 15 individuals exhibiting the MEAM1 pattern were confirmed to belong to MEAM1. Of the eight individuals representative of the six non-MEAM1 patterns, two belonged to the indigenous New World (NW) group of B. tabaci (NW), one belonged to a distinct species of Bemisia, and five belonged to MEAM1. One individual belonging to NW exhibited 99.9% nucleotide identity with a NW individual from Puerto Rico. The other was identified as the most divergent individual of the North and Central American genetic cluster. We conclude that a highly homogenous MEAM1 population has extensively settled in the Caribbean and that heterogeneous NW populations were still detectable although severely displaced.

Bacterial wilt resistance in tomato, pepper, and eggplant: genetic resources respond to diverse strains in the Ralstonia solanacearum species complex

Bacterial wilt, caused by strains belonging to the Ralstonia solanacearum species complex, inflicts severe economic losses in many crops worldwide. Host resistance remains the most effective control strategy against this disease. However, wilt resistance is often overcome due to the considerable variation among pathogen strains. To help breeders circumvent this problem, we assembled a worldwide collection of 30 accessions of tomato, eggplant and pepper (Core-TEP), most of which are commonly used as sources of resistance to R. solanacearum or for mapping quantitative trait loci. The Core-TEP lines were challenged with a core collection of 12 pathogen strains (Core-Rs2) representing the phylogenetic diversity of R. solanacearum. We observed six interaction phenotypes, from highly susceptible to highly resistant. Intermediate phenotypes resulted from the plants' ability to tolerate latent infections (i.e., bacterial colonization of vascular elements with limited or no wilting). The Core-Rs2 strains partitioned into three pathotypes on pepper accessions, five on tomato, and six on eggplant. A "pathoprofile" concept was developed to characterize the strain clusters, which displayed six virulence patterns on the whole set of Core-TEP host accessions. Neither pathotypes nor pathoprofiles were phylotype specific. Pathoprofiles with high aggressiveness were mainly found in strains from phylotypes I, IIB, and III. One pathoprofile included a strain that overcame almost all resistance sources.

A New Type of Strain of Xanthomonas euvesicatoria Causing Bacterial Spot of Tomato and Pepper in Grenada

Bacterial spot of tomato and pepper (BSTP) can be caused by several Xanthomonas genospecies (2). BSTP is a major disease in Grenada where A and B phenotypic groups (Xanthomonas euvesicatoria and X. vesicatoria, respectively, [2]) have been reported (3). There is no previous report of group A strains, which are strongly amylolytic and pectolytic, in Grenada. In March 2007, tomato and pepper leaves with lesions typical of BSTP were collected in Saint David and Saint Andrew parishes of Grenada. Bacterial isolations were performed on KC semiselective agar medium (4), resulting in isolation of five yellow-pigmented, Xanthomonas-like strains. Three strains isolated from tomato or pepper in Saint David were negative for starch hydrolysis and pectate degradation, two tests that were found useful for strain identification in the 1990s (2). Two strains isolated from pepper in Saint David were strongly amylolytic and degraded pectate. Amplified fragment length polymorphism (AFLP) and multilocus sequence analysis (MLSA) assays targeting atpD, dnaK, efp, and gyrB were performed on the five strains from Grenada together with a type strain of each of X. euvesicatoria, X. perforans, X. gardneri, and X. vesicatoria as well as other reference strains of X. euvesicatoria and X. perforans as described previously (1). All strains from Grenada were identified as X. euvesicatoria regardless of the typing technique. On the basis of AFLP assays, the two strains with phenotypic features not reported in Grenada were closely related (distances of ≤0.002 nucleotide substitutions per site [1]) to a group of strains from India (ICMP 3381, LMG 907, LMG 908, and LMG 918). These two strains were also identical to the Indian strains based on MLSA, but differed from the X. euvesicatoria type strain by at least one nucleotide substitution in all loci examined. The three strains from Grenada that were negative for starch hydrolysis and pectate degradation had sequences identical to that of the type strain. Young leaves of tomato plants of cv. Marmande and pepper plants of cvs. Yolo Wonder and Aiguille were infiltrated (six inoculation sites per leaf, three replicate plants per cultivar per experiment, and the experiment was replicated once) using inoculum of each of the five strains from Grenada made from suspensions in Tris buffer containing approximately 1 × 10⁵ CFU/ml. Two reference strains of X. euvesicatoria (NCPPB 2968 and LMG 922) were also inoculated as positive control treatments. Negative control treatments consisted of leaves infiltrated with sterile Tris buffer. Typical water-soaked lesions that developed into necrotic spots were observed 3 to 8 days after inoculation (dai) for all strains on all cultivars, except NCPPB 2968, which was not pathogenic on pepper cv. Aiguille. Xanthomonas population sizes from lesions plated onto KC agar medium (4) 25 dai ranged from 3 × 10⁶ to 5 × 10⁷, 8 × 10⁷ to 2 × 10⁸, and 9 × 10⁶ to 2 × 10⁸ CFU/lesion on tomato cv. Marmande and pepper cvs. Yolo Wonder and Aiguille, respectively. The epidemiological importance of this previously unreported group of X. euvesicatoria strains in Grenada needs to be assessed. References: (1) L. Bui Thi Ngoc et al. Int. J. Syst. Evol. Microbiol. 60:515, 2010. (2) J. B. Jones et al. Syst. Appl. Microbiol. 27:755, 2004. (3) L. W. O'Garro. Plant Dis. 82:864, 1998. (4) O. Pruvost et al. J. Appl. Microbiol. 99:803, 2005.