<p>  </p> <p>Tar spot is a new foliar disease of corn in the United States. Tar spot was first detected in 2015 and is now among the most important corn diseases in the Midwest. Tar spot is caused by the obligate biotrophic fungus, <em>Phyllachora maydis</em> Maubl, from the genus, <em>Phyllachora </em>which consist of over 1,200 species of host-specific fungi. Due to the recent emergence, studies relating to <em>P. maydis</em> population dynamics in the U.S. are limited. How much genetic diversity, variation, and level of gene flow are occurring within and among these populations? Knowledge of the population dynamics is imperative for understanding the pathogen’s biology, ecology, epidemiology, and management. Currently, no corn hybrid is fully resistant to tar spot. Foliar fungicides are currently the most effective option for disease management, but best practices for fungicide management remain unknown. Better information is needed on fungicide efficacy and fungicide application timing to reduce tar spot severity, protect yield, and increase profitability for Indiana corn growers. </p> <p>This research dissertation presents four chapters to answers those questions and bridge the gaps between the knowns and unknows of this novel corn-<em>Phyllachora maydis</em> pathosystem. <strong>Chapter 1</strong> presents a literature review on tar spot of corn, its economic impact, the causal pathogen, its host, lifecycle, distribution, and known management strategies as a resource for understanding the pathosystem in the U.S. <strong>Chapter 2</strong> examines the genetic population structure, diversity, geneflow and mode of reproduction in Midwest U.S. by employing microsatellite (SSR) markers. <strong>Chapter 3</strong> presents results from multi-year, multi-location, small-plot field trials on the net return of foliar fungicides and fungicide timing on tar spot management in Indiana. Lastly, <strong>Chapter 4</strong> concludes by evaluating of an integrated management strategy for tar spot by examining the integration of tillage, corn hybrids and fungicide application in reducing tar spot severity while protecting yields.</p> <p>Results provided in this research dissertation will be used to guide future studies and provide stakeholders such as researchers, corn growers, extension personnel in academia and industry with valuable information needed to guide effective disease management decisions. </p>

The focus of this study is the problem of declining trend in obstructive sleep apnea (OSA) patient compliance. Studies reported improved compliance in patients with chronic diseases due to technology-based interventions. However, researchers have not investigated the advantages of technology to improve the compliance of OSA patients in detail. The specific problem was the lack of engagement between patients and healthcare managers, resulting in low compliance within OSA patients. The purpose of this qualitative study was to evaluate how technology-based interventions can improve OSA patient engagement with the healthcare managers resulting in improved compliance with treatment procedures. In this study, the technology acceptance model was used as the instrument in evaluating the information collected through interviews with 20 healthcare managers about their attitudes toward usage, perceived usefulness, and perceived ease of use. The transcribed interviews were open-coded using the RQDA library in R Studio. In general, results from this study indicated that the healthcare managers showed a positive attitude towards the use of technology for patient engagement and expressed that the technology is useful for patient engagement and is easier to use. However, they identified technology-related and patient-related challenges in implementing technology for patient engagement. Further, the respondents identified process-related and patient-related opportunities in using technology for patient engagement. Results from this study have practice and policy implications by enabling healthcare managers to devise better compliance plans for OSA patient management. The findings could have a social benefit by helping healthcare managers to implement technology-based interventions to better achieve a higher compliance resulting in better patient health at lower costs.

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<p>The management of gray mold, caused by the fungus <em>Botrytis cinerea</em>, on ornamental plants relies heavily on fungicide applications. To improve fungicide efficacy, the manipulation of nozzle type, spray volume, and pressure influence droplet size (µm) and density (droplets/cm2) on the leaf’s surface. However, leaf wettability dictates how well the application droplets adhere and spread across the surface. When leaf surfaces are waxy (hydrophobic) or hairy (tomentose), droplets fail to adhere, impacting fungicide sorption.</p> <p>The goal of this research was to evaluate how the interaction of droplet density and leaf wettability impact the efficacy of chemical and biological fungicides against <em>Botrytis cinerea</em>. Leaf surfaces vary between species, within species, leaf age, and leaf sides (abaxial or adaxial). Hydrophobic leaf surfaces influence fungicide efficacy by reducing fungicide droplet spread compared to the wettable and hydrophilic leaf surfaces. The presence of trichomes on the leaf surface can inhibit droplets from reaching the surface.</p> <p>To quantify droplet density, a fine and coarse spray of fungicide treatments was applied with a yellow fluorescent dye. After application, <em>Begonia</em> x <em>hybrida</em> ‘Dragon wing’ leaves were placed on black, blackout curtains below a blacklight. Images were analyzed by ImageJ, using an image processing method. The number of lesions, disease incidence, were counted to observe fungicide efficacy. Results show there was no interaction between the actual droplet density within treatments applied with fine and coarse sprays. However, the interaction between spray type (fine and coarse) and treatments can have a significant effect on disease incidence. Disease incidence was significantly different between the systemic and contact fungicides for fine and coarse sprays. However, the systemic fungicide treatment had the highest disease incidence compared to the contact fungicide.</p> <p>To assess leaf wettability impact on fungicide efficacy, five <em>Begonia </em>species (<em>B. scharffii, B. erythrophylla, B. </em>x<em> hybrida ‘</em>Dragon Wing’<em>, B. epipsila, and B. goldingiana</em>) were used based on their observed leaf surface type. A contact angle goniometer was used to take pictures of a droplet on <em>Begonia</em> leaf surfaces. The quantification of the leaf surface took place by using the ImageJ program ‘Drop-Snake’ within the plugin ‘Drop Analysis’. The number of lesions, an indicator of disease incidence, were counted to observe fungicide efficacy. Results showed the contact angles were different between the <em>Begonia</em> species. There was a significant interaction between the <em>Begonia</em> species and treatments, where <em>Begonia</em> ‘hairy’ and ‘waxy’ leaf surfaces can influence fungicide efficacy. However, there was no significance for the interaction between <em>Begonia</em> species’ contact angles and treatments.</p> <p>These studies advance our understanding of how droplet density and leaf surfaces influence fungicide efficacy, thus improving our ability to manage <em>Botrytis</em> for diverse ornamental plants. </p>

The COVID-19 pandemic affected regular health care for patients with chronic diseases. However, the impact of the pandemic on primary care for patients with coronary artery disease (CAD) who are enrolled in a structured disease management program (DMP) in Germany is not clear. We investigated whether the pandemic affected primary care and health outcomes of DMP-CAD patients (n = 750) by using a questionnaire assessing patients’ utilization of medical care, CAD symptoms, as well as health behavior and mental health since March 2020. We found that out of concern about getting infected with COVID-19, 9.1% of the patients did not consult a medical practitioner despite having CAD symptoms. Perceived own influence on infection risk was lower and anxiety was higher in these patients compared to symptomatic CAD patients who consulted a physician. Among the patients who reported chest pain lasting longer than 30 min, one third did not consult a medical practitioner subsequently. These patients were generally more worried about COVID-19. Patients with at least one worsening CAD symptom (chest pain, dyspnea, perspiration, or nausea without apparent reason) since the pandemic showed more depressive symptoms, higher anxiety scores, and were less likely to consult a doctor despite having CAD symptoms out of fear of infection. Our results provide evidence that the majority of patients received sufficient medical care during the COVID-19 pandemic in Germany. However, one in ten patients could be considered particularly at risk for medical undersupply and adverse health outcomes. The perceived infection risk with COVID-19 might have facilitated the decision not to consult a medical doctor.

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The South African health care environment is a two-tier health care delivery system consisting of the public sector and the private sector. The focus of this study is on the private health care sector. Private health care is funded by medical schemes through employer and employee contributions. The private sector is also the most profitable sector for multinational pharmaceutical organisations to market and sell their products within the South African health care environment. The major cost saving initiative by employers and medical schemes in the private health care sector has also been the introduction of managed health care initiatives. The goal of managed health care is to establish a system which delivers value by giving people access to quality and cost-effective healthcare. The new reality of managed health care initiatives are changing the boundaries of the South African pharmaceutical industry. The managed health care wake is overturning the business processes which made the pharmaceutical industry so successful and are rendering obsolete the industry's conventional models of corporate strategy and management systems. In the context of these turbulent changes, pharmaceutical companies are being forced simultaneously to develop new strategic approaches for the future, design new business processes which will link them more firmly to their new customers, and implement the cultural changes neccessary to accomplish the transformation from yesterday's successful pharmaceutical company to tomorrow's customer-led, integrated health care supplier. The way forward lies in three organising concepts. The first is cutomer alignment. The effort of transformation must start with an understanding of how the customer defines the value of the services and/or products offered by the organisation. Everything that follows involves aligning internal processes with external contingencies. The second is sequencing. It is vital to understand not just what needs to happen first in the transformation process, but also what the subsequent steps is and in what order the steps need to be undertaken. The third organising concept is learning. The sequence of interventions that lead to organisational transformation must occur in such a way as to maximize the ability of the organisation to learn: from customers and the marketplace, and from itself. / Business Management / D.B.L.

The South African health care environment is a two-tier health care delivery system consisting of the public sector and the private sector. The focus of this study is on the private health care sector. Private health care is funded by medical schemes through employer and employee contributions. The private sector is also the most profitable sector for multinational pharmaceutical organisations to market and sell their products within the South African health care environment. The major cost saving initiative by employers and medical schemes in the private health care sector has also been the introduction of managed health care initiatives. The goal of managed health care is to establish a system which delivers value by giving people access to quality and cost-effective healthcare. The new reality of managed health care initiatives are changing the boundaries of the South African pharmaceutical industry. The managed health care wake is overturning the business processes which made the pharmaceutical industry so successful and are rendering obsolete the industry's conventional models of corporate strategy and management systems. In the context of these turbulent changes, pharmaceutical companies are being forced simultaneously to develop new strategic approaches for the future, design new business processes which will link them more firmly to their new customers, and implement the cultural changes neccessary to accomplish the transformation from yesterday's successful pharmaceutical company to tomorrow's customer-led, integrated health care supplier. The way forward lies in three organising concepts. The first is cutomer alignment. The effort of transformation must start with an understanding of how the customer defines the value of the services and/or products offered by the organisation. Everything that follows involves aligning internal processes with external contingencies. The second is sequencing. It is vital to understand not just what needs to happen first in the transformation process, but also what the subsequent steps is and in what order the steps need to be undertaken. The third organising concept is learning. The sequence of interventions that lead to organisational transformation must occur in such a way as to maximize the ability of the organisation to learn: from customers and the marketplace, and from itself. / Business Management / D.B.L.