Integrating behaviour change interventions and patient decision aids: How to accomplish synergistic effects?

People make numerous health-related choices each day: For example, deciding to brush one's teeth or to eat well and healthy - or not to do these activities. To support complex decisions and subsequent behaviour change, both Behaviour Change Interventions (BCIs) and Patient Decision Aids (PtDAs) have been developed and evolved independently to support people in health-related decision making. In this paper, we critically review BCIs and PtDAs, examine their similarities and differences, and identify potential for integration of expertise to increase the benefits for people engaging with healthcare and health behaviours. The two approaches appear to mainly differ in terms of their (1) goals and foci, (2) theoretical basis, (3) development frameworks, (4) active ingredients and (5) effect evaluation. To facilitate the integration of scientific insights from these two fields, we recommend to (1) bring both fields together and promote interprofessional discussions, (2) train (health) professionals to recognise strengths of both approaches, (3) investigate the synergy of the two fields, (4) be prepared for and try to mitigate a culture shock when the fields start to interact. Knowledge generated by researching PtDAs could be used to facilitate decisional processes that enable patients to choose goals that are in line with their values and preferences, while insights from researching BCIs could be used to facilitate engagement with, and implementation of those goals. This integration could allow researchers and intervention providers to increase the benefits for people engaging with healthcare and health behaviours. (c) 2021 Elsevier B.V. All rights reserved

First Fruiting Intergeneric Hybrids between Citrus and Citropsis

Fruiting hybrids are reported for the first time between the genera Citrus L. and Citropsis (Engl.) Swing. & M.Kell. Conventional hybridization using the recently described species Citrus wakonai P.I.Forst. & M.W.Sm. and Citropsis gabunensis (Engl.) Swing. & M.Kell. resulted in high rates of fruit set and seed formation. Although seed were only half normal size, over 90% germinated without the need for embryo rescue techniques. Plant losses were high during the first few months but after six months, the 327 surviving hybrids were potted on. These grew vigorously on their own roots and 35 of them flowered within two years of sowing. Plants flowered continuously but all were pollen-sterile and ovaries abscised shortly after petal fall. However, at 25 months, two newly flowering hybrids began setting fruit. The development, identification, morphology, breeding efficiency, and future implications of this unique germplasm are described

Citrus tristeza virus replication and movement in seedlings of 71 rootstock genotypes.

Citrus tristeza virus (CTV) replication and movement were studied in 1-year-old seedlings of 71 rootstock genotypesi, by inoculation with buds of an Imperial mandarin carrying multiple endemic strains of CTV including those causing seedling-yellows and quick-decline, but free of orange-stem-pitting strains. A virus-free Rough lemon bud was inserted 30-40 mm above the infected bud on each of the 965 nursery trees to study virus movement. A further subset of 226 trees of the same rootstock genotypes were budded with virus-free Imperial mandarin to serve as a control. Virus replication was detected (using direct tissue blot immunoassay) in most seedlings within six months of budding, with levels of infection indicating significant differences between nucellar selections, hybrid families, and within hybrid families. Genotypes lacking Poncirus in their pedigree were rapidly colonised by the virus, while those with Poncirus parentage were often either resistant or slow to replicate CTV. Large differences in the percentage of infected seedlings from Citrus x Poncirus hybrid families indicate that transmission of resistance is complex and not independent of the seed parent. CTV moved rapidly even in resistant genotypes with 100% of virus-free Rough lemon buds acquiring the virus within three months of budding. Tolerance to the diseases caused by CTV is an essential requirement of rootstocks used in Australia and this work has helped to describe initial virus replication in existing and potentially new commercial rootstocks

Citrus tristeza virus replication and movement in seedlings of 71 rootstock genotypes.

Citrus tristeza virus (CTV) replication and movement were studied in 1-year-old seedlings of 71 rootstock genotypesi, by inoculation with buds of an Imperial mandarin carrying multiple endemic strains of CTV including those causing seedling-yellows and quick-decline, but free of orange-stem-pitting strains. A virus-free Rough lemon bud was inserted 30-40 mm above the infected bud on each of the 965 nursery trees to study virus movement. A further subset of 226 trees of the same rootstock genotypes were budded with virus-free Imperial mandarin to serve as a control. Virus replication was detected (using direct tissue blot immunoassay) in most seedlings within six months of budding, with levels of infection indicating significant differences between nucellar selections, hybrid families, and within hybrid families. Genotypes lacking Poncirus in their pedigree were rapidly colonised by the virus, while those with Poncirus parentage were often either resistant or slow to replicate CTV. Large differences in the percentage of infected seedlings from Citrus x Poncirus hybrid families indicate that transmission of resistance is complex and not independent of the seed parent. CTV moved rapidly even in resistant genotypes with 100% of virus-free Rough lemon buds acquiring the virus within three months of budding. Tolerance to the diseases caused by CTV is an essential requirement of rootstocks used in Australia and this work has helped to describe initial virus replication in existing and potentially new commercial rootstocks

Hereditary diseases and child wish: exploring motives, considerations, and the (joint) decision-making process of genetically at-risk couples

Couples who are at risk of transmitting a genetic disease to their offspring may face difficult challenges regarding reproductive decision-making. Deciding if, and how, to purse their child wish can be a demanding process. This study aims to describe the reproductive joint decision-making process of genetically at-risk couples. A qualitative study was conducted with 16 couples (N=31) at risk of transmitting a genetic disease to their offspring and who received genetic counseling. Most couples were not aware of all available reproductive options in the Netherlands. A variety of motives was reported with almost all couples expressing a preference towards a reproductive option in which the child is genetically related to both parents. Only a few couples considered other options such as the use of donor gametes, adoption, and foster parenting. All couples indicated that they had multiple conversations to reach a mutually supported reproductive decision. Several carriers reported feelings of guilt and in some couples, the woman appeared to have a greater impact in the decision-making process as she should carry a pregnancy and should undergo medical treatments. This study provides insight in the extensive decision-making process of genetically at-risk couples and the role of both partners in this process. These findings can guide the development of genetic counseling (e.g., increase awareness of available reproductive options) and decision support for these couples

A co-inoculation technique to rapidly screen citrus hybrids for resistance to both Alternaria Brown Spot caused by Alternaria alternata and Citrus Scab caused by Elsinoe fawcettii.

A simple and inexpensive technique has been developed to allow the simultaneous screening of young hybrid seedlings for susceptibility to Alternaria Brown Spot (ABS) caused by Alternaria alternata and Citrus Scab (CS) caused by Elsinoë fawcettii. It is employed within six months of seed sowing, prior to hybrids being field planted, and has significantly improved breeding efficiency. By using the same culture techniques to multiply each pathogen, greater flexibility and ease of inoculation has been achieved. Plates of each pathogen are scraped/macerated to remove spores and other colony-forming units, strained through a coarse filter, combined and immediately sprayed onto vigorously growing seedlings. These seedlings are then incubated at ~25°C and high humidity for 4-7 days before being returned to the greenhouse. Hybrids susceptible to ABS develop symptoms within two weeks and are immediately discarded. A second round of culling is performed after four weeks when CS symptoms have expressed. The process is repeated three times to minimise ‘disease escapes’ and has virtually eliminated these diseases from our field plantings of new hybrids. Nucellar seedlings of genotypes known to be resistant and/or susceptible to each pathogen were used to confirm that mixing the two pathogens did not cause a change in symptom development for either disease

A co-inoculation technique to rapidly screen citrus hybrids for resistance to both Alternaria Brown Spot caused by Alternaria alternata and Citrus Scab caused by Elsinoe fawcettii.

A simple and inexpensive technique has been developed to allow the simultaneous screening of young hybrid seedlings for susceptibility to Alternaria Brown Spot (ABS) caused by Alternaria alternata and Citrus Scab (CS) caused by Elsinoë fawcettii. It is employed within six months of seed sowing, prior to hybrids being field planted, and has significantly improved breeding efficiency. By using the same culture techniques to multiply each pathogen, greater flexibility and ease of inoculation has been achieved. Plates of each pathogen are scraped/macerated to remove spores and other colony-forming units, strained through a coarse filter, combined and immediately sprayed onto vigorously growing seedlings. These seedlings are then incubated at ~25°C and high humidity for 4-7 days before being returned to the greenhouse. Hybrids susceptible to ABS develop symptoms within two weeks and are immediately discarded. A second round of culling is performed after four weeks when CS symptoms have expressed. The process is repeated three times to minimise ‘disease escapes’ and has virtually eliminated these diseases from our field plantings of new hybrids. Nucellar seedlings of genotypes known to be resistant and/or susceptible to each pathogen were used to confirm that mixing the two pathogens did not cause a change in symptom development for either disease

Commercial-scale Alternaria brown spot resistance screening as the first step in breeding new mandarins for Australia

Rapid screening tests and an appreciation of the simple genetic control of Alternaria brown spot (ABS) susceptibility have existed for many years, and yet the application of this knowledge to commercial-scale breeding programs has been limited. Detached leaf assays were first demonstrated more than 40 years ago and reliable data suggesting a single gene determining susceptibility has been emerging for at least 20 years. However it is only recently that the requirement for genetic resistance in new hybrids has become a priority, following increased disease prevalence in Australian mandarin production areas previously considered too dry for the pathogen. Almost all of the high-fruit-quality parents developed so far by the Queensland-based breeding program are susceptible to ABS necessitating the screening of their progeny to avoid commercialisation of susceptible hybrids. This is done effectively and efficiently by spraying 3-6 month old hybrid seedlings with a spore suspension derived from a toxin-producing field isolate of Alternaria alternate, then incubating these seedlings in a cool room at 25°C and high humidity for 5 days. Susceptible seedlings show clear disease symptoms and are discarded. Analysis of observed and expected segregation ratios loosely support the hypothesis for a single dominant gene for susceptibility, but do not rule out the possibility of alternative genetic models. After implementing the routine screening for ABS resistance for three seasons we now have more than 20,000 hybrids growing in field progeny blocks that have been screened for resistance to the ABS disease

Commercial-scale Alternaria brown spot resistance screening as the first step in breeding new mandarins for Australia

Rapid screening tests and an appreciation of the simple genetic control of Alternaria brown spot (ABS) susceptibility have existed for many years, and yet the application of this knowledge to commercial-scale breeding programs has been limited. Detached leaf assays were first demonstrated more than 40 years ago and reliable data suggesting a single gene determining susceptibility has been emerging for at least 20 years. However it is only recently that the requirement for genetic resistance in new hybrids has become a priority, following increased disease prevalence in Australian mandarin production areas previously considered too dry for the pathogen. Almost all of the high-fruit-quality parents developed so far by the Queensland-based breeding program are susceptible to ABS necessitating the screening of their progeny to avoid commercialisation of susceptible hybrids. This is done effectively and efficiently by spraying 3-6 month old hybrid seedlings with a spore suspension derived from a toxin-producing field isolate of Alternaria alternate, then incubating these seedlings in a cool room at 25°C and high humidity for 5 days. Susceptible seedlings show clear disease symptoms and are discarded. Analysis of observed and expected segregation ratios loosely support the hypothesis for a single dominant gene for susceptibility, but do not rule out the possibility of alternative genetic models. After implementing the routine screening for ABS resistance for three seasons we now have more than 20,000 hybrids growing in field progeny blocks that have been screened for resistance to the ABS disease

Application of a MITE Citrus apomixis marker in the Australian rootstock breeding program

Australia's citrus breeding efforts are small by international standards, and unashamedly focused on conventional approaches. Molecular markers had not yet been used in the program because they failed to meet our four essential criteria of being: linked to a trait of economic significance; technically difficult to phenotype by conventional methods; temporally difficult to phenotype by conventional methods and; likely controlled by a simple genetic mechanism. This situation changed dramatically with the 2017 publication of a miniature inverted-repeat transposable element (MITE) marker that co-segregated with the Citrus apomixis trait. This met all of the above four criteria and was quickly verified on local germplasm. Application of this MITE marker is now a standard screening procedure in our rootstock breeding research. An extensive network of field rootstock trials is used to identify parents for rootstock breeding, and the resulting segregating populations are nursery-screened within 18 months of sowing for tolerance to phytophthora, resistance to CTV, and salt exclusion using conventional screening techniques. Hybrids that survive this screening are then assessed for apomixis using the MITE marker. Monoembryonic and polyembryonic hybrids are both useful for future breeding, but those with apomixis have more immediate commercial application. Consequently, putative apomictic hybrids are propagated in greater numbers (via cuttings) to maximise replication and data precision in rootstock field trials. Use of the MITE marker has enabled maximum replication of putative apomictic hybrids, dramatically reducing the size and cost of field trials and hastened the establishment of seed-source trees. We consider it to be the first useful molecular marker in citrus breeding