Статті в журналах з теми "Forced chicory root"

The objectiv of this study was to determine wheather the root diameter had an effect on the yield components of forced chicory. The roots of cv. Goriški were divided into four diameters: 10, 20, 30 and 40 mm. Overall results have cleraly demonstrated a high correlation between the root diameter and most of the yield parameters. An increase in root diameter resulted in a significant increase in the total weight, as well as in the net weight of chicons. Net weight of yield varied from 4.20 g per chicon at 10 mm to 72.75 g per chicon at 40 mm. The thickness of the roots had no remarkeble influence on discarded yield of chicons. Root productivity gradually decreased in proportion to root diameter, except at minimum ones. Most of the morphological features of chicons were improved with diameter thickness. In the end it has been verified that marketable yield of forced chicory per unit area, was independent of the root diameter, except at the smallest size.

A method was developed to improve the yield and quality of chicons of witloof chicory (Cichorium intybus L.) forced hydroponically from roots taken following long-term storage. The method combines the use of a resilient material (polyurethane foam) with the application of pressure to the developing chicons. At the start of forcing, weights of 0, 150, 300, 450, and 900 g/root were applied to the crown and maintained until harvest. Marketable yields and density of chicons of the late-forcing cultivar Faro increased with increasing weight applied. Increasing weight also significantly decreased the length: diameter ratio of chicons, an indicator of quality. Increased marketable yield and improved quality of `Bea' (intermediate to late-forcing cultivar) chicons were achieved with application of 450 g/root. The technique provides a tool for improving economic yields of late-season, hydroponically forced witloof chicory.

Relevance. One of the types of agricultural raw materials for the food industry is the root chicory, the product from the roots of which is produced in pure form, as well as is an important component in the production of tea and coffee drinks, confectionery. Its value is determined by the content in the roots of inulin, fructose, intibin and chicory. Despite the great economic importance and economic profitability of chicory cultivation, in recent years, the local processing industry is not provided with this type of raw material and is forced to buy the product from dried root crops in other countries, such as Ukraine, Italy and India. Modern agricultural production is in dire need of new varieties of root chicory, combining high yields and chemical and technological qualities, having the form of a root crop suitable for mechanized harvesting, and adapted to cultivation in soil and climatic conditions of the Non-chernozem zone. Purpose of work: to assess the nature of the impact of ultraviolet radiation in the time mode on watermelon seeds using cytogenetic analysis.Material and methods. The article describes the results of the test in the control nursery of a new sample of chicory root with 0428 selection of Rostov OSC.Results. As a result of breeding work, a promising sample of root chicory. It was isolated early maturing, with high yields and economically valuable properties, root crop truncated, suitable for mechanized harvesting by commercially available machines.

Relevance. One of the types of agricultural raw materials for the food industry is the root chicory, the product from the roots of which is produced in pure form, as well as is an important component in the production of tea and coffee drinks, confectionery. Its value is determined by the content in the roots of inulin, fructose, intibin and chicory. Despite the great economic importance and economic profitability of chicory cultivation, in recent years, the local processing industry is not provided with this type of raw material and is forced to buy the product from dried root crops in other countries, such as Ukraine, Italy and India. Modern agricultural production is in dire need of new varieties of root chicory, combining high yields and chemical and technological qualities, having the form of a root crop suitable for mechanized harvesting, and adapted to cultivation in soil and climatic conditions of the Non-chernozem zone. Purpose of work: to assess the nature of the impact of ultraviolet radiation in the time mode on watermelon seeds using cytogenetic analysis.Material and methods. The article describes the results of the test in the control nursery of a new sample of chicory root with 0428 selection of Rostov OSC.Results. As a result of breeding work, a promising sample of root chicory. It was isolated early maturing, with high yields and economically valuable properties, root crop truncated, suitable for mechanized harvesting by commercially available machines.

Production of witloof chicory (Cichorium intybus) roots for chicons or for inulin is typically a northern U. S. or European enterprise. Although chicons (Belgian endive) command a high market price, nearly all are imported from Europe. If appropriate cultivars and optimum summer growing conditions can be identified, Tennessee's mild winters may permit relatively low cost forcing techniques. Studies with these objectives were initiated in 1992 at two locations using six cultivars, two planting dates and two within row plant densities. Root yields varied from 13 to 40 Mg·ha-1 between locations and among cultivars. Incidence of bolting was greater than 50% for the earliest maturing cultivar, `Daliva', but less than 5% for the late maturing cultivar, `Rinof', at the warmer experimental site (Knoxville, elev. 251m). No bolting of any cultivar occurred at the cooler experimental site (Crossville, elev. 549m). Data on yield and quality of forced chicons and nitrate content of edible leaf tissue will be presented.

Daily living and functioning under stress can lead to mental health problems such as anxiety or depression. Over the past decades, a number of studies have been conducted to determine the relationship between the central nervous system (CNS), intestinal flora and bidirectional communication along the gut brain axis (GBA) in the maintaining of homeostasis. One of the most important factors regulating GBA functioning in exposure to stress may be a proper diet enriched in the supplementation with pre-, pro-and synbiotics. In the present study, we examined whether a 10-week oral preventive supplementation with natural prebiotics: topinambur powder (TPB) and chicory root inulin (INU) influenced an anxiety, depressive behavior and cognition in mice exposed to the chronic unpredictable mild stress (CUMS). Additionally, a fluoxetine (FLU) has been used as a reference antidepressive drug. Furthermore, we assessed the effect of TPB, INU and FLU administration on neurogenesis in mice exposed to CUMS and finally analyzed fecal microbiota for possible changes after TPB and INU supplementation in CUMS induced mice. Results obtained from the behavioral studies (elevated plaze maze, forced swim and Morris water maze test) indicated, that 10 week supplementation with TPB (250 mg/kg) and INU (66 mg/kg), similarly to FLU (12 mg/kg), significantly mitigated an anxiety and stress as well as protected learning and memory functions in the CUMS induced mice compared to the control stressed group. Additionally, TPB and INU CUMS mice showed significantly higher level of neurogenesis in comparison to control CUMS group. Interestingly, results obtained from the fecal microbiota analysis showed a beneficial effect of TPB and INU supplementation against CUMS-induced intestinal dysbiosis in mice. In conclusion, the obtained results showed that a long-term, preventive supplementation with TPB or INU alleviates the negative effects such as anxiety, cognitive disorders or dysbiosis in mice exposed to chronic unpredictable stress.

One of the reserves for improving the quality indicators of haulm harvesters is to improve the technological process of haulm cutting by improving the design of cutters for haulm residues from the heads of root crops. In this regard, the development of new and improved working bodies for trimming the remains of tops from the heads of chicory root crops and studying the influence of the constructive and kinematic parameters of the cutter in order to improve the performance of haulm harvesters is an urgent scientific task. The developed mathematical models of the process of contact interaction of the copier with the head of the chicory root crop are the initial prerequisites for further technological analysis of cutting the remains of tops from the heads of root crops. The final solutions of integral equations will make it possible to justify the main parameters of the pruner based on the conditions of permissible horizontal force and permissible normal stresses, or from the condition of not knocking out root crops from the soil and not damaging root crops.

The search for effective technical solutions and scientific directions for substantiating the rational parameters of the working bodies of hedge cutting devices, which ensure an increase in the production of the strategically important for the leading sectors of the economy of Ukraine (energy - biofuel, food - coffee, pharmaceutical - inulin) culture, or root crops of chicory is a relevant and significant direction research, both for science and practice. The article provides the results of testing the adequacy of the developed analytical model, which functionally describes the process of unloading the cut stubble onto the surface of the harvested field by the transport element (screw conveyor) of the stubble cutting module of the root harvester depending on the parameters of the screw conveyor. Based on the processing of the experimental array of data, the regression equation of the change in the width of the formed swath of cut swath was obtained depending on the input parameters: the speed of the swath harvesting module, the swath yield and the rotation frequency of the screw conveyor. It was found that within the range of variation of the input factors, the speed of movement of the module from 1.6 to 2.4 m/s, the yield of chicory root crops from 120 to 180 t/ha and the rotation frequency of the screw conveyor from 40 to 100 rpm, the width of the formed roll of chopped the width of the swath is in the range from 0.5 to 1.4 m. The difference between the experimental and theoretical values of the width of the formed swath is within 5...10%. The obtained results of scientific research are a further step in the improvement of the methodology for optimizing the rational parameters of the working bodies of root-harvesting machines.

The study aimed to analyze gene expression linked to skeletal muscle growth and lipid metabolism in broiler chickens fed with plant extracts. Five groups of chickens were formed: four experimental groups and one control group. The diets of the experimental groups were supplemented with different plant extracts: chicory, St. John’s wort, maral root, and creeping thyme, whereas the control group received feed without phytobiotic compounds. Weekly weighings were conducted (n = 36). The chickens were slaughtered at day 26 for tissue sampling of four birds from each group. Gene expression (MYOG, MSTN, FASN) related to muscle growth and fatty acid synthesis was analyzed using the β-actin ACTB gene as a reference. Blood samples were taken at day 35 for biochemical analysis and anatomical dissection was performed. The study revealed that using plant extracts from chicory, thyme, and maral root increased MYOG gene activity by 4.21, 7.45, and 8.93 times, respectively. T. serpyllum extract boosted the MSTN gene by 10.93 times, impacting muscle growth regulation. FASN gene expression for fatty acid synthesis increased significantly by 18.22–184.12 times with plant extracts. The best results regarding meat productivity of chickens were obtained when using R. carthamoides extract. The results of the study will serve as a basis for further development of a phytocomposition designed to increase the meat productivity of broiler chickens in the production of environmentally safe poultry products.

The study was conducted during the winter (rabi) season of 201617 and 201718 at Ludhiana, Punjab with the objective to evaluate the effect of sowing methods and seed rates on productivity, quality and economics of chicory (Cichorium intybus L.). The experiment was laid out in split-plot design keeping sowing methods, i.e. bed (1 row), bed (2 rows), ridge (1 row), ridge (2 rows), flat (60 cm) and flat (30 cm), in main plots and seed rates, i.e. 0.5, 0.75, 1.0 and 1.25 kg/ha, in subplots. Results revealed that, the higher plant population under bed (2 rows) and better yield attributes under ridge (1 row) resulted in the highest root yield and net returns. Although crop sown as flat (30 and 60 cm) also gave root yield similar to former sowing methods but roots obtained under flat sowing were physically distorted, i.e. forked and cracked. Growth, photosynthetic parameters and root yield and benefit: cost ratio showed increasing trend only up to 1.0 kg/ha seed rate but shoot yield increased linearly up to 1.5 kg/ha seed rate. Final plant population, plant height at harvesting, root length and shoot yield had direct positive effect on root yield but dry matter of root at harvesting had positive indirect effect on root yield via. plant population

Magnetic nanoparticles (MNPs) were “green” synthesized from a FeCl3/FeSO4/CoCl2 mixture using ethanolic extracts of Artemisia tilesii Ledeb ‘hairy’ roots. The effect of chemical composition and reducing power of ethanolic extracts on the morphology, size destribution and other features of obtained MNPs was evaluated. Depending on the extract properties, nanosized magnetic materials of spherical (8–11 nm), nanorod-like (15–24 nm) and cubic (14–24 nm) shapes were obtained via self-assembly. Microspherical MNPs composed of nanoclusters were observed when using extract of the control root line in the synthesis. Polyhedral magnetic nanoparticles with an average size of ~30 nm were formed using ‘hairy’ root ethanolic extract without any additive. Studied samples manifested excellent magnetic characteristics. Field-dependent magnetic measurements of most MNPs demonstrated a saturation magnetization of 42.0–72.9 emu/g with negligible coercivity (∼0.02–0.29 emu/g), indicating superparamagnetic behaviour only for solids with a magnetite phase. The synthesized MNPs were minimally aggregated and well-dispersed in aqueous medium, probably due to their stabilization by bioactive compounds in the initial extract. The nanoparticles were tested for magnetic solid-phase extraction of copper (Cu), cadmium (Cd) and arsenic (As) pollutants in aqueous solution, followed by ICP-OES analysis. The magnetic oxides, mainly magnetite, showed high adsorption capacity and effectively removed arsenic ions at pH 6.7. The maximum adsorption capacity was ~150 mg/g for As(III, V) on the selected MNPs with cubic morphology, which is higher than that of previously reported adsorbents. The best adsorption was achieved using Fe3O4-based nanomaterials with low crystallinity, non-spherical form and a large number of surface-localized organic molecules. The phytotoxicity of the obtained MNPs was estimated in vitro using lettuce and chicory as model plants. The obtained MNPs did not exhibit inhibitory activity. This work provides novel insights on the morphology of “green” synthesized magnetic nanoparticles that can be used for applications in adsorption technologies.

The study was performed to evaluate the effect of a dietary level of two types of inulin differing in the degree of polymerization (DP), supplemented at different levels, on selected metabolic and immunological parameters of broiler chicken blood. Two hundred and forty 1-day-old broiler chickens were fed a diet without inulin addition (control group, C) or with standard inulin from chicory root with DP ≥ 10 (SI) or long-chain inulin (LCI) of DP ≥ 23 (Inulin Orafti®GR or Inulin Orafti®HPX, respectively; Orafti Beneo GmbH, Mannheim, Germany) at a level of 0.2%, 0.4%, or 0.6%. Therefore, 7 dietary treatments were formed. The experiment was carried out for 6 weeks. The addition of inulin had a significant (p ≤ 0.05) impact on the blood parameters analyzed, especially on the protein and lipid profile. The degree of polymerization of inulin and its level in the diet significantly affected the content of glucose and uric acid and creatinine levels in the blood plasma of 21-day-old chickens. The addition of the different types (SI vs. LCI) and levels (0.2, 0.4, and 0.6) of inulin to the diet and the interaction of these factors affected the total protein level and the content of albumins and globulins. Some differences (p ≤ 0.05) were found between the experimental groups in total cholesterol and its HDL fraction content as well as in the activity of ALT and LDH. The other biochemical indices were not affected by the experimental factors. In conclusion, it may be stated that inulin with the higher polymerization degree (LCI; DP ≥ 23) provided better results of the blood metabolic profile throughout the broiler fattening period. However, the impact of this factor is not explicit. The addition of the inulin extract at an amount of 4-6 g per kg of mixture is recommended, but further experiments are recommended....

This paper deal with recognition of first granulite occurrence in the eastern portion of the Sul-rio-grandense Shield. The granulitic rocks outcrop in the Varzea do Capivarita region, Encruzilhada do Sul block, as gneisses mostly quartzo-feldspatic with orthopyroxene and biotite, associated with supracrustal rocks metamorphosed under upper amphibolite facies conditions. Microprobe analyses show the orthopyroxene as ferrohypersthene. The mineral assemblage of upper amphibolite facies rocks, such as andulazite + sillimanite + biotite + D-feldpars + quartz, points to low pressure conditions of ca. 4 kb. This high grade association is Brasiliano in age, preserved as roof pendants and megaxenoliths within the younger Brasiliano granitoids. On other side, the Santa Maria Chico Granulites Complex, situated in the western portion of Sul-rio-grandense Shield, formed in higher pressure (9,4 kb) during the Paleoproterozoic.

Abstract Background The study aimed at exploring an optimal temperature model of forced air warming during the first hour after induction and intraoperation to prevent hyperthermia for elderly patients undergoing laparoscopic abdominal surgery. Methods There were 218 patients that were randomly divided into 3 groups warmed with a forced-air warmer during surgery: Group L (intraoperative warming set to 38 °C, n = 63), Group H (intraoperative warming set to 42 °C, n = 65) and Group LH (intraoperative warming set to 42 °C for the first hour then set to 38 °C, n = 65). Core temperature in the preoperative room and PACU was measured by a tympanic membrane thermometer and in the operation room, a nasopharyngeal temperature probe was recorded. The rate of perioperative hypothermia, defined as a reduction in body temperature to < 36 °C was recorded as the primary outcome. Intraoperative anesthetic dosage, recovery time, adverse events, thermal comfort and satisfaction score were measured as secondary outcome. Results The incidence of intraoperative and postoperative hypothermia was significantly lower in Group LH and Group H than Group L (18.75 and 15.62% vs 44.44%, P<0.001; 4.69 and 4.69% vs 20.63%, P<.05). Anesthetic dosage of rocuronium was lower in Group L than other two groups, with the opposite result of recovery time. The number of patients with shivering was higher in Group L but sweating was higher in Group H. Both of the thermal comfort and satisfaction score was highest in Group LH. Conclusion A temperature pattern of forced air warming set at 42 °C during the first hour after anesthesia induction and maintained with 38 °C was a suitable choice for elderly patients undergoing laparoscopic abdominal surgery lasting for more than 120 min. Trial registration Chictr.org.cn ChiCTR-2,100,053,211.

Abstract Background Orthodontic treatment is commonly more time-consuming in adults than in teenagers, especially when it comes to the maxillary en-masse retraction, which may take 9 months or even longer. As to solve this concern, orthodontists have been striving to seek new methods for shortening orthodontic treatment time. Piezocision, as a popular alternative treatment, has been widely used in different types of tooth movement. However, its effect on en-masse retraction of maxillary anterior teeth remains unclear. This randomized controlled trial intends to figure out the role piezocision plays in accelerating en-masse retraction. Methods This protocol is designed for a prospective, single-center, assessor-blinded and parallel-group randomized controlled trial. Twenty adult patients aged from 18 to 40 whose orthodontic treatment required bilateral maxillary first premolars extraction will be randomly assigned to the piezocision group and the control group at a ratio of 1:1. The piezocision group will undergo en-masse retraction immediately after the piezo surgery, while the control group will start en-masse retraction directly. Both groups will be followed up every 2 weeks to maintain the retraction force until the end of space closure. The space closing time is set as the primary endpoint. Meanwhile, the secondary endpoints include the change of root length, labial and palatal alveolar bone thickness, vertical bone height, probing depth of maxillary anterior teeth, cephalometric measurements, visual analogue scale, and postoperative satisfaction questionnaire. Discussion This study will attempt to provide more convincing evidence to verify whether piezocision will shorten the time of en-masse retraction or not. Distinguished with previous studies, our study has made some innovations in orthodontic procedure and primary outcome measurement, aiming to clarify the efficacy and safety of piezocision-assisted en-masse retraction in Chinese population. Trial registration Chinese Clinical Trial Registry ChiCTR 1900024297. Registered on 5 July 2019

Photo by National Cancer Institute on Unsplash INTRODUCTION Gift-giving by patients or their families to physicians has happened since there were patients and physicians, and in many places, it’s still quite common. It’s also potentially problematic, and the why and how of it offer important insight into the physician-patient relationship and human relationships more broadly. Yet ethicists, regulators, and the public have not paid much systematic attention. In the United States, no federal or state legislation directly addresses it. Only in the past two decades did the American Medical Association (AMA) release guidance to physicians about it. That guidance, which permits physicians to accept certain gifts by certain patients under certain circumstances, namely, when it will not influence their medical judgment or cause hardship to the gift-giver, is vague and incomplete – indeed, it’s all of 200 words.[1] Other physician professional organizations have little to add.[2] A few academics and opinion columnists have studied or reflected on the psychology of gift-giving and -receiving and recommended everything from categorical rejection of patient gifts[3] to erring on the side of accepting them, provided they are of modest value, and the motivation behind them can be discerned.[4] However, insufficient attention has been paid to the when and where of those gifts or the significance of clinic-, hospital- or other systems-level ethical safeguards. ANALYSIS When deciding whether they will accept a gift from a patient or their family, physicians must balance the possibility that the gift could cloud medical judgment, lead to favoritism, exploitation, and slippery slopes, or pressure other patients to give, and perhaps even debase the meaning of medical treatment, against the prospect that gift-giving could increase patient trust and satisfaction, as well as empower patients and respect their autonomy and culture.[5] Performing this harm-benefit calculation case by case is challenging and time-consuming. Unsurprisingly, many physicians opt simply to tell would-be gift-giving patients that they appreciate the sentiment, but, as a rule, they accept no gifts. I submit many physicians do this also because they are unaware of how meaningful giving a gift can be for patients or anyone in a disadvantaged position with respect to the gift recipient. They may also not know that there are simple accountability mechanisms they can institute that may prevent many of the possible adverse consequences of gift-giving and -receiving in the context of the physician-patient or physician-patient-family relationship. Unfortunately, many instances in which accepting a gift would have led to net benefit are foregone. It is my belief a consensus could quickly be formed about which types of gifts would clearly be wrong to accept. Few would defend the physician who agrees to use a patient’s villa in the Bahamas or welcomes expensive jewelry or lewd photos. The timing and intent of a gift also matter. Few would forgive the physician who accepted even a modestly valuable voucher to eat at a patient’s restaurant while their eligibility for transplant was being debated or after they had run out of opioid painkillers and were denied a prescription renewal. On the other hand, I doubt even Charles Weijer or the College of Physicians and Surgeons of Prince Edward Island, which views accepting gifts from patients as “boundary crossing,”[6] would demand an orthopedic surgeon turn down the happy picture a pediatric patient drew after recovering from a hip injury and resuming sports. They are also unlikely to criticize an oncology team that graciously receives a fruitcake baked by the sister of an elderly cancer patient after the decision was made and agreed to, around Christmastime, not to initiate another round of chemotherapy. These unlikely refusals may be because rejecting those gifts, all things considered, would seem cruel. But it might also be because there is disagreement about what constitutes a gift: whether it must be a tangible object (are heartfelt thank-yous and hugs not also “gifts”?) or whether it must be something that requires the physician actively do something, e.g., get on a plane. These disagreements about definitions may also partially underlie disagreements about practice. Suppose a patient in a sparsely populated, heavily wooded part of Maine takes it upon himself to offer a sack of apples from his orchard to his internist, who regularly waives fees for those who cannot pay them or will make a house call at any time of the night. In that case, the internist may not consider the apples a gift. He may not think of them as payment or re-payment either. They may exist in some in-between category, much like the knitted slippers brought in by a patient in whose culture “thank you” is seldom said. But clearly, some things are widely perceived as gifts or to have substantial gift-like character. Should they, at least, be rejected? I don’t think so. The act of gift-giving and -receiving can be a sort of ritual and gradually lead to trust and closeness.[7] Perhaps a shy patient whose wife previously sent chocolates to his physician around Christmastime will come to see the physician as a part of his extended family. Perhaps he needs to do so to feel comfortable talking about his erectile dysfunction. Gifts can be expressions of caring.[8] Perhaps an elderly Texan patient imagines her younger physician, whom she has known for thirty years and often sees at the grocery store, as her son and asks to prepare a homecoming mum (traditionally a chrysanthemum flower corsage) for his children’s school dance. Perhaps doing so will give her purpose, make her feel useful, as all her own children have moved away. Giving gifts may also provide patients with a sense of control and help them feel as if less of a power imbalance exists between them and their physician. Perhaps a young judge, who is not used to not being in control, and was previously misdiagnosed with rheumatoid arthritis, is now struggling to come to terms with his Lupus. Perhaps giving the physician who made the correct diagnosis a moderately-priced bottle of scotch restores his confidence or sense of pride to. Gifts are also undoubtedly important to the recipient. When medical providers receive a gift, they may interpret it as a sign that they are valued. While it would be wrong to practice medicine to receive gifts or expect them, there are times, like when ERs and ICUs are overwhelmed because of a viral pandemic,[9] which threatens the will to continue working, and most anything (within reason) that bolsters resolve can be considered good. There is also no obvious distinction between the satisfaction physicians normally receive on seeing their patients recover or being thanked or smiled at and what they feel when they receive a small or “token” gift, like a plate of homemade cookies. The point is that the physician-patient relationship is a human one. Many advocate it should be personal, that physicians should be emotionally invested in their patients, care about and have compassion for them in ways that professional oaths do not fully capture.[10] This dynamic is particularly important in primary care or when the physician-patient relationship continues for long periods. According to one Israeli study, many patients even wish for a relationship with their physician akin to friendship. Those who felt they had such a relationship were more satisfied with their care than those who believed the relationship was business-like.[11] The precedent for this “friendship between unequals” goes back at least to the time of Erasmus, some five hundred years ago.[12] There may be good reasons for physicians to draw the line before friendship, but if accepting certain gifts builds intimacy, and that intimacy does not cross over into an inappropriate relationship, e.g., a sexual or romantic relationship, and if it has the chance to improve healthcare outcomes through improved mood or early disclosure of problems, I think it should be done. Physicians have a prima facie duty to do good for their patients.[13] Most physicians want to do good for their patients and respect their traditions and preferences. I suspect that accepting the gifts from the patients in the examples above would do a lot of good, or at least that rejecting them could do significant harm, including making them or their families feel estranged from the medical community, impeding future care. Physicians might be more comfortable accepting gifts if receiving gifts would not subject them to scrutiny or penalty. They also may feel better if they knew that receiving gifts would not harm their patients and that rejecting gifts might. They should document all gifts they receive.[14] This will enable them to detect if gifts from a particular patient are increasing in frequency or lavishness or changing markedly in character, which could warrant attention. I maintain this “Gift Log” should be maintained in common with everyone at the clinic or in the relevant hospital department and potentially made available to hospital administration for audit. Investigation might be necessary if a gift is given (and accepted) with no explicable context, e.g., not near holiday season or after a treatment milestone is achieved. When possible, gifts should be shared communally, such as placing fruit baskets or chocolates in the staff room. Other gifts, like artwork, can be displayed on the walls. Others should be encouraged to hold physicians accountable if they feel patients who have given gifts receive preferential treatment, including something as seemingly small as priority for appointment bookings. Appearances matter and even the appearance of impropriety can affect the public’s trust in medicine. The culture of medicine has already changed such that nurses now reproach physicians they feel violate the standard of care,[15] and this would be an extension of that trend. Depending on the set-up of the practice, a staff member can be designated for receiving gifts and politely declining those that ought to be declined. Staff members should tell patients, who give gifts in full view of other patients, that they cannot do so in the future. Physicians can politely rebuff patients who wish to give inappropriate gifts, or gifts at inappropriate times and suggest they donate to charity instead. Medical practices and hospitals should develop a gift policy in consultation with staff and patients to avoid needlessly rejecting gifts that benefit both doctor and patient and to avoid pressuring patients into giving gifts. The policy should be flexible to account for the crucial human element in any provider-patient relationship and the cultural nuances of any practice setting. Psychiatrists, who work with particularly vulnerable patients, may need to be more vigilant when accepting gifts.[16] CONCLUSION Though we tend to think health innovation occurs in urban medical centers and spreads outward, there may be something big-city physicians can learn from their rural colleagues about personalized patient-physician relationships. The value of gifts is only one example. Normalizing the acceptance of patient gifts in appropriate restricted circumstances has the added benefit of shining a spotlight on the acceptance of patient gifts in dubious ones. By bringing an already fairly common practice into the open and talking about it, we can create policies that respect patients as persons, prevent abuse, and deconstruct the stereotype of the austere and detached physician. While there is no reason to think that gift-giving would get out of control if appropriate safeguards are put in place, the medical community can always re-evaluate after a period, or an individual medical practice can re-evaluate based on the circumstances of their practice environment. Gift-giving, especially when gifts are of small monetary value, should be recognized as a culturally appropriate gesture with meaning far beyond that monetary value. It is best governed by reasonable gift-giving policies, not banned altogether. - [1] Council on Ethical and Judicial Affairs. “Ethics of Patient-Physician Relationships.” In AMA Code of Medical Ethics, 11. Chicago: American Medical Association, 2021. https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/code-of-medical-ethics-chapter-1.pdf. [2] Sulmasy, Lois Snyder, and Thomas A. Bledsoe. “American College of Physicians Ethics Manual.” Annals of Internal Medicine 170, no. 2_Supplement (January 15, 2019): S1–32. https://doi.org/10.7326/M18-2160; Committee on Bioethics. “Pediatrician-Family-Patient Relationships: Managing the Boundaries.” Pediatrics 124, no. 6 (December 1, 2009): 1685–88. https://doi.org/10.1542/peds.2009-2147. [3] Weijer, Charles. “No: Gifts Debase the True Value of Care.” Western Journal of Medicine 175, no. 2 (August 2001): 77. [4] Lyckholm, Laurie J. “Should Physicians Accept Gifts From Patients?” JAMA 280, no. 22 (December 9, 1998): 1944–46. https://doi.org/10.1001/jama.280.22.1944; Spence, Sean A. “Patients Bearing Gifts: Are There Strings Attached?” BMJ 331, no. 7531 (December 22, 2005): 1527–29. https://doi.org/10.1136/bmj.331.7531.1527; Gaufberg, Elizabeth. “Should Physicians Accept Gifts from Patients?” American Family Physician 76, no. 3 (August 1, 2007): 437; Caddell, Andrew, and Lara Hazelton. “Accepting Gifts from Patients.” Canadian Family Physician 59, no. 12 (December 2013): 1259–60. [5] See above commentators and Drew, Jennifer, John D. Stoeckle, and J. Andrew Billings. “Tips, Status and Sacrifice: Gift Giving in the Doctor-Patient Relationship.” Social Science & Medicine 17, no. 7 (January 1, 1983): 399–404. https://doi.org/10.1016/0277-9536(83)90343-X. [6] College of Physicians and Surgeons of Prince Edward Island. “Respecting Boundaries.” Accessed April 4, 2021. https://cpspei.ca/respecting-boundaries/. [7] The Atlantic’s Marketing Team. “What Gifting Rituals from Around the Globe Reveal About Human Nature.” The Atlantic, 2018. https://www.theatlantic.com/sponsored/hennessy-2018/what-gifting-rituals-around-globe-reveal-about-human-nature/2044/. [8] Parker-Pope, Tara. “A Gift That Gives Right Back? The Giving Itself.” The New York Times, December 11, 2007, sec. Health. https://www.nytimes.com/2007/12/11/health/11well.html. [9] Harlan, Chico, and Stefano Pitrelli. “As Coronavirus Cases Grow, Hospitals in Northern Italy Are Running out of Beds.” Washington Post. Accessed April 4, 2021. https://www.washingtonpost.com/world/europe/italy-coronavirus-patients-lombardy-hospitals/2020/03/12/36041dc6-63ce-11ea-8a8e-5c5336b32760_story.html. [10] Frankel, Richard M. “Emotion and the Physician-Patient Relationship.” Motivation and Emotion 19, no. 3 (September 1, 1995): 163–73. https://doi.org/10.1007/BF02250509. [11] Magnezi, Racheli, Lisa Carroll Bergman, and Sara Urowitz. “Would Your Patient Prefer to Be Considered Your Friend? Patient Preferences in Physician Relationships.” Health Education & Behavior 42, no. 2 (April 1, 2015): 210–19. https://doi.org/10.1177/1090198114547814. [12] Albury, W. R., and G. M. Weisz. “The Medical Ethics of Erasmus and the Physician-Patient Relationship.” Medical Humanities 27, no. 1 (June 2001): 35–41. https://doi.org/10.1136/mh.27.1.35. [13] Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. 7th edition. New York: Oxford University Press, 2012. [14] Caddell and Hazelton, 2013. [15] See, e.g. Peplau, Hildegard E. “A Glance Back in Time: Nurse-Doctor Relationships.” Nursing Forum 34, no. 3 (1999): 31–35. https://doi.org/10.1111/j.1744-6198.1999.tb00991.x and Ahmad, Ahmir. “The Doctor-Nurse Relationship: Time for Change?” British Journal of Hospital Medicine (2005), September 27, 2013. https://doi.org/10.12968/hmed.2009.70.Sup4.41642. [16] Hundert, Edward M. “Looking a Gift Horse in the Mouth: The Ethics of Gift-Giving in Psychiatry.” Harvard Review of Psychiatry 6, no. 2 (January 1, 1998): 114–17. https://doi.org/10.3109/10673229809000319.