bluuebunny/crossref_metadata_2025 huggingface dataset:
Conservation Status as a Biodiversity Trend Indicator: Recommendations from a Decade of Listing Species at Risk in British Columbia
Authors: QUAYLE JAMES F. , RAMSAY LEAH R.
Published: July 2005

Abstract:  Species conservation status is commonly used as a broad‐scale indicator of the state of biological diversity. To learn about its value for tracking trends, we examined provincial lists of terrestrial vertebrate species and subspecies at risk in British Columbia, Canada, for 1992 and 2002 to see whether changes in these lists reflected changes in the status of the taxa they represent. Examination of the case histories of individual species and subspecies showed that 65% of additions and deletions to the British Columbia Red List were the result of improvement in knowledge of species status, changes in assessment procedures, and refinements in taxonomy rather than actual changes in a species' status. Comparison to an alternate set of rank scores provided by NatureServe for taxa that appeared on both 1992 and 2002 British Columbia Red Lists revealed changes in status that were not reflected by movement from the list. Estimates of historical conservation status for species on the 1992 British Columbia Red List demonstrated ambiguity around the natural baseline with regard to tracking changes in list composition over time. We discourage the continued use of indicators based solely on conservation status as a means of tracking biodiversity. Instead we recommend advancing strategic indicators around species at risk based on long‐term monitoring data, deliberate and explicitly stated baselines, and consistent methods of conservation ranking.
Thresholds in Forest Bird Response to Habitat Alteration as Quantitative Targets for Conservation
Authors: GUÉNETTE JEAN‐SÉBASTIEN , VILLARD MARC‐ANDRÉ
Published: July 2005

Abstract: The notion that species might exhibit thresholds in their response to habitat alteration is appealing from a conservation perspective. Such thresholds could be used as targets for conservation in managed landscapes. In New Brunswick, Canada, forest management produces mosaics of varying stand age, species composition, and structure. We sampled this gradient in habitat suitability to examine the shape of species response functions and to look for evidence of statistically significant thresholds. We focused our attention on bird species breeding in late‐seral forest and surveyed them at 390 point‐count stations sampling broad‐leaved deciduous to pure coniferous stands and a variety of silvicultural treatments (patch cutting, single‐tree selection, spruce plantation [35–45 years old], and no recent treatment). A principal components analysis (PCA) on local vegetation separated stations along two axes reflecting gradients in stand composition and habitat alteration (increasingly open canopy and decreasing density of large trees/snags), respectively. We combined logistic regression and receiver‐operating characteristic (ROC) analysis to detect thresholds in species occurrence along these gradients. Of the 42 species frequent enough to be included in the analyses, 13 (31%) showed a significant (p< 0.01) negative response to habitat alteration. Eight of the 13 species sensitive to habitat alteration exhibited thresholds in their occurrence after controlling for the suitability of local habitat. According to curves of the expected number of sensitive species (based on their ROC‐derived thresholds), canopy closure and the density of large trees (>30 cm dbh) should be at least 70% and 80 stems/ha, respectively, to expect to find the complete assemblage of bird species. However, these values should be viewed as liberal, given the nature of our response variable. More refined (e.g., fitness) parameters should be used to be conservative. Nonetheless, the approach allowed us to establish preliminary quantitative targets for conservation planning based on time‐efficient sampling methods, and to explicitly account for the continuous variability existing within and among silvicultural treatments rather than to assume homogeneity within treatments.
The Cost Efficiency of Wild Dog Conservation in South Africa
Authors: LINDSEY P. A. , ALEXANDER R. , DU TOIT J. T. , MILLS M.G.L.
Published: July 2005

Abstract:  Aside from Kruger National Park, no other suitable reserves of sufficient size exist in South Africa that will hold a viable population of wild dogs (Lycaon pictus). Consequently, conservation efforts have been focused on creating a metapopulation through a series of wild dog reintroductions into isolated fenced reserves. Additional potential exists for conserving wild dogs on private ranch land. Establishing the metapopulation was an expensive process, accounting for approximately 75% of the US$380,000 spent on wild dog conservation in South Africa during 1997‐2001. The principal goal of the metapopulation project was to reduce the risk of catastrophic population decline. Now that this has been achieved, we developed a uniform cost‐efficiency index to estimate the cost efficiency of current and potential future conservation strategies in South Africa. Conserving wild dogs in large protected areas was predicted to be the most cost‐efficient conservation strategy (449 packs/$100,000 expenditure). Establishing the metapopulation has been less cost efficient (23 packs/$100,000), and expansion of the metapopulation was predicted to be even less cost efficient if predation by wild dogs results in additional costs, as is to be expected if private reserves are used for reintroductions (3‐13 packs/$100,000). Because of low logistical costs, conserving wild dogs in situ on private ranch land was potentially more cost efficient than reintroducing wild dogs (14‐27 packs/$100,000). We recommend that donor funding be used to reintroduce wild dogs into transfrontier parks, when they are established, to maintain the existing metapopulation and to establish conservation programs involving wild dogs on private ranch land. Investing in the expansion of the metapopulation should be limited to state‐owned nature reserves willing to carry predation costs without compensation.
Beta Diversity and Nature Reserve System Design in the Yukon, Canada
Authors: WIERSMA YOLANDA F. , URBAN DEAN L.
Published: July 2005

Abstract:  Design of protected areas has focused on setting targets for representation of biodiversity, but often these targets do not include prescriptions as to how large protected areas should be or where they should be located. Principles of island biogeography theory have been applied with some success, but they have limitations. The so‐called SLOSS (single large or several small reserves) debate hinged on applications of island biogeography theory to protected areas but was resolved only to the point that parties agreed there might be different approaches in different situations. Although proponents on both sides of the SLOSS debate generally agree that replicating protected areas is desirable, it is difficult to determine how to replicate reserves in terms of number and spatial arrangement. More important, many targets for representation often do not address issues of species persistence. Here, we used a geographic information system in a study of disturbance‐sensitive mammals of the Yukon Territory, Canada, to design a protected‐areas network that maintains a historical assemblage of species goals for component ecoregions. We simultaneously determined patterns of diversity as Whittaker's beta and compositional turnover and examined how these two measures can give further insights into reserve location and spatial arrangement. Both regional heterogeneity and compositional turnover between nonadjacent sites were significant predictors of the number of protected areas necessary to represent mammals within each ecoregion. Thus, protected‐area planners can use diversity measures to identify number and spacing of protected areas within ecologically bounded regions.
Gaia's Handmaidens: the Orlog Model for Conservation Biology
Authors: BOWEN BRIAN W. , ROMAN JOE
Published: July 2005

Abstract: The Gaia hypothesis, which proposes that Earth's biota and material environment form a self‐regulating system, has been influential in conservation biology, but it has not translated into specific guidelines. Proponents of phylogenetics and ecology often claim primacy over the foundations of conservation biology, a debate that has deep roots in philosophy and science. A more recent claim is that conservation efforts should protect evolutionary processes that will allow diversification. Phylogenetics, ecology, and evolution all have legitimate roles in conservation, when viewed in a temporal perspective. Phylogenetic studies identify the bioheritage of past species radiations, ecology preserves the life‐support systems for these lineages in the present, and evolutionary processes allow adaptation of these lineages to novel challenges in the future. The concept of temporal domains in conservation (past, present, future) has an appropriate metaphor in the Norse worldview known as the Orlog. In this body of mythology, three sisters tend the tree of life and fend off a dragon gnawing at the roots. The names of these sisters, Urd, Verdandi, and Skuld, translate to Past, Present, and Future. In Viking mythology, the threads of life cannot persist without the cooperation of these sisters. In the science of conservation biology, they represent the handmaidens of Gaia–three scientific disciplines that can succeed only with a spirit of familial cooperation.
Susceptibility of a Northern Hardwood Forest to Exotic Earthworm Invasion
Authors: GUNDALE MICHAEL J. , JOLLY WILLIAM M. , DELUCA THOMAS H.
Published: July 2005

Abstract:  Numerous exotic earthworm species are colonizing northern hardwood forests of North America, where no native earthworms exist. Upon invasion, earthworms have been shown to alter the surface soil environment and plant populations and communities. We sought to identify land‐use factors in the Ottawa National Forest (ONF), Michigan (U.S.A.), that contribute to earthworm invasion in forest dominated by sugar maple (Acer saccharum Marsh.) so that the susceptibility to additional colonization could be evaluated. We sampled earthworm communities in Sylvania Wilderness Area, a unique old‐growth hardwood forest, and nonwilderness sites influenced by recreational fishing, recent timber harvesting, or roads. All the nonwilderness sites contained one to five species of exotic earthworms. In contrast, only 50% of wilderness sites contained exotic earthworms, all of a single species. Nonwilderness sites also had thinner litter and duff layers, higher soil C and N content, and higher nitrogen mineralization potentials than Sylvania sites. Two central differences between Sylvania and nonwilderness sites were that all nonwilderness sites were in close contact with roads and had a history of timber harvest, whereas these factors were not present in Sylvania Wilderness Area. Using average rates of colonization, we constructed two geographic information system models to estimate the percentage of sugar maple on the ONF falling within a theoretical 100‐year invasion distance of roads and of second‐growth sugar maple as relative indices of susceptibility to invasion. Both models indicated high susceptibility to invasion, with 91.7% and 98.9% of sugar maple habitat falling within a theoretical 100‐year invasion distance of roads or historical harvests, respectively.
Patterns of Genetic Diversity and Its Loss in Mammalian Populations
Authors: GARNER ALISSE , RACHLOW JANET L. , HICKS JASON F.
Published: July 2005

Abstract:  Policy aimed at conserving biodiversity has focused on species diversity. Loss of genetic diversity, however, can affect population persistence, evolutionary potential, and individual fitness. Although mammals are a well‐studied taxonomic group, a comprehensive assessment of mammalian genetic diversity based on modern molecular markers is lacking. We examined published microsatellite data from populations of 108 mammalian species to evaluate background patterns of genetic variability across taxa and body masses. We tested for loss of genetic diversity at the population level by asking whether populations that experienced demographic threats exhibited lower levels of genetic diversity. We also evaluated the effect of ascertainment bias (a reduction in variability when microsatellite primers are transferred across species) on our assessment of genetic diversity. Heterozygosity did not vary with body mass across species ranging in size from shrews to whales. Differences across taxonomic groupings were noted at the highest level, between populations of marsupial and placental mammals. We documented consistently lower heterozygosity, however, in populations that had experienced demographic threats across a wide range of mammalian species. We also documented a significant (p = 0.01) reduction in heterozygosity as a result of ascertainment bias. Our results suggest that populations of both rare and common mammals are currently losing genetic diversity and that conservation efforts focused above the population level may fail to protect the breadth of persisting genetic diversity. Conservation policy makers may need to focus their efforts below the species level to stem further losses of genetic resources.
Species Extinction in the Marine Environment: Tasmania as a Regional Example of Overlooked Losses in Biodiversity
Authors: EDGAR GRAHAM J. , SAMSON CATH R. , BARRETT NEVILLE S.
Published: July 2005

Abstract:  We used Tasmania as a case example to question the consensus that few marine species have recently become extinct or are approaching extinction. Threats to marine and estuarine species—primarily in the form of climate change, invasive species, fishing, and catchment discharges—are accelerating, fully encompass species ranges, and are of sufficient magnitude to cause extinction. Our ignorance of declining biodiversity in the marine environment largely results from an almost complete lack of systematic broad‐scale sampling and an overreliance on physicochemical data to monitor environmental trends. Population declines for marine species approaching extinction will generally go unnoticed because of the hidden nature of their environment and lack of quantitative data.
Demographic Processes Underlying Population Growth and Decline inSalamandra salamandra
Authors: SCHMIDT BENEDIKT R. , FELDMANN REINER , SCHAUB MICHAEL
Published: July 2005

Abstract: Human activity commonly has negative impacts on wildlife. Often, however, only a single element of the life cycle is affected, and it is unclear whether such effects translate into effects on population growth. This is particularly true for research into the causes of global amphibian declines, where experimental research focuses primarily on the aquatic larval stages but theory suggests these stages have only minor importance for population growth. We used data from long‐term mark‐recapture studies of two natural populations of the salamanderSalamandra salamandrato confirm the predictions of population models. One population remained stable (i.e., stationary) throughout the 20 years of the study whereas the other declined to local extinction. We used mark‐recapture models to break down population growth rate into its two main components, recruitment and adult survival. Survival of postmetamorphic salamanders was constant over time in the stable population, whereas the declining population was characterized by a decrease in survival and constant recruitment. Population growth was most sensitive to variation in adult survival. Current amphibian research focuses on preadult stages, and researchers assume recruitment is the most important determinant of population growth. This may not be the case. A better understanding of amphibian population dynamics is possible only through the integration of experiments, theory, and data from natural populations. Our results also suggest that amphibian conservation efforts should focus on all stages of the life cycle and their associated habitats.
Using Indicator Species to Predict Species Richness of Multiple Taxonomic Groups
Authors: FLEISHMAN ERICA , THOMSON JAMES R. , MAC NALLY RALPH , MURPHY DENNIS D. , FAY JOHN P.
Published: July 2005

Abstract: Values of species richness are used widely to establish conservation and management priorities. Because inventory data, money, and time are limited, use of surrogates such as “indicator” species to estimate species richness has become common. Identifying sets of indicator species that might reliably predict species richness, especially across taxonomic groups, remains a considerable challenge. We used genetic algorithms and a Bayesian approach to explain individual and combined species richness of two taxonomic groups as a function of occurrence patterns of indicator species drawn from either both groups or one group. Genetic algorithms iteratively screen large numbers of potential models and predictor variables in a process that emulates natural selection. The best‐fitting models of bird species richness and butterfly species richness explained approximately 80% of deviances and included only indicator species from the same taxonomic group. Using species from both taxonomic groups as potential predictors did not improve model fit but slightly improved the parsimony (fewer predictors) of the model of bird species richness. The best model of combined species richness included five butterflies and one bird and explained 83% of deviance, whereas a model of combined species richness based on six butterflies as indicators explained 82% of deviance. A model of combined species richness based on birds alone explained 72% of deviance. We found that a small, common set of species could be used to predict separately the species richness of multiple taxonomic groups. We built models explaining approximately 70% of the deviance in species richness of birds and butterflies based on a common set of three bird species and three butterfly species. We also identified a set of six species of butterflies that predicted ≥66% of both bird species richness and butterfly species richness. Our approach is applicable to any assemblage or ecosystem, and may be useful both for estimating species richness and for gaining insight into mechanisms that influence diversity patterns.
HMO Participation in Medicare+Choice
Authors: Cawley John , Chernew Michael , McLaughlin Catherine
Published: July 2005

In recent years, many health maintenance organizations (HMOs) have exited Medicare+Choice (M+C), the program that provides a managed‐care option to Medicare. This paper answers the following questions: How does the equilibrium number of HMOs participating in county M+C markets vary with the capitation payment they are offered? How large a payment is required at the margin to ensure that various percentages of county markets have a M+C HMO, or to ensure that various percentages of Medicare beneficiaries have the choice of a M+C plan in their county of residence? The strategy for identifying the effect of government payment on HMO participation relies on a natural experiment; in 1997, Congress divorced M+C payments to HMOs from changes in underlying costs. The results in this paper suggest that the Centers for Medicare & Medicaid Services (CMS) has consistently underestimated the payment necessary to support HMOs in rural, sparsely populated areas. We also find that it would require a large incremental payment to support HMOs in M+C for the final 10% of counties or final 10% of Medicare beneficiaries.
The Existence and Nature of Physician Agency: Evidence of Stinting from the British National Health Service
Authors: Chalkley Martin , Tilley Colin
Published: July 2005

The ability of physicians to make take‐it‐or‐leave‐it offers of treatment implies that even fully informed consumers of health care may receive treatments that they would not themselves choose. This paper examines both the extent and direction of this distortion away from patient choice—the physician agency effect—using a large patient‐level claims‐based data set for dental treatments under the British National Health Service. We find that an improvement in the outside opportunities of patients results in a small but significant increase in the level of service provided when dentists are remunerated on a fee‐for‐service basis. This is suggestive of stinting, wherein physician agency results in undertreatment relative to what patients would choose. We further find that the effect is increased when patients are fully insulated from the cost of their treatment.
The Impact of a Three‐Tier Formulary on Demand Response for Prescription Drugs
Authors: Huskamp Haiden A. , Frank Richard G. , McGuigan Kimberly A. , Zhang Yuting
Published: July 2005

A large number of health plans and employers have adopted three‐tier prescription drug formularies in an effort to control rising prescription drug costs. We assessed the behavioral response to three‐tier adoption by estimating econometric models of the probability of selecting drugs assigned to the third tier with the highest co‐payment requirement and changes in expected out‐of‐pocket (OOP) spending. We concluded that implementation of the three‐tier formulary resulted in some shifting of costs from the plan to enrollees and some bargaining power gained for the payer, with plan savings from manufacturer rebates a likely result.
Potentially Inappropriate Prescribing in Elderly Veterans: Are We Using the Wrong Drug, Wrong Dose, or Wrong Duration?
Authors: Pugh Mary Jo V. , Fincke B. Graeme , Bierman Arlene S. , Chang Bei‐Hung , Rosen Amy K. , Cunningham Francesca E. , Amuan Megan E. , Burk Muriel L. , Berlowitz Dan R.
Published: July 2005

Objectives: To identify the extent of inappropriate prescribing using criteria for proper use developed by the Agency for Healthcare Research and Quality (AHRQ) and dose‐limitation criteria defined by Beers, as well as to describe duration of use and patient characteristics associated with inappropriate prescribing for older people.

Design: Retrospective national Veterans Health Administration (VA) administrative database analysis.

Setting: VA outpatient facilities during fiscal year 2000 (FY00).

Participants: Veterans aged 65 and older having at least one VA outpatient visit in FY00 (N=1,265,434).

Measurements: Operational definitions of appropriate use were developed based on recommendations of an expert panel convened by the AHRQ (Zhan criteria). Inappropriate use was identified based on these criteria and inappropriate use of drugs per Beers criteria for dose‐limitations in older people. Furthermore, duration of use and patient characteristics associated with inappropriate use were described.

Results: After adjusting for diagnoses, dose, and duration, inappropriate prescribing decreased from 33% to 23%. Exposure to inappropriate drugs was prolonged. Pain relievers, benzodiazepines, antidepressants, and musculoskeletal agents constituted 61% of inappropriate prescribing. Whites, patients with psychiatric comorbidities, and patients receiving more medications were most likely to receive inappropriate drugs. Women were more likely to receive Zhan criteria drugs; men were more likely to receive dose‐limited drugs

Conclusion: For the most part, the Zhan criteria did not explain inappropriate prescribing, which includes problems related to dose and duration of prescriptions. Interventions targeted at prescriptions for pain relievers, benzodiazepines, antidepressants, and musculoskeletal agents may dramatically decrease inappropriate prescribing and improve patient outcomes.
Atypical Antipsychotic Medications and Risk of Falls in Residents of Aged Care Facilities
Authors: Hien Le T. T. , Cumming Robert G. , Cameron Ian D. , Chen Jian S. , Lord Stephen R. , March Lyn M. , Schwarz Jennifer , Le Couteur David G. , Sambrook Philip N.
Published: July 2005

Objectives: To determine whether use of atypical antipsychotics (olanzapine and risperidone) is associated with lower risk of falls than use of typical antipsychotics.

Design: Prospective cohort study with 1‐month follow‐up.

Setting: Residential aged care facilities in Sydney, Australia.

Participants: Two thousand five people aged 65 to 104 (mean age 86).

Measurements: Medication use at baseline was collected from medical records. Data on potential confounders were collected at interview and physical examination and from medical records. The outcome was accidental falls (one or more).

Results: One thousand one hundred seven subjects (55%) used at least one type of psychotropic medication, with 289 (14%) using an antipsychotic. There were 82 olanzapine users, 38 risperidone users, and 181 users of typical antipsychotics. Eleven percent of subjects (n=226) had at least one fall during follow‐up. After adjusting for a comprehensive range of falls risk factors, hazard ratios (HRs) for falls were 1.35 (95% confidence interval (CI)=0.87–2.09) for typical antipsychotics, 1.32 (95% CI=0.57–3.06) for risperidone, and 1.74 (95% CI=1.04–2.90) for olanzapine. Antidepressants were also associated with falls (adjusted HR=1.45, 95% CI=1.09–1.93).

Conclusion: Despite fewer extrapyramidal side effects, atypical antipsychotic medications are not associated with fewer falls than the older, more‐established antipsychotics.
Frailty: Emergence and Consequences in Women Aged 65 and Older in the Women's Health Initiative Observational Study
Authors: Fugate Woods Nancy , LaCroix Andrea Z. , Gray Shelly L. , Aragaki Aaron , Cochrane Barbara B. , Brunner Robert L. , Masaki Kamal , Murray Anne , Newman Anne B.
Published: July 2005

Objectives: To define frailty using simple indicators; to identify risk factors for frailty as targets for prevention; and to investigate the predictive validity of this frailty classification for death, hospitalization, hip fracture, and activity of daily living (ADL) disability.

Design: Prospective study, the Women's Health Initiative Observational Study.

Setting: Forty U.S. clinical centers.

Participants: Forty thousand six hundred fifty‐seven women aged 65 to 79 at baseline.

Measurements: Components of frailty included self‐reported muscle weakness/impaired walking, exhaustion, low physical activity, and unintended weight loss between baseline and 3 years of follow‐up. Death, hip fractures, ADL disability, and hospitalizations were ascertained during an average of 5.9 years of follow‐up.

Results: Baseline frailty was classified in 16.3% of participants, and incident frailty at 3‐years was 14.8%. Older age, chronic conditions, smoking, and depressive symptom score were positively associated with incident frailty, whereas income, moderate alcohol use, living alone, and self‐reported health were inversely associated. Being underweight, overweight, or obese all carried significantly higher risk of frailty than normal weight. Baseline frailty independently predicted risk of death (hazard ratio (HR)=1.71, 95% confidence interval (CI)=1.48–1.97), hip fracture (HR=1.57, 95% CI=1.11–2.20), ADL disability (odds ratio (OR)=3.15, 95% CI=2.47–4.02), and hospitalizations (OR=1.95, 95% CI=1.72–2.22) after adjustment for demographic characteristics, health behaviors, disability, and comorbid conditions.

Conclusion: These results support the robustness of the concept of frailty as a geriatric syndrome that predicts several poor outcomes in older women. Underweight, obesity, smoking, and depressive symptoms are strongly associated with the development of frailty and represent important targets for prevention.
The Life Cycle of Bruises in Older Adults
Authors: Mosqueda Laura , Burnight Kerry , Liao Solomon
Published: July 2005

Objectives: To summarize the occurrence, progression, and resolution of accidentally acquired bruises in a sample of adults aged 65 and older. The systematic documentation of accidentally occurring bruises in older adults could provide a foundation for comparison when considering suspicious bruising in older adults.

Design: Between April 2002 and August 2003, a convenience sample of 101 seniors was examined daily at home (up to 6 weeks) to document the occurrence, progression, and resolution of accidental bruises that occurred during the observation period.

Setting: Three community‐based settings and two skilled nursing facilities in Orange County, California.

Participants: One hundred one adults aged 65 and older (mean age=83).

Measurements: Age, sex, ethnicity, functional status, handedness, medical conditions, medications, cognitive status, depression, history of falls, bruise size, bruise location, initial bruise color, color change over time.

Results: Nearly 90% of the bruises were on the extremities. There were no bruises on the neck, ears, genitalia, buttocks, or soles of the feet. Subjects were more likely to know the cause of the bruise if the bruise was on the trunk. Contrary to the common perception that yellow coloration indicates an older bruise, 16 bruises were predominately yellow within the first 24 hours after onset. People on medications known to affect coagulation pathways and those with compromised function were more likely to have multiple bruises.

Conclusion: Accidental bruises occur in a predictable location pattern in older adults. One cannot reliably predict the age of a bruise by its color.
Improving Physical Function and Blood Pressure in Older Adults Through Cobblestone Mat Walking: A Randomized Trial
Authors: Li Fuzhong , Fisher K. John , Harmer Peter
Published: July 2005

Objectives: To determine the relative effects of cobblestone mat walking, in comparison with regular walking, on physical function and blood pressure in older adults.

Design: Randomized trial with allocation to cobblestone mat walking or conventional walking.

Setting: General community in Eugene, Oregon.

Participants: One hundred eight physically inactive community‐dwelling adults aged 60 to 92 (mean age±standard deviation=77.5±5.0) free of neurological and mobility‐limiting orthopedic conditions.

Intervention: Participants were randomized to a cobblestone mat walking condition (n=54) or regular walking comparison condition (n=54) and participated in 60‐minute group exercise sessions three times per week for 16 consecutive weeks.

Measurements: Primary endpoint measures were balance (functional reach, static standing), physical performance (chair stands, 50‐foot walk, Up and Go), and blood pressure (systolic, diastolic). Secondary endpoint measures were Short Form‐12 physical and mental health scores and perceptions of health‐related benefits from exercise.

Results: At the 16‐week posttest, differences between the two exercise groups were found for balance measures (P=.01), chair stands (P<.001), 50‐foot walk (P=.01), and blood pressure (P=.01) but not for the Up and Go test (P=.14). Although significant within‐group changes were observed in both groups for the secondary outcome measures, there were no differences between intervention groups.

Conclusion: Cobblestone mat walking improved physical function and reduced blood pressure to a greater extent than conventional walking in older adults. Additional benefits of this walking program included improved health‐related quality of life. This new physical activity may provide a therapeutic and health‐enhancing exercise alternative for older adults.
Antiaging Medicine and Mild Cognitive Impairment: Practice and Policy Issues for Geriatrics
Authors: Whitehouse Peter J. , Juengst Eric T.
Published: July 2005

The claim that aging itself is treatable or even preventable has repeatedly been made over the centuries. Antiaging medicine is the current leader of approaches that even claim that geriatrics as a discipline will become increasingly unnecessary. The concept of mild cognitive impairment (MCI) as a condition intermediate between normal cognitive aging and Alzheimer's disease highlights the conceptual and practical difficulty of differentiating aging from disease. What should geriatricians and their organizations make of scientifically mainstream attempts to decelerate, arrest, or compress aspects of the normal human aging, including the brain aging process? This article reviews the political, philosophical, practice‐related, and economical implications of antiaging medicine for geriatrics using MCI as a practical example. It concludes by suggesting actions that geriatricians should consider to strengthen their profession and to improve patient care in response to the challenges of longevity medicine.
Postprandial Hypotension Predicts All‐Cause Mortality in Older, Low‐Level Care Residents
Authors: Fisher Alexander A. , Davis Michael W. , Srikusalanukul Wichat , Budge Marc M.
Published: July 2005

Objectives: To evaluate which indices of blood pressure (BP) homeostasis are the strongest predictors of mortality in older low‐level‐care residents in long‐term health facilities.

Design: Prospective cohort study.

Setting: Eight long‐term healthcare facilities in Canberra, Australia.

Participants: A total of 179 randomly selected semi‐independent residents aged 65 and older (mean age±standard deviation 83.2±7.0; 80% women).

Measurements: Baseline BP levels taken while lying, after standing for 1 and 3 minutes, and sitting before and 1 hour after meal intake were recorded, as well as demographic information, chronic medical conditions, medications, and all‐cause mortality during follow‐up. Postprandial hypotension (PPH) was defined as a fall in systolic BP (SBP) of 20 mmHg or more 1 hour postmeal while sitting. Orthostatic hypotension (OH) was defined as a fall in SBP of 20 mmHg or more or in diastolic BP (DBP) of 10 mmHg or more within 3 minutes of standing from a supine position. Hypertension was defined as BP greater than 160/90 mmHg at commencement of the study. Mean arterial pressure (MAP) and pulse pressure (PP) were calculated.

Results: At baseline, 47% of participants had hypertension, 38% PPH, and 23% OH; PP was 70 mmHg or greater in 54%, and DBP was 65 mmHg or lower in 6%. Over 4.7 years, 97 (54%) participants died. Those who died were significantly older and more likely to have PPH (47% vs 28%) and atrial fibrillation (35% vs 17%) and a significantly greater decrease in BP after meal intake. Mortality rates in those with and without PPH were 145.0 and 98.5 per 1,000 person‐years, respectively. Using multivariate Cox proportional hazards models after adjustment for age, sex, presence of atrial fibrillation, Parkinson's disease, and use of diuretics, PPH was the only BP parameter that significantly and independently predicted 4.7‐year all‐cause mortality (relative risk (RR)=1.79; 95% confidence interval (CI)=1.19−2.68; P=.005). Further adjustment for the presence of OH, hypertension, low resting BP, coronary artery disease, cerebrovascular disease, congestive heart failure, history of syncope, cognitive impairment, cancer, diabetes mellitus, chronic obstructive pulmonary disease, and history of smoking did not reveal any new statistically significant associations. There was a dose–response relationship between postprandial fall in SBP and mortality rates. Absolute postprandial SBP of 120 mmHg or less was also significantly associated with total mortality (RR=1.69, 95% CI=1.04−2.78; P=.04). Low DBP was also associated with increased mortality (RR=1.10, 95% CI=1.01−1.13; P=.03), although this association became nonsignificant in multivariate analysis.

Conclusion: In older low‐level‐care residents, PPH is an independent predictor of all‐cause mortality with no added predictive value explained by other BP indices: OH, hypertension, PP, MAP.
Serum Albumin and Muscle Strength: A Longitudinal Study in Older Men and Women
Authors: Schalk Bianca W. M. , Deeg Dorly J. H. , Penninx Brenda W. J. H. , Bouter Lex M. , Visser Marjolein
Published: July 2005

Objectives: To examine whether low serum albumin is associated with low muscle strength and future decline in muscle strength in community‐dwelling older men and women.

Design: Population‐based cohort study.

Setting: The Longitudinal Aging Study Amsterdam.

Participants: Six hundred seventy‐six women and 644 men aged 65 to 88.

Measurements: Serum albumin was determined at baseline. Muscle strength was assessed using grip strength at baseline, after 3 (n=1,009), and 6 (n=741) years. The outcomes were continuous baseline muscle strength, 3‐ and 6‐year change in muscle strength, and a dichotomous indicator for substantial decline (a decrease if ≥1 standard deviations for women=11 kg, for men=12 kg) in muscle strength.

Results: Mean serum albumin concentration±standard deviation was 45.0±3.3 g/L for women and 45.2±3.2 g/L for men. At baseline, adjusting for age, lifestyle factors, and chronic conditions, lower serum albumin was cross‐sectionally associated with weaker muscle strength (P<.001) in women and men. After 3 years of follow‐up, mean decline in muscle strength was −5.6±10.9 kg in women and −9.6±11.9 kg in men. After adjustment for potential confounders, lower serum albumin was associated with muscle strength decline over 3 years (P<.01) in women and men (β=0.57, standard error (SE)=0.18; β=0.37, SE=0.16, respectively). Lower serum albumin was also associated with substantial decline in muscle strength in women (per unit albumin (g/L) adjusted odds ratio (OR)=1.14, one‐sided 95% confidence limit (CL)=1.07) and men (per unit albumin (g/L) adjusted OR=1.14, 95% CL=1.08). Similar but slightly weaker associations were found between serum albumin and 6‐year change in muscle strength (P<.05).

Conclusion: These results suggest that low serum albumin, even within the normal range, is independently associated with weaker muscle strength and future decline in muscle strength in older women and men.
Obesity in Nursing Homes: An Escalating Problem
Authors: Lapane Kate L. , Resnik Linda
Published: July 2005

Objectives: To estimate trends in the prevalence of obesity in nursing homes, to characterize the obese nursing home population, and to evaluate the extent to which estimates of the prevalence of obesity varied by facility and geographic location.

Design: Cross‐sectional.

Setting: One thousand six hundred twenty‐five nursing homes in Kansas, Maine, Mississippi, New York, and South Dakota from 1992 to 2002; 16,110 nursing homes in the United States in 2002.

Participants: Newly admitted residents between 1992 and 2002 (n=847,601) in selected states and 1,448,046 residents newly admitted to a U.S. nursing home in 2002 with height and weight documented on the Minimum Data Set (MDS) assessment.

Measurements: Data were from the Systematic Assessment of Geriatric Drug Use via Epidemiology database. Residents were classified as having a body mass index of less than 18.5 kg/m2, 18.5 to 24.9 kg/m2, 25.0 to 29.9 kg/m2, 30 to 34.9 kg/m2, or 35.0 kg/m2 or greater.

Results: Adjusting for sociodemographics, in Kansas, Maine, Mississippi, New York, and South Dakota, fewer than 15% of newly admitted residents were obese in 1992, rising to more than 25% in 2002. In U.S. nursing homes, the distribution of obese residents is not shared equally across facilities. Nearly 30% of residents with a BMI of 35 kg/m2 or greater are younger than 65, and a disproportionate percentage of obese residents are non‐Hispanic black. Residents identified as obese had a higher likelihood of comorbid conditions (e.g., diabetes mellitus, arthritis, hypertension, depression, and allergies).

Conclusion: Increasing prevalence of obesity in nursing homes and substantial variation of obesity prevalence within facilities raise concerns about nursing home preparedness and access.
A Pilot Study of Usefulness of Clinician–Patient Videoconferencing for Making Routine Medical Decisions in the Nursing Home
Authors: Laflamme Mark R. , Wilcox David C. , Sullivan Jacquelyn , Schadow Gunther , Lindbergh Donald , Warvel Jill , Buchanan Heydon , Ising Terry , Abernathy Greg , Perkins Susan M. , Daggy Joanne , Frankel Richard M. , Dexter Paul , McDonald Clement J. , Weiner Michael
Published: July 2005

Objectives: To pilot and assess the role of videoconferencing in clinicians' medical decision‐making and their interactions with nursing home residents (NHRs).

Design: Paired virtual and bedside examinations. Face‐to‐face (FTF) examination of NHRs by off‐site clinicians immediately followed videoconferencing between the same clinician–NHR pair.

Setting: A 240‐bed, county‐managed, urban nursing home.

Participants: NHRs (n=35) and clinicians (n=3) receiving or providing routine care between 2002 and 2003.

Measurements: Orders generated by clinicians, clinicians' ratings of videoconferencing, and coded review of video encounters. After both examinations, clinicians rated the encounters and generated orders necessary for NHRs. Orders were categorized and counted according to timing (before or after the FTF visit). Clinician–NHR interactions were assessed using coding videos with a 31‐item instrument.

Results: For 71% of the encounters, clinicians stated that videoconferencing facilitated their assessment. Difficulties included sound quality (19%) and participants' familiarity with videoconferencing (7%). Although NHRs were alert in 50% of encounters, 62% of alert NHRs did not indicate understanding of the recommended treatment.

Conclusion: FTF examination was superior for most assessments, but videoconferencing was judged to be valuable, especially for wound care. Even when NHRs were alert, informed medical decision‐making by NHRs with their clinicians was limited. Enhancing videoconferencing quality and providing more training about informed decision‐making using videoconferencing might improve the effectiveness of the technology.
What Predicts Influenza Vaccination Status in Older Americans over Several Years?
Authors: Tabbarah Melissa , Zimmerman Richard Kent , Nowalk Mary Patricia , Janosky Janine E. , Troy Judith A. , Raymund Mahlon , Jewell Ilene Katz
Published: July 2005

Objectives: To examine the correlates of repeat influenza vaccination and determine whether there are age‐group (50–64, ≥65) differences in decision‐making behavior.

Design: Longitudinal survey study.

Setting: Two community health centers in Pittsburgh, Pennsylvania.

Participants: Two hundred fifty‐three patients aged 50 and older in 2001 who visited one of the health centers and completed telephone surveys in 2002 and 2003 after the respective influenza seasons.

Measurements: Influenza vaccination status, demographic characteristics, and decision‐making behavior were self‐reported. Vaccination status was identified for three seasons: 2000–2001, 2001–2002, and 2002–2003. A three‐level outcome was defined as unvaccinated all 3 years, vaccinated one to two times over 3 years, and vaccinated all 3 years. Factor analysis identified three decision‐making behaviors.

Results: Predictors of being vaccinated across 3 years included being older, the belief that social forces influence vaccination behavior, and disagreement with the view that vaccine is detrimental.

Conclusion: National educational efforts should be intensified to dispel the myths about alleged adverse events, including contracting influenza from inactivated influenza vaccine. Physicians should continue to share their personal experiences of treating patients with influenza, including the incidence of hospitalization and death.
Ultrastructure and chromogranin A immunogold labelling of ECL cell carcinoids
Authors: FOSSMARK REIDAR , MARTINSEN TOM C. , QVIGSTAD GUNNAR , BENDHEIM MARIANNE Ø. , KOPSTAD GUNNAR , KASHIMA KENJI , WALDUM HELGE L.
Published: July 2005

Poorly differentiated neuroendocrine cells can be difficult to recognise. Sensitive methods are needed to label cells that have lost their ultrastructural features and have reduced concentrations of neuroendocrine markers. In gastric neoplasms, enterochromaffin‐like cells might dedifferentiate and lose their characteristic granules and secretory vesicles, making detection of such cells increasingly difficult. However, chromogranin A (CgA) immunogold labelling could provide sensitive and specific detection of gastric neuroendocrine cells. We present ultrastructural findings, CgA immunogold labelling as well as conventional immunohistochemical findings of two human enterochromaffin‐like cell carcinoids. Electron‐dense granules of poorly differentiated cells were less intensely labelled than granules in well‐differentiated cells. Granules with atypical shape as well as punctuate granules previously found in neuroendocrine neoplasms were also CgA labelled. The CgA labelling efficacy after antigen retrieval in an alkaline solution was higher after heating in an autoclave at 135 °C compared to a microwave at 100 °C for both granules and secretory vesicles without significant deterioration of the ultrastructure. In conclusion, the use of CgA immunogold labelling could ensure a specific classification of cells with neuroendocrine granules and be a supplement to immunohistochemical examination of poorly differentiated tumours.
Trimethylamine and trimethylamine oxide levels in normal women and women with bacterial vaginosis reflect a local metabolism in vaginal secretion as compared to urine
Authors: WOLRATH H. , STÅHLBOM B. , HALLÉN A. , FORSUM U.
Published: July 2005

The smell of rotten fish is one of the characteristics of bacterial vaginosis (BV), and is due to trimethylamine (TMA). Trimethylamine can be found in human urine, although most of it occurs as the nonvolatile oxide (TMAO) form. The fraction TMA/TMAO can be expected to be the same in different body fluids if no local production of TMA occurs. In women with BV, TMAO in the vaginal fluid is expected to be chemically reduced by the local bacterial flora to the much more odorous TMA. We have therefore studied the local vaginal production of TMA in vaginal secretion compared to the general TMA‐TMAO metabolism that was measured in urine using gas chromatography. Both vaginal fluid and random urine samples were collected from women, with and without BV, attending a Swedish clinic for sexually transmitted diseases, and these samples were analyzed for TMA and TMAO. The results show that a local production of TMA occurs in the vagina that is not part of the general metabolism of TMA‐TMAO.
Aerococcus urinae: polyphasic characterization of the species
Authors: CHRISTENSEN J. J. , KILIAN M. , FUSSING V. , ANDRESEN K. , BLOM J. , KORNER B. , STEIGERWALT A. G.
Published: July 2005

A polyphasic characterization of Aerococcus urinae is presented. In this study the intraspecies relationships between 26 strains of varying geographical origin were examined by phenotypic tests, ribotyping and multilocus enzyme electrophoresis. The results demonstrated two main phenotypic patterns that could be distinguished in tests for hydrolysis of aesculin, and acid production from amygdalin and salicin. Strains were either negative (n=19) or positive (n=6) in these tests. One strain had a deviating pattern. Heterogeneity within the 19 pattern I strains was demonstrated especially by phenotypic tests (acid production from ribose, mannitol, sorbitol, sucrose and D‐arabitol) and by multilocus enzyme electrophoresis. However, DNA sequence analysis of the 16S rRNA (n=7) and gyrB genes (n=3) from strains representing the two main patterns showed no variation in sequences among strains. Comparison of A. urinae and representatives of related taxa by 16S rDNA sequence analysis showed that the taxon is related to, but distinct from, other Aerococcus spp.