bluuebunny/crossref_metadata_2025 huggingface dataset:
SALINITY TOLERANCE OF DIATOMS FROM THALASSIC HYPERSALINE ENVIRONMENTS
Authors: Clavero Ester , Hernández‐Mariné Mariona , Grimalt Joan O. , Garcia‐Pichel Ferran
Published: March 2003

Thirty‐four benthic diatom strains were isolated from thalassic hypersaline marine environments and their salinity tolerance characterized in growth experiments conducted at salinities ranging from 0.5% to 17.5% (weight of total salts per volume, g·100 mL−1). The results were compared with the patterns of diatom species distribution and abundance in hypersaline evaporation ponds and tidal channels of Guerrero Negro, Baja California Sur, Mexico. The isolated strains were representative of the diatom assemblages present in the saltern ponds but were less so of natural assemblages in tidal channels. In general, we found a clear decreasing trend of diatom diversity in the field and in the isolated strains with increasing salinity. With some exceptions, the upper limit of salinity tolerance in cultivated strains corresponded to their distribution in field samples. However, the relative abundance of species in the field was not correlated with growth rates achieved in culture for the same salinities. Most cultured strains exhibited extreme euryhalinity growing well from brackish to hypersaline conditions, but the particulars of salt tolerance were quite diverse among strains. The most halotolerant taxa, twoAmphoraspecies,Amphoracf.subacutiusculaSchoeman,Nitzschia fusiformisGrunow, andEntomoneissp., grew well in salinities ranging from 0.5% to 15%. Three strains ofPleurosigma strigosumW. Smith that were unable to grow in salinities less than 5% total salts represent the only true halophilic diatoms ever reported. The fact that many strains displayed a remarkable halotolerance, with optimal or near‐optimal growth rates at salinities as high as three times that of seawater, implies that diatoms from hypersaline environments are evolutionarily highly adapted to such environments.
HALOGENATED MONOTERPENE PRODUCTION IN REGENERATED PLANTLET CULTURES OF OCHTODES SECUNDIRAMEA (RHODOPHYTA, CRYPTONEMIALES)
Authors: Maliakal Sanjiv , Cheney Donald P. , Rorrer Gregory L.
Published: March 2003

Three genera of macrophytic red algae (Ochtodes, Plocamium, and Portieria) contain novel halogenated monoterpenes. To develop an in vitro system for studying halogenated monoterpene production, a laboratory tissue culture was established for Ochtodes secundiramea (Montagne) Howe (Cryptonemiales, Rhizophyllidaceae). Specifically, callus cells were induced from thallus explants of O. secundiramea plants. Shoot primordia regenerated from callus cells and developed into plantlets that released tetraspores. A sporeling from one of these tetraspores was selected for further culture. Axenic plantlets were cultivated in ESS‐enriched natural seawater. Thallus tissue was cut into small pieces before subculture. Each plantlet grew as a symmetrical array of highly branched shoot tissues emanating from a common center, ultimately assuming a spherical shape of 20 mm diameter 4 weeks after subculture. Specific growth rates of over 20% per day were attained in bubble‐aerated flask culture at an optimal temperature of 26° C and photosynthetic saturation light intensity of 200 μmol photons·m−2·s−1. The cultured plantlets contained myrcene and seven halogenated monoterpenes, based on gas chromatography–mass spectroscopy analysis of dichloromethane extracts. Although bromomyrcene was the dominant acyclic halogenated monoterpene, the cyclic halogenated monoterpenes chondrocole C and ochtodene were also produced by the O. secundiramea plantlet cultures. Halogenated monoterpene production at light‐saturated growth conditions increased with decreasing nitrogen availability below 1.0 mM medium nitrate concentration (N:P ratios of 1.6:1 to 32:1). The halogenated monoterpene yield was insensitive to medium nitrate concentrations above 1.0 mM (N:P ratios of 32:1 to 320:1), where the bromomyrcene yield was 1700 μg per gram of dry cell mass.
TRADITIONAL GENERIC CONCEPTS VERSUS 18S rRNA GENE PHYLOGENY IN THE GREEN ALGAL FAMILY SELENASTRACEAE (CHLOROPHYCEAE, CHLOROPHYTA)
Authors: Krienitz Lothar , Ustinova Iana , Friedl Thomas , Huss Volker A. R.
Published: March 2003

Coccoid green algae of the Selenastraceae were investigated by means of light microscopy, TEM, and 18S rRNA analyses to evaluate the generic concept in this family. Phylogenetic trees inferred from the 18S rRNA gene sequences showed that the studied species of autosporic Selenastraceae formed a well‐resolved monophyletic clade within the DO group of Chlorophyceae. Several morphological characteristics that are traditionally used as generic features were investigated, especially the arrangement of autospores in the mother cells, colony formation, and pyrenoid structure. The parallel arrangement of autospores was confirmed for the generaAnkistrodesmus,Podohedriella, andQuadrigula.In mother cells ofMonoraphidiumandKirchneriella, the autospores were arranged serially. Colony formation was either stable (Quadrigula) or variable (Ankistrodesmus,Podohedriella) within genera. All strains studied possessed naked or starch‐covered pyrenoids within the chloroplast. The pyrenoid matrix was homogenous or penetrated by thylakoids. In contrast to considerations of traditional systematics, the present study showed that the presence and structure of pyrenoids are unsuitable for differentiation of genera in Selenastraceae. Furthermore, the molecular analyses showed that any morphological criterion considered so far is not significant for the systematics of the Selenastraceae on the generic level. Species assigned to different genera such asAnkistrodesmusandMonoraphidiumwere not monophyletic and therefore not distinguishable as separate genera. Species ofMonoraphidiumappeared in four different lineages of the Selenastraceae. Our phylogenetic analyses support earlier discussions to abandon the common practice of conceiving “small” genera (i.e. genera that are differentiated from other genera by only a few diacritic characteristics and that contain only a small number of species) and to reestablish “large” genera of Selenastraceae such asAnkistrodesmus.
FIRST REPORT OF THE CYANOTOXINS CYLINDROSPERMOPSIN AND DEOXYCYLINDROSPERMOPSIN FROM RAPHIDIOPSIS CURVATA (CYANOBACTERIA)
Authors: Li Renhui , Carmichael Wayne W. , Brittain Scott , Eaglesham Geoffrey K. , Shaw Glen R. , Liu Yongding , Watanabe Makoto M.
Published: March 2003

A strain of Raphidiopsis (Cyanobacteria) isolated from a fish pond in Wuhan, P. R. China was examined for its taxonomy and production of the alkaloidal hepatotoxins cylindrospermopsin (CYN) and deoxy‐cylindrospermopsin (deoxy‐CYN). Strain HB1 was identified as R. curvata Fritsch et Rich based on morphological examination of the laboratory culture. HB1 produced mainly deoxy‐CYN at a concentration of 1.3 mg·g−1 (dry wt cells) by HPLC and HPLC‐MS/MS. CYN was also detected in trace amounts (0.56 μg·g−1). A mouse bioassay did not show lethal toxicity when tested at doses up to 1500 mg dry weight cells·kg−1 body weight within 96 h, demonstrating that production of primarily deoxy‐CYN does not lead to significant mouse toxicity by strain HB1. The presence of deoxy‐CYN and CYN in R. curvata suggests that Raphidiopsis belongs to the Nostocaceae, but this requires confirmation by molecular systematic studies. Production of these cyanotoxins by Raphidiopsis adds another genus, in addition to Cylindrospermopsis, Aphanizomenon, and Umezakia, now known to produce this group of hepatotoxic cyanotoxins. This is also the first report from China of a CYN and deoxy‐CYN producing cyanobacterium.
A NOVEL VIRUS (HaNIV) CAUSES LYSIS OF THE TOXIC BLOOM‐FORMING ALGA HETEROSIGMA AKASHIWO (RAPHIDOPHYCEAE)
Authors: Lawrence Janice E. , Chan Amy M. , Suttle Curtis A.
Published: March 2003

We describe a previously unknown virus that causes lysis of the toxic bloom‐forming alga Heterosigma akashiwo (Hada) Hara et Chihara (Raphidophyceae). Heterosigma akashiwo nuclear inclusion virus (HaNIV) does not resemble other algal viruses described to date. HaNIV is small (ca. 30 nm diameter), is assembled in the nucleus, and forms crystalline arrays. We estimate that approximately 105 HaNIV particles are released during lysis of a cell. During a time‐course experiment, TEM revealed the first signs of HaNIV infection 24 h after viral addition, and by 74 h 98% of observed cells were visibly infected. The onset of cell lysis, as indicated by a decrease in the relative fluorescence of the cultures, was apparent by 42 h postinfection. The heterochromatin of infected cells is frequently found at the margin of the nucleoplasm, which is consistent with virus‐mediated programmed cell death, or apoptosis. HaNIV is clearly different from other described viruses that infect algae, including other viral pathogens of H. akashiwo. These results indicate that viruses other than Phycodnaviridae are pathogens and cause mortality of microalgae in marine systems. It is likely that HaNIV plays an integral role in the population dynamics of H. akashiwo.
MOLECULAR CLONING AND EXPRESSION OF THE PROLIFERATING CELL NUCLEAR ANTIGEN GENE FROM THE COCCOLITHOPHORID PLEUROCHRYSIS CARTERAE (HAPTOPHYCEAE)1
Authors: Lin Senjie , Corstjens Paul L. A. M.
Published: March 2003

The gene encoding proliferating cell nuclear antigen (PCNA) was isolated from the marine coccolithophorid microalga Pleurochrysis carterae (Braarud et Fagerland) Christensen (Haptophyceae). Two mRNAs (Pcpcna1 and Pcpcna2) were identified and contained an identical coding region for 222 amino acid residues and an untranslated sequence of 302 base pair (Ut1) and 246 base pair (Ut2), respectively. Comparison between PCR‐derived genomic DNA fragments and cDNA sequences revealed five introns. The coding region of Pcpcna is similar to counterparts in other organisms and contains highly conserved functional domains. Phylogenetic analyses indicated clustering of Pcpcna with pcna in its haptophyte relative Isochrysis galbana Parke. A recombinant fusion protein of Pcpcna, overexpressed in Escherichia coli, was recognized by the PC10 antibody against rat PCNA. Using RT‐PCR and Western blotting, Pcpcna was found to be highly transcribed and translated during the exponential growth phase relative to the stationary growth phase, with a positive correlation between gene expression and growth rate. It can be concluded that the pcna is conserved in this coccolithophorid phytoplankton and that its expression is growth stage related.
DIVERSITY, LIFE HISTORY, AND ECOLOGY OFTRENTEPOHLIAANDPRINTZINA(TRENTEPOHLIALES, CHLOROPHYTA) IN URBAN HABITATS IN WESTERN IRELAND1
Authors: Rindi Fabio , Guiry Michael D.
Published: March 2003

On the basis of field and culture investigations, five species of the generaTrentepohliaandPrintzinawere found to occur in urban habitats in western Ireland:Trentepohlia abietina(Flotow) Hansgirg,T. aurea(Linnaeus) Martius,T. iolithus(Linnaeus) Wallroth,T.cf.umbrina(Kützing) Bornet, andPrintzina lagenifera(Hildebrandt) Thompson et Wujek. These species formed perennial populations on a variety of substrata.T. abietinaoccurred on bark of trees;T.cf.umbrinaoccurred on stone walls; andP. lageniferagrew on several substrata, mainly cement and asbestos sheeting.T. aureaandT. iolithuswere found on old concrete and cement walls; in particular, the latter species formed characteristic, extensive, deep‐red patches on many buildings. In culture, best growth and reproduction of these species were observed at 10 and 15° C, 16:8 h light:dark. Both in culture and in the field, reproduction took place by release of biflagellate swarmers behaving as asexual spores, germinating to produce new plants without any evidence of sexual fusion; release of biflagellate swarmers in the field was generally observed in all seasons throughout a whole annual cycle. Confirmation of the occurrence of sexual reproduction inTrentepohliawas not obtained.
TWO DIFFERENT SPECIES OFEUGLENA,E. GENICULATAANDE. MYXOCYLINDRACEA(EUGLENOPHYCEAE), ARE VIRTUALLY GENETICALLY AND MORPHOLOGICALLY IDENTICAL1
Authors: Zakryś Boz.ena , Milanowski Rafal , Empel Joanna , Borsuk Piotr , Gromadka Robert , Kwiatowski Jan
Published: March 2003

We investigated the similarity of a singleEuglena myxocylindraceastrain, isolated originally by Bold and MacEntee, to severalEuglena geniculatastrains on both morphological and DNA levels. We found the three DNA stretches, consisting of fragments coding for the parts of cytoplasmic and chloroplast small subunit rRNA, and the internal transcribed spacer (ITS2) of cytoplasmic rDNA, with the combined length of 4332 nucleotides, are identical inE. myxocylindraceaandE. geniculata, strain SAG 1224‐4b. Morphological differences betweenE. myxocylindraceaand anyE. geniculatastrain examined were well within the range ofE. geniculatavariability as well. The only difference behind the distinction ofE. myxocylindraceafromE. geniculatais the presence of the second chloroplast in the latter. However, we were able to induce the appearance of the second chloroplast in the cells ofE. myxocylindraceaand its disappearance in the cells ofE. geniculataby changing the composition of the culture media. We therefore conclude thatE. myxocylindraceaBold and MacEntee should be regarded as an environmental form ofE. geniculataDujardin. For the first time the morphology ofE. geniculatachloroplasts was shown as revealed by confocal laser microscopy.
REPLY TO COMMENT ON THE LIFE CYCLE AND TOXICITY OFPFIESTERIA PISCICIDAREVISITED1
Authors: Litaker R. Wayne , Vandersea Mark W. , Kibler Steven R. , Noga Edward J. , Tester Patricia A.
Published: March 2003

Free‐living, marine dinoflagellates are typified by a well‐defined, haplontic life cycle with relatively few stages. The most unusual departure from this life cycle is one reported for the heterotrophic dinoflagellatePfiesteria piscicidaSteidinger et Burkholder. This species is alleged to have at least 24 life cycle stages including amoebae and a chrysophyte‐like cyst form (Burkholder et al. 1992,Burkholder and Glasgow 1997a) not previously known in free‐living marine dinoflagellates.Litaker et al. (2002)redescribed the life cycle ofP. piscicidafrom single‐cell isolates and found only life cycle stages typical of free‐living marine dinoflagellates. The discrepancy between these observations and the life cycle reported in the literature prompted a rigorous study to resolve the life cycle ofP. piscicida.Burkholder and Glasgow (2002)took exception to this study, arguing thatLitaker et al. (2002)misunderstood the life cycle ofP. piscicidaand ignored recent publications. We present a rebuttal of their criticisms and suggest a simple way to resolve the discrepancies in theP. piscicidalife cycle.
A REVISED ESTIMATE OF THE IRON USE EFFICIENCY OF NITROGEN FIXATION, WITH SPECIAL REFERENCE TO THE MARINE CYANOBACTERIUM TRICHODESMIUM SPP. (CYANOPHYTA)1
Authors: Kustka Adam , Sañudo‐Wilhelmy Sergio , Carpenter Edward J. , Capone Douglas G. , Raven John A.
Published: March 2003

Estimates of the iron use efficiency (IUE) for diazotrophic plant growth have been used to suggest iron limitation of marine N2 fixation. However, in the course of these inferences, neither the physiological complexity of these estimates nor the specific physiological parameters of marine diazotrophs were evaluated. Here, a semiempirical prediction of the IUE of diazotrophic growth for Trichodesmium was computed from considerations of the Fe content and reaction rates of the nitrogenase complex and PSI:PSII ratios, as well as field measurements of Mehler activity, cellular Fe‐superoxide dismutase activity, and diel variability in C and N2 fixation. With a PSI:PSII ratio of 1 and 48% Mehler activity, the instantaneous IUE (0.33 mol C fixed·mol cellular Fe−1·s−1) was only 4‐fold lower than that calculated for a phytoplankter growing on reduced N. We computed a range of daily integrated IUE values from 2900 to 7700 mol C·mol Fe−1·d−1, accounting for the diel variability in C and N2 fixation as well as the uncertainties in cyanobacterial nitrogenase biochemistry and PSI:II ratios of field‐collected Trichodesmium. The lowest observed Fe‐superoxide dismutase:C quota of 2.9 (μmol:mol) suggests a maintenance requirement for this enzyme. The maintenance Fe:C requirement of 13.5 μmol:mol (derived from cultures of Trichodesmium IMS 101) and values of the IUE yielded an Fe requirement ranging from 27 to 48 Fe:C (μmol:mol) to achieve a diazotrophic growth rate of 0.1 d−1. Based on these predicted requirements, the Fe:C contents of Caribbean Sea and most North Atlantic Ocean populations sampled thus far exceed that required to support the observed rates of N2 fixation.
PHYSIOLOGICAL CHARACTERIZATION OF A SYNECHOCOCCUS SP. (CYANOPHYCEAE) STRAIN PCC 7942 IRON‐DEPENDENT BIOREPORTER FOR FRESHWATER ENVIRONMENTS1
Authors: Porta David , Bullerjahn George S. , Durham Kathryn A. , Wilhelm Steven W. , Twiss Michael R. , McKay R. Michael L.
Published: March 2003

The complex chemical speciation of Fe in aquatic systems and the uncertainties associated with biological assimilation of Fe species make it difficult to assess the bioavailability of Fe to phytoplankton in relation to total dissolved Fe concentrations in natural waters. We developed a cyanobacterial Fe‐responsive bioreporter constructed in Synechococcus sp. strain PCC 7942 by fusing the Fe‐responsive isiAB promoter to Vibrio harveyi luxAB reporter genes. A comprehensive physiological characterization of the bioreporter has been made in defined Fraquil medium at free ferric ion concentrations ranging from pFe 21.6 to pFe 19.5. Whereas growth and physiological parameters are largely constrained over this range of Fe bioavailability, the bioreporter elicits a luminescent signal that varies in response to Fe deficiency. A dose‐response characterization of bioreporter luminescence made over this range of Fe3+ bioavailability demonstrates a sigmoidal response with a dynamic linear range extending between pFe 21.1 and pFe 20.6. The applicability of using this Fe bioreporter to assess Fe availability in the natural environment has been tested using water samples from Lake Huron (Laurentian Great Lakes). Parallel assessment of dissolved Fe and bioreporter response from these samples reinforces the idea that measures of dissolved Fe should not be considered alone when assessing Fe availability to phytoplankton communities.
PHYLOGENY OF EUGLENOPHYCEAE BASED ON SMALL SUBUNIT rDNA SEQUENCES: TAXONOMIC IMPLICATIONS1
Authors: Nudelman María Alejandra , Rossi María Susana , Conforti Visitación , Triemer Richard E.
Published: March 2003

Small subunit rDNA sequences of 42 taxa belonging to 10 genera were used to infer phylogenetic relationships among euglenoids. Members of the phototrophic generaEuglena,Phacus,Lepocinclis,Colacium,Trachelomonas, andStrombomonasplus the osmotrophsAstasia longa,Khawkinea quartana, andHyalophacus ocellatuswere included. Six major clades were found in most trees using multiple methods. The utility of Bayesian analyses in resolving these clades is demonstrated. The genusPhacuswas polyphyletic with taxa sorting into two main clades. The two clades correlated with overall morphology and corresponded in large part to the previously defined sections, Pleur‐ aspis Pochmann and Proterophacus Pochmann.Euglenawas also polyphyletic and split into two clades. In Bayesian analyses species with less plastic pellicles and small disk‐like chloroplasts diverged at the base of the tree. They grouped into a single clade which included the twoLepocinclisspp., which also are rigid and bear similar chloroplasts. The metabolicEuglenaspecies with larger plastids bearing pyrenoids and paramylon caps arose near the top of the tree. The loricatesStrombomonasandTrachelomonasformed two well‐ supported, but paraphyletic, clades. The strong support for the individual clades confirmed the value of using lorica features as taxonomic criteria. The separation of the osmotrophic speciesA. longa,K. quartana, andH. ocellatusinto different clades suggested that the loss of the photosynthetic ability has occurred multiple times.
AN IMPROVED STRIPPING TECHNIQUE FOR LIGHTLY ARMORED DINOFLAGELLATES1
Authors: Mason Patrice L. , Vogelbein Wolfgang K. , Haas Leonard W. , Shields Jeffrey D.
Published: March 2003

Identification of armored heterotrophic dinoflagellates relies, in part, on plate tabulations obtained by SEM. Currently, two methods are used to visualize plate morphology and develop plate tabulations: swelling the sutures between the cellulose plates of intact organisms or stripping off the outer membranes with ethanol to expose the underlying cellulose plates. Both approaches are problematic with lightly armored dinoflagellates because sutures do not consistently swell to enable visualization, and the outer membranes are not consistently stripped. Further, generic and species differences necessitate frequent modification of these protocols to obtain reliable results. We describe an improved membrane stripping technique using the detergent Triton X‐100. Our method provides a more consistent standardized approach to removing the outer membranes of lightly armored dinoflagellates, including Pfiesteria shumwayae Glasgow & Burkholder, a taxon that has, until now, proven very difficult to strip with currently published methods. This method allows visualization of the sulcus, a region previously difficult to observe, and will greatly facilitate taxonomic studies of the lightly armored forms.
Why Older Community‐Dwelling Adults Do Not Discuss Urinary Incontinence with Their Primary Care Physicians
Authors: Dugan Elizabeth , Roberts Christine P. , Cohen Stuart J. , Preisser John S. , Davis Cralen C. , Bland Deirdre R. , Albertson Elizabeth
Published: March 2003

OBJECTIVES: This study explored reasons why older adults with urinary incontinence (UI) do not initiate discussions with or seek treatment for UI from their primary care provider.

DESIGN: A randomized, prospective controlled trial involving 41 primary care sites.

SETTING: Primary care practice sites.

PARTICIPANTS: 49 older adults age 60 and older not previously screened for UI by their primary care doctor.

MEASUREMENTS: Demographic data, self‐reported bladder‐control information using questionnaires, and health status.

RESULTS: Adults who did not discuss UI were older, had less‐frequent leaking accidents and fewer nighttime voids and were less bothered by UI than those who did. The two main reasons why patients did not seek help were the perceptions that UI was not a big problem (45%) and was a normal part of aging (19%).

CONCLUSIONS: Embarrassment or lack of awareness of treatment options were not significant barriers to discussing UI. Adults with a fairly high frequency of UI (average of 1.7 episodes per day) did not view UI as abnormal or a serious medical condition.
Effects of Aging on Hand Function
Authors: Ranganathan Vinoth K. , Siemionow Vlodek , Sahgal Vinod , Yue Guang H.
Published: March 2003

OBJECTIVES: The purpose of this study was to quantify age‐induced changes in handgrip and finger‐pinch strength, ability to maintain a steady submaximal finger pinch force and pinch posture, speed in relocating small objects with finger grip, and ability to discriminate two identical mechanical stimuli applied to the finger tip.

DESIGN: A cross‐sectional study.

SETTINGS: Greater Cleveland area of Ohio.

PARTICIPANTS: Healthy, independent, young (n = 27, range 20–35 years) and older (n = 28, range 65–79 years) subjects.

MEASUREMENTS: Handgrip strength, maximum pinch force (MPF), ability to maintain a steady pinch force at three relative force levels (5%, 10%, and 20% MPF) and three absolute force levels (2.5 Newtons (N), 4 N, and 8 N), ability to maintain a precision pinch posture, speed in relocating pegs from a nearby location onto the pegboard, and the shortest distance for discriminating two stimuli were measured in both young and older groups.

RESULTS: Compared with young subjects, the older group's handgrip force was 30% weaker (P < .001), MPF was 26% lower (P < .05), and ability to maintain steady submaximal pinch force and a precision pinch posture was significantly less (P < .05). The time taken to relocate the pegs and the distance needed to discriminate two identical stimuli increased significantly with age (P < .01). The decrease in the ability to maintain steady submaximal pinch force was more pronounced in women than men.

CONCLUSION: Aging has a degenerative effect on hand function, including declines in hand and finger strength and ability to control submaximal pinch force and maintain a steady precision pinch posture, manual speed, and hand sensation.
Does Hospice Have a Role in Nursing Home Care at the End of Life?
Authors: Casarett David J. , Hirschman Karen B. , Henry Michelle R.
Published: March 2003

OBJECTIVES:

To assess the possible benefits and challenges of hospice involvement in nursing home care by comparing the survival and needs for palliative care of hospice patients in long‐term care facilities with those living in the community.

DESIGN:

Retrospective review of computerized clinical care records.

SETTING:

A metropolitan nonprofit hospice.

PARTICIPANTS:

The records of 1,692 patients were searched, and 1,142 patients age 65 and older were identified. Of these, 167 lived in nursing homes and 975 lived in the community.

MEASUREMENTS:

Patient characteristics, needs for palliative care, and survival.

RESULTS:

At the time of enrollment, nursing home residents were more likely to have a Do Not Resuscitate order (90% vs 73%; P < .001) and a durable power of attorney for health care (22% vs 10%; P < .001) than were those living in the community. Nursing home residents also had different admitting diagnoses, most notably a lower prevalence of cancer (44% vs 74%; P < .032). Several needs for palliative care were less common among nursing home residents, including constipation (1%vs 5%; P = .02), pain (25% vs 41%; P < .001), and anticipatory grief (1% vs 9%; P < .001). Overall, nursing home residents had fewer needs for care (median 0, range 0–3 vs median 1, range 0–5; rank sum test P < .001). Nursing home residents had a significantly shorter survival (median 11 vs 19 days; log rank test of survivor functions P < .001) and were less likely to withdraw from hospice voluntarily (8%vs 14%; P = .03). However, there was no difference in the likelihood of becoming ineligible during hospice enrollment (6% for both groups).

CONCLUSIONS:

These results suggest that hospices identify needs for palliative care in a substantial proportion of nursing home residents who are referred to hospice, although nursing home residents may have fewer identifiable needs for care than do community‐dwelling older people. However, the finding that nursing home residents' survival is shorter may be of concern to hospices that are considering partnerships with nursing homes. An increased emphasis on hospice care in nursing homes should be accompanied by targeted educational efforts to encourage early referral. J Am Geriatr Soc 49:1493–1498, 2001.
Urban‐Rural Differences in a Memory Disorders Clinical Population
Authors: Wackerbarth Sarah B. , Johnson Mitzi M. S. , Markesbery William R. , Smith Charles D.
Published: March 2003

OBJECTIVES: To compare patient characteristics and family perceptions of patient function at one urban and one rural memory disorders clinic.

DESIGN: Secondary, cross‐sectional data analyses of an extant clinical database.

SETTING/PARTICIPANTS: First time visits (n = 956) at two memory disorders clinics.

MEASUREMENTS: Patient and family‐member demographics and assessment results for the Mini‐Mental State Examination (MMSE), instrumental activities of daily living (IADLs), activities of daily living (ADLs), the Memory Change and Personality Change components of the Blessed Dementia Rating Scale, and the Revised Memory and Behavior Problems Checklist.

RESULTS: In both clinics, patients and family members were more likely female. The typical urban clinic patient was significantly more likely to be living in a facility and more educated than the typical rural patient. Urban and rural patients did not show significant differences in age‐ and education‐adjusted MMSE scores or raw ADL/IADL ratings, but the urban family members reported more memory problems, twice as many personality changes, more‐frequent behavior problems, and more adverse reactions to problems.

CONCLUSION: Physicians who practice in both urban and rural areas can anticipate differences between patients, and their families, who seek a diagnosis of memory disorders. Our most important finding is that despite similarities in reported functional abilities, urban families appear to be more sensitive to and more distressed by patients' cognitive and behavioral symptoms than rural families. These differences may reflect different underlying needs, and should be explored in further research.
Delirium Before and After Operation for Femoral Neck Fracture
Authors: Edlund Agneta , Lundström Maria , Brännström Benny , Bucht Gösta , Gustafson Yngve
Published: March 2003

OBJECTIVES:

The aim of this study was to investigate the differences between preoperative and postoperative delirium regarding predisposing, precipitating factors and outcome in older patients admitted to hospital with femoral neck fractures.

DESIGN:

A prospective clinical assessment of patients treated for femoral neck fractures.

SETTING:

Department of orthopedic surgery at Umeå University Hospital, Sweden.

PARTICIPANTS:

One hundred one patients, age 65 and older admitted to the hospital for treatment of femoral neck fractures.

MEASUREMENTS:

The Organic Brain Syndrome (OBS) Scale.

RESULTS:

Thirty patients (29.7%) were delirious before surgery and another 19 (18.8%) developed delirium postoperatively. Of those who were delirious preoperatively, all but one remained delirious postoperatively. The majority of those delirious before surgery were demented, had been treated with drugs with anticholinergic properties (mainly neuroleptics), had had previous episodes of delirium, and had fallen indoors. Patients who developed postoperative delirium had perioperative falls in blood pressure and had more postoperative complications such as infections. Male patients were more often delirious both preoperatively and postoperatively. Patients with preoperative delirium were more often discharged to institutional care and had poorer walking ability both on discharge and after 6 months than did patients with postoperative delirium only.

CONCLUSIONS:

Because preoperative and postoperative delirium are associated with different risk factors it is necessary to devise different strategies for their prevention. J Am Geriatr Soc 49:1335–1340, 2001.
Factors Associated with Healthy Aging: The Cardiovascular Health Study
Authors: Burke Gregory L. , Arnold Alice M. , Bild Diane E. , Cushman Mary , Fried Linda P. , Newman Anne , Nunn Cathy , Robbins John ,   for the CHS Collaborative Research Group
Published: March 2003

OBJECTIVES: To identify factors associated with remaining healthy in older adults.

DESIGN: Longitudinal cohort study.

SETTING: Data were collected at the four Cardiovascular Health Study field centers.

PARTICIPANTS: 5,888 participants age 65 years and older in the Cardiovascular Health Study.

MEASUREMENTS: Presence of chronic disease was assessed at baseline and over a maximum 7‐year followup period. Participants who were free of chronic disease (no cardiovascular disease (CVD), chronic obstructive pulmonary disease, or self‐reported cancer, except nonmelanoma skin cancer) at the baseline examination were then monitored for the onset of incident cancer, cardiovascular disease, and fatal outcomes.

RESULTS: A high proportion of these older adults was healthy at the initial examination and remained healthy over the follow‐up period. Numerous behavioral factors were associated with continued health, including physical activity, refraining from cigarette smoking, wine consumption (women), higher educational status, and lower waist circumference. A number of CVD risk factors and subclinical disease measures were associated with continued health, including higher high‐density lipoprotein (HDL) cholesterol, lack of diabetes, thinner common carotid intimal medial thickness, lower blood pressure, lower C‐reactive protein, and higher ankle‐arm blood pressure ratio. Among the behavioral factors, exercise, not smoking, and not taking aspirin remained significant predictors of health even after controlling for CVD risk factors and subclinical disease in older adults.

CONCLUSIONS: These data suggest that a number of modifiable behavioral factors (physical activity, smoking, and obesity) and cardiovascular risk factors (diabetes, HDL cholesterol, and blood pressure) are associated with maintenance of good health in older adults.
Vascular Risk and Cognitive Impairment in an Older, British, African‐Caribbean Population
Authors: Stewart Robert , Richards Marcus , Brayute Carol , Mann Anthony
Published: March 2003

OBJECTIVES: In an older, British, African‐Caribbean population with high prevalence rates of hypertension and diabetes mellitus, we ascertained clinical vascular disease (stroke or ischemic heart disease) and vascula; risk (including hypertension, diabetes, and lipid profile) and investigated their associations with cognitive impairment.

DESIGN: Cross‐sectional community‐based study. SETTING: The sample was drawn from registration lists for seven primary care services in south London, United Kingdom.

PARTICIPANTS: 278 individuals, age 55 to 75, who were born in a Caribbean nation.

MEASUREMENTS: Participants were interviewed and examined for cardiovascular risk factors, including a blood test for lipid profile and fibrinogen. A battery of 11 psychometric tests was administered blind to medical status. Cognitive impairment was defined on the basis of a composite measure derived from individual test scores.

RESULTS: Seventy‐nine (28%) subjects were classified as having relative cognitive impairment and were compared with the remainder of the sample. Marked differences were seen between low and normal/high educational levels in the strength of associations between measures of vascular risk and cognitive impairment. Hypertension, diabetes, and raised triglycerides were significant factors in those with lower levels of education. Low fibrinogen (negatively associated), high cholesterol, and manual occupation were significant factors in those with normal/high levels of education. Physical exercise was negatively associated with adjustment for age, occupation, depression, and physical disability and after excluding subjects with the most severe impairment.

CONCLUSION: Measures of vascular risk were associated with relative cognitive impairment in this population. These associations were modified by previous educational attainment. Physical activity was negatively associated with cognitive impairment.
Incidence of Dementia, Alzheimer's Disease, and Vascular Dementia in Italy. The ILSA Study
Authors: Di Carlo Antonio , Baldereschi Marzia , Amaducci Luigi , Lepore Vito , Bracco Laura , Maggi Stefania , Bonaiuto Salvatore , Perissinotto Egle , Scarlato Guglielmo , Farchi Gino , Inzitari Domenico , For The ILSA Working Group
Published: March 2003

OBJECTIVES:To estimate the incidence of dementia, Alzheimer's disease (AD), and vascular dementia (VaD) in older Italians and evaluate the relationship of age, gender, and education to developing dementia.

DESIGN:Cohort incidence study in the context of the Italian Longitudinal Study on Aging.

SETTING:Population sample from eight Italian municipalities.

PARTICIPANTS:A dementia‐free cohort of 3,208 individuals (aged 65–84), individuated after a baseline evaluation performed in 1992  /  93, aimed at detecting prevalent cases.

MEASUREMENTS:The dementia‐free cohort was reexamined in 1995 to identify incident cases. The Mini‐Mental State Examination (cutoff 23 /  24) was employed to screen for dementia. Trained neurologists evaluated the individuals who screened positive. Final diagnoses had to meetDiagnostic and Statistical Manual of Mental Disorders, Third Edition, Revisedcriteria for dementia, National Institute of Neurological and Communicative Disorders and Stroke—Alzheimer's Disease and Related Disorders Association criteria for AD, andInternational Classification of Diseases, Tenth Revisioncriteria for VaD.

RESULTS:Before the follow‐up examination, 382 individuals had died (232 had reliable information). Of the 2,826 survivors, 2,266 completed the study. Overall, 127 new dementia cases were identified. Average incidence rates per 1,000 person‐years were 12.47 (95% confidence interval (CI) = 10.23–14.72) for dementia, 6.55 (95% CI = 4.92–8.17) for AD, and 3.30 (95% CI = 2.14–4.45) for VaD. Both AD and VaD showed age‐dependent patterns. Education was protective against dementia and AD. Women carried a significantly higher risk of developing AD (hazard ratio = 1.67, 95% CI = 1.02–2.75), and men of developing VaD (hazard ratio = 2.23, 95% CI = 1.06–4.71).

CONCLUSIONS:Incidence of dementia in Italy paralleled that in most industrialized countries. About 150,000 new cases per year are expected. A significant gender effect was evidenced for major dementia subtypes. The burden of VaD, especially in men, offers opportunities for prevention.
Recreational Physical Activity Levels in Healthy Older Women: The Importance of Fear of Falling
Authors: Bruce David G. , Devine Amanda , Prince Richard L.
Published: March 2003

OBJECTIVES: To examine whether fear of falling is a probable cause of reduced recreational physical activity levels in healthy older women.

DESIGN: Cross‐sectional analysis of baseline data from a longitudinal study.

PARTICIPANTS: One thousand five hundred older, ambulatory women (aged 70–85), selected at random from the electoral roll.

MEASUREMENTS: Self‐reported recreational physical activity levels and fear of falling, demographic variables, anthropometric variables and measures of disability, and physical and cognitive function.

RESULTS: The study subjects had low levels of physical and cognitive impairments; 24.1% of the group was obese (body mass index> 30). Twenty‐six percent of the women did not participate in recreational physical activity; 39% participated in sufficient activity to gain probable health benefits. Although the women who did not participate in recreational activities were most likely to report fear of falling (45.2%), it was common in the group as a whole (33.9%), including the most active women (27.0%). Independent risk factors for nonparticipation in physical activity were fear of falling (odds ratio (OR) = 0.70, 95% confidence interval (CI) = 0.54–0.90, P = .006), obesity (OR = 0.50, 95% CI = 0.38–0.66, P = .001), and slower times on the timed up‐and‐go test (OR = 0.88, 95% CI = 0.84–0.92, P = .001). Fear of falling was also independently associated with lower recreational physical activity levels in women who were active (β = −0.09, P = .003). Subgroup analysis suggested that fear of falls affected activity levels at a predisability stage in women with mildly impaired mobility.

CONCLUSIONS: Fear of falling is common in healthy, high‐functioning older women and is independently associated with reduced levels of participation in recreational physical activity. Fear of falling is an important psychological barrier that may need to be overcome in programs attempting to improve activity levels in older women.
A Randomized, Double‐Blind, Placebo‐Controlled Study of Oral Vitamin B12 Supplementation in Older Patients with Subnormal or Borderline Serum Vitamin B12 Concentrations
Authors: Seal Eric C. , Metz Jack , Flicker Leon , Melny Joy
Published: March 2003

OBJECTIVES: To determine the effect of small doses of oral cyanocobalamin supplements in older patients with low or borderline serum vitamin B12 concentrations but no other evidence of pernicious anemia (PA).

DESIGN: Randomized, double‐blind, placebo‐controlled study assessing the efficacy of oral cyanocobalamin 10 μg and 50 μg daily for 1 month.

SETTING: Two geriatric hospitals in the North Western Health Care Network, Melbourne, Australia.

PARTICIPANTS: Thirty‐one inpatients with serum vitamin B12 levels between 100 and 150 pmol/L, without PA, other malabsorption disorders, or progressive neurological or terminal illness. The mean age was 81.4 years.

INTERVENTION: After informed consent, a medical and drug history was taken and the Mini‐Mental State Examination (MMSE) completed. A dietitian made assessment of oral cobalamin intake. Blood was taken for serum vitamin B12, serum and red cell folate assay, full blood examination, fasting serum gastrin, parietal and intrinsic factor antibodies, fasting serum homocysteine, and creatinine. Patients were then randomized to receive 10 μg oral cyanocobalamin, 50 μg oral cyanocobalamin, or placebo treatment for 1 month, after which the investigations and clinical examinations were repeated.

MEASUREMENTS: Percentage change in the level of vitamin B12, homocysteine, folate, and red cell parameters and absolute changes in MMSE were calculated and compared between groups. The groups were compared on the number of responders who improved their level of B12 by 20%. Chi‐square calculations on changes in serum vitamin B12 concentration were also performed.

RESULTS: Mean serum vitamin B12± standard deviation improved by 51.7 ± 47.1% in the 50‐μg group, 40.2 ± 34.4% in the 10‐μg group, and 11.7 ± 24.5% in the placebo group. The change in the 50‐μg cyanocobalamin group was significantly greater than that in the placebo group (P = .044). The change in the 10‐μg cyanocobalamin group was not significantly different from that in the placebo group (P = .186). Eight of 10 subjects in each treatment group were classified as responders, compared with two of 11 in the placebo group (P = .004). Homocysteine levels fell in patients receiving cyanocobalamin, but this fall failed to reach statistical significance. There were no significant changes in the other parameters measured.

CONCLUSION: Cyanocobalamin supplementation of 50 μg but not 10 μg daily produced a significant increase in serum vitamin B12. This result has implications for the management of patients with subnormal or borderline serum vitamin B12 concentrations and for food fortification with vitamin B12.
Effects of a Care Protocol on Care Outcomes in Older Nursing Home Patients with Chronic Obstructive Pulmonary Disease
Authors: Lee Diana T. F. , Lee Iris F. K. , Mackenzie Ann E. , Ho Rosalie N. L.
Published: March 2003

OBJECTIVES:To evaluate the effects of a care protocol used by community nurses to support nursing home staff in the care of patients with chronic obstructive pulmonary disease (COPD).

DESIGN:Matched, randomized case‐control trial.

SETTING:Forty‐five nursing homes of the New Territories South (NTS) cluster of Hong Kong.

PARTICIPANTS:Eighty‐nine older people (≥65, present resident of a nursing home in the NTS region, main diagnosis of COPD, at least one hospital admission in previous 6 months) discharged to the nursing homes from the geriatric units of two hospitals.

INTERVENTION:Using a care protocol, community nurses followed up older patients in the experimental group for 6 months after their discharge from the hospitals to the nursing homes.

MEASUREMENTS:Data on functional, respiratory, and psychological parameters were collected at entry to study and 6 months later with standard measures. Data on hospital service utilization, nursing home staff, and patient satisfaction were also collected at 6 months.

RESULTS:Experimental group participants had significant (P= .008) improvements in psychological well‐being. Nursing home staff and experimental group patients were highly satisfied with the use of the protocol. There was no significant difference between the two groups in functional and respiratory outcomes or hospital service utilization.

CONCLUSION:Psychological well‐being as an important factor in rehabilitation in chronic illness has been much neglected in the literature. Supporting nursing home staff in the care of COPD patients through community nursing visits can enhance older residents' psychological well‐being. Psychological aspects of care should be emphasized and incorporated into the delivery of regular nursing home care.
Pain in Cognitively Impaired Nursing Home Residents: How Well Are Physicians Diagnosing It?
Authors: Cohen‐Mansfield Jiska , Lipson Steven
Published: March 2003

OBJECTIVES: This study examined the reliability and validity of geriatricians' assessments of pain in cognitively impaired nursing home residents.

DESIGN: Cross‐sectional analysis.

SETTING: A large suburban nursing home.

PARTICIPANTS: Seventy‐nine nursing home residents participated in the study. Of these, 31 had mild/moderate cognitive impairment (average Mini‐Mental State Examination (MMSE) = 16.04) and 48 were severely cognitively impaired (average MMSE = 1.91). More than 80% of the participants were female, and the average age was 87.

MEASUREMENTS: Two geriatricians from outside the nursing home examined laboratory results, performed a physical examination, and completed a detailed assessment of pain. The personal geriatricians of 42 of the participants also completed the same assessment.

RESULTS: Intergeriatrician agreement rates were statistically significant and moderate in magnitude. When examined by subgroup, the correlations were significant only for those with mild/moderate impairment. Some of the geriatricians' ratings of pain correlated significantly with residents' self‐reports. All relationships were weaker in the severely cognitively impaired group. Ratings of greater pain were significantly correlated with higher cognitive functioning.

CONCLUSIONS: The results validate geriatricians' evaluations of pain during a medical examination for moderately impaired persons and question their ability to evaluate pain in the severely cognitively impaired. There is a need for increased awareness of pain in this population and a need for improved methodologies to identify it.
Biological Interactions of Aging and Anemia: A Focus on Cytokines
Authors: Ershler William B.
Published: March 2003

Anemia is one of the characteristics of the frailty phenotype and is often observed in elderly patients. Although anemia in people of advancing age can often be attributed to underlying etiologies such as iron deficiency or chronic disease, some cases do not have any identifiable cause. Therefore, it has been suggested that the aging process itself might be an intrinsic factor in the development of anemia, possibly through the age‐related dysregulation of certain proinflammatory cytokines such as interleukin‐6 (IL‐6). Although the mechanism underlying the association between increased IL‐6 and anemia has not been fully elucidated, it has been suggested that, like with other cytokines, it involves direct inhibition of erythropoietin production or interaction with the erythropoietin receptor.
Disc Related and Non‐Disc Related Disorders of the Thoracic Spine
Authors: Sizer Phillip S. , Phelps Valerie , Azevedo Esteban
Published: March 2003

Abstract: Different anatomical structures and pathophysiological functions can be responsible for lumbar pain, each producing a distinctive clinical profile. Pain can arise from the intervertebral disc, either acutely as a primary disc related disorder, or as result of the degradation associated with chronic internal disc disruption. In either case, greatest pain provocation will be associated with movements and functions in the sagittal plane. Lumbar pain can also arise from afflictions within the zygapophyseal joint mechanism, as a result of synovitis or chondropathy. Either of these conditions will produce the greatest pain provocation during three‐dimensional movements, due to maximal stress to either the synovium or joint cartilage. Finally, patients can experience different symptoms associated with irritation to the dural sleeve, dorsal root ganglion, or chemically irritated lumbar nerve root. Differential diagnosis of these conditions requires a thorough examination and provides information that can assist the clinician in selecting appropriate management strategies.