bluuebunny/crossref_metadata_2025 huggingface dataset:
Flagellar oscillation: a commentary on proposed mechanisms
Authors: Woolley David M.
Published: December 2009

Eukaryotic flagella and cilia have a remarkably uniform internal ‘engine’ known as the ‘9+2’ axoneme. With few exceptions, the function of cilia and flagella is to beat rhythmically and set up relative motion between themselves and the liquid that surrounds them. The molecular basis of axonemal movement is understood in considerable detail, with the exception of the mechanism that provides its rhythmical or oscillatory quality. Some kind of repetitive ‘switching’ event is assumed to occur; there are several proposals regarding the nature of the ‘switch’ and how it might operate. Herein I first summarise all the factors known to influence the rate of the oscillation (the beating frequency). Many of these factors exert their effect through modulating the mean sliding velocity between the nine doublet microtubules of the axoneme, this velocity being the determinant of bend growth rate and bend propagation rate. Then I explain six proposed mechanisms for flagellar oscillation and review the evidence on which they are based. Finally, I attempt to derive an economical synthesis, drawing for preference on experimental research that has been minimally disruptive of the intricate structure of the axoneme. The ‘provisional synthesis' is that flagellar oscillation emerges from an effect of passive sliding direction on the dynein arms. Sliding in one direction facilitates force‐generating cycles and dynein‐to‐dynein synchronisation along a doublet; sliding in the other direction is inhibitory. The direction of the initial passive sliding normally oscillates because it is controlled hydrodynamically through the alternating direction of the propulsive thrust. However, in the absence of such regulation, there can be a perpetual, mechanical self‐triggering through a reversal of sliding direction due to the recoil of elastic structures that deform as a response to the prior active sliding. This provisional synthesis may be a useful basis for further examination of the problem.
Linking biotic homogenization to habitat type, invasiveness and growth form of naturalized alien plants in North America
Authors: Qian Hong , Guo Qinfeng
Published: December 2009

Aim  Biotic homogenization is a growing phenomenon and has recently attracted much attention. Here, we analyse a large dataset of native and alien plants in North America to examine whether biotic homogenization is related to several ecological and biological attributes.

Location  North America (north of Mexico).

Methods  We assembled species lists of native and alien vascular plants for each of the 64 state‐ and province‐level geographical units in North America. Each alien species was characterized with respect to habitat (wetland versus upland), invasiveness (invasive versus non‐invasive), life cycle (annual/biennial versus perennial) and habit (herbaceous versus woody). We calculated a Jaccard similarity index separately for native, for alien, and for native and alien species. We used the average of Jaccard dissimilarity index (1 − Jaccard index) of all paired localities as a measure of the mean beta diversity of alien species for each set of localities examined in an analysis. We used a homogenization index to quantify the effect of homogenization or differentiation.

Results  We found that (1) wetland, invasive, annual/biennial and herbaceous alien plants markedly homogenized the state‐level floras whereas non‐invasive and woody alien plants tended to differentiate the floras; (2) beta diversity was significantly lower for wetland, invasive, annual/biennial and herbaceous alien plants than their counterparts (i.e. upland, non‐invasive, perennial and woody alien plants, respectively); and (3) upland and perennial alien plants each played an equal role in homogenizing and differentiating the state‐level floras.

Main conclusions  Our study shows that biotic homogenization is clearly related to habitat type (e.g. wetland versus uplands), species invasiveness and life‐history traits such as life cycle (e.g. annual/biennial and herbaceous versus woody species) at the spatial scale examined. These observations help to understand the process of biotic homogenization resulting from alien vascular plants in North America.
Comparison of direct and indirect methods of intra‐abdominal pressure measurement in normal horses
Authors: Munsterman Amelia S. , Hanson R. Reid
Published: December 2009

Objectives –To develop a direct method for measuring intra‐abdominal pressures in the standing horse, identify a reference interval for direct intra‐abdominal pressures, compare these pressures to indirect intra‐abdominal pressures measured from the bladder, and determine the optimal bladder infusion volume for indirect pressure measurement.

Design –Prospective, experimental study.

Setting –A university‐based equine research facility.

Animals –Ten healthy adult horses, 5 males and 5 females.

Interventions –Direct intra‐abdominal pressures were measured through an intraperitoneal cannula and zeroed at the height midway between the height of the tuber ishii and point of the shoulder. Indirect measurements of intra‐abdominal pressure were performed by measuring intravesicular pressures through a transurethral catheter zeroed at the tuber ishii.

Measurements and Main Results –Direct pressure measurements obtained in the standing horse were subatmospheric (mean, −1.80 cm H2O; SD, 1.61 cm H2O; 95% CI, −2.80 to −0.80) and were shown to decrease as the horse's weight increased (Pearson'sr=−0.67,P=0.04), with no effect of head position (P=0.15). Mean baseline indirect pressure measurements (mean, −8.63 cm H2O; SD, 4.37 cm H2O; 95% CI, −13.05 to −4.21) were significantly different from the pressures measured directly from the abdomen (P<0.001). Indirect pressure measurements were noted to increase with increasing volumes infused into the bladder, and were statistically different at a volume of 100 mL (P=0.004). There was low to moderate correlation between direct and indirect pressure measurements of intra‐abdominal pressure over a range of fluid volumes infused into the bladder (Pearson's correlation range −0.38 to 0.58).

Conclusion –Pressures measured directly in the standing horse were subatmospheric, and increased as the horse's weight increased. Indirect pressures measured were altered by increasing volumes infused in the bladder. There was no significant correlation between the 2 methods of intra‐abdominal pressure measurement.
Bimolecular fluorescence complementation: lighting up seven transmembrane domain receptor signalling networks
Authors: Rose Rachel H , Briddon Stephen J , Holliday Nicholas D
Published: December 2009

There is increasing complexity in the organization of seven transmembrane domain (7TM) receptor signalling pathways, and in the ability of their ligands to modulate and direct this signalling. Underlying these events is a network of protein interactions between the 7TM receptors themselves and associated effectors, such as G proteins and β‐arrestins. Bimolecular fluorescence complementation, or BiFC, is a technique capable of detecting these protein–protein events essential for 7TM receptor function. Fluorescent proteins, such as those from Aequorea victoria, are split into two non‐fluorescent halves, which then tag the proteins under study. On association, these fragments refold and regenerate a mature fluorescent protein, producing a BiFC signal indicative of complex formation. Here, we review the experimental criteria for successful application of BiFC, considered in the context of 7TM receptor signalling events such as receptor dimerization, G protein and β‐arrestin signalling. The advantages and limitations of BiFC imaging are compared with alternative resonance energy transfer techniques. We show that the essential simplicity of the fluorescent BiFC measurement allows high‐content and advanced imaging applications, and that it can probe more complex multi‐protein interactions alone or in combination with resonance energy transfer. These capabilities suggest that BiFC techniques will become ever more useful in the analysis of ligand and 7TM receptor pharmacology at the molecular level of protein–protein interactions.

This article is part of a themed section on Imaging in Pharmacology. To view the editorial for this themed section visit http://dx.doi.org/10.1111/j.1476‐5381.2010.00685.x
Dopamine transporter down‐regulation following repeated cocaine: implications for 3,4‐methylenedioxymethamphetamine‐induced acute effects and long‐term neurotoxicity in mice
Authors: Peraile I , Torres E , Mayado A , Izco M , Lopez‐Jimenez A , Lopez‐Moreno JA , Colado MI , O'Shea E
Published: December 2009

Background and purpose: 3,4‐Methylenedioxymethamphetamine (MDMA) and cocaine are two widely abused psychostimulant drugs targeting the dopamine transporter (DAT). DAT availability regulates dopamine neurotransmission and uptake of MDMA‐derived neurotoxic metabolites. We aimed to determine the effect of cocaine pre‐exposure on the acute and long‐term effects of MDMA in mice.

Experimental approach: Mice received a course of cocaine (20 mg·kg−1, ×2 for 3 days) followed by MDMA (20 mg·kg−1, ×2, 3 h apart). Locomotor activity, extracellular dopamine levels and dopaminergic neurotoxicity were determined. Furthermore, following the course of cocaine, DAT density in striatal plasma membrane and endosome fractions was measured.

Key results: Four days after the course of cocaine, challenge with MDMA attenuated the MDMA‐induced striatal dopaminergic neurotoxicity. Co‐administration of the protein kinase C (PKC) inhibitor NPC 15437 prevented cocaine protection. At the same time, after the course of cocaine, DAT density was reduced in the plasma membrane and increased in the endosome fraction, and this effect was prevented by NPC 15437. The course of cocaine potentiated the MDMA‐induced increase in extracellular dopamine and locomotor activity, following challenge 4 days later, compared with those pretreated with saline.

Conclusions and implications: Repeated cocaine treatment followed by withdrawal protected against MDMA‐induced dopaminergic neurotoxicity by internalizing DAT via a mechanism which may involve PKC. Furthermore, repeated cocaine followed by withdrawal induced behavioural and neurochemical sensitization to MDMA, measures which could be indicative of increased rewarding effects of MDMA.
NS309 restores EDHF‐type relaxation in mesenteric small arteries from type 2 diabetic ZDF rats
Authors: Brøndum E , Kold‐Petersen H , Simonsen U , Aalkjaer C
Published: December 2009

Background and purpose:  The endothelium‐derived hyperpolarizing factor (EDHF)‐type relaxation in mesenteric small arteries from 21 week old Zucker lean (ZL) and Zucker diabetic fatty (ZDF) rats was investigated using (6,7‐dichloro‐1H‐indole‐2,3‐dione 3‐oxime) (NS309), a potent activator of small‐conductance, calcium‐activated potassium channel (SKCa) and intermediate‐conductance, calcium‐activated potassium channel (IKCa).

Experimental approach:  In the presence of inhibitors of cyclooxygenase and nitric oxide synthase [indomethacin and Nω‐nitro‐L‐arginine methyl ester (l‐NAME), respectively], acetylcholine (ACh)‐induced hyperpolarization and EDHF‐type relaxation were investigated under isometric conditions in the wire myograph using 0.5 and 1 µM NS309 and/or selective blockers of SKCa and IKCa channels. Membrane potential was recorded with glass microelectrodes, and changes in the intracellular calcium concentration of endothelial cells were visualized by confocal microscopy. SKCa expression was assessed by Western blotting.

Key results:  In arteries from ZDF rats, ACh‐induced relaxation and membrane hyperpolarization were attenuated and, compared with arteries from ZL rats, NS309 was less potent at causing relaxation. Incubation with 0.5 µM NS309 did not increase ACh‐induced relaxation in arteries from ZDF rats significantly. However, 1 µM NS309 restored it (both in the absence and in the presence of indomethacin and l‐NAME) without changing endothelial intracellular calcium concentration. The restored EDHF‐type relaxation was more sensitive to TRAM‐34 (1‐[(2‐chlorophenyl) diphenylmethyl]‐1H‐pyrazole) (1 µM) than to apamin. Expression of the SKCa channel was unaltered.

Conclusions and implications:  The attenuated EDHF‐type relaxation in mesenteric small arteries from ZDF rats can be restored by NS309 without changes in the intracellular calcium concentration of endothelial cells. These results may have clinical implications for the treatment of endothelial dysfunction in overweight type 2 diabetic patients.
Advances in imaging of new targets for pharmacological intervention in stroke: real‐time tracking of T‐cells in the ischaemic brain
Authors: Ortolano F , Maffia P , Dever G , Rodolico G , Millington OR , De Simoni MG , Brewer JM , Bushell TJ , Garside P , Carswell HV
Published: December 2009

Background and purpose:  T‐cells may play a role in the evolution of ischaemic damage and repair, but the ability to image these cells in the living brain after a stroke has been limited. We aim to extend the technique of real‐time in situ brain imaging of T‐cells, previously shown in models of immunological diseases, to models of experimental stroke.

Experimental approach:  Male C57BL6 mice (6–8 weeks) (n= 3) received a total of 2–5 × 106 carboxyfluorescein diacetate succinimidyl ester (CFSE)‐labelled lymphocytes from donor C57BL6 mice via i.v. injection by adoptive transfer. Twenty‐four hours later, recipient mice underwent permanent left distal middle cerebral artery occlusion (MCAO) by electrocoagulation or by sham surgery under isoflurane anaesthesia. Female hCD2‐green fluorescent protein (GFP) transgenic mice that exhibit GFP‐labelled T‐cells underwent MCAO. At 24 or 48 h post‐MCAO, a sagittal brain slice (1500 µm thick) containing cortical branches of the occluded middle cerebral artery (MCA) was dissected and used for multiphoton laser scanning microscopy (MPLSM).

Key results:  Our results provide direct observations for the first time of dynamic T‐cell behaviour in living brain tissue in real time and herein proved the feasibility of MPLSM for ex vivo live imaging of immune response after experimental stroke.

Conclusions and Implications:  It is hoped that these advances in the imaging of immune cells will provide information that can be harnessed to a therapeutic advantage.

This article is part of a themed section on Imaging in Pharmacology. To view the editorial for this themed section visit http://dx.doi.org/10.1111/j.1476‐5381.2010.00685.x
Modulatory effects of neuropsychopharmaca on intracellular pH of hippocampal neuronesin vitro
Authors: Bonnet Udo , Bingmann Dieter , Wiltfang Jens , Scherbaum Norbert , Wiemann Martin
Published: December 2009

Background and purpose: The intracellular pH (pHi) of neurones is tightly regulated by, for example, membrane‐bound acid‐exchangers and loaders. Nevertheless, excessive bioelectric activity lowers steady‐state pHi. In turn, even a moderate acidification can inhibit neuronal activity, a process believed to be part of a negative feedback loop controlling neuronal excitation. As moclobemide, an antidepressant, and also some antiepileptic drugs can reduce neuronal pHi in hippocampus slicesin vitro, we screened a panel of currently used neuropsychopharmaca for comparable effects.

Experimental approach: BCECF‐AM loaded hippocampal slices were superfused with 16 different neuroleptics, antidepressants and antiepileptics under bicarbonate‐buffered conditions. Changes in steady‐state pHi of CA3 neurones were measured fluorometrically.

Key results: The antipsychotics haloperidol, clozapine, ziprasidone, and the antidepressants amitriptyline, doxepin, trimipramine, citalopram, mirtazapine, as well as the anticonvulsive drug tiagabine reversibly reduced the steady‐state pHi by up to 0.35 pH‐units in concentrations of 5–50 µM. In contrast, venlafaxine, the anticonvulsants carbamazepine, clonazepam, gabapentin, lamotrigine, zonisamide, and the mood stabilizer lithium had no effect on neuronal pHi.

Conclusion and implications: These data substantiate the view that clinically relevant concentrations of neuroleptics and antidepressants can mediate changes in neuronal pHi, which may contribute to their pharmacological mode of action. Effects on pHi should be taken into account when therapeutic or even harmful effects of these drugs are evaluated.
Experimental Test of Postfire Management in Pine Forests: Impact of Salvage Logging versus Partial Cutting and Nonintervention on Bird–Species Assemblages
Authors: CASTRO JORGE , MORENO‐RUEDA GREGORIO , HÓDAR JOSÉ A.
Published: December 2009

Abstract:  There is an intense debate about the effects of postfire salvage logging versus nonintervention policies on regeneration of forest communities, but scant information from experimental studies is available. We manipulated a burned forest area on a Mediterranean mountain to experimentally analyze the effect of salvage logging on bird–species abundance, diversity, and assemblage composition. We used a randomized block design with three plots of approximately 25 ha each, established along an elevational gradient in a recently burned area in Sierra Nevada Natural and National Park (southeastern Spain). Three replicates of three treatments differing in postfire burned wood management were established per plot: salvage logging, nonintervention, and an intermediate degree of intervention (felling and lopping most of the trees but leaving all the biomass). Starting 1 year after the fire, we used point sampling to monitor bird abundance in each treatment for 2 consecutive years during the breeding and winter seasons (720 censuses total). Postfire burned‐wood management altered species assemblages. Salvage logged areas had species typical of open‐ and early‐successional habitats. Bird species that inhabit forests were still present in the unsalvaged treatments even though trees were burned, but were almost absent in salvage‐logged areas. Indeed, the main dispersers of mid‐ and late‐successional shrubs and trees, such as thrushes (Turdus spp.) and the European Jay (Garrulus glandarius) were almost restricted to unsalvaged treatments. Salvage logging might thus hamper the natural regeneration of the forest through its impact on assemblages of bird species. Moreover, salvage logging reduced species abundance by 50% and richness by 40%, approximately. The highest diversity at the landscape level (gamma diversity) resulted from a combination of all treatments. Salvage logging may be positive for bird conservation if combined in a mosaic with other, less‐aggressive postfire management, but stand‐wide management with harvest operations has undesirable conservation effects.
Prognostic Value of Usual Gait Speed in Well‐Functioning Older People—Results from the Health, Aging and Body Composition Study
Authors: Cesari Matteo , Kritchevsky Stephen B. , Penninx Brenda W. H. J. , Nicklas Barbara J. , Simonsick Eleanor M. , Newman Anne B. , Tylavsky Frances A. , Brach Jennifer S. , Satterfield Suzanne , Bauer Douglas C. , Visser Marjolein , Rubin Susan M. , Harris Tamara B. , Pahor Marco
Published: December 2009

Objectives: To define clinically relevant cutpoints for usual gait speed and to investigate their predictive value for health‐related events in older persons.

Design: Prospective cohort study.

Setting: Health, Aging and Body Composition Study.

Participants: Three thousand forty‐seven well‐functioning older persons (mean age 74.2).

Measurements: Usual gait speed on a 6‐m course was assessed at baseline. Participants were randomly divided into two groups to identify (Sample A; n=2,031) and then validate (Sample B; n=1,016) usual gait‐speed cutpoints. Rates of persistent lower extremity limitation events (mean follow‐up 4.9 years) were calculated according to gait speed in Sample A. A cutpoint (defining high‐ (<1 m/s) and low risk (≥1 m/s) groups) was identified based on persistent lower extremity limitation events. The predictive value of the identified cutpoints for major health‐related events (persistent severe lower extremity limitation, death, and hospitalization) was evaluated in Sample B using Cox regression analyses.

Results: A graded response was seen between risk groups and health‐related outcomes. Participants in the high‐risk group had a higher risk of persistent lower extremity limitation (rate ratio (RR)=2.20, 95% confidence interval (CI)=1.76–2.74), persistent severe lower extremity limitation (RR=2.29, 95% CI=1.63–3.20), death (RR=1.64, 95% CI=1.14–2.37), and hospitalization (RR=1.48, 95% CI=1.02–2.13) than those in the low‐risk group.

Conclusion: Usual gait speed of less than 1 m/s identifies persons at high risk of health‐related outcomes in well‐functioning older people. Provision of a clinically meaningful cutpoint for usual gait speed may facilitate its use in clinical and research settings.
Universal Bone Densitometry Screening Combined with Alendronate Therapy for Those Diagnosed with Osteoporosis Is Highly Cost‐Effective for Elderly Women
Authors: Schousboe John T. , Ensrud Kristine E. , Nyman John A. , Melton L. Joseph , Kane Robert L.
Published: December 2009

Objectives:To investigate the cost‐effectiveness of universal bone densitometry in women aged 65 and older combined with alendronate treatment for those diagnosed with osteoporosis (femoral neck T‐score ≤−2.5).

Design:A Markov model with a lifetime time horizon and eight health states (no fracture, distal forearm fracture, radiographic (but clinically inapparent) vertebral fracture, clinical vertebral fracture, hip fracture, hip and vertebral fracture, and other fractures), using the societal perspective.

Setting:Women living independently and those in nursing homes.

Participants:Caucasian women aged 65, 75, 85, or 95.

Intervention:Bone densitometry of the hip, with 5 years of alendronate therapy for those found to have osteoporosis versus no intervention (densitometry or drug therapy).

Measurements:Lifetime accumulated quality adjusted life years (QALYs), costs, and incremental cost‐effectiveness ratios.

Results:The cost per QALY gained for the screen‐and‐treat strategy was $43,000 per QALY gained for 65‐year‐old women and $5,600 per QALY gained for 75‐year‐old women. For 85‐ and 95‐year‐old women, the screen‐and‐treat strategy was cost saving. Sensitivity analyses showed that the screen‐and‐treat strategy was cost‐effective even under assumptions of reduced adherence to drug therapy, reduced fracture reduction benefit from alendronate therapy, or reduced QALYs saved by preventing fracture.

Conclusion:Universal bone densitometry combined with alendronate therapy for those found to have osteoporosis is highly cost‐effective for women aged 65 and older and may be cost saving for ambulatory women aged 85 and older (whether independently living or residing in nursing homes).
Physicians “Missing in Action”: Family Perspectives on Physician and Staffing Problems in End‐of‐Life Care in the Nursing Home
Authors: Shield Renée R. , Wetle Terrie , Teno Joan , Miller Susan C. , Welch Lisa
Published: December 2009

Objectives: To understand the roles of physicians and staff in nursing homes in relation to end‐of‐life care through narrative interviews with family members close to a decedent.

Design: Qualitative follow‐up interviews with 54 respondents who had participated in an earlier national survey of 1,578 informants.

Setting: Brown University interviewers conducted telephone interviews with participants throughout the United States.

Participants: The 54 participants agreed to a follow‐up qualitative interview and were family members or close to the decedent.

Measurements: A five‐member, multidisciplinary team to identify overarching themes taped, transcribed, and then coded interviews.

Results: Respondents report that healthcare professionals often insufficiently address the needs of dying patients in nursing homes and that “missing in action” physicians and insufficient staffing create extra burdens on dying nursing home residents and their families.

Conclusion: Sustained efforts to increase the presence of physicians and improve staffing in nursing homes are suggested to improve end‐of‐life care for dying residents in nursing homes.
The National Pressure Ulcer Long‐Term Care Study: Outcomes of Pressure Ulcer Treatments in Long‐Term Care
Authors: Bergstrom Nancy , Horn Susan D. , Smout Randall J. , Bender Stacy A. , Ferguson Maree L. , Taler George , Sauer Abby C. , Sharkey Siohban S. , Voss Anne Coble
Published: December 2009

Objectives: To identify resident, wound, and treatment characteristics associated with pressure ulcer (PrU) healing in long‐term care residents.

Design: Retrospective cohort study with convenience sampling.

Setting: Ninety‐five long‐term care facilities participating in the National Pressure Ulcer Long‐Term Care Study throughout the United States.

Participants: Eight hundred eighty‐two residents, aged 18 and older, with length of stay of 14 days or longer, who had at least one Stage II to IV PrU.

Measurements: Data collected for each resident over a 12‐week period included resident characteristics, treatment characteristics, and change in PrU area. Data were obtained from medical records, Minimum Data Set, and other records.

Results: Two multiple regression models, one for each stage grouping (Stage II, Stage III and IV), were completed. The area of Stage II PrU was reduced more with moist (F=21.91, P<.001) than with dry (F=13.41, P<.001) dressings. PrUs cleaned with saline or soap showed less decrease in area (F=12.34, P<.001) than PrUs cleaned with other cleansers such as antiseptic, antibiotic, or commercial cleansers. Change in area of Stage III and IV PrUs was related to sufficient enteral feeding (F=5.23, P=.02), enteral feeding without higher acuity levels (F=3.94, P=.048), size of PrU (very large (F=120.89, P=.001) and large (F=27.82, P=.001)), and type of dressing (moist (F=14.70, P<.001) and dry (F=5.88, P=.02)). Stage III and IV PrUs increased in area when debrided (F=5.97, P=.02). The overall models were significant (Stage III and IV, F=20.30, coefficient of determination (R2)=0.06, P<.001; Stage II, F=40.28, R2=0.13, P<.001) but explained little of the variation in change in PrU area.

Conclusion: In this sample of nursing facility residents, use of moist dressings (Stage II, Stage III and IV) and adequate nutritional support (Stage III and IV) are strong predictors of PrU healing.
Interrater Reliability and Accuracy in Identifying Ischemic Strokes Using Computed Tomography Scans in People with Dementia
Authors: Bowen James D. , Kamin Richard , Leverenz James B. , Fishel Mark A. , McCormick Wayne C. , Kukull Walter A. , Larson Eric B.
Published: December 2009

Objectives: To assess the reliability and interobserver agreement of stroke identification on neuroimaging in patients presenting with dementia.

Design: Comparison study between neurologists, radiology reports, and autopsy.

Setting: Dementia registry within a health maintenance organization.

Participants: Dementia patients with computed tomography (CT) scans obtained near the time of diagnosis and postmortem neuropathological examinations (N=99).

Measurements: Three neurologists independently read CT scans for the presence and locations of strokes. Radiology reports from these scans were reviewed. The results from neurologists, radiologists, and autopsies were compared.

Results: The positive predictive value for CT‐observed strokes compared with their presence on autopsy was 0.44 to 0.49, regardless of the specialty of the observer. Strokes were present at autopsy in 46 of 99 cases. Agreement between neurologists on the presence of strokes was fair to moderate (kappa=0.27–0.56). Less agreement was found between neurologists and radiologists (kappa=0.00–0.11). Results improved slightly when each case was evaluated as any stroke present versus no stroke on imaging (kappa=0.34–0.75) or for the presence of multiple strokes (kappa=0.17–0.69).

Conclusion: There is only fair to moderate agreement between observers regarding the identification of strokes on CT scans in patients presenting with dementia. Furthermore, strokes identified on imaging were present on pathology only half the time.
The State of Chronic Pain Education in Geriatric Medicine Fellowship Training Programs: Results of a National Survey
Authors: Weiner Debra K. , Turner Gregory H. , Hennon John G. , Perera Subashan , Hartmann Susanne
Published: December 2009

A survey of U.S. geriatric medicine fellowship training programs was performed to assess the status of teaching about chronic pain evaluation and management and identify opportunities for improvement. After an initial e‐mail query, 43 of 96 programs agreed to participate. A self‐administered questionnaire, with items adapted from a 2002 consensus panel statement, was mailed to their 171 fellows‐in‐training and 43 fellowship directors. Thirty‐two programs (33% of nationwide sample) including 79 fellows (30% of nationwide sample) and 25 directors (26% of nationwide sample) returned surveys; 21 institutions returned both faculty and fellow surveys. Overall, directors endorsed the 19 items identified by the consensus panel as essential components of fellowship training, but fellows identified deficiencies, both before and during fellowship training. Specific areas of undereducation included comprehensive musculoskeletal assessment, neuropathic pain evaluation, indications for low back pain imaging, the role of multidisciplinary pain clinics and nonpharmacological modalities, the effect of physical and psychosocial comorbidities in formulating treatment goals, and the effect of aging on analgesic metabolism and prescription. Both groups were generally positive about fellows' abilities to implement pain‐related clinical skills. Discrepancies existed between fellowship directors' ratings of importance of teaching individual items and the degree to which teaching was actually done, as well as faculty versus fellow assessments of whether some of the 19 items were taught. Primary care training programs (e.g., internal medicine, family medicine, geriatric medicine) should pay more systematic attention to educating trainees about chronic pain to optimize patient care, decrease suffering, and diminish healthcare expenditures.
The Beneficial Effects of Group‐Based Exercises on Fall Risk Profile and Physical Activity Persist 1 Year Postintervention in Older Women with Low Bone Mass: Follow‐Up After Withdrawal of Exercise
Authors: Liu‐Ambrose Teresa Y. L. , Khan Karim M. , Eng Janice J. , Gillies Graham L. , Lord Stephen R. , McKay Heather A.
Published: December 2009

Objectives: To determine whether exercise‐induced reductions in fall risk are maintained in older women 1 year after the cessation of three types of interventions—resistance training, agility training, and general stretching.

Design: One‐year observational study.

Setting: Community.

Participants: Ninety‐eight women aged 75 to 85 with low bone mass.

Measurements: Primary outcome measure was fall risk, measured using the Physiological Profile Assessment tool. Secondary outcome measures were current physical activity level, assessed using the Physical Activity Scale for the Elderly, and formal exercise participation, assessed using an interview.

Results: At the end of the follow‐up, the fall risk of former participants of all three exercise programs was maintained (i.e., still reduced) from trial completion. Mean fall risk value at the end of follow‐up was 43.3% lower than mean baseline value in former participants of the resistance‐training group, 40.1% lower in the agility‐training group, and 37.4% lower in the general stretching group. Physical activity levels were also maintained from trial completion. Specifically, there was a 3.8% increase in physical activity from baseline for the resistance‐training group, a 29.2% increase for the agility‐training group, and a 37.7% increase for the general stretching group.

Conclusion: After three types of group‐based exercise programs, benefits are sustained for at least 12 months without further formal exercise intervention. Thus, these 6‐month exercise interventions appeared to act as a catalyst for increasing physical activity with resultant reductions in fall risk profile that were maintained for at least 18 months in older women with low bone mass.
Two‐Minute Mental Health Care for Elderly Patients: Inside Primary Care Visits
Authors: Tai‐Seale Ming , McGuire Thomas , Colenda Christopher , Rosen David , Cook Mary Ann
Published: December 2009

OBJECTIVES: To assess how care is delivered for mental disorders using videotapes of office visits involving elderly patients.

DESIGN: Mixed‐method observational analysis of the nature of the topics discussed, content of discussion, and the time spent on mental health.

SETTINGS: Three types of settings: an academic medical center, a managed care group, and fee‐for‐service solo practitioners.

PARTICIPANTS: Thirty‐five primary care physicians and 366 of their elderly patients.

MEASUREMENTS: Videotapes of 385 visits covering 2,472 diverse topics were analyzed. Coding of the videotapes identified topics, determined talk time, and coded the dynamics of talk.

RESULTS: Mental health topics occurred in 22% of visits, although patient survey indicated that 50% of the patients were depressed. A typical mental health discussion lasted approximately 2 minutes. Qualitative analysis suggested wide variations in physician effort in providing mental health care. Referrals to mental health specialists were rare even for severely depressed and suicidal patients.

CONCLUSION: Little time is spent on mental health care for elderly patients despite heavy disease burdens. Standards of care based on a count of visits “during which a mental health problem is discussed” may need to be supplemented with guidelines about what should happen during the visit. System‐level interventions are needed.
Effects of Change in Physical Activity on Physical Function Limitations in Older Women: Mediating Roles of Physical Function Performance and Self‐Efficacy
Authors: McAuley Edward , Morris Katherine S. , Doerksen Shawna E. , Motl Robert W. , Liang Hu , White Siobhan M. , Wójcicki Thomas R. , Rosengren Karl
Published: December 2009

OBJECTIVES: To examine the hypothesis that changes in self‐efficacy and functional performance mediate, in part, the beneficial effect of physical activity on functional limitations over time.

DESIGN: Prospective, observational study.

SETTING: Community‐based.

PARTICIPANTS: Two hundred forty‐nine community‐dwelling older women.

MEASUREMENTS: Participants completed measures of self‐reported physical activity, functional limitations, and self‐efficacy. Four measures of physical function performance were also assessed. Measures were completed at baseline and 24 months. Data were analyzed using a panel model within a covariance modeling framework.

RESULTS: Results indicated that increases in physical activity over time were associated with greater improvements in self‐efficacy, which was associated in turn with improved physical function performance, both of which mediated the association between physical activity and functional limitations. Fewer functional limitations at baseline were also associated with higher levels of self‐efficacy at 24 months. Age, race, and health status covariates did not significantly change these relationships.

CONCLUSION: The findings support the mediating roles of self‐efficacy and physical function performance in the relationship between longitudinal changes in physical activity and functional limitations in older women.
After‐Hours Calls from Long‐Term Care Facilities in a Geriatric Medicine Training Program
Authors: Hastings S. Nicole , Whitson Heather E. , White Heidi K. , Sloane Richard , MacDonald Heather , Lekan Deborah A. , McConnell Eleanor S.
Published: December 2009

OBJECTIVES: To describe after‐hours telephone calls from nurses in long‐term care (LTC) facilities to doctors in a geriatric medicine training program.

DESIGN: Evaluation of 1,928 after‐hours calls from LTC facilities over a 10‐month period in 2005/06.

SETTING: Geriatrics fellowship program and three affiliated LTC facilities.

PARTICIPANTS: Eight geriatrics fellows and 40 medicine interns.

MEASUREMENTS: Data were collected on call characteristics (such as reason for call and call outcome) and physician attitudes about the call, scored using a 5‐point Likert scale.

RESULTS: Clinical problems were the focus of 70.4% of the calls. The range of clinical problems was broad; most common reasons for calls were falls (n=377), pain (n=138), and agitation (n=100). The majority of calls resulted in medical intervention, including new medications or treatments (43.4%), diagnostic tests (10.2%), or more‐extensive medical evaluation in the emergency department (9.1%) or by an on‐site physician (2.4%). Overall, physician trainees had favorable attitudes about most after‐hours calls, although medicine interns taking calls had a less‐favorable impression and felt less prepared to manage them.

CONCLUSION: After‐hours telephone calls from LTC facilities are common, reflect the heterogeneity of geriatric health concerns, and typically result in intervention. As the LTC population grows, more study is needed on telephone care and optimal strategies for training physicians in this important aspect of LTC.
The Development of Academic Geriatric Medicine: Progress Toward Preparing the Nation's Physicians to Care for an Aging Population
Authors: Warshaw Gregg A. , Bragg Elizabeth J. , Brewer David E. , Meganathan Karthikeyan , Ho Mona
Published: December 2009

Academic geriatric medicine programs are critical for training the physician workforce to care effectively for aging Americans. This article describes the progress made by medical schools in developing these programs. Academic leaders in geriatrics at all 145 accredited allopathic and osteopathic medical schools in the United States were surveyed in the winter of 2005 (68% response rate) and results compared with findings from a similar 2001 survey. Physician faculty in geriatrics at U.S. medical schools increased from 7.5 (mean) full‐time equivalents (FTEs) in 2001 to 9.6 FTEs in 2005. Faculty and staff effort is mostly devoted to clinical practice (mean 36.9%) and education (mean 34.6%). A small number of programs focus on research; only six responding schools devote more than 40% of faculty effort to research. Seventy‐one percent reported that their medical school required a geriatrics medical student clerkship or that their geriatric training was integrated into a required clinical rotation. In summary, from 2001 to 2005, more fellows and faculty have been recruited and trained, and some academic programs have emerged with strong education, research, and clinical initiatives. Medical student exposure to geriatrics curriculum has increased, although few academic geriatricians are pursuing research careers, and the number of practicing geriatricians is declining. An expanded investment in training the physician workforce to care for older adults will be required to ensure adequate care for aging Americans.
Health Care for Older Americans with Multiple Chronic Conditions: A Research Agenda
Authors: Norris Susan L. , High Kevin , Gill Thomas M. , Hennessy Sean , Kutner Jean S. , Reuben David B. , Unützer Jürgen , Landefeld C. Seth
Published: December 2009

In response to the substantial and increasing healthcare requirements of older adults with multiple chronic conditions and acknowledgment of major gaps in knowledge and funding, two expert meetings were convened to identify a research agenda addressing the needs of this population. Research priorities are to develop and evaluate more‐effective models of health care, develop and evaluate management practices and organizational structures that lead to improved long‐term care, develop and implement relevant and effective preventive health strategies, determine the most effective interventions in patients who have concurrent cognitive or emotional impairments, and determine how interventions during and after hospitalization affect the outcomes of hospitalized patients.
Volume of Home‐ and Community‐Based Medicaid Waiver Services and Risk of Hospital Admissions
Authors: Xu Huiping , Weiner Michael , Paul Sudeshna , Thomas Joseph , Craig Bruce , Rosenman Marc , Doebbeling Caroline Carney , Sands Laura P.
Published: December 2009

OBJECTIVES: To evaluate whether type and volume of Medicaid Home‐ and Community‐Based Services (HCBS) waiver program are associated with risk of hospitalization and whether this association changes over time.

DESIGN: Prospective.

SETTING: Indiana Medicaid claims data from June 2001 to December 2004.

PARTICIPANTS: Medicaid recipients (N=1,354) who enrolled in the Aged and Disabled waiver program between January 2002 and June 2004.

MEASUREMENTS: Time to hospital admission since enrollment in the HCBS waiver program, adjusted for demographics, comorbidities, prior use of health services, and volume of HCBS received, including attendant care, homemaking, and home‐delivered meals.

RESULTS: A greater volume of attendant care, homemaking services, and home‐delivered meals was associated with a lower risk of hospitalization. This effect diminished over time for attendant care and homemaking. The risk of hospitalization for subjects receiving 5 hours of attendant care per month was 54% (hazard ratio (HR)=0.46, 95% confidence interval (CI)=0.38–0.57) lower during the first month of enrollment and 20% lower by Month 10 (HR=0.80, 95% CI=0.73–0.88) than for those receiving no attendant care.

CONCLUSION: Greater volume of HCBS services was associated with lower risk of hospitalization. The findings highlight the potential importance of assessing and monitoring the volume of HCBS patients receive.
The Poor Outcome of Ischemic Stroke in Very Old People: A Cohort Study of Its Determinants
Authors: Denti Licia , Scoditti Umberto , Tonelli Claudio , Saccavini Marsilio , Caminiti Caterina , Valcavi Rita , Benatti Mario , Ceda Gian Paolo
Published: December 2009

OBJECTIVES: To assess how much of the excess risk of poor outcome from stroke in people aged 80 and older aging per se explains, independent of other prognostic determinants.

DESIGN: Cohort, observational.

SETTING: University hospital.

PARTICIPANTS: One thousand five hundred fifty‐five patients with first‐ever ischemic stroke consecutively referred to an in‐hospital Clinical Pathway program were studied.

MEASUREMENTS: The relationship between age and 1‐month outcome (death, disability (modified Rankin Scale 3–5), and poor outcome (modified Rankin Scale 3–6)) was assessed, with adjustment for several prognostic factors.

RESULTS: Six hundred twelve patients aged 80 and older showed worse outcome after 1 month than those who were younger, in terms of mortality (19% vs 5%, hazard ratio (HR)=3.85, 95% confidence interval (CI)=2.8–5.4) and disability (51% vs 33%, odds ratio (OR)=3.16, 95% CI=2.5–4.0), although in multivariate models, the adjusted HR for mortality decreased to 1.47 (95% CI=1.0–2.16) and the ORs for disability and poor outcome decreased to 1.76 (95% CI=1.32–2.3.) and 1.83 (95% CI=137–2.43), respectively. Stroke severity, the occurrence of at least one medical complication, and premorbid disability explained most of the risk excess in the oldest‐old.

CONCLUSION: Stroke outcome is definitely worse in very old people, and most of the excess risk of death and disability is attributable to the higher occurrences of the most‐severe clinical stroke syndromes and of medical complications in the acute phase. These represent potential targets for preventive and therapeutical strategies specifically for elderly people.
An Evaluation of an Adapted U.S. Model of Pharmaceutical Care to Improve Psychoactive Prescribing for Nursing Home Residents in Northern Ireland (Fleetwood Northern Ireland Study)
Authors: Patterson Susan M. , Hughes Carmel M. , Crealey Grainne , Cardwell Chris , Lapane Kate L.
Published: December 2009

OBJECTIVES: To test the effect of an adapted U.S. model of pharmaceutical care on prescribing of inappropriate psychoactive (anxiolytic, hypnotic, and antipsychotic) medications and falls in nursing homes for older people in Northern Ireland (NI).

DESIGN: Cluster randomized controlled trial.

SETTING: Nursing homes randomized to intervention (receipt of the adapted model of care; n=11) or control (usual care continued; n=11).

PARTICIPANTS: Residents aged 65 and older who provided informed consent (N=334; 173 intervention, 161 control).

INTERVENTION: Specially trained pharmacists visited intervention homes monthly for 12 months and reviewed residents' clinical and prescribing information, applied an algorithm that guided them in assessing the appropriateness of psychoactive medication, and worked with prescribers (general practitioners) to improve the prescribing of these drugs. The control homes received usual care.

MEASUREMENTS: The primary end point was the proportion of residents prescribed one or more inappropriate psychoactive medicine according to standardized protocols; falls were evaluated using routinely collected falls data mandated by the regulatory body for nursing homes in NI.

RESULTS: The proportion of residents taking inappropriate psychoactive medications at 12 months in the intervention homes (25/128, 19.5%) was much lower than in the control homes (62/124, 50.0%) (odds ratio=0.26, 95% confidence interval=0.14–0.49) after adjustment for clustering within homes. No differences were observed at 12 months in the falls rate between the intervention and control groups.

CONCLUSION: Marked reductions in inappropriate psychoactive medication prescribing in residents resulted from pharmacist review of targeted medications, but there was no effect on falls.
Higher Level of Systemic C‐Reactive Protein Is Independently Predictive of Coronary Heart Disease in Older Community‐Dwelling Adults: The Three‐City Study
Authors: Straczek Celine , Ducimetiere Pierre , Barberger‐Gateau Pascale , Helmer Catherine , Ritchie Karen , Jouven Xavier , Carcaillon Laure , Amouyel Philippe , Tzourio Christophe , Empana Jean‐Philippe
Published: December 2009

OBJECTIVES: To assess the association between systemic C‐reactive protein (CRP) and incident coronary heart disease (CHD) in community‐dwelling elderly people.

DESIGN: A French population‐based multicenter prospective cohort study.

SETTING: Three cities in France: Bordeaux in the southwest, Dijon in the northeast, and Montpellier in the southeast.

PARTICIPANTS: After 4 years of follow‐up, a case–cohort study was designed including 1,004 subjects randomly selected from the initial cohort of 9,294 subjects free of CHD at baseline and 174 subjects who developed first CHD events during follow‐up.

MEASUREMENTS: Hazard ratios (HRs) were estimated using a Cox proportional hazard model adapted for the case–cohort design using a CRP level less than 1 mg/L as the reference category.

RESULTS: Of the random sample, 24.3% had a CRP level less than 1.0 mg/L, 45.8% had a CRP level of 1.0 to 2.9 mg/L, and 29.9% had a CRP level of 3.0 to 10.0 mg/L. The HRs for CHD, adjusted for age, sex, and study center, were 1.69 (95% confidence interval (CI)=1.04–2.75) for CRP from 1.0 to 2.9 mg/L and 2.32 (95% CI=1.41–3.82) for CRP from 3.0 to 10.0 mg/L (P for trend <.001). After additional adjustment for smoking, body mass index, diabetes mellitus, systolic blood pressure, high‐density lipoprotein cholesterol, low‐density lipoprotein cholesterol, triglycerides, statin use, and antihypertensive treatment, a baseline CRP of 3.0 to 10.0 mg/L remained associated with risk of CHD (HR=1.87, 95% CI=1.09–3.25), although CRP did not improve the discriminative ability of a predicting model based on traditional risk factors (receiver operating characteristic curves from 0.740 to 0.749).

CONCLUSION: CRP is an independent CHD risk marker but does not improve CHD risk prediction in community‐dwelling elderly people.