bluuebunny/crossref_metadata_2025 huggingface dataset:
The Relationship Between Ethnicity and Advance Directives in a Frail Older Population
Authors: Eleazer G. Paul , Hornung Carlton A. , Egbert Carolyn B. , Egbert John R. , Eng Catherine , Hedgepeth Jennifer , McCann Robert , Strothers Harry , Sapir Marc , Wei Ming , Wilson Malissa
Published: April 2015

OBJECTIVE: To assess the relationship between ethnicity and Health Care wishes, including Advance Directives, in a group of frail older persons in PACE (Program For All Inclusive Care Of The Elderly).

DESIGN: Retrospective chart review of 1193 participants in the PACE program.

SETTING: Program of All Inclusive Care Of The Elderly (PACE), a comprehensive managed care demonstration program serving frail older participants at 10 sites across the nation.

PARTICIPANTS: A total of 1193 older adults, all of whom met state criteria for nursing home level of care. There were 385 non‐Hispanic whites, 364 blacks, 156 Hispanics, and 288 Asians.

MEASUREMENTS: Presence or absence of advance directives, type of health care wishes selected including living will, durable power of attorney, and health care proxy.

RESULTS: Frail older white, black, Hispanic and Asian Americans differ significantly in their health care wishes and how they choose to express them. Blacks were significantly more likely to select aggressive interventions and less likely than non‐Hispanic whites and Hispanics to utilize a written instrument for expressing health care wishes. Whites were significantly more likely to utilize written documents for advance directives, whereas Asians were more likely to select less aggressive interventions but were unlikely to use written advance directives.

CONCLUSIONS: In this population, we found significant ethnic variations in choice of health care wishes. Although health care wishes are an individual decision, an awareness of cross cultural patterns can assist practitioners in addressing the concerns of their patients, as well as assisting Health Care Policy Development. J Am Geriatr Soc 44:938–943, 1996.
Drug‐Drug Interactions Related to Hospital Admissions in Older Adults: A Prospective Study of 1000 Patients
Authors: Doucet J. , Chassagne P. , Trivalle C. , Landrin I. , Pauty M. D. , Kadri N. , Ménard J. F. , Bercoff E.
Published: April 2015

OBJECTIVE: To investigate the frequency, nature, and side effects of drug‐drug interactions (DDI) in a group of geriatric inpatients.

DESIGN: Study of drugs administered at home in the 2 weeks preceding hospitalization.

SETTING: Evaluation of patients admitted to a geriatric unit from the emergency unit.

PATIENTS: One thousand inpatients more than 70 years of age (83.0 $pL 7.1 years), admitted consecutively to a hospital for acute illness.

MEASUREMENTS: All possible two by two combinations of drugs administered at home were considered to determine whether these associations could lead to a DDI and whether side effects resulted from these interactions.

RESULTS: Five hundred thirty‐eight patients were exposed to 1087 DDI. The most frequently involved drugs were cardiovascular and psychotropic medications. There were 189 side effects observed in 130 patients. The most frequent side effects were neuropsychological impairment, arterial hypotension, and acute renal failure. The number of side effects did not differ between the 66 contraindicated drug associations and the 1021 associations that only required precautionary use.

CONCLUSIONS: DDI frequently lead to side effects in older adults. Classifications of DDI must be adapted to increased DDI sensitivity in this population. Nevertheless the frequency of side effects might be reduced by limiting the prescription of the most frequent and dangerous DDI. J Am Geriatr Soc 44:944–948, 1996.
Nutritional Risk in Inner‐City‐Dwelling Older Black Americans
Authors: Miller Douglas K. , Carter Myrtle E. , Sigmund Robert H. , Smith John Q. , Miller J. Philip , Bentley Judy A. , McDonald Kim , Coe Rodney M. , Morley John E.
Published: April 2015

OBJECTIVE: To define the degree of nutritional risk in older inner‐city black Americans and to identify important underlying factors associated with high nutritional risk.

DESIGN: Cross‐sectional descriptive study.

SETTING AND PARTICIPANTS: A population‐based sample of 400 noninstitutionalized persons older than 69 years of age in north St. Louis (NSL), Missouri, and a community‐based sample of 115 residents aged 50 years and older living in public housing in East St. Louis (ESL), Illinois. Both study areas have high levels of poverty.

MEASUREMENTS: Nutritional risk was measured using the Nutrition Screening Initiative Checklist. Demographic information, economic status, self‐rated health, Geriatric Depression Scale score, and body mass index were assessed using established standardized instruments.

MAIN RESULTS: Forty‐eight percent of NSL and 66% of ESL subjects scored high on the Checklist. Compared with a mostly white (96%) comparison group from New England, both samples demonstrated particularly high prevalence for limited intake of fruits, vegetables, and milk; tooth and mouth problems; lack of money for food; eating alone; polypharmacy; and inability to shop, cook or feed on their own. High levels of depressive symptoms, fair or poor self‐rated health, perceived inadequacy of income, and low income levels were associated with high risk, but even those subjects with no or few such predisposing factors were still high on the Checklist score compared with the New England sample.

CONCLUSIONS: If confirmed, these results indicate that inner‐city‐dwelling older black Americans are at high nutritional risk. Attempts to reduce their nutritional risk should focus on improving nutritional content of their diet, oral health, polypharmacy, depressive symptoms, and poor general health; offering group meals; and providing assistance with shopping and cooking. J Am Geriatr Soc 44:959–962, 1996.
Characteristics of Urinary Incontinence in Homebound Older Adults
Authors: McDowell B. Joan , Engberg Sandra J. , Rodriguez Eric , Engberg Richard , Sereika Susan
Published: April 2015

OBJECTIVE: To describe the characteristics of urinary incontinence and related factors in incontinent homebound older adults.

DESIGN: A descriptive study of 90 cognitively intact incontinent homebound older persons referred to a clinical trial to examine the effectiveness of behavioral therapies in the treatment of urinary incontinence (UI) in homebound patients.

SETTING AND PARTICIPANTS: Incontinent patients more than 60 years of age who met the Health Care Financing Administration's definition of homebound were referred to a clinical trial by home care nurses from a Medicare‐approved home care agency in a large metropolitan county in Pennsylvania.

MEASURES: Structured continence and medical history, basic and instrumental activities of daily living, Folstein MMSE, Geriatric Depression Scale, mobility‐toileting skills, bladder diaries, and physical examination.

RESULTS: Four hundred eighty‐four persons were referred to the clinical trial, and 90 cognitively intact persons were found eligible to participate in this study (80 women and 10 men). Subjects had a mean age of 75.8 years, reported a mean of 8.4 medical problems, and most, 80%, had functional limitations in ambulation. Subjects recorded a mean of 3.8 urinary accidents/day–1.4 large and 2.4 small accidents/ day – in baseline bladder diaries. The majority, 73.3%, had more than 10 accidents per week, and most patients reported mixed urge, stress (57.1%), or pure urge (37.7%) UI. Half (54.4%) reported that UI further restricted their activities, and 52.2% reported that this problem was extremely disturbing. However, 90.5% believed that UI could be treated.

CONCLUSIONS: Urinary incontinence tends to be severe among cognitively intact homebound older adults in both frequency and volume of accidents. Although subjects were homebound with many health and functional disabilities, they perceived UI as a very disturbing problem that further restricted their activities. Participants in this study were optimistic about the potential benefits of treatment. J Am Geriatr Soc 44:963–968, 1996.
ELEVATED CEREBROSPINAL FLUID TAU LEVELS: IMPLICATIONS FOR THE EARLY DIAGNOSIS OF ALZHEIMER'S DISEASE
Authors: Terajima Masanori , Itabashi Shigeru , Higuchi Makoto , Zhu Cuiqing , Kosaka Yo‐ichi , Nakagawa Takuma , Sasaki Hidetada
Published: April 2015

Hiroyuki Arai, MD, PhD
Predictors of Change in Walking Velocity in Older Adults
Authors: Gibbs James , Hughes Susan , Dunlop Dorothy , Singer Ruth , Chang Rowland W.
Published: April 2015

OBJECTIVE: To determine factors that predict change in walking velocity in older people using a multivariate model.

DESIGN: Longitudinal observational study.

SUBJECTS: A total of 588 persons older than age 60, including subjects residing in a continuing care retirement community (CCRC) (n = 248), and homebound (n = 79) and ambulatory (n = 261) subjects. Mean age at baseline = 77.

MEASUREMENT: Independent variables included demographics, physician measures of lower‐extremity joint impairment and other musculoskeletal and neurological variables, comorbidities derived from physical examination and chart abstract, self‐assessed arthritis pain, depression, and anxiety. The major dependent variables were 2‐ and 4‐year decline in walking velocity below a threshold associated with nursing home placement.

MAIN RESULTS: From baseline to Year 4, median walking velocity declined from 61.8 to 53.0 m/min, and the proportion of subjects above a threshold value of 11.5 m/min declined from 95.3% to 80.4%. Age, joint impairment, and weakness of quadriceps, measured at baseline, predicted 2‐year and 4‐year decline in walking velocity.

CONCLUSIONS: The findings indicate that joint impairment and quadriceps strength contribute significantly to crossing a clinically significant threshold in walking velocity among older people over time. Future research is needed to determine whether these risk factors can be modified through preventive interventions such as muscle‐strengthening exercises and pain medication. J Am Geriatr Soc 44:126–132, 1996.
The Benefits of Psychiatric Hospitalization for Older Nursing Home Residents
Authors: Kunik Mark E. , Ponce Hernando , Molinari Victor , Orengo Claudia , Emenaha Ify , Workman Richard
Published: April 2015

OBJECTIVE

To examine the demographic characteristics and treatment outcomes of nursing home residents admitted to a geropsychiatric inpatient unit.

DESIGN

A retrospective cohort design based on an ongoing data base effort.

SETTING

The geropsychiatric inpatient unit of the Houston Veterans Affairs Medical Center Hospital.

PARTICIPANTS

All admissions to the unit from nursing homes during an 18‐month period.

MEASUREMENTS

Mini‐Mental State Examination, Brief Psychiatric Rating Scale, Hamilton Rating Scale for Depression, Cohen‐Mansfield Agitation Inventory, Rating Scale for Side Effects, and Global Assessment of Functioning were administered on admission and discharge.

RESULTS

Paired t tests comparing change scores revealed significant decreases in general psychiatric symptoms (P < .001), depression (P < .001), and agitation (P < .001); significant improvement in global functioning (P < .001); with no significant changes in cognitive status (P = .485) or side effects (P = .120). When the patients were subgrouped according to reasons for admission, paired t tests revealed decreases in violence (CMAI Factor 1; P = .000), psychosis (BPRS thought disorder scale; P = .000 and hostility subscale; P < .008), and depression (HAM‐D; P = .002). Four patients were discharged to less restrictive environments, all with chronic mental illnesses.

CONCLUSION

Inpatient psychiatric hospitalization significantly benefits nursing home residents with and without dementia who are admitted for severe behavior problems.
Attitudes Toward Use of Nursing Homes and Home Care in Older Japanese‐Americans
Authors: McCormick Wayne C. , Uomoto Jay , Young Heather , Graves Amy B. , Vitaliano Peter , Mortimer James A. , Edland Steven D. , Larson Eric B.
Published: April 2015

OBJECTIVE: A cohort of 1142 older Japanese Americans was identified to study preferences and attitudes regarding use of long‐term care (nursing home or home care).

DESIGN: Prospective cohort study.

PARTICIPANTS AND SETTING: Older Japanese Americans in King County, Washington.

RESULTS: Subjects were asked to consider hypothetical situations in which they were temporarily disabled by hip fracture or permanently disabled by dementing illness. If they fractured a hip, only 12% intended to use a nursing home; 29% intended to recover at home with the help of family or friends; another 54% intended to use paid home health care. If they became demented, the majority (53%) intended to use a nursing home; only 11% intended to rely on family or friends for care, and another 29% intended to use paid home health care. Similar responses were observed when subjects were asked what most members of their family or friends would wish them to do; however, they tended to value the perceived wishes of religious figures or the Japanese American community‐at‐large less than those of family or friends. Significant correlates with intention to enter nursing homes were lack of social support (unmarried, few or no close relatives or housemates), female gender, and high levels of acculturation into American society (never lived in Japan, English‐speaking only). Other factors that were not significantly correlated were health perceptions, satisfaction and life control scales, and health care utilization (hospitalizations and MD visits). In multivariate logistic regression, marital status and level of acculturation were the most powerful independent predictors of intention to enter nursing homes. Age and female gender were predictors of intention to use home care. In the base population of subjects, the prevalence of nursing homes use (5%) was similar to that of the general US older population.

CONCLUSIONS: We conclude that older Japanese Americans in the Pacific Northwest often intend to enter nursing homes if they became disabled by dementing illness. Actual use is similar to other older populations. This may be attributable largely to the existence of an ethnically appropriate nursing home which is strongly supported by, and familiar to, this close‐knit community. Intention to use long‐term care services appears to be dependent primarily on the level of social supports and acculturation into American society.
Do Neural Factors Underlie Age Differences in Rapid Ankle Torque Development?
Authors: Thelen Darryl G. , Ashton‐Miller James A. , Schultz Albert B. , Alexander Neil B.
Published: April 2015

OBJECTIVES: Rapid torque development is substantially slower in healthy old adults compared with young adults, but the underlying cause of this age‐related loss remains unclear. Measurements of myoelectric signals in ankle dorsi‐ and plantarflexor muscles during rapid exertions were used to explore the extent to which the loss might be attributed to neural factors.

METHODS: Myoelectric signals were measured in a laboratory setting in 24 healthy young and 24 healthy old adult volunteers during rapid isometric and isokinetic torque development. Premotor times, muscle activation rates, and myoelectric activity levels of agonistic and antagonistic muscles were quantified.

RESULTS: There were few marked age differences in the premotor times or in the onset rates or magnitudes of agonistic muscles activities during maximum isometric and during isokinetic exertions. Premotor times were statistically associated with age but, in the mean, were only approximately 10 to 25 ms longer in the old. Age effects on agonist muscle activity magnitudes were significant only in the lateral gastrocnemius. Small decreases in antagonistic muscle activity levels with age were found.

CONCLUSIONS: Given the outcomes of this study, the differences observed previously in rapid torque development abilities in healthy older adults, compared with healthy younger adults, seem attributable largely to differences in muscle contraction mechanisms rather than to differences in speeds of stimulus sensing or central processing of motor commands, or to differences in muscle recruitment strategies.
Looking Inside the Black Box of Comprehensive Geriatric Assessment: A Classification System for Problems, Recommendations, and Implementation Strategies
Authors: Reuben David B. , Fishman Linda K. , McNabney Matthew , Wolde‐Tsadik Girma
Published: April 2015

OBJECTIVE: To develop and test the inter‐rater reliability of a coding system for geriatric problems identified through Comprehensive Geriatric Assessment (CGA) of hospitalized older persons, recommendations generated by the assessment, and implementation strategies for these recommendations.

DESIGN: Validation study.

SETTING: A health maintenance organization and a geriatrics academic program.

PARTICIPANTS: A total of 49 hospitalized older persons, who met at least 1 of 13 inclusionary “targeting” criteria, two geriatricians, and one social worker who coded forms.

MEASUREMENTS: Standardized coding of CGA consultation sheets into (1) geriatric problems identified, (2) recommendations, and (3) implementation strategies; inter‐rater reliability testing of coding system using two physicians and a social worker.

RESULTS: On average, each assessed patient had 4.8 recommendations. The largest percentages of recommendations were for non‐physician referrals (18.2%), advance directives (13.4%), medication adjustments (11.5%), diagnostic evaluation/monitoring (11.5%), and community services (10.9%). The proportions of agreement between raters in coding problems ranged from 0.77 to 0.90, in coding recommendations from 0.69 to 0.86, and in coding implementation strategies from 0.68 to 0.83.

CONCLUSION: A classification system for measuring some components of the process of care of CGA has satisfactory inter‐rater reliability, can be adapted for other settings, and may provide valuable insight into determining which components of CGA confer health benefits.
Self‐Report of Difficulty in Performing Functional Activities Identifies a Broad Range of Disability in Old Age
Authors: Langlois Jean A. , Maggi Stefania , Harris Tamara , Simonsick Eleanor M. , Ferrucci Luigi , Pavan Mara , Sartori Leonardo , Enzi Giuliano
Published: April 2015

OBJECTIVE: To describe a broad range of physical disability by examining the association between a four‐level measure of disability, based on self‐report of difficulty in performing functional activities, and previously identified risk factors for disability.

DESIGN: Cross‐sectional.

SETTING: Community‐based.

PARTICIPANTS: A total of 2373 noninstitutionalized men and women aged 65 and older from the Veneto Region of Italy.

MEASUREMENTS: Odds ratios for the association of the four levels of disability (none, mild, moderate, and ADL disability) differentiated by this new measure with known risk factors for physical disability.

MAIN RESULTS: This summary measure of physical disability distinguished older persons with disability from the population typically classified as nondisabled. Twenty‐one percent of study participants were identified as having Activities of Daily Living (ADL) disability (defined as self‐report of difficulty in one or more ADLs), and an additional 40% had mild or moderate disability based on degree of difficulty in Instrumental Activities of Daily Living (IADLs) and physical functional activities. Hip fracture and lower extremity performance were strongly independently associated with each level of disability. The association of a range of established risk factors for disability and health care utilization measures with the levels of disability identified in our study, and the trend toward increasing odds with increasing disability, provide evidence of the construct validity of this measure.

CONCLUSIONS: Self‐report of difficulty in performing functional activities identifies older persons with physical disability not ascertained by self‐report of the need for help,
The Relative Importance of Strength and Balance in Chair Rise by Functionally Impaired Older Individuals
Authors: Schenkman Margaret , Hughes Michael A. , Samsa Greg , Studenski Stephanie
Published: April 2015

OBJECTIVE: The ability to stand independently and safely from the seated position is essential for independent function. This investigation determined the relative contributions of measures of lower extremity strength and measures of balance control in explaining the performance characteristics of sitting‐to‐standing. Variables analyzed included those related to success of the activity (e.g., time to rise, lowest chair height) and to biomechanical characteristics of performance (e.g., how fast specific body segments moved).

SETTING: Durham Veteran's Affairs Medical Center motion analysis laboratory.

DESIGN: Cross‐sectional correlational study.

PARTICIPANTS: Fifty‐eight men and women aged 66 to 96 (mean = 77) with functional limitations.

MEASUREMENTS: Predictor variables were lower extremity strength (isometric) and balance (functional reach and sway). The outcome variable, chair rise performance, was quantified by: lowest successful chair height (chairs at 33 to 58 cm); time to rise; maximum hip flexion angular velocity; and the maximum horizontal and vertical velocities of the motion of the body center of mass (COM). Covariates were lower extremity range of motion and sensory status.

RESULTS: With bivariate analysis, lower extremity strength demonstrated relationships with the lowest chair height (r = −0.639) and maximum vertical velocity of the COM (r = .389); functional reach was associated with three variables (lowest chair height r = .374; time to rise r = .297; and maximum horizontal velocity of the COM r = .251). Using a multivariate regression analysis (including lower extremity strength, functional reach, sensory loss, and lower extremity range of motion), the model accounted for 47% of the variance in lowest chair height; lower extremity strength was the only significant predictor (P < .001). The model also accounted for 20% of the variance in maximum horizontal velocity of the COM; lower extremity strength was a significant predictor (P = .006).

CONCLUSIONS: Lower extremity strength and balance control both play a role in performance of chair rise; lower extremity strength is the stronger predictor of success for functionally impaired older adults.
Markers of Failure to Thrive Among Older Hip Fracture Patients
Authors: Fox Kathleen M. , Hawkes William G. , Magaziner Jay , Zimmerman Sheryl I. , Hebel J. Richard
Published: April 2015

OBJECTIVES: To determine whether there is a group of recent hip fracture patients who exhibit the signs of failure to thrive and to identify potential precursors to their decline in physical functioning.

DESIGN: Prospective (nonintervention) study of hip fracture recovery; patients were assessed in the hospital and at 2, 6, 12, 18, and 24 months post‐fracture.

SETTING: Hip fracture patients admitted to one of eight Baltimore area hospitals from the community with a new fracture of the proximal femur between January 1, 1990, and June 15, 1991.

PARTICIPANTS: Patients were 65 years of age and older and lived in the community before the fracture. A total of 804 patients were eligible for the study; the present study analyses were restricted to the 252 patients who survived 1 year and had a self‐report assessment at 6 and 12 months post‐fracture.

MEASUREMENTS: A questionnaire administered during hospitalization assessed pre‐fracture functional and health status and current affective and cognitive status. In‐home interviews post‐fracture ascertained dependence and difficulty with physical and instrumental activities of daily living. Abstraction of the medical records provided information about comorbidities, surgical procedure, and hospital length of stay.

RESULTS: Patients who declined in ability to walk from 6 to 12 months post‐fracture had greater use of health resources (more hospitalizations) and poorer physical functioning up to 2 years post‐fracture. Impaired function in physical activities of daily living at 6 months, high glucose, calcium, and CO2 at admission, and low BUN and creatinine at admission were more prevalent among decliners than among non‐decliners.

CONCLUSIONS: Findings indicate that certain older hip fracture patients begin to exhibit signs and symptoms of failure to thrive. About 10% of patients who survived at least 1 year after fracture could not retain their recovery level of functioning after 6 months and began to decline further. High glucose and CO2 and low BUN and creatinine on hospital admission were associated with later functional decline among hip fracture patients, but their clinical significance is uncertain. J Am Geriatr Soc 44:371–376, 1996.
The Epidemiology, Clinical Characteristics, and Natural History of Older Nursing Home Residents with a Diagnosis of Parkinson's Disease
Authors: Mitchell Susan L. , Kiely Dan K. , Kiel Douglas P. , Lipsitz Lewis A.
Published: April 2015

OBJECTIVE: To determine the epidemiology, clinical characteristics and natural history of nursing home residents with a diagnosis of Parkinson's disease (PD).

DESIGN: A cohort study with 18‐month follow‐up utilizing resident assessments from the National HealthCorp 1991–1992 dataset.

SETTING: Seventy‐one National HealthCorp nursing homes.

PARTICIPANTS: A total of 5020 nursing home residents older than age 55 were studied. Residents with primary and secondary diagnoses of PD were identified from the population using theInternational Classification of Diseases, Ninth Revision, Clinical Modification code 332.0.

MEASUREMENTS: Baseline demographic and clinical characteristics were compared for residents with and those without Parkinson's disease. Outcome measures over the course of 18 months included death and functional status.

RESULTS: The prevalence of a diagnosis of PD was 6.8%. Significant factors associated independently with PD included: younger age (79 ± 7 vs 81 ± 9 years;P< .001), male sex (32% vs 23%;P< .001), severe dependence in activities of daily living (OR = 1.26; 95% CI 1.08–1.46), impaired body control (OR = 1.38; 95% CI 1.03–1.68), symptoms of depression (OR = 1.29; 95% CI 1.02–1.64), and the number of daily medications (OR = 1.23; 95% CI 1.08–1.44). Residents with a diagnosis of PD had a faster rate of functional decline over 18 months (P< .001) but did not have a higher mortality rate than residents without PD.

CONCLUSIONS: Parkinson's disease is a relatively common diagnosis among nursing home residents and is associated with increased functional disability. There are several potentially modifiable conditions associated with PD that may offer an opportunity to design specific interventions and health services to improve the quality of life and slow functional decline in this frail population.J Am Geriatr Soc 44:394–399, 1996.
Attitudes of Older Adults' on Being Told the Diagnosis of Alzheimer's Disease
Authors: Holroyd Suzanne , Snustad Diane G. , Chalifoux Zona L.
Published: April 2015

OBJECTIVE: Controversy exists as to whether Alzheimer's disease (AD) patients should be told their diagnosis, yet no research has been done examining older patients' attitudes on this topic. This study examines patient's attitudes toward this topic.

DESIGN: A prospective, community‐based study. Participants read vignettes of two patients, one with AD and one with terminal cancer, and then answered questions regarding their attitudes toward these illnesses.

SETTING: A community‐based retirement community in Charlottesville, Virginia.

PARTICIPANTS: One hundred fifty‐six community‐dwelling older persons (mean age 79.7 ± 6.9 years).

MEASUREMENTS: A structured questionnaire disclosed demographic data (age, sex, race, religion, marital status), personal experience with cancer and AD, and opinions about being told the diagnosis of these diseases.

RESULTS: Most participants (n = 124, 79.5%) responded that they would prefer to know if they had AD, but the number was significantly fewer (Fisher exact test, P < .001) than those who would want to know if they had terminal cancer (n = 143, 91.7%) Interestingly, significantly fewer married subjects would want their spouse to know if the spouse had either illness. Only 65.7% (n = 69) of subjects would want their spouse to know if the spouse had AD (Fisher exact test, P = .008), whereas for cancer, 80.2% (n = 77) would want their spouse to know if the spouse had cancer (Fisher exact test P < .001). No demographic variables distinguished subjects who did from those who did not want to know the diagnosis for themselves or their spouses for either AD or cancer. Among the reasons some subjects gave for wanting to know of the diagnosis of AD was being able to consider suicide.

CONCLUSION: Although these results may support disclosure of diagnosis for most patients with AD, clinical and ethical issues remain in individual cases. J Am Geriatr Soc 44:400–403, 1996.
The 13th International Workshops on Opportunistic Protists (IWOP13)
Authors: Calderon Enrique J. , Cushion Melanie T. , Xiao Lihua , Lorenzo‐Morales Jacob , Matos Olga , Kaneshiro Edna S. , Weiss Louis M.
Published: April 2015

The 13th International Workshops on Opportunistic Protists (IWOP‐13) was held November 13–15, 2014 in Seville, Spain. The objectives of the IWOP meetings are to: (1) serve as a forum for exchange of new information among active researchers concerning the basic biology, molecular genetics, immunology, biochemistry, pathogenesis, drug development, therapy, and epidemiology of these immunodeficiency‐associated pathogenic eukaryotic microorganisms that are seen in patients with AIDS and; (2) to foster the entry of new and young investigators into these underserved research areas. The IWOP meeting focuses on opportunistic protists; e.g. the free‐living amoebae, Pneumocystis, Cryptosporidium, Toxoplasma, the Microsporidia, and kinetoplastid flagellates. This conference represents the major conference which brings together research groups working on these opportunistic pathogens. Progress has been achieved on understanding the biology of these pathogenic organisms, their involvement in disease causation in both immune deficient and immune competent hosts and is providing important insights into these emerging and reemerging pathogens. A continuing concern of the participants is the ongoing loss of scientific expertise and diversity in this research community. This decline is due to the small size of these research communities and an ongoing lack of understanding by the broader scientific community of the challenges and limitations faced by researchers working on these organisms, which makes these research communities very sensitive to declines in research funding.
Preoperative psychological distress, coping and quality of life in Chinese patients with newly diagnosed gastric cancer
Authors: Hong Jingfang , Wei Zengzeng , Wang Weili
Published: April 2015

Aims and objectives

The purpose of this study was to investigate the prevalence of preoperative psychological distress and its relationship with coping style and quality of life in Chinese patients with newly diagnosed gastric cancer.

Background

Being newly diagnosed with cancer can be a source of psychological distress. Understanding the preoperative psychological distress may contribute to the development of appropriate interventions.

Design

This is a descriptive correlational survey study.

Methods

The study was conducted in two teaching hospitals in Anhui province, China. A total of 165 patients with gastric cancer completed a battery of self‐report questionnaires including the Distress Thermometer, the revised Chinese version of the Quality of Life Questionnaire‐Stomach 22 and the Cancer Coping Modes Questionnaire.

Results

The prevalence of clinically significant preoperative psychological distress was 76·97% in this group. Statistically significant correlations were identified between the distress score and stomach pain, eating restrictions and anxiety subscale. Positive associations were found between the distress scores and four subdimensions of coping (avoidance and suppression, resignation, fantasy and catharsis), whereas a negative association was found between the distress scores and one subdimension of coping (Confrontation). There were also significant differences in the quality of life and coping style of patients who had different psychological distress statuses.

Conclusion

These findings indicate a relatively high prevalence of preoperative psychological distress among Chinese patients with gastric cancer. Patients with clinically psychological distress were more likely to have poor quality of life and to demonstrate negative coping styles.

Relevance to clinical practice

Nursing professionals need to carefully assess the psychological status of patients with gastric cancer. Tailored interventions can be administered to help these patients appropriately cope with the disease and to enhance their quality of life.
Exploring the role of practical nursing wisdom in the care of patients with urinary problems at the end of life: a qualitative interview study
Authors: Farrington Naomi , Fader Mandy , Richardson Alison , Sartain Samantha
Published: April 2015

Aims and objectives

This study examined how nurses understand urinary problems at the end of life, and identified sources of evidence upon which they base their practice through semi‐structured qualitative interviews. The aim was to decide whether research or interventions (such as formulation of best practice guidelines) could improve continence care at the end of life.

Background

There is little evidence in nursing literature to indicate how nurses should manage urinary problems at the end of life. Evidence is particularly lacking regarding the insertion of indwelling urinary catheters.

Design

This was an applied qualitative interview study which used the ‘guided interview’ approach.

Methods

Twelve participants who worked in two hospital wards and one hospice were interviewed about management of patients with urinary problems approaching the end of life. The transcribed interviews were organised using the qualitative analysis software qsr NVivo version 10 (QSR International, Melbourne, Australia). Constant comparison was used to analyse the interviews.

Results

The patient and their family were a key concern of all interviewees. Participants focused on processes including: giving care, making decisions, managing uncertainty and assimilating knowledge. These processes are mediated by ‘phronesis’ or practical wisdom.

Conclusions

Within each of the processes (giving care, making decisions, managing uncertainty and assimilating knowledge), participants approached each patient as an individual, using experience, patient wishes, available resources, clinical knowledge and advice from colleagues to provide care. A generalised set of guidelines on managing urinary problems at the end of life would probably not be useful.

Relevance to clinical practice

There is uncertainty about what constitutes best practice in specific areas of continence care at the end of life such as indwelling urinary catheter insertion. A careful approach is needed to ensure that the intellectual and moral knowledge that constitutes practical wisdom is shared and developed throughout teams.
The CYP17 MspA1 Polymorphism and the Gender Dysphoria
Authors: Fernández Rosa , Cortés-Cortés Joselyn , Esteva Isabel , Gómez-Gil Esther , Almaraz Mari Cruz , Lema Estefanía , Rumbo Teresa , Haro-Mora Juan-Jesús , Cortés-Cortés Joselyn , Esteva Isabel , Gómez-Gil Esther , Almaraz Mari Cruz , Lema Estefanía , Rumbo Teresa , Haro-Mora Juan-Jesús , Roda Ester , Guillamón Antonio , Pásaro Eduardo
Published: April 2015

Introduction

The A2 allele of the CYP17 MspA1 polymorphism has been linked to higher levels of serum testosterone, progesterone, and estradiol.

Aim

To determine whether the CYP17 MspA1 polymorphism is associated with transsexualism.

Methods

We analyzed 151 male-to-female (MtF), 142 female-to-male (FtM), 167 control male, and 168 control female individuals. Fragments that included the mutation were amplified by PCR and digested with MspA1. Our data were compared with the allele/genotype frequencies provided by the 1000 Genomes Data Base, and contrasted with a MEDLINE search of the CYP17 MspA1 polymorphism in the literature.

Main Outcome Measures

We investigated the association between transsexualism and the CYP17 MspA1 polymorphism.

Results

A2 frequency was higher in the FtM (0.45) than the female control (0.38) and male control (0.39) groups, or the MtF group (0.36). This FtM > MtF pattern reached statistical significance (P = 0.041), although allele frequencies were not gender specific in the general population (P = 0.887). This observation concurred with the 1000 Genomes Data Base and the MEDLINE search.

Conclusion

Our data confirm a sex-dependent allele distribution of the CYP17 MspA1 polymorphism in the transsexual population, FtM > MtF, suggestive of a hypothetical A2 involvement in transsexualism since the allele frequencies in the general population seem to be clearly related to geographic origin and ethnic background, but not sex.
Analysis of automated quantification of motor activity in REM sleep behaviour disorder
Authors: Frandsen Rune , Nikolic Miki , Zoetmulder Marielle , Kempfner Lykke , Jennum Poul
Published: April 2015

Rapid eye movement (REM) sleep behaviour disorder (RBD) is characterized by dream enactment and REM sleep without atonia. Atonia is evaluated on the basis of visual criteria, but there is a need for more objective, quantitative measurements. We aimed to define and optimize a method for establishing baseline and all other parameters in automatic quantifying submental motor activity during REM sleep. We analysed the electromyographic activity of the submental muscle in polysomnographs of 29 patients with idiopathic RBD (iRBD), 29 controls and 43 Parkinson's (PD) patients. Six adjustable parameters for motor activity were defined. Motor activity was detected and quantified automatically. The optimal parameters for separating RBD patients from controls were investigated by identifying the greatest area under the receiver operating curve from a total of 648 possible combinations. The optimal parameters were validated on PD patients. Automatic baseline estimation improved characterization of atonia during REM sleep, as it eliminates inter/intra‐observer variability and can be standardized across diagnostic centres. We found an optimized method for quantifying motor activity during REM sleep. The method was stable and can be used to differentiate RBD from controls and to quantify motor activity during REM sleep in patients with neurodegeneration. No control had more than 30% of REM sleep with increased motor activity; patients with known RBD had as low activity as 4.5%. We developed and applied a sensitive, quantitative, automatic algorithm to evaluate loss of atonia in RBD patients.
Online Simultaneous Reconstruction of Wind Load and Structural Responses—Theory and Application to Canton Tower
Authors: Niu Yan , Fritzen Claus‐Peter , Jung Henning , Buethe Inka , Ni Yi‐Qing , Wang You‐Wu
Published: April 2015

The actual wind load information is helpful in evaluating the health status of high‐rise structures. However, as a type of distributed load, the wind load is very difficult to be measured directly. A possible solution is to reconstruct it from the structural response measurements. This is often an ill‐posed inverse problem. In this article, such ill posedness is solved by using a stable input estimator. With the help of the proposed application‐oriented algorithm selection guidance, a type of state and input estimator is formulated. This type of estimator is designed based on the Kalman filter scheme, and is capable of estimating the unknown inputs and the system states within one sampling time. This actually facilitates the online simultaneous reconstruction of the wind load and the structural responses. The 600 m tall Canton Tower is situated in a typhoon active area, and a structural health monitoring system has already been integrated onto this tower. These two points make the Canton Tower an ideal test bed for validating the above illustrated online reconstruction strategy for the wind load and the structural responses. An operational modal analysis (OMA) is first performed to identify the modal properties of the Canton Tower under the Typhoon Nanmadol in 2011. Then a reduced‐order finite element model (FEM) of the Canton Tower is updated according the OMA results. Finally, the equivalent fluctuating lateral loads and moments, which act on the nodes of the reduced‐order FEM are reconstructed using the acceleration measurements recorded during Tyhoon Kai‐tak in 2012. The reconstruction results are validated by comparing the simultaneously reconstructed structural acceleration with the corresponding sensor measurements. The mean component of the loads and moments are calculated using the real‐time wind speed measurements and the available aerodynamic force coefficients. It is noted here that the focus of this article is not to develop a totally new theory, but rather to explore the application of a state and input estimator in the foreground to a practical complex structure.
A lipid‐managing program maintains a stout Spitzenkörper
Authors: Peñalva Miguel A.
Published: April 2015

The Spitzenkörper (SPK) is an accumulation of vesicles interleaved with actin microfilaments present at the cytosolic side of the apical plasma membrane (PM) of hyphal tips of many species of filamentous fungi. The physiological role of the SPK has captivated fungal biologists over the years, but only very recently this ‘organelle’ is starting to be understood in the molecular terminology used for cell biological models. One aspect that has received little attention is the role of cellular membrane asymmetry in the organization of membrane traffic, in particular in the genetic and cell biological model Aspergillus nidulans. The paper by Schultzhaus et al. (2015) in this issue breaks the ice, providing original insight that may foster research in phospholipid composition in the context of intracellular traffic and the organization of the SPK. Notably, it shows that like the stout Neurospora crassa SPK, the much slimmer one of A. nidulans, appears to be formed by different strata, altogether suggesting that the SPK might be a mosaic of exocytic carriers with different functional specializations, and a major sorting hub for intracellular membranes.
Non‐neutrality in forest communities: evolutionary and ecological determinants of tree species abundance distributions
Authors: Kubota Yasuhiro , Kusumoto Buntarou , Shiono Takayuki , Ulrich Werner , Jabot Franck
Published: April 2015

The unified neutral theory of biodiversity and biogeography provides a promising framework that can be used to integrate stochastic and ecological processes operating in ecological communities. Based on a mechanistic non‐neutral model that incorporates density‐dependent mortality, we evaluated the deviation from a neutral pattern in tree species abundance distributions and explored the signatures of historical and ecological processes that have shaped forest biomes. We compiled a dataset documenting species abundance distributions in 1168 plots encompassing 16 973 tree species across tropical, temperate, and boreal forests. We tested whether deviations from neutrality of species abundance distributions vary with climatic and historical conditions, and whether these patterns differ among regions. Non‐neutrality in species abundance distributions was ubiquitous in tropical, temperate, and boreal forests, and regional differences in patterns of non‐neutrality were significant between biomes. Species abundance evenness/unevenness caused by negative density‐dependent or abiotic filtering effects had no clear macro‐scale climatic drivers, although temperature was non‐linearly correlated with species abundance unevenness on a global scale. These findings were not significantly biased by heterogeneity of plot data (the differences of plot area, measurement size, species richness, and the number of individuals sampled). Therefore, our results suggest that environmental filtering is not universally increasing from warm tropical to cold boreal forests, but might affect differently tree species assembly between and within biomes. Ecological processes generating particularly dominant species in local communities might be idiosyncratic or region‐specific and may be associated with geography and climate. Our study illustrates that stochastic dynamical models enable the analysis of the interplay of historical and ecological processes that influence community assemblies and the dynamics of biodiversity.
Capnometry monitoring during intravenous sedation with midazolam for oral surgery
Authors: Brady P.J. , Wilson K.E. , Meeke R. , Girdler N.M. , Mc Creary C.
Published: April 2015

Aims

To investigate changes in end‐tidal carbon dioxide (ETCO2) and the utility of ETCO2 as an additional monitor of ventilation during intravenous sedation with midazolam for oral surgery. There are no data on capnography in dental sedation, nor is the frequency of abnormal ventilatory activity known in this setting.

Materials and methods

This was a prospective observational study of 33 healthy adults (mean age 38 years). Monitoring included pulse oximetry, blood pressure measurement and visual assessment. Patients were also monitored with blinded capnometry.

Results

Post‐hoc analysis revealed 33% of patients had peripheral capillary oxygen saturation (SPO2) < 95% and 30% had ETCO2 changes indicating respiratory depression. Mean increase in ETCO2 was 2.19 mm Hg (95% confidence interval = 0.83–3.55) P = 0.0025 during sedation.

Conclusion

During intravenous sedation for oral surgery in healthy adult's breathing room air, significant changes in ETCO2 values occur. However, desaturation detectable by pulse oximetry usually occurs before clinically significant changes in capnometry are recognisable.
H+‐pyrophosphatase from Salicornia europaea confers tolerance to simultaneously occurring salt stress and nitrogen deficiency in Arabidopsis and wheat
Authors: Lv Sulian , Jiang Ping , Nie Lingling , Chen Xianyang , Tai Fang , Wang Duoliya , Fan Pengxiang , Feng Juanjuan , Bao Hexigeduleng , Wang Jinhui , Li Yinxin
Published: April 2015

High salinity and nitrogen (N) deficiency in soil are two key factors limiting crop productivity, and they usually occur simultaneously. Here we firstly found that H+‐PPase is involved in salt‐stimulated NO3− uptake in the euhalophyte Salicornia europaea. Then, two genes (named SeVP1 and SeVP2) encoding H+‐PPase from S. europaea were characterized. The expression of SeVP1 and SeVP2 was induced by salt stress and N starvation. Both SeVP1 or SeVP2 transgenic Arabidopsis and wheat plants outperformed the wild types (WTs) when high salt and low N occur simultaneously. The transgenic Arabidopsis plants maintained higher K+/Na+ ratio in leaves and exhibited increased NO3− uptake, inorganic pyrophosphate‐dependent vacuolar nitrate efflux and assimilation capacity under this double stresses. Furthermore, they had more soluble sugars in shoots and roots and less starch accumulation in shoots than WT. These performances can be explained by the up‐regulated expression of ion, nitrate and sugar transporter genes in transgenic plants. Taken together, our results suggest that up‐regulation of H+‐PPase favours the transport of photosynthates to root, which could promote root growth and integrate N and carbon metabolism in plant. This work provides potential strategies for improving crop yields challenged by increasing soil salinization and shrinking farmland.