bluuebunny/crossref_metadata_2025 huggingface dataset:
Cognition in myotonic dystrophy type 1: a 5‐year follow‐up study
Authors: Winblad S. , Samuelsson L. , Lindberg C. , Meola G.
Published: June 2016

Background and purpose

Studies on cognitive decline in myotonic dystrophy type 1 (DM1) are characterized by conflicting results. The purpose of the present study was to analyse possible decline in classical/adult onset DM1 at a 5‐year follow‐up and to explore the correlation with disease‐related and demographic factors.

Methods

Patients with DM1 (n = 37) were examined with a comprehensive neuropsychological test battery yielding measures on memory, attention, verbal, visuospatial and executive functions. Assessment of muscle impairment and CTG repeat expansion size was performed.

Results

A majority of the participants (65%) performed worse at follow‐up. Compared to normative data, patients scored significantly worse on tests measuring memory, attention, visuospatial construction and verbal ability. Neither CTG repeat size nor muscle impairment related to cognitive decline. However, age at onset and disease duration were correlated with the number of tests in which performance was below 1 SD at both baseline and follow‐up examination.

Conclusions

Measurements show that classical/adult onset DM1 is characterized by cognitive decline. Both earlier onset and longer duration of the disease are indicative of more cognitive deficits.
Geographical and annual variations in the proportion of extended diapausing individuals of Illiciomyia yukawai (Diptera: Cecidomyiidae) with reference to an adaptive significance of its bimodal emergence pattern
Authors: Yukawa Junichi , Nakagawa Kohjin , Kohno Akihiro , Tokuda Makoto , Kiritani Keizi , Matsuo Kazunori , Mitsui Hideyuki , Fujii Tomohisa
Published: June 2016

Illiciomyia yukawai (Diptera: Cecidomyiidae) induces leaf galls on Illicium anisatum (Schisandraceae) and exhibits 1‐year (yr) and 2‐yr type life history patterns. Geographical and annual variations in the proportion of 2‐yr to 1‐yr type individuals of I. yukawai were studied from 1977 to 1994 and in 2008, 2009 and 2014. An analysis of geographical variation at 13 different census fields indicated that the proportion of 2‐yr type individuals significantly increased with the decrease of mean annual temperature reflected by altitudinal and latitudinal gradients. However, a multiple regression analysis indicated that the annual variation in the proportion was not correlated with temperature, gall density, abundance of host resources or parasitism by hymenopteran parasitoids. Thus, we eliminated the effects of these external factors that have been thought to determine the annual variation. We need to take alternative intrinsic factors, instead of external factors, into consideration to explain the annual variation. The fall of galled leaves occasionally caused a higher mortality of 2‐yr type individuals than those of 1‐yr type. Nevertheless, 2‐yr type individuals exist. We considered that the existence of 2‐yr type individuals of I. yukawai has an adaptive significance to diversify risks against catastrophic events such as the serious shortage of host buds and high percentage of parasitism that happen more frequently than the high mortality caused by the fall of galled leaves.
Open Arms Behind Barred Doors: Fear, Hypocrisy and Policy Schizophrenia in the European Migration Crisis
Authors: Greenhill Kelly M.
Published: June 2016

In 2015, over one million refugees and migrants arrived in Europe, laying bare the limitations of the EU's common border control and burden‐sharing systems. This article examines consequences of the EU's disjoint, schizophrenic and, at times, hypocritical responses to what has become known as the European migration crisis. It explains how unilateral, national‐level responses have made the EU as a whole particularly susceptible to a unique brand of coercive bargaining that relies on the threat (or actual generation) of mass population movements as a non‐military instrument of state‐level coercion. After outlining who employs this kind of foreign policy tool, to what ends, and under what circumstances, the article offers an illustration of this kind of coercion in action, by analyzing the March 2016 deal between the EU and Turkey. The article concludes with a discussion of broader consequences of the deal and implications both for the displaced and for the EU going forward.
Contrasting effects of field boundary management on three pollinator groups
Authors: Söderman Annika M.E. , Ekroos Johan , Hedlund Katarina , Olsson Ola , Smith Henrik G.
Published: June 2016

Uncultivated field boundaries constitute a significant part of the remaining semi‐natural habitat in simplified agricultural landscapes, providing habitats for many grassland species. In Europe, agri‐environment schemes (AES) offer incentives to farmers to manage farmland more environmentally friendly. In Sweden, one AES has specifically targeted management of incidental habitats on farmland by promoting removal of woody vegetation to benefit cultural heritage and biodiversity.

This study investigates if pollinating insects benefit from removal of woody vegetation and whether any such benefits depend on the structural complexity of the surrounding landscape. Using a nested study design, pollinator communities were compared in pairs of managed and unmanaged field boundaries in landscapes of different complexity.

The effect of removing trees and bushes in field boundaries varied among pollinator groups. Bumblebee species richness and abundance benefited from the management, whereas the species richness of solitary bees and hoverflies were unaffected. The abundance of solitary bees was higher in managed field boundaries, but only late in the season in complex landscapes, while the same management lowered the hoverfly abundance particularly late in the season. Landscape complexity did not affect bumblebees, while the abundance of solitary bees and the species richness of hoverflies were positively correlated with increasing landscape complexity, but at different spatial scales.

The contrasting effects of management on different organism groups shown in this study, illustrate the importance of studies conducted on multiple taxa. Management prescriptions based on results from one pollinator group may not benefit other pollinator groups.
Frequencies of red blood cell major blood group antigens and phenotypes in the Chinese Han population from Mainland China
Authors: Yu Y. , Ma C. , Sun X. , Guan X. , Zhang X. , Saldanha J. , Chen L. , Wang D.
Published: June 2016

Alloantibodies directed to red blood cell (RBC) antigens play an important role in alloimmune‐mediated haemolytic transfusion reactions and haemolytic disease of the foetus and newborn. The frequencies and phenotypes of RBC antigens are different in populations from different geographic areas and races. However, the data on major blood group antigens in the Chinese Han population from Mainland China are still very limited; thus, we aimed to investigate them in this study. A total of 1412 unrelated voluntary Chinese Han blood donors were randomly recruited. All donors were typed for blood group antigens: D, C, c, E, e, Cw, Jka, Jkb,M, N, S, s, Lea, Leb, K, k. Kpa, Kpb, Fya, Fyb, Lua, Lub, P1 and Dia using serological technology. Calculations of antigen and phenotype frequencies were expressed as percentages and for allele frequencies under the standard assumption of Hardy–Weinberg equilibrium. Amongst the Rh antigens, D was the most common (98.94%) followed by e (92.28%), C (88.81%), c (58.43%), E (50.78%) and Cw (0.07%) with DCe/DCe (R1R1, 40.72%) being the most common phenotype. In the Kell blood group system, k was present in 100% of the donors and a rare phenotype, Kp (a+b+), was found in 0.28% of the donors. For the Kidd and Duffy blood group systems, Jk (a+b+) and Fy (a+b−) were the most common phenotypes (44.05% and 84.35%, respectively). In the MNS blood group system, M+N+S–s+ (45.54%) was the most common, whereas M+N–S–s− and M–N+S–s− were not found. The rare Lu (a−b−) and Lu (a+b+) phenotypes were identified in 0.43% and 1.13% of the donors, respectively. Lea and Leb were seen in 17.92% and 63.03% of donors, respectively. The frequency of Dia was 4.75%, which was higher than in the Chinese population in Taiwan region or the Caucasian and Black populations (P < 0.0001). This study systematically describes the frequencies of 24 blood group antigens in the Chinese Han population from Mainland China. The data can be helpful in creating a donor database for preparation of indigenous cell panels and providing antigen‐negative blood to patients with multiple alloantibodies.
Quantitative fetomaternal hemorrhage assessment with the use of five laboratory tests
Authors: Gielezynska A. , Stachurska A. , Fabijanska‐Mitek J. , Debska M. , Muzyka K. , Kraszewska E.
Published: June 2016

Introduction

In various countries, standard doses of anti‐D IgG used for postpartum immunoprophylaxis of hemolytic disease of fetus and newborn (HDFN) vary from 100 μg to 300 μg. There are also different regulations concerning FMH assessment, and opinions about applicable tests are inconclusive.

Methods

Three flow cytometry tests (FCTs) with anti‐D, anti‐HbF, anti‐HbF+CA antibodies, and two modifications of microscopic Kleihauer–Betke test (KBT) were used.

Results

In all artificial mixtures with known concentrations, FCTs and KBT with counting 10 000 RBCs had similar satisfying sensitivity and specificity. KBT with counting 2000 RBCs had to be disqualified because of significant discrepancies between expected and measured values of FMH. The test procedure with anti‐D was easier and shorter than the remaining tests, but it can be only used for FMH assessment in RhD‐negative mothers with RhD‐positive newborns. In one clinical sample, it was impossible to distinguish fetal RBCs from maternal F cells in KBT and FC with anti‐HbF but other tests were useful.

Conclusion

In the four tests, correlation between expected and obtained results was appropriate (CCC ̴1). Each test had some advantage and limitation in any clinical situation. Therefore, it is best to have opportunity to perform two or three assays in the laboratory.
Autophagy proteins in antigen processing for presentation on MHC molecules
Authors: Münz Christian
Published: June 2016

Autophagy describes catabolic pathways that deliver cytoplasmic constituents for lysosomal degradation. Since major histocompatibility complex (MHC) molecules sample protein degradation products and present them to T cells for adaptive immunity, it is maybe not too surprising that autophagy contributes to this protein antigen processing for MHC presentation. However, the recently recognized breath of pathways, by which autophagy contributes to MHC antigen processing, is exciting. Macroautophagy does not only seem to deliver intracellular but facilitates also extracellular antigen processing by lysosomal hydrolysis for MHC class II presentation. Moreover, even MHC class I molecules that usually display proteasomal products are regulated by macroautophagy, probably using a pool of these molecules outside the endoplasmic reticulum, where MHC class I molecules are loaded with peptide during canonical MHC class I antigen processing. This review aims to summarize these recent developments and point out gaps of knowledge, which should be filled by further investigation, in order to harness the different antigen‐processing pathways via autophagy for vaccine improvement.
MHC class I‐related molecule, MR1, and mucosal‐associated invariant T cells
Authors: Franciszkiewicz Katarzyna , Salou Marion , Legoux Francois , Zhou Qian , Cui Yue , Bessoles Stéphanie , Lantz Olivier
Published: June 2016

The MHC‐related 1, MR1, molecule presents a new class of microbial antigens (derivatives of the riboflavin [Vitamin B2] biosynthesis pathway) to mucosal‐associated invariant T (MAIT) cells. This raises many questions regarding antigens loading and intracellular trafficking of the MR1/ligand complexes. The MR1/MAIT field is also important because MAIT cells are very abundant in humans and their frequency is modified in many infectious and non‐infectious diseases. Both MR1 and the invariant TCRα chain expressed by MAIT cells are strikingly conserved among species, indicating important functions. Riboflavin is synthesized by plants and most bacteria and yeasts but not animals, and its precursor derivatives activating MAIT cells are short‐lived unless bound to MR1. The recognition of MR1 loaded with these compounds is therefore an exquisite manner to detect invasive bacteria. Herein, we provide an historical perspective of the field before describing the main characteristics of MR1, its ligands, and the few available data regarding its cellular biology. We then summarize the current knowledge of MAIT cell differentiation and discuss the definition of MAIT cells in comparison to related subsets. Finally, we describe the phenotype and effector activities of MAIT cells.
CD4+ T‐cell help amplifies innate signals for primary CD8+ T‐cell immunity
Authors: Bedoui Sammy , Heath William R. , Mueller Scott N.
Published: June 2016

CD8+ T cells provide an important component of protection against intracellular infections and cancer. Immune responses by these T cells involve a primary phase of effector expansion and differentiation, followed by a contraction phase leading to memory formation and, if antigen is re‐encountered, a secondary expansion phase with more rapid differentiation. Both primary and secondary phases of CD8+ T‐cell immunity have been shown to depend on CD4+ T‐cell help, although during certain infections the primary phase is variable in this requirement. One explanation for such variability relates to the strength of associated inflammatory signals, with weak signals requiring help. Here, we focus on our studies that have dissected the requirements for help in the primary phase of the CTL response to herpes simplex virus, elucidating intricate interactions and communications between CD4+ T cells, various dendritic cell subsets, and CD8+ T cells. We place our studies in the context of others and describe a simple model of help where CD40 signaling amplifies innate signals to enable efficient CD8+ T‐cell expansion and differentiation. This model facilitates CTL induction to various different agents, without altering the qualitative innate signals that direct other important arms of immunity.
The comings and goings of MHC class I molecules herald a new dawn in cross‐presentation
Authors: Blander J. Magarian
Published: June 2016

MHC class I (MHC‐I) molecules are the centerpieces of cross‐presentation. They are loaded with peptides derived from exogenous sources and displayed on the plasma membrane to communicate with CD8 T cells, relaying a message of tolerance or attack. The study of cross‐presentation has been focused on the relative contributions of the vacuolar versus cytosolic pathways of antigen processing and the location where MHC‐I molecules are loaded. While vacuolar processing generates peptides loaded onto vacuolar MHC‐I molecules, how and where exogenous peptides generated by the proteasome and transported by TAP meet MHC‐I molecules for loading has been a matter of debate. The source and trafficking of MHC‐I molecules in dendritic cells have largely been ignored under the expectation that these molecules came from the Endoplasmic reticulum (ER) or the plasma membrane. New studies reveal a concentrated pool of MHC‐I molecules in the endocytic recycling compartment (ERC). These pools are rapidly mobilized to phagosomes carrying microbial antigens, and in a signal‐dependent manner under the control of Toll‐like receptors. The phagosome becomes a dynamic hub receiving traffic from multiple sources, the ER–Golgi intermediate compartment for delivering the peptide‐loading machinery and the ERC for deploying MHC‐I molecules that alert CD8 T cells of infection.
Dendritic cell maturation and cross‐presentation: timing matters!
Authors: Alloatti Andrés , Kotsias Fiorella , Magalhaes Joao Gamelas , Amigorena Sebastian
Published: June 2016

As a population, dendritic cells (DCs) appear to be the best cross‐presenters of internalized antigens on major histocompatibility complex class I molecules in the mouse. To do this, DCs have developed a number of unique and dedicated means to control their endocytic and phagocytic pathways: among them, the capacity to limit acidification of their phagosomes, to prevent proteolytic degradation, to delay fusion of phagosomes to lysosomes, to recruit ER proteins to phagosomes, and to export phagocytosed antigens to the cytosol. The regulation of phagocytic functions, and thereby of antigen processing and presentation by innate signaling, represents a critical level of integration of adaptive and innate immune responses. Understanding how innate signals control antigen cross‐presentation is critical to define effective vaccination strategies for CD8+ T‐cell responses.
Mechanistic understanding and significance of small peptides interaction with MHC class II molecules for therapeutic applications
Authors: Afridi Saifullah , Hoessli Daniel C. , Hameed Muhammad Waqar
Published: June 2016

Major histocompatibility complex (MHC) class II molecules are expressed by antigen‐presenting cells and stimulate CD4+ T cells, which initiate humoral immune responses. Over the past decade, interest has developed to therapeutically impact the peptides to be exposed to CD4+ T cells. Structurally diverse small molecules have been discovered that act on the endogenous peptide exchanger HLA‐DM by different mechanisms. Exogenously delivered peptides are highly susceptible to proteolytic cleavage in vivo; however, it is only when successfully incorporated into stable MHC II–peptide complexes that these peptides can induce an immune response. Many of the small molecules so far discovered have highlighted the molecular interactions mediating the formation of MHC II–peptide complexes. As potential drugs, these small molecules open new therapeutic approaches to modulate MHC II antigen presentation pathways and influence the quality and specificity of immune responses. This review briefly introduces how CD4+ T cells recognize antigen when displayed by MHC class II molecules, as well as MHC class II–peptide‐loading pathways, structural basis of peptide binding and stabilization of the peptide–MHC complexes. We discuss the concept of MHC‐loading enhancers, how they could modulate immune responses and how these molecules have been identified. Finally, we suggest mechanisms whereby MHC‐loading enhancers could act upon MHC class II molecules.
Factors influencing decision‐making around family presence during resuscitation: a grounded theory study
Authors: Giles Tracey , de Lacey Sheryl , Muir‐Cochrane Eimear
Published: June 2016

Aim

The aim of this study was to examine factors impacting family presence during resuscitation practices in the acute care setting.

Background

Family presence during resuscitation was introduced in the 1980s, so family members/significant others could be with their loved ones during life‐threatening events. Evidence demonstrates important benefits; yet despite growing support from the public and endorsement from professional groups, family presence is practiced inconsistently and rationales for poor uptake are unclear.

Design

Constructivist grounded theory design.

Methods

Twenty‐five health professionals, family members and patients informed the study. In‐depth interviews were undertaken between October 2013–November 2014 to interpret and explain their meanings and actions when deciding whether to practice or participate in FPDR.

Findings

The Social Construction of Conditional Permission explains the social processes at work when deciding to adopt or reject family presence during resuscitation. These processes included claiming ownership, prioritizing preferences and rights, assessing suitability, setting boundaries and protecting others/self. In the absence of formal policies, decision‐making was influenced primarily by peoples’ values, preferences and pre‐existing expectations around societal roles and associated status between health professionals and consumers. As a result, practices were sporadic, inconsistent and often paternalistic rather than collaborative.

Conclusion

An increased awareness of the important benefits of family presence and the implementation of clinical protocols are recommended as an important starting point to address current variations and inconsistencies in practice. These measures would ensure future practice is guided by evidence and standards for health consumer safety and welfare rather than personal values and preferences of the individuals ‘in charge’ of permissions.
“You are either out on the court, or sitting on the bench”: understanding accountability from the perspectives of nurses and nursing managers
Authors: Leonenko Marina , Drach‐Zahavy Anat
Published: June 2016

Aims

The aims of this study were: (1) to understand the implicit and explicit perceptions of accountability from the perspective of bedside nurses and their managers; (2) to identify the factors that facilitate accountability behaviours.

Background

Despite the importance attributed to accountability in nursing education and practice, empirical research lacks clarity regarding how nurses perceive accountability and decide whether or not to act accountably.

Design

Qualitative study.

Method

Data of a purposeful sample of 23 nurses were collected through in‐depth semi‐structured interviews during 2015. They were tape‐recorded, transcribed verbatim and content analysed.

Results

Nurses agreed that accountability, more particularly responsibility, was crucial to nursing professionalism. However, they perceived the demands for transparency and answerability as unjustified. Bedside nurses held this view more than nursing managers. Still, accountability was not considered an integral organizational norm but the choice of each nurse and his or her assessment of risks or benefits of acting accountably.

Conclusions

Nurses’ individual accountability was insufficient to generate accountability behaviours. They tended to weigh up the unit's accountability level in gauging risks and benefits before acting accountably. Risks of accountability behaviour included isolation, resistance and bullying, while benefits included professionalism, empowerment and pride.
Transformational leadership in nursing: a concept analysis
Authors: Fischer Shelly A.
Published: June 2016

Aim

To analyse the concept of transformational leadership in the nursing context.

Background

Tasked with improving patient outcomes while decreasing the cost of care provision, nurses need strategies for implementing reform in health care and one promising strategy is transformational leadership. Exploration and greater understanding of transformational leadership and the potential it holds is integral to performance improvement and patient safety.

Design

Concept analysis using Walker and Avant's (2005) concept analysis method.

Data sources

PubMed, CINAHL and PsychINFO.

Methods

This report draws on extant literature on transformational leadership, management, and nursing to effectively analyze the concept of transformational leadership in the nursing context.

Implications for nursing

This report proposes a new operational definition for transformational leadership and identifies model cases and defining attributes that are specific to the nursing context. The influence of transformational leadership on organizational culture and patient outcomes is evident. Of particular interest is the finding that transformational leadership can be defined as a set of teachable competencies. However, the mechanism by which transformational leadership influences patient outcomes remains unclear.

Conclusion

Transformational leadership in nursing has been associated with high‐performing teams and improved patient care, but rarely has it been considered as a set of competencies that can be taught. Also, further research is warranted to strengthen empirical referents; this can be done by improving the operational definition, reducing ambiguity in key constructs and exploring the specific mechanisms by which transformational leadership influences healthcare outcomes to validate subscale measures.
Beware of “reducing prejudice”: imagined contact may backfire if applied with a prevention focus
Authors: West Keon , Greenland Katy
Published: June 2016

Imagined intergroup contact—the mental simulation of a (positive) interaction with a member of another group—is a recently developed, low‐risk, prejudice‐reducing intervention. However, regulatory focus can moderate of the effects of prejudice‐reducing interventions: a prevention focus (as opposed to a promotion focus) can lead to more negative outcomes. In two experiments we found that a prevention focus altered imagined contact's effects, causing the intervention to backfire. In Experiment 1, participants who reported a strong prevention‐focus during imagined contact subsequently reported higher intergroup anxiety and (indirectly) less positive attitudes toward Asians. We found similar moderating effects in Experiment 2, using a different outgroup (gay men) and a subtle regulatory focus manipulation. Theoretical and practical implications for imagined contact are discussed.
Analysis of Red Sea fish species' introductions into the Mediterranean reveals shifts in introduction patterns
Authors: Samaha Carol , zu Dohna Heinrich , Bariche Michel
Published: June 2016

Aim

The Mediterranean Sea is one of the most threatened marine systems in the world. One of the major threats is the introduction of alien species from the Red Sea through the Suez Canal into the Mediterranean. The aim of our study was to address two interrelated questions, namely which traits of Red Sea fish species are associated with the species' introduction into the Mediterranean Sea and how the introduction patterns changed over time.

Location

Red Sea and Mediterranean Sea

Methods

We used Cox regressions to identify traits of Red Sea species that are associated with the rate at which new alien Red Sea species are recorded in the Mediterranean (hazard rate) and to identify groups of species with different temporal trends of their baseline hazard rates. We fitted latent‐variable models to determine whether different trends in baseline hazard rates can be attributed to trends in detection or introduction.

Results

Our results showed that the highest hazard rate occurred among pelagic species, species living over soft bottoms, species present in small families and species recorded in the Red Sea close to the Suez Canal. We also found that alien species could be separated into three groups with different temporal trends in baseline hazard rates. The different trends were due to changes in introduction rate rather than detection. Two groups with historically low introduction rate showed an increase in introduction rate over time.

Main conclusions

Our results provide novel biogeographical explanations for introduction patterns that were previously attributed to the effects of sea surface temperature and interspecific competition. The trends uncovered by our analysis indicate that the profile of introduced species is changing with potentially profound consequences for the Mediterranean Sea.
Dominance has a biogeographical component: do plants tend to exert stronger impacts in their invaded rather than native range?
Authors: Hejda Martin , Štajerová Kateřina , Pyšek Petr
Published: June 2016

Aim

Using three North American species invading Europe (Aster novi‐belgii, Lupinus polyphyllus and Solidago canadensis) and three European species invading North America (Agrostis capillaris, Bromus tectorum and Cirsium arvense), we tested (1) whether the dominant species impact differs between its native and invaded ranges and (2) whether the impacts differ according to the direction of invasion (from Europe to North America and vice versa).

Location

North America (USA) and central Europe (Czech Republic).

Methods

The dominance of the selected species was expressed as its relative cover, and its relationship to species richness was tested using marginal and mixed‐effect regression models.

Results

All the three North American species invading Europe suppressed species richness in the native range, while only two (A. novi‐belgii and L. polyphyllus) impacted native species richness in the invaded range. On the contrary, of the three European species invading North America, only A. capillaris was found to suppress species richness in its native range, while all three suppressed it in the invaded range. Overall, the richness of native species responded significantly more negatively to the dominant species cover in its invaded rather than native range, regardless of the identity of the dominant species.

Main conclusions

Invasive species suppress diversity more in the invaded range, and European invaders have more profound impacts in North America than North American invaders in Europe. We suggest that long‐term coexistence and species filtering are responsible for the lower impacts in the native range, while large‐scale evolutionary patterns are likely to be associated with the more profound impacts of selected European species as invaders in North America than vice versa.
Biogeography of anurans and squamates in the Cerrado hotspot: coincident endemism patterns in the richest and most impacted savanna on the globe
Authors: Azevedo Josué A. R. , Valdujo Paula H. , de C. Nogueira Cristiano
Published: June 2016

Aim

To analyse ranges of endemic squamates and anurans in the Cerrado hotspot, searching for coincident distributional patterns in two ecologically distinct clades, and proposing a testable and comprehensive regionalization scheme for the richest and most threatened savanna on the planet.

Location

Cerrado region, central South America.

Methods

We updated previous point‐locality compilations for endemic species of the Cerrado herpetofauna, gathering 4588 unique occurrence records. Using a 1° grid cell, we compared regionalization results of biotic element (BE) and endemicity analyses. To search for a unified regionalization pattern, we compared analyses with a combined dataset (anurans + squamates) with those obtained in single‐group analyses.

Results

The analysis with the combined dataset recovered more complete results than those in taxon‐specific analyses. We found 13 main biogeographical units formed by anurans and squamates that were recovered in both analyses with the combined dataset, and formed our general regionalization scheme. In general, biogeographical units defined by BEs correspond to those recovered by endemicity analysis with the combined dataset. Most recovered biogeographical units were formed both by anurans and squamates, with fewer areas determined solely by one group.

Main conclusions

Common regionalization processes operated on both anurans and squamates, shaping general biogeographical patterns for the Cerrado. The general regionalization pattern recovered with anurans and squamates may be valid for other taxa, and should be tested in future studies. As in previous results, most biogeographical units are found over ancient plateaus, separated by peripheral depressions. These major topographical barriers may explain major coincident patterns, linking the evolution of Cerrado biotas to the geomorphological history of the Brazilian shield.
The effect of elevation and time on mountain spider diversity: a view of two aspects in the Cederberg mountains of South Africa
Authors: Foord Stefan H. , Dippenaar‐Schoeman Anna S.
Published: June 2016

Aim

Our aim is to test if long‐term patterns in α alpha and β beta diversity along an elevational transect on two aspects of a mountain are consistent through time using spiders as model organisms, quantify the role of elevation and time (seasonal and inter‐annual) in explaining these patterns and partition the relative contribution of nestedness, species turnover and species loss in explaining these diversity patterns.

Location

The transect is across the Cederberg mountains in the Cape Floristic Kingdom, Western Cape, South Africa and is constituted by 17 sites with an elevational range of 1900 m on two aspects of the mountain (east and west).

Methods

Spider assemblages were sampled biannually (wet and dry seasons) over 6 years. Four replicates per site, each consisting of a 5 × 2 pitfall grid, were sampled for 5 days sessions. Generalized linear mixed models with Poisson error structure for species richness (alpha diversity), binomial error structure for beta diversity (Jaccard dissimilarity βccand its partitioned components, β‐3and βrich), and Gaussian error structure for beta diversity values standardized by a null model (SES) were used to model the effects of elevation and season on these two indices respectively.

Results

Although varying considerably between years, spider alpha diversity had a hump‐shaped pattern on the western aspect and U‐shaped on the eastern aspect. However, season interacted with elevation to produce more complex patterns during the dry season. There was no significant nestedness except for two instances on the western aspect. Replacement accounted for 60–70% of beta diversity between sites, and elevational distance decay in beta diversity was the result of increased turnover on the western aspect and increased species loss on the eastern aspect. Standardized patterns suggest that there are no effects of season on beta diversity except for a decreased distance decay during the dry season on the western aspect.

Main conclusions

Large‐scale predictors of spider alpha diversity explained small amounts variation in spider diversity, pointing to the importance of local and stochastic processes. Regional turnover of spider diversity is mainly the result of niche processes, suggesting localized adaptation of taxa, further supported by the lack of nestedness in assemblages.
Cognitive Reserve and Postoperative Delirium in Older Adults
Authors: Tow Amanda , Holtzer Roee , Wang Cuiling , Sharan Alok , Kim Sun Jin , Gladstein Aharon , Blum Yossef , Verghese Joe
Published: June 2016

Objectives

To examine the role of cognitive reserve in reducing delirium incidence and severity in older adults undergoing surgery.

Design

Prospective cohort study.

Setting

Hospital.

Participants

Older adults (mean age 71.2, 65% women) undergoing elective orthopedic surgery (N = 142).

Measurements

Incidence (Confusion Assessment Method) and severity (Memorial Delirium Assessment Scale) of postoperative delirium were the primary outcomes. Predictors included early‐ (literacy) and late‐life (cognitive activities) proxies for cognitive reserve.

Results

Forty‐five participants (32%) developed delirium. Greater participation in cognitive activity was associated with lower incidence (odds ratio = 0.92 corresponding to increase of 1 activity per week, 95% confidence interval (CI) = 0.86–0.98, P = .006) and severity (B = −0.06, 95% CI = −0.11 to −0.01, P = .02) of delirium after adjustment for age, sex, medical illnesses, and baseline cognition. Greater literacy was not associated with lower delirium incidence or severity. Of individual leisure activities, reading books, using electronic mail, singing, and computer games were associated with lower dementia incidence and severity.

Conclusion

Greater late‐life cognitive reserve was associated with lower delirium incidence and severity in older adults undergoing surgery. Interventions to enhance cognitive reserve by initiating or increasing participation in cognitive activities may be explored as a delirium prophylaxis strategy.
Validation of the interRAI Pressure Ulcer Risk Scale in Acute Care Hospitals
Authors: Xie Haiyan , Peel Nancye M. , Hirdes John P. , Poss Jeff W. , Gray Leonard C.
Published: June 2016

Objectives

To validate the Pressure Ulcer Risk Scale (PURS) to screen for pressure ulcer (PU) outcomes in the acute hospital setting.

Design

Secondary data analysis was undertaken using a combined dataset from three prospective cohort studies.

Setting

General medical, surgical, and orthopedic wards in 11 hospitals in two states of Australia.

Participants

Individuals aged 70 and older admitted to the hospital for longer than 48 hours from July 2005 to May 2010 (N = 1418). Individuals in coronary or intensive care units, palliative care, or transferred out of the ward within 24 hours were excluded.

Measurements

Trained nurses used the international Resident Assessment Instrument (interRAI) Acute Care (AC) assessment tool to collect data at admission and discharge. Adverse outcomes were documented on daily ward visits. The PURS was calculated from interRAI items, and its association with PU outcomes was tested using the c‐statistic (area under the receiver operator characteristic curve).

Results

Complete data were available for 1,371 (96.7%) participants, 85 of whom (6.2%) had a PU at admission. Of the 1,286 without PUs at admission, 42 (3.3%) developed a new PU during their hospital stay. The association between PURS and outcomes had a c‐statistic of 0.81 (standard error (SE) 0.02) for prevalent ulcers at admission and 0.70 (SE 0.04) for incidence of new PUs.

Conclusion

When derived from the interRAI AC tool, the PURS demonstrated good to strong ability to screen for PU outcome in acute care. Assessment burden is reduced without loss of fidelity by integrating the risk scale into an existing assessment system.
Improving Prospective Memory in Healthy Older Adults and Individuals with Very Mild Alzheimer's Disease
Authors: Shelton Jill Talley , Lee Ji Hae , Scullin Michael K. , Rose Nathan S. , Rendell Peter G. , McDaniel Mark A.
Published: June 2016

Objectives

To test the utility of a memory‐encoding strategy for improving prospective memory (PM), the ability to remember to execute future goals (e.g., remembering to take medications), which plays an important role in independent living in healthy older adults and those with very mild Alzheimer's disease (AD).

Design

Participants were randomly assigned to an encoding strategy condition or a standard encoding condition.

Setting

A longitudinal study conducted at an Alzheimer's disease research center. Testing took place at the center and in a university testing room.

Participants

Healthy older adults (Clinical Dementia Rating (CDR) = 0.0, n = 38) and those classified as being in the very mild stage of AD (CDR = 0.5, n = 34).

Intervention

A simple strategy (“If I see Cue X, then I will perform Intention Y”) was used to strengthen PM encoding and reduce the probability of forgetting to execute one's future plans.

Measurements

PM was assessed using Virtual Week, a laboratory task that requires the simulation of common PM tasks (the types of tasks performed in everyday life), such as taking one's medication at breakfast.

Results

The encoding strategy significantly reduced PM failures in healthy older adults and those with very mild AD and was effective regardless of the individual's episodic memory ability.

Conclusion

This encoding strategy was successful in reducing PM errors in healthy older adults and those with mild AD with a range of memory abilities.
Prevalence and Incidence of Frailty in Community‐Dwelling Older People: Beijing Longitudinal Study of Aging II
Authors: Zheng Zheng , Guan Shaochen , Ding Hui , Wang Zhihui , Zhang Jin , Zhao Jing , Ma Jinghong , Chan Piu
Published: June 2016

Objectives

To estimate the prevalence and incidence of frailty and evaluate the effect of frailty on adverse outcomes in Chinese elderly adults.

Design

Secondary analysis of prospective cohort study.

Setting

Community in Beijing, China.

Participants

Individuals aged 55 and older (N = 10,039).

Measurements

A Frailty Index (FI) was derived from 34 items using Rockwood's cumulative deficits method. A FI of 0.25 or greater indicated frailty. The clinical outcome was evaluated using a composite variable of any of the following adverse events: falls, hospitalization, activity of daily living disability, and death.

Results

The overall crude prevalence of frailty was 12.3% (95% confidence interval (CI) = 11.7–13.0%), and the standardized prevalence was 9.1% (95% CI = 8.6–9.7%). The crude incidence was 13.0% (95% CI = 12.2–13.9%), and the standardized incidence 10.8% (95% CI = 10.0–11.6%). Prevalence and incidence were significantly greater with age (P for trend < .001) and greater in women (P < .001) and urban residents (P < .001). Participants with lower education and having three or more diseases and taking four or more medications daily were more likely to develop frailty over follow‐up (all P < .05). After adjusting for age, number of diseases, and smoking at baseline, the risk of any adverse event in 1 year in the frail group was 58% higher than in the nonfrail group (adjusted odds ratio = 1.58, 95% CI = 1.30–1.93, P < .001).

Conclusion

A feasible FI that can be used in routine medical evaluation in a primary care setting was developed, and a 12.3% prevalence and a 13% incidence of frailty was demonstrated in community‐dwelling Chinese older adults. Frailty is more common for urban and female residents in the oldest old group. Being frail significantly predicts geriatric adverse outcomes, indicating the importance of early screening and intervention in frail individuals in primary care.
“If You Don't Know, All of a Sudden, They're Gone”: Caregiver Perspectives About Prognostic Communication for Disabled Elderly Adults
Authors: Cagle John G. , McClymont Keelan M. , Thai Julie N. , Smith Alexander K.
Published: June 2016

Objectives

To describe preferences and experiences of caregivers of disabled older adults regarding being included in patient‐clinician discussions about life expectancy.

Design

Qualitative interview study.

Setting

Caregivers were recruited from a Program of All‐Inclusive Care for the Elderly (PACE), caregiver support groups and an advertisement on a nationwide caregiver advocacy group website.

Participants

Active and bereaved caregivers whose primary language was either English or Cantonese who had provided care within the last 5 years to a disabled adult aged 65 and older (N = 42, 79% female, 60% white, average age 54).

Measurements

Semistructured telephone interviews were conducted with caregivers who were asked about experiences and preferences related to clinician communication about life expectancy, including preferences for and attitudes toward being included in discussions about life expectancy, how such information should be delivered, and how clinicians should address concerns about uncertainty and hope. Responses were analyzed qualitatively using constant comparison until thematic saturation was reached.

Results

Twenty‐six percent of caregivers had been involved in a conversation with a clinician about life expectancy, even though 79% expressed a preference to have such a discussion. According to caregivers, clinician concerns about taking away hope or the uncertainty of prognostic information should not deter them from bringing up the topic of life expectancy. Thematic analysis suggested several approaches that may facilitate prognosis communication: establishing a relationship with the caregiver and care recipient; delivering the prognosis in clear, plain language; and responding to emotion with empathy.

Conclusion

Caregivers reported a preference for being included in conversations about a care recipient's life expectancy.
Telemedicine for Specialist Geriatric Care in Small Rural Hospitals: Preliminary Data
Authors: Gray Leonard C. , Fatehi Farhad , Martin‐Khan Melinda , Peel Nancye M. , Smith Anthony C.
Published: June 2016

Small rural hospitals admit and manage older adults who, in city hospitals, would usually be offered geriatrician‐supported comprehensive geriatric assessment and coordinated subacute care if required. Distance and diseconomies of scale prohibit access to the conventional in‐person approach. A telegeriatric service model involving a geriatrician consulting remotely using wireless, mobile, high‐definition videoconferencing; a trained host nurse at the rural site; structured geriatric assessment configured on a web‐based clinical decision support system; routine weekly virtual rounds; and support from a local multidisciplinary team was established to overcome these barriers. This was a prospective observational study to examine the feasibility and sustainability of the model. Patient characteristics were recorded using the interRAI Acute Care assessment system. Usage patterns were derived from health service data sets and a service statistics database. Patients had characteristics that are consistent with characteristics of individuals typically referred for geriatric assessment. Overall, 53% of patients had cognitive impairment, 75% had limitations with activities of daily living, and the average Frailty Index was 0.44 ± 0.12. Stable patterns of consultation occurred within 6 months of start‐up and continued uninterrupted for the remainder of the 24‐month observation period. The estimated overall rate of initial consultation was 1.83 cases per occupied bed per year and 2.66 review cases per occupied bed per year. The findings indicate that the model was feasible and was sustained throughout and beyond the study period. This telegeriatric service model appears suitable for use in small rural hospitals.
A New Standard in Dementia Knowledge Measurement: Comparative Validation of the Dementia Knowledge Assessment Scale and the Alzheimer's Disease Knowledge Scale
Authors: Annear Michael J. , Eccleston Claire E. , McInerney Frances J. , Elliott Kate‐Ellen J. , Toye Christine M. , Tranter Bruce K. , Robinson Andrew L.
Published: June 2016

Objectives

To compare the psychometric performance of the Dementia Knowledge Assessment Scale (DKAS) and the Alzheimer's Disease Knowledge Scale (ADKS) when administered to a large international cohort before and after online dementia education.

Design

Comparative psychometric analysis with pre‐ and posteducation scale responses.

Setting

The setting for this research encompassed 7,909 individuals from 124 countries who completed the 9‐week Understanding Dementia Massive Open Online Course (MOOC).

Participants

Volunteer respondents who completed the DKAS and ADKS before (n = 3,649) and after (n = 878) completion of the Understanding Dementia MOOC.

Measurements

Assessment and comparison of the DKAS and ADKS included evaluation of scale development procedures, interscale correlations, response distribution, internal consistency, and construct validity.

Results

The DKAS had superior internal consistency, wider response distribution with less ceiling effect, and better discrimination between pre‐ and posteducation scores and occupational cohorts than the ADKS.

Conclusion

The 27‐item DKAS is a reliable and preliminarily valid measure of dementia knowledge that is psychometrically and conceptually sound, overcomes limitations of existing instruments, and can be administered to diverse cohorts to measure baseline understanding and knowledge change.