bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of a Self‐Medication Program
Authors: Pereles L. , Romonko L. , Murzyn T. , Hogan D. , Silvius J. , Stokes E. , Long S. , Fung T.
Published: April 2015

OBJECTIVE: To determine the effect of an inpatient self‐medication program (SMP) on the ability to self‐medicate, patient medication knowledge, compliance, and patient morale.

DESIGN: Randomized controlled clinical trial.

POPULATION: One hundred seven consecutive patients admitted to a geriatric assessment and rehabilitation program were randomized to either participate in the SMP or to receive standard care.

INTERVENTION: The SMP was a three‐stage program in which patients were given increasing responsibility for the administration of their own medications.

MEASUREMENTS: Ability to self‐medicate on discharge from hospital; medication compliance at 1 month; patient medication knowledge; Philadelphia Morale Scale.

MAIN RESULTS: Participation in the self‐medication program did not increase the proportion of patients who were able to self‐medicate on discharge from hospital. Compliance was improved by the program. On a proportional basis, the self‐medication group made significantly fewer medication errors than the control group at 1‐month follow‐up (0.045 vs 0.086, P < .001). There were no significant differences in morale or medication knowledge between the SMP and control groups, although both groups made significant gains in knowledge about the names, administration times, and purposes of their medications from admission to follow‐up (P < .001).

CONCLUSIONS: A SMP can improve compliance in geriatric patients who are discharged to the community. Participation in a SMP does not improve patients' morale nor does it improve their medication knowledge more than pharmacy counselling alone. Participation in a SMP is unlikely to increase the probability that patients will be able to self‐medicate on discharge. Cognitive factors limit patients' ability to self‐medicate. J Am Geriatr Soc 44:161–165, 1996.
Depression and Disability in Older People with Impaired Vision: A Follow‐Up Study
Authors: Rovner Barry W. , Zisselman Pamela M. , Shmuely‐Dulitzki Yochi
Published: April 2015

OBJECTIVE: To determine the prevalence of depressive symptoms and their relationship to disability in older low vision patients.

DESIGN: Panel study with 2‐year follow‐up.

PARTICIPANTS: Community‐residing older people (N = 31).

MEASUREMENTS: Geriatric Depression Scale, Community Disability Scale, and Snellen visual acuity.

RESULTS: Twelve of 31 patients (38.7%) had GDS scores ≥ 11 at baseline. Two years later, 10 of these 12 patients remained depressed, and three of the 19 (15.8%) previously nondepressed patients had become depressed. Depressed patients tended to be more disabled functionally than nondepressed patients at follow‐up.

The correlation of disability with depression and with vision were examined for the entire sample and revealed a strong correlation between disability and depression (r = .40; P = .013) compared with that of disability and vision (r = .34; P = .032) at baseline and at follow‐up: depression (r = .68; P = .001), vision (r = .45; P = .006). There was no significant correlation between depression and vision at baseline (r = .06; P = .383), but there was a trend toward correlation at follow‐up (r = .28; P = .067).

CONCLUSION: Depressive symptoms are prevalent and persistent among low vision patients and appear more highly related to disability than is vision. The frequent occurrence of depression and the availability of effective treatment argue for its recognition and treatment as possible ways to reduce disability in older persons with low vision. J Am Geriatr Soc 44:181–184, 1996.
Urinary Incontinence in Rural Older Women: Prevalence, Incidence and Remission
Authors: Nygaard Ingrid E. , Lemke Jon H.
Published: April 2015

OBJECTIVES

To determine the prevalence, incidence, and remission rates of urinary incontinence in a large group of older women over a 6‐year time span and to assess factors associated with incontinence incidence and remission.

DESIGN

Longitudinal cohort study

SETTING

Two rural counties in Iowa

PARTICIPANTS

2025 women aged 65 years or older residing in rural Iowa, enrolled in the Iowa 65+ Rural Health Study of EPESE (Establishment of Populations for Epidemiologic Studies of the Elderly) were interviewed in person annually for 6 years; specific responses to queries about urinary incontinence were given at baseline, 3‐, and 6‐year intervals.

MEASUREMENTS

Conditional multivariate logistic regression analysis was done to assess the relationship between incontinence symptoms and various factors previously found to be related to incontinence.

RESULTS

The baseline prevalence of urge incontinence was 36.3%, and of stress incontinence it was 40.3%. For urge incontinence, the 3‐year incidence and remission rates between the third and sixth years were 28.5% and 22.1%, respectively. For stress incontinence, the 3‐year incidence and remission rates between years 3 and 6 were 28.6% and 25.1%, respectively. Seventy‐six percent and 84% of women who reported no urge or stress incontinence, respectively, at the baseline interview were continent at both follow‐up interviews. The only significant factors related to changes in incontinence status were age, which was associated with an increased incidence of urge incontinence (OR 1.11, P = .017, 95% CI 1.019–1.203), and improvement in activities of daily living, which was associated with a increased remission of urge incontinence (OR 0.50, P = .015, 95% CI 0.28–0.9)

CONCLUSION

In some older women, urinary incontinence is a dynamic state, with women moving back and forth along a continuum between continence and incontinence. These results are tempered by limitations of the study, which include its questionnaire design and lack of ability to detect potential treatment effect.
Affective Disturbances in Alzheimer's Disease
Authors: Bungener Catherine , Jouvent Roland , Derouesné Christian
Published: April 2015

OBJECTIVE

To evaluate the emotional disturbances in patients with Alzheimer's disease (AD) using both a categorical and a dimensional approach.

DESIGN

Prospective study.

SETTING

Outpatient clinic in a neurological department from a general University Teaching Hospital.

MEASURES

A semi‐structured interview was used to fill in the Hamilton Depression Rating Scale, the Retardation Rating Scale for depression, the Tyrer and Covi scales for anxiety, and the Depressive Mood Scale for emotional disturbances. The cognitive status was assessed by the Mini‐Mental State Examination and the Mattis Dementia Rating Scale.

PATIENTS

One hundred eighteen consecutive AD outpatients fitting the criteria for probable or possible AD, according to the National Institute of Neurological and Communication Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association, were compared with 34 community‐dwelling healthy older controls and with 20 inpatients meeting the diagnostic criteria for depression according to the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition‐Revised.

RESULTS

No AD patient met the criteria for Major Depressive Episode or Generalized Anxiety Disorder, but 10 (8%) met the criteria for Dysthymic Disorder. AD patients scored significantly higher than the control group but lower than the depressed group for depressive and anxious symptomatology. Depressive symptomatology was correlated negatively to the cognitive status and positively to anxious symptomatology. Two main dimensions in emotional disturbances were described using the Depressive Mood Scale: Emotional Deficit (anhedonia, hypoexpressiveness) and Loss of Control (felt irritability, hyperexpressiveness). Emotional Deficit was correlated positively to the depressive symptomatology and correlated negatively to the cognitive status and the Loss of Control dimension. Loss of Control was correlated positively to the severity of the depressive and anxious symptomatology and weakly to cognitive performance.

CONCLUSION

Affective changes were found frequently in AD patients, but no major affective disorder was found. The dimensional approach seems to be more appropriate than the categorical approach to describe the emotional disturbances in these patients.
A Comparison by Payor/Provider Type of the Cost of Dying Among Frail Older Adults
Authors: Experton Bettina , Ozminkowski Ronald J. , Branch Laurence G. , Li Zili
Published: April 2015

OBJECTIVE

To compare expenditures and healthcare service use between decedents (in their last year of life) and survivors, all of whom were frail older people, under three payor/provider types.

DESIGN

In‐home interviews were conducted by home care nurses at baseline and at 6‐month intervals for an 18‐month period. Utilization and cost data were collected directly from providers and the Health Care Financing Administration for 12 months immediately before death for decedents and for the first 12 months of follow‐up for survivors.

SAMPLE

Five hundred seventy‐seven frail older patients of an integrated healthcare system who were receiving physician prescribed home health services, under Medicare fee‐for‐service (FFS), Medicare HMO, or Medicare‐Medicaid coverage. Frailty was defined as the receipt of physician‐prescribed home healthcare services.

OUTCOME MEASURES

Acute and long‐term healthcare service utilization and expenditures; total healthcare expenditures.

RESULTS

After controlling for baseline differences, significant differences in utilization and expenditures of survivors (n = 450) and decedents (n = 127) were demonstrated. Compared with survivors, frail older decedents were approximately:

7 times as likely to have had any hospital admissions

3 times as likely to have had one or more emergency room visits

8 times as likely to have 30 or more physician visits

4 times as likely to have been admitted to a skilled nursing facility and twice as likely to have used home health services after the baseline episode.

On average, total expenditures for decedents were 276% higher than for survivors. Total expenditures for Medicaid‐Medicare beneficiaries were 42% higher than expenditures for FFS participants, primarily because of higher hospitalization and emergency room expenditures. There were no differences in utilization and expenditures between HMO enrollees and FFS beneficiaries. Finally, interactions between decedent status and payor/provider were not statistically significant in multivariate analyses.

CONCLUSION

During the last year of life, frail older people exhibit the same pattern of higher expenditures and service utilization as the general Medicare population. However, differences between decedents' and survivors' healthcare expenditures and resource use did not vary by payor/provider. Thus, cost‐containment strategies should focus on new forms of managing healthcare services beyond those currently practiced within Medicare HMOs, traditional FFS, or Medicare‐Medicaid in California.
Individual Sulfonylureas and Serious Hypoglycemia in Older People
Authors: Shorr Ronald I. , Ray Wayne A. , Daugherty James R. , Griffin Marie R.
Published: April 2015

OBJECTIVE: To compare the risk of serious hypoglycemia associated with the use of individual sulfonylureas in older people.

DESIGN: A retrospective cohort study

SETTING: The Tennessee Medicaid Program

PATIENTS: A total of 13,963 Medicaid enrollees, aged 65 years or older, who were prescribed one of six sulfonylureas from 1985 to 1989.

MAIN OUTCOME MEASURE: Hospitalization, emergency room admission, or death associated with neuroglycopenic or autonomic symptoms, myocardial infarction, stroke, or injury, with a concomitant blood glucose determination of less than 2.8 mmol/L (50 mg/dL).

RESULTS: We identified 255 persons with a first episode of serious hypoglycemia during 20,715 person‐years of sulfonylurea use. The crude rate (per 1000 person‐years) of serious hypoglycemia was highest in glyburide users, 16.6 (95% confidence interval [CI], 13.2 to 19.9) and lowest among users of tolbutamide, 3.5 (95% CI, 1.2 to 5.9). Users of tolbutamide, tolazamide, and glipizide had lower risks of serious hypoglycemia than users of chlorpropamide, whereas the risk of serious hypoglycemia among glyburide users did not differ from that of chlorpropamide users. Among second generation sulfonylureas, the adjusted relative risk of severe hypoglycemia among glyburide users, compared with glipizide users, was 1.9 (95% CI, 1.2 to 2.9). An increased risk of serious hypoglycemia associated with use of glyburide compared with glipizide occurred in all strata, including those defined by gender, race, nursing home residence, dose, and duration of use.

CONCLUSIONS: Significant differences in risk of serious hypoglycemia were observed among users of individual agents. This may be explained by duration, timing, or potency of hypoglycemic action. These data confirm previous findings that chlorpropamide use is associated with high risk of hypoglycemia and indicate that among second generation sulfonylureas, glipizide is less associated with hypoglycemia than is glyburide. More information comparing the effectiveness of glycemic control among individual sulfonylureas is needed to assist prescribers in selecting a specific agent for use in clinical practice.
Cross‐Discipline Disparities in Perceptions of Mental Disorders in a Long‐Term Care Facility
Authors: Podgorski Carol Ann , Tariot Pierre N. , Blazina Linda , Cox Christopher , Leibovici Adrian
Published: April 2015

OBJECTIVES: This study compared prevalence rates of mental disorders in a single long‐term care facility as perceived by three professional disciplines and compared professionals' perceptions with two standardized measures of psychopathology

DESIGN: Comparison of (1) prospective standardized psychiatric evaluations performed by psychiatrists, (2) chart reviews of mental disorders as documented by primary care physicians, and (3) interviews of nurses.

SETTING: The residential health care facility at Monroe Community Hospital in Rochester, New York.

PARTICIPANTS: A 20% random sample of adult residents, stratified by ward(n = 80).

MEASUREMENTS: Prevalence rates of psychopathology as determined by each data collection method: psychiatric diagnoses as determined by psychiatrists and primary care physicians, the Brief Psychiatric Rating Scale, and the Psychogeriatric Dependency Rating Scale.

RESULTS: Prevalence rates of psychopathology ranged from 60 to 91% across discipline‐specific data collection methods. Using psychiatrists' diagnoses as the benchmark, primary care physicians and nurses underestimated the prevalence of mental disorders, particularly organic mental disorders. All disciplines agreed on the presence of personality and developmental disorders. The Brief Psychiatric Rating Scale and Psychogeriatric Dependency Rating Scale validated perceptions of psychopathology by psychiatrists and nurses, but not by primary care physicians' chart diagnoses.

CONCLUSION: Disparities in perceptions of mental disorders across disciplines pose a threat to patient care and suggest a need for more reliable incorporation of mental health expertise in the long‐term care setting.
Postural Hypotension and Dizziness in a General Aged Population: A Four‐Year Follow‐Up of the Helsinki Aging Study
Authors: Tilvis Reijo S. , Hakala Suvi‐Marja , Valvanne Jaakko , Erkinjuntti Timo
Published: April 2015

OBJECTIVE: To evaluate the frequency, risk factors, and prognostic significances of postural hypotension (PH) and dizziness on postural testing (DPT).

DESIGN: A prospective cohort study.

SETTING: General community, The Helsinki (Finland) Aging Study.

SUBJECTS: Persons of three age cohorts (75, 80, and 85 years, n = 569) were chosen randomly and followed for 4 years.

MEASURES: Postal questionnaires, structured interview, extensive clinical and laboratory examinations, blood pressure (BP) changes in a postural test using different definitions for PH, history of dizziness, dizziness on testing postural blood pressure reactions (DPT), and date of death during a 4‐year follow‐up.

RESULTS: The frequency of a fall in systolic blood pressure greater than 20 mm Hg or a fall in diastolic pressure greater than 10 mm Hg (PH‐I) was 30.3%. Both criteria occurred simultaneously (PH‐II) in 7.5%, and if dizziness on postural testing (DPT) was an additional symptom (PH‐III), the prevalence was 2.6%. The overall prevalence of DPT was 19.7%. PH‐I, PH‐II, and DPT were also frequent among the healthy aged (26.6%, 6.6%, and 17.3%, respectively). The postural change in BP correlated inversely with the initial supine BP levels (systolic r = –.149, P < .001 and diastolic r = –.218, P < .001), but in persons with isolated systolic hypertension PH was rather less frequent (21.9% and 2.3%). DPT was more common in the subjects with heart failure (26.3%, P < .05), impaired exercise tolerance (NYHA III‐IV) (33.7%, P < .05), and PH‐II (37.2%, P < .05) compared with the healthy controls (17.3%). The 1‐year mortality was higher in subjects with than without DPT (7.1% vs 4.8%, P < .05), but the difference was not significant after controlling for age and gender. PH‐I, PH‐II, and PH‐III were not significantly related to 4‐year mortality.

CONCLUSIONS: In this study of older people in Helsinki, Finland, asymptomatic hypotensive postural BP reactions and DPT were found frequently among healthy oplder people, and they tended to be increased in people with some diseases. Neither PH nor DPT were of prognostic significance for mortality in this population.
The Effects of Hormone Replacement Therapy, Lipoprotein Cholesterol Levels, and Other Factors on a Clock Drawing Task in Older Women
Authors: Paganini‐Hill Annlia , Henderson Victor W
Published: April 2015

OBJECTIVES: To assess the associations of a clock drawing task with hormone replacement therapy and other factors in older women.

DESIGN: Group comparisons.

SETTING: Leisure World Laguna Hills, a retirement community in southern California.

PARTICIPANTS: Two hundred ninety‐two postmenopausal women who were analyzed for lipoprotein levels in 1987–88 were contacted by postal survey, which included a clock drawing task, in 1992; 168 women who drew normal clocks were compared with 46 who drew abnormal or blank clocks.

MEASUREMENTS: Clock drawings; lipoprotein cholesterol levels; serum progesterone, estrone, estradiol, and steroid hormone binding globin levels; self‐reported data on smoking, alcohol intake, prior medical diagnoses, and use of certain medications including hormone replacement therapy and analgesics.

RESULTS: Women with normal clocks had significantly lower total cholesterol (P = .01), LDL cholesterol (P = .03), and serum progesterone levels (P = .03). They weighed, on average, 5 more pounds at the time of last menstrual period (P = .05), were more likely to use combined hormonal replacement therapy (P = .06), and were less likely to use acetaminophen daily (P = .02) than women with abnormal clocks. Serum estrone and estradiol levels did not differ significantly between women with normal and abnormal clocks.

CONCLUSION: The associations found here suggest that high serum cholesterol and progesterone levels might have a negative effect on clock drawing performance. Acetaminophen may also be related to worse performance on this task.
Cross‐validation of the Delirium Rating Scale in Older Patients
Authors: Rockwood Kenneth , Goodman Julie , Flynn Michael , Stolee Paul
Published: April 2015

OBJECTIVE: To cross‐validate the Delirium Rating Scale (DRS).

DESIGN: Cross‐sectional

SETTING: Geriatric medicine and geriatric psychiatry assessment units and consultation services.

PARTICIPANTS: A total of 104 older patients on the above services.

MEASUREMENTS: Mini‐Mental State Examination (MMSE) score, Barthel Index score, DRS score, Blessed Dementia Scale score, clinical diagnoses using DSM‐III‐R criteria.

MAIN RESULTS: The mean DRS score was highest in the delirium group. Cronbach's alpha was .90, and inter‐rater reliability of total scores was .91 (intra‐class correlation). Receiver Operating Characteristic curve analysis showed that the area under the curve for the DRS was significantly higher than the MMSE as a test for delirium. At its published cutpoint of 10, the sensitivity of the DRS is .82 and the specificity is 94. The value at which the sensitivity of the DRS is .90 is 8, at which specificity is .82.

CONCLUSIONS: The DRS appears to a feasible instrument. In a sample with a high proportion of delirious patients, it has acceptable measurement properties when used by expert observers.
An Intervention on Discharge Polypharmacy
Authors: Smith David M. , Cox Mark R. , Brizendine Edward J. , Hui Siu L. , Freedman Jay A. , Martin Douglas K. , Murray Michael D.
Published: April 2015

OBJECTIVE: To determine if providing a way to cancel pre‐admission prescriptions would reduce the number of active drug prescriptions (RXs) at discharge.

DESIGN: A randomized non‐blinded clinical trial.

SETTING: Inpatient acute medical service of a university‐affiliated Veterans Administration medical center.

PARTICIPANTS: Twelve medicine ward teams were randomized to control and intervention groups. Patients enrolled had been discharged from these teams during 12 weeks and were receiving outpatient medications from this facility at hospital admission; control = 180, intervention = 168.

INTERVENTION: At discharge, intervention teams used a computer‐generated drug list to cancel or renew previous outpatient RXs or to prescribe new medications. Control teams could not cancel outpatient drugs and wrote all medications on individual prescriptions.

MEASUREMENTS: The difference between admission and discharge RXs.

RESULTS: There were no significant differences in patients' age, sex, race, Charlson Index (CI), or LOS between patient groups at discharge. The intervention group had fewer RXs on admission (5.4 vs 6.2, P < .05) and at discharge (8.3 vs 9.1, P < .04), but the increase from admission to discharge was not significantly different (2.9 vs 2.9, P = .87) from the control group.

CONCLUSIONS: Providing a method for canceling preadmission medications did not reduce the number of RXs at discharge. Further research is needed to evaluate the appropriateness of the large increase in RXs from admission to discharge for patients in acute hospital settings. J Am Geriatr Soc 44:416–419, 1996.
Geriatric Oral Health and Its Impact on Eating
Authors: Ship Jonathan A. , Duffy Valerie , Jones Judith A. , Langmore Susan
Published: April 2015

OBJECTIVE: Adequate food and fluid intake and nutritional health are requisites for sustaining life. The oral‐pharyngeal region has evolved multiple, highly regulated processes to ensure that the intake, chewing, and swallowing of foods and beverages is maintained. The objective of this paper is to identify the independent and collective roles of oral health on eating in older people.

DESIGN: Research reports from peer‐reviewed scientific journals. Hypothesis‐driven research that objectively examined taste, smell, dental and oral mucosal health, dental prostheses, chewing, and swallowing in the context of aging.

DATA EXTRACTION AND SYNTHESIS: Data results were extracted independently by multiple observers. A qualitative synthesis of data results from independent studies was made in order to form conclusions regarding the role of oral health on eating in older people.

CONCLUSIONS: Many oral functions remain intact in healthy older adults. However, significant alterations arise from oral and systemic diseases and their treatments, and these may have a profound effect on eating, drinking, and the nutritional status of older individuals. The care of older persons with smell, taste, dental/alveolar, oral mucosal, chewing, and swallowing problems requires a multidisciplinary team of health care providers. Recognition of the interrelationship between oral, pharyngeal, and systemic physiological processes will help practitioners identify the etiology of these disorders and implement appropriate therapy. J Am Geriatr Soc 44:456–464, 1996.
Sex Differences in Device Therapies for Ventricular Arrhythmias or Death in the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT‐CRT) Trial
Authors: TOMPKINS CHRISTINE M. , KUTYIFA VALENTINA , ARSHAD AYSHA , MCNITT SCOTT , POLONSKY BRONISLAVA , WANG PAUL J. , MOSS ARTHUR J. , ZAREBA WOJCIECH
Published: April 2015

Sex Differences in VT/VF or Death in MADIT‐CRT

Introduction

Studies suggest that women with ischemic heart disease are less likely to experience appropriate ICD therapies for ventricular arrhythmias (VT/VF). We evaluated the influence of sex on arrhythmic events or death in subjects enrolled in MADIT‐CRT.

Methods and Results

Arrhythmic event rates, defined as VT/VF treated with defibrillator therapy or all‐cause death, were determined among 1,790 subjects enrolled in MADIT‐CRT with documented 3‐year follow‐up. Predictors of VT/VF/death were identified using multivariate analysis. Ninety‐one (21%) women and 466 (35%) men experienced VT/VF/death over the follow‐up period. The overall probability of VT/VF/death was significantly lower in women versus men (HR 0.62; P < 0.001). The probability of VT/VF/death was the lowest in women with ischemic heart disease (HR 0.51; P = 0.003). In ICD subjects, the 3‐year risk of VT/VF was lower in ischemic women versus men (P = 0.021), and in nonischemic women versus men (P = 0.049). The probability of VT/VF/death was significantly lower in women (HR 0.52; P = 0.007) and men (HR 0.74; P = 0.018) with LBBB who received CRT‐D. Appropriate shock therapy strongly correlated with increased risk of death during postshock follow‐up in women (HR 5.18; P = 0.001) and men (HR 1.63; P = 0.033); interaction P value of 0.034.

Conclusion

In this substudy of MADIT‐CRT, sex, etiology of heart disease and type of device implanted significantly influenced subsequent risk for VT/VF or death. Women with ischemic heart disease and women with LBBB who received CRT‐D had the lowest incidence of VT/VF or death when compared to men. Appropriate shock therapy was a strong predictor of death, particularly in women.
Access to Care, Treatment Ambivalence, Medication Nonadherence, and Long‐Term Mortality Among Severely Hypertensive African Americans: A Prospective Cohort Study
Authors: Young J. Hunter , Ng Derek , Ibe Chidinma , Weeks Kristina , Brotman Daniel J. , Dy Sydney Morss , Brancati Frederick L. , Levine David M. , Klag Michael J.
Published: April 2015

African Americans living in poor neighborhoods bear a high burden of illness and early mortality. Nonadherence may contribute to this burden. In a prospective cohort study of urban African Americans with poorly controlled hypertension, mortality was 47.6% over a median follow‐up of 6.1 years. Patients with pill‐taking nonadherence were more likely to die (hazard ratio, 1.80; 95% confidence interval [CI], 1.18–2.76) after adjustment for potential confounders. With regard to factors related to nonadherence, poor access to care such as difficulty paying for medications was associated with prescription refill nonadherence (odds ratio [OR], 4.12; 95% CI, 1.88–9.03). Pill‐taking nonadherence was not associated with poor access to care; however, it was associated with factors related to treatment ambivalence including lower hypertension knowledge (OR, 2.97; 95% CI, 1.39–6.32), side effects (OR, 3.44; 95% CI, 1.47–8.03), forgetfulness (OR, 3.62; 95% CI, 1.78–7.34), and feeling that the medications do not help (OR, 2.78; 95% CI, 1.09–7.09). These data suggest that greater access to care is a necessary but insufficient remedy to the disparities experienced by urban African Americans with hypertension. To achieve its full promise, health reform must also address treatment ambivalence.
Experiencing transformation: the case of Jordanian nurse immigrating to the UK
Authors: Al‐Hamdan Zaid M , Al‐Nawafleh Ahmad H , Bawadi Hala A , James Veronica , Matiti Milika , Hagerty Bonnie M
Published: April 2015

Aims and objectives

This study explored how Jordanian nurses experienced the transition from home to host country to illuminate the elements of transformation.

Background

Much research has been conducted on topics such as the current international nursing shortage and the recruitment of nurses from various countries. International nurses have unique needs with regard to adapting to new host cultures and workplaces; furthermore, the literature has revealed little evidence of nurses' professional and personal experiences related to migration.

Design

A qualitative study was conducted, collecting data via individual interviews.

Methods

Twenty‐five face‐to‐face and telephone interviews with Jordanian migrant nurses.

Result

This study showed that living and working in a host country changes the personal, social and professional attributes of migrant nurses. When nurses migrate, they encounter opportunities and significant challenges in their professional and personal lives. Although Jordanian nurses contributed their knowledge and skills to the UK healthcare system, they encountered enormous professional adaptation demands. Work setting discrepancies between source and host country are likely a major element behind the required nursing profession alteration. nurses' lives are transformed in terms of their personal and social networks in the host country.

Conclusions

Social transformation is an integral and inseparable part of engagement with professional organisation(s) in the host community. Professional integration likely has far‐reaching effects and consequences involving not only the individual but also their home and host country families and their professional networks.

Relevance to clinical practice

To provide high‐quality nursing care, we must learn about the transformation experience, expand our sense of who we are and gain a degree of control over how we perform our nursing roles when we move away from our home.
Intravascular carcinomatosis of central nervous system due to metastatic inflammatory breast cancer: A case report
Authors: Takei Hidehiro , Rouah Emilie , Barrios Roberto
Published: April 2015

Central nervous system (CNS) involvement by metastatic cancer is well‐recognized and typically presents with multifocal solid tumors within the brain parenchyma or leptomeningeal dissemination. We describe herein a histologically very rare case of CNS metastasis in a 52‐year‐old woman who presented with mental status changes. Post mortem examination revealed extensive CNS involvement by metastatic inflammatory breast carcinoma, characterized by the presence of single tumor cells diffusely present within capillaries without parenchymal or perivascular invasion, and acute ischemic changes/infarcts bilaterally involving multiple areas. The cancer cells were found predominantly in the cerebral cortices and deep gray matter structures. Pre‐mortem magnetic resonance and CT imaging of the brain did not identify metastatic cancer; however, widespread ischemic changes (i.e. brain infarcts) were identified. Inflammatory breast carcinoma is well‐known to have a predilection for spread through lymphovascular spaces. Post mortem examination revealed tumor involvement of bilateral lungs, heart and bladder, with sinusoidal spread in the liver and lymph nodes and prominent involvement of the splenic red pulp in addition to extensive vascular involvement of the brain and spinal cord without a discrete mass, despite the presence of widely metastatic disease. The tumor cells in the CNS were strongly immunoreactive for pancytokeratin, E‐cadherin, cytokeratin‐7, epithelial membrane antigen and CAM 5.2. This unique histologic pattern of tumor spread is considered to represent “intravascular carcinomatosis” in the CNS, and most likely the cause of the patient's widespread ischemic injuries.
Nepalese primiparous mothers' knowledge of newborn care
Authors: Shrestha Sharmila , Adachi Kumiko , Petrini Marcia A. , Shuda Akihiro , Shrestha Sarita
Published: April 2015

A cross‐sectional study was carried out to explore the knowledge level of newborn care and to investigate the relationship between newborn‐care knowledge and selected demographic variables among primiparous mothers. It was carried in outpatient department of a maternity and women's hospital in Kathmandu, Nepal with 276 primiparous mothers between 38 and 42 weeks of gestation. Data were collected during the antenatal period with using two instruments: the Newborn‐care Knowledge Questionnaire and State‐Trait Anxiety Inventory for Adults. Participants had a moderate level of knowledge on newborn care (56%), and among its four components, participants had lowest knowledge in breastfeeding (44%) and adequate knowledge (78%) of immunization. Maternal education and socioeconomic status had a significant, positive association with newborn‐care knowledge. Newborn‐care knowledge was strongly predicted by anxiety. This is the first study to examine the maternal levels of knowledge of newborn care in Nepal. This study identified specific knowledge gaps in newborn care among primiparous mothers. Moreover, the results suggest the need of maternal‐education programs in improving the health and well‐being of mothers and newborns.
Hydraulic lift as a determinant of tree–grass coexistence on savannas
Authors: Yu Kailiang , D'Odorico Paolo
Published: April 2015

The coexistence of woody plants and grasses in savannas is determined by a complex set of interacting factors that determine access to resources and demographic dynamics, under the control of external drivers and vegetation feedbacks with the physical environment. Existing theories explain coexistence mainly as an effect of competitive relations and/or disturbances. However, theoretical studies on the way facilitative interactions resulting from hydraulic lift affect tree–grass coexistence and the range of environmental conditions in which savannas are stable are still lacking.

We investigated the role of hydraulic lift in the stability of tree–grass coexistence in savannas. To that end, we developed a new mechanistic model that accounts for both competition for soil water in the shallow soil and fire‐induced disturbance.

We found that hydraulic lift favors grasses, which scavenge the water lifted by woody plants. Thus, hydraulic lift expands (at the expenses of woodlands) the range of environmental conditions in which savannas are stable.

These results indicate that hydraulic lift can be an important mechanism responsible for the coexistence of woody plants and grasses in savannas. Grass facilitation by trees through the process of hydraulic lift could allow savannas to persist stably in mesic regions that would otherwise exhibit a forest cover.
Step‐wise and lineage‐specific diversification of plant RNA polymerase genes and origin of the largest plant‐specific subunits
Authors: Wang Yaqiong , Ma Hong
Published: April 2015

Proteins often function as complexes, yet little is known about the evolution of dissimilar subunits of complexes. DNA‐directed RNA polymerases (RNAPs) are multisubunit complexes, with distinct eukaryotic types for different classes of transcripts. In addition to Pol I–III, common in eukaryotes, plants have Pol IV and V for epigenetic regulation. Some RNAP subunits are specific to one type, whereas other subunits are shared by multiple types.

We have conducted extensive phylogenetic and sequence analyses, and have placed RNAP gene duplication events in land plant history, thereby reconstructing the subunit compositions of the novel RNAPs during land plant evolution.

We found that Pol IV/V have experienced step‐wise duplication and diversification of various subunits, with increasingly distinctive subunit compositions. Also, lineage‐specific duplications have further increased RNAP complexity with distinct copies in different plant families and varying divergence for subunits of different RNAPs. Further, the largest subunits of Pol IV/V probably originated from a gene fusion in the ancestral land plants.

We propose a framework of plant RNAP evolution, providing an excellent model for protein complex evolution.
Engineering plants to reflect light: strategies for engineering water‐efficient plants to adapt to a changing climate
Authors: Zamft Bradley M. , Conrado Robert J.
Published: April 2015

Population growth and globally increasing standards of living have put a significant strain on the energy–food–water nexus. Limited water availability particularly affects agriculture, as it accounts for over 70% of global freshwater withdrawals (Aquastat). This study outlines the fundamental nature of plant water consumption and suggests a >50% reduction in renewable freshwater demand is possible by engineering more reflective crops. Furthermore, the decreased radiative forcing resulting from the greater reflectivity of crops would be equivalent to removing 10–50 ppm CO2 from the atmosphere. Recent advances in engineering optical devices and a greater understanding of the mechanisms of biological reflectance suggest such a strategy may now be viable. Here we outline the challenges involved in such an effort and suggest three potential approaches that could enable its implementation. While the local benefits may be straightforward, determining the global externalities will require careful modelling efforts and gradually scaled field trials.
A petal‐specific InMYB1 promoter from Japanese morning glory: a useful tool for molecular breeding of floricultural crops
Authors: Azuma Mirai , Morimoto Reina , Hirose Mana , Morita Yasumasa , Hoshino Atsushi , Iida Shigeru , Oshima Yoshimi , Mitsuda Nobutaka , Ohme‐Takagi Masaru , Shiratake Katsuhiro
Published: April 2015

Production of novel transgenic floricultural crops with altered petal properties requires transgenes that confer a useful trait and petal‐specific promoters. Several promoters have been shown to control transgenes in petals. However, all suffer from inherent drawbacks such as low petal specificity and restricted activity during the flowering stage. In addition, the promoters were not examined for their ability to confer petal‐specific expression in a wide range of plant species. Here, we report the promoter of InMYB1 from Japanese morning glory as a novel petal‐specific promoter for molecular breeding of floricultural crops. First, we produced stable InMYB1_1kb::GUS transgenic Arabidopsis and Eustoma plants and characterized spatial and temporal expression patterns under the control of the InMYB1 promoter by histochemical β‐glucuronidase (GUS) staining. GUS staining patterns were observed only in petals. This result showed that the InMYB1 promoter functions as a petal‐specific promoter. Second, we transiently introduced the InMYB1_1 kb::GUS construct into Eustoma, chrysanthemum, carnation, Japanese gentian, stock, rose, dendrobium and lily petals by particle bombardment. GUS staining spots were observed in Eustoma, chrysanthemum, carnation, Japanese gentian and stock. These results showed that the InMYB1 promoter functions in most dicots. Third, to show the InMYB1 promoter utility in molecular breeding, a MIXTA‐like gene function was suppressed or enhanced under the control of InMYB1 promoter in Arabidopsis. The transgenic plant showed a conspicuous morphological change only in the form of wrinkled petals. Based on these results, the InMYB1 promoter can be used as a petal‐specific promoter in molecular breeding of floricultural crops.
Variation in heterostylous breeding systems in neighbouring populations of Oxalis alpina (Oxalidaceae)
Authors: Weller S. G. , Sakai A. K. , Gray T. , Weber J. J. , Tsyusko O. V. , Domínguez C. A. , Fornoni J. , Molina‐Freaner F. E.
Published: April 2015

The heterostylous reproductive system of Oxalis alpina in the Galiuro Mts. of Arizona was investigated using field surveys, controlled crosses in the greenhouse and measurements of reproductive morphs. Although populations in the Pinaleño Mts. to the immediate east and in the Santa Catalina Mts. to the immediate west have derived distylous reproductive systems, tristyly, the ancestral reproductive system in O. alpina, has been retained in the Galiuro Mts. population. Tristylous incompatibility relationships in the Galiuro population are modified from the ancestral condition, with significant loss of incompatibility differentiation between stamen whorls of both short‐ and long‐styled morphs. Morphological adjustments of anther positions in the Galiuro population of O. alpina match those expected in light of incompatibility modification, with divergence of the mid‐level anthers away from the position of the mid stigmas of the mid‐styled morph. The occurrence of tristyly in an area of Arizona where distyly is found in adjacent mountain ranges is particularly remarkable, and indicates both the isolation of populations restricted to the upper elevations of these mountain ranges and variation in the tempo of evolution over short geographic distances.
Conceptualizing Social Responsibility in Operations Via Stakeholder Resource‐Based View
Authors: Sodhi ManMohan S.
Published: April 2015

We seek to conceptualize social responsibility for operations management (OM) research to develop a social responsibility lens through which to view operations. To do so, we first consider the corporate social responsibility, sustainability, as well as the bottom‐of‐the‐pyramid and shared value approaches and identify three challenges to developing such a lens: selecting the level of analysis, tackling the huge multitude of objectives, and developing theoretical underpinnings. We then propose a “stakeholder resource‐based view” (SRBV) building on resource‐based view, stakeholder theory, and utility theory to address these challenges. Under SRBV, all stakeholders are treated on a par with each other. These different stakeholders are all presumed to seek maximizing their respective (expected) utility, with different drivers shaping their preferences and do so they use their respective resources, routines and dynamic capabilities. SRBV provides (a) a descriptive framework for qualitative research, (b) an instrumental framework for empirical research, and (c) a normative framework for analytical research. It enables tackling many opportunities for OM research to do with social responsibility and we outline some of these in each of the three types of research methodologies.
Heat Transfer Performance of a Glass Thermosyphon Using Graphene–Acetone Nanofluid
Authors: Asirvatham Lazarus Godson , Wongwises Somchai , Babu Jithu
Published: April 2015

This study presents an enhancement in the heat transfer performance of a glass thermosyphon using graphene–acetone nanofluid with 0.05%, 0.07%, and 0.09% volume concentrations. The heat load is varied between 10 and 50 W in five steps. The effect of heat load, volume concentration, and vapor temperature on thermal resistance, evaporator and condenser heat transfer coefficients, are experimentally investigated. A substantial reduction in thermal resistance of 70.3% is observed for the maximum concentration of 0.09% by volume of graphene–acetone nanofluid. Further, an enhancement in the evaporator heat transfer coefficient of 61.25% is observed for the same concentration. Also from the visualization study the different flow patterns in the evaporator, adiabatic, and condenser regions are obtained for acetone at different heat inputs.
Reducing Sedentary Behavior: Active Steps for Overweight Women
Authors: Adams Melanie M. , Gill Diane L.
Published: April 2015

Even with adequate levels of physical activity, sedentary behavior contributes to cardiovascular disease and type 2 diabetes. Reducing sedentary behavior through increased daily movements, not solely exercise, can reduce health risks; particularly for women who are inactive and overweight. This study examined an intervention to increase overweight women’s self-efficacy for reducing sedentary behavior. Volunteers (M age =58.5 yrs, M BMI =36) were waitlisted (n = 24) or enrolled in the intervention (n = 40), called On Our Feet, which combined face-to-face sessions and e-mail messages over 6 weeks. Physical activity and sedentary behavior were measured by accelerometer and self-report. A 4-item survey assessed self-efficacy. Process evaluations included participant ratings of intervention components and open-ended questions. Repeated-measures ANOVAs revealed no changes in accelerometer-determined physical activity or sedentary behavior, but a significant multivariate interaction was found for self-reported sitting and physical activity, F(3,60) = 3.65, p = .02. Intervention participants increased both light and moderate physical activity and both groups decreased sedentary behavior. Self-efficacy decreased for all at midpoint, but intervention recipients rebounded at post. A moderately strong relationship (r = .48, p = .01) between midpoint self-efficacy and reduced sedentary behavior was found. Participants rated the pedometer, intervention emails, and goal setting as effective and highly used. Open-ended responses pointed to barriers of required sitting and a need to match intervention components to women’s lives. Community-based interventions for reducing sedentary behavior have the potential to improve health. Ideas to enhance future interventions are discussed.
Urinary metabolic signatures of human adiposity
Authors: Elliott Paul , Posma Joram M. , Chan Queenie , Garcia-Perez Isabel , Wijeyesekera Anisha , Bictash Magda , D. Ebbels Timothy M. , Ueshima Hirotsugu , Zhao Liancheng , van Horn Linda , Daviglus Martha , Stamler Jeremiah , Holmes Elaine , Nicholson Jeremy K.
Published: April 2015

In a large-scale population-based metabolic phenotyping study, diverse sets of urinary metabolites, including gut microbial co-metabolites, were reproducibly associated with human adiposity.
Behold morphing monocytes at sites of liver damage
Authors: Shaw Tanya J.
Published: April 2015

Classical proinflammatory monocytes transition to a pro-repair phenotype during repair of sterile tissue damage in the liver.