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Aim: To understand the meaning of surviving out of hospital cardiac arrest and its aftereffects among Greek‐speaking survivors. Design: Hermeneutical phenomenological method based on Martin Heidegger's philosophy. Methods: Eight Greek‐speaking out of hospital cardiac arrest survivors were recruited using purposive sampling method. Data collection and analysis using the seven stages of hermeneutic analysis described by Diekelman. Data were collected through semi‐structured personal interviews with open‐ended questions. Results: Analysis revealed five themes: 'The unexpected attack', 'Experiencing a different world: Transformation of Body, Time, Emotion and Sensation', 'Restoration of the re‐embodied self', 'Life transformation' and 'Personal transformation'. The themes are commensurate with transcultural components of Near‐Death Experiences. Surviving out of hospital cardiac arrest was perceived as a 'divine gift' and a chance to continue 'living in a more conscious and meaningful way'. Despite participants' physical and psychosocial challenges, the narratives highlighted a newly acquired deep appreciation for the joy of life, living and others. Construction of meaning and a heightened spirituality seem central in reconstructing life after out of hospital cardiac arrest survivors. Patient or Public Contribution: Out of hospital cardiac arrest survivors reflected and described in‐depth on their lived experiences of out of hospital cardiac arrest through a 60‐ to 90‐min interview. In addition, the participants provided their feedback on the interpretation of the findings, confirmed the study findings, and ensured that the analysis reflected aspects of their individual experiences and were true to them. [ABSTRACT FROM AUTHOR]

Aim: Nurse leaders influence workplace culture; however, little is known about ethnic cultural influences on nurse leader development. This research aims to identify personal strategies promoting effective leadership by nurse leaders from European small island countries. Design: Descriptive qualitative study. Methods: In 2017, nineteen semi‐structured interviews with nurse leaders from England, Greece, Republic of Ireland and Malta explored leadership journeys, strategies employed to support their growth and development, and how cultural identity played a role. Transcripts were analysed using reflexive thematic analysis. Results: Four main themes and 12 subthemes captured the strategies and approaches of the nurse leaders: (1) Influences, (2) Communication, (3) Process and (4) Relationships. These findings reflect and validate the five transformational leadership practices of the Exemplary Leadership Model. While cultural island identity was discussed, there was a shared cultural identity within the role of "nurse leader" that spanned all islands. Patient or Public Contributions: Nineteen nurse leaders contributed to this study. [ABSTRACT FROM AUTHOR]

Pregnant women and newborns are at increased risk of vitamin D deficiency. Our objective was to create a global summary of maternal and newborn vitamin D status. We completed a systematic review (1959–2014) and meta‐analysis of studies reporting serum 25‐hydroxyvitamin D [25(OH)D] concentration in maternal and newborn populations. The 95 identified studies were unevenly distributed by World Health Organization (WHO) region: Americas (24), European (33), Eastern Mediterranean (13), South‐East Asian (7), Western Pacific (16) and African (2). Average maternal 25(OH)D concentrations (nmol L−1) by region were 47–65 (Americas), 15–72 (European), 13–60 (Eastern Mediterranean), 20–52 (South‐East Asian), 42–72 (Western Pacific) and 92 (African). Average newborn 25(OH)D concentrations (nmol L−1) were 35–77 (Americas), 20–50 (European), 5–50 (Eastern Mediterranean), 20–22 (South‐East Asian), 32–67 (Western Pacific) and 27–35 (African). The prevalences of 25(OH)D <50 and <25 nmol L−1 by WHO region in pregnant women were: Americas (64%, 9%), European (57%, 23%), Eastern Mediterranean (46%, 79%), South‐East Asian (87%, not available) and Western Pacific (83%, 13%). Among newborns these values were: Americas (30%, 14%), European (73%, 39%), Eastern Mediterranean (60%, not available), South‐East Asian (96%, 45%) and Western Pacific (54%, 14%). By global region, average 25(OH)D concentration varies threefold in pregnant women and newborns, and prevalence of 25(OH)D <25 nmol L−1 varies eightfold in pregnant women and threefold in newborns. Maternal and newborn 25(OH)D concentrations are highly correlated. Addressing vitamin D deficiency in pregnant women and newborns should be a global priority. To protect children from the adverse effects of vitamin D deficiency requires appropriate interventions during both pregnancy and childhood. [ABSTRACT FROM AUTHOR]

Aim The aims of this study were to assess the distribution of putative Mediterranean refugia of plants, to compare the locations of refugia and those of regional hotspots of plant biodiversity, and to provide a critical analysis of the Mediterranean refugium paradigm. Furthermore, we consider how biogeographical and genetic results can be combined to guide global conservation strategies. Location The Mediterranean region. Methods We started from a detailed analysis of the scientific literature (1993–2007) in order to identify refugia in the Mediterranean region, based on intra-specific phylogeographical studies of plant species. We used population locations together with gene-pool identity to establish the database, comparing patterns of phylogeographical concordance with the locations of Mediterranean refugia. We then tested the biogeographical congruence between two biodiversity components, namely phylogeographical refugia and regional hotspots. Results We identified 52 refugia in the Mediterranean bioclimatic region and confirmed the role played by the three major peninsulas, with a shared total of 25 refugia. We emphasize the importance of areas that have previously been attributed a lesser role (large Mediterranean islands, North Africa, Turkey, Catalonia). Of the 52 refugia identified, 33 are situated in the western Mediterranean Basin and 19 in the eastern part. The locations of the phylogeographically defined refugia are significantly associated with the 10 regional hotspots of plant biodiversity, with 26 of these refugia (i.e. 50%) occurring within the hotspots. Main conclusions The locations of refugia are determined by complex historical and environmental factors, the cumulative effects of which need to be considered because they have occurred since the Tertiary, rather than solely during the last glacial period. Refugia represent climatically stable areas and constitute a high conservation priority as key areas for the long-term persistence of species and genetic diversity, especially given the threat posed by the extensive environmental change processes operating in the Mediterranean region. The refugia defined here represent ‘phylogeographical hotspots’; that is, significant reservoirs of unique genetic diversity favourable to the evolutionary processes of Mediterranean plant species. [ABSTRACT FROM AUTHOR]

Although a number of recent studies have demonstrated biotic homogenization, these have mainly focused on larger spatial scales. Homogenizing effects are equally important at finer resolutions, e.g. through increasing similarity between habitats, which may result in a simplification of ecosystem structure and function. One major cause of homogenization is the expanding ranges of alien species, although it is not clear whether they are inherently homogenizing at smaller scales. We therefore assessed whether the alien flora is less complex across habitats than the resident native flora of Mediterranean Islands. From a regional data base, we examined floristic lists for between-habitat taxonomic and functional similarity, and within-habitat functional diversity, using resampled data sets to control for sample size biases. Aliens and natives showed equivalent complexity in most respects. At the taxonomic level, between-island and between-habitat similarities were almost identical, and when ecosystem function was measured by a functional group classification system, this was also true of between-habitat similarities and within-habitat diversities. When ecosystem function was measured using Grime's CSR classification, aliens were found to be more functionally homogenous between-habitats and less functionally diverse within habitats. However, since the CSR profiles of aliens and natives differed, simplification is not inevitable due to ecological segregation of the two floras (aliens tend to be recruited to disturbed habitats rather than displacing natives). One deficiency is a lack of large scale species abundance data. A simple simulation exercise indicated that this is likely to lead to substantial overestimation of true levels of similarity, although would only influence the comparison between aliens and natives if they have different abundance distribution curves. The results indicate that alien floras are not intrinsically more simple than natives, but a higher proportion of competitive strategists among aliens may still cause small-scale homogenization as these include many strong competitors that are likely to dominate communities. [ABSTRACT FROM AUTHOR]

Aim To investigate the effects of human-induced landscape changes in Mediterranean islands on the ecological and evolutionary responses of bird communities and populations. The combination of mass extinction of large mammals and massive deforestation by humans was hypothesized to produce new selection regimes to which organisms were likely to respond. Habitat selection and niche breadth have been investigated at the scale of species, and phenotypic variation at the scale of local populations. Location The study was carried out along habitat gradients and in habitat mosaics at different spatial scales on the island of Corsica and in areas of similar size and structure in continental France. Methods Two sets of gradients have been used for investigating habitat selection and niche breadth: gradients of altitude, and gradients of vegetation structure. Population studies focused on the blue tit, Cyanistes caeruleus. Large samples of breeding attempts by this species in 10 habitats provided detailed data on phenotypic variation of fitness-related traits both on Corsica and on the mainland. Results The extent of niche space used by birds differed substantially depending on which habitat gradient was considered. Many species have been found to contract their habitat niche along the elevation gradient on Corsica compared with the mainland, whereas all species in the vegetation gradient broadened their niche on the island. Breeding patterns of the blue tit differed considerably depending on whether they settle in deciduous oaks ( Quercus humilis) or in evergreen sclerophyllous oaks ( Quercus ilex). Phenotypic variation of breeding traits was much higher on the island, where more populations were correctly timed for the best breeding period than on the mainland, a pattern that is likely to result from lower dispersal of organisms on the island. Main conclusions The differences in observed niche breadth between the two series of habitat gradients is explained both by the species-specific ecology of the species and the human-induced environmental history of Corsica. Large-scale landscape changes provided new opportunities for island colonization by non-forest species, which are isolated as small, ‘fugitive’ local populations. In both gradients, forest species that are typical components of the Corsican bird fauna definitely expanded their niche and occupied a wider range of habitats on Corsica than on the mainland. At the population scale, landscapes included habitat patches with contrasted selection regimes, which resulted in high phenotypic variation for many fitness-related traits. Reduced dispersal of birds on the island resulted in a much higher degree of local differentiation on Corsica than on the mainland. [ABSTRACT FROM AUTHOR]

1. The Mediterranean region has been invaded by a wide range of introduced plant species which differ greatly in their ecology, morphology and human utilization. In order to identify a suite of traits which characterize invasiveness, recent studies have advocated the use of evolutionary relationships to unravel highly confounded influences. 2. This study attempts to identify an evolutionary component to invasiveness and other complex invasion-related traits in the Mediterranean alien flora using an autocorrelation technique, the ‘phylogenetic association test’. I compared a traditional hierarchical taxonomy with the recent phylogeny of the Angiosperm Phylogeny Group. 3. Invasiveness did not have a significant phylogenetic component. Any weak clustering was generally at the genus level. 4. Several associated ‘meta-traits’ (high introduction frequency, adaptation to several habitat types and favourability for different modes of introduction), exhibited stronger phylogenetic components. Although each of these conveys some of the attributes of invasiveness, their clustering patterns differed considerably, suggesting that they arise from independent evolutionary pressures. Furthermore, within each meta-trait, different clusters may have been selected for different reasons. 5. Other reasons for the lack of a detectable evolutionary component to invasiveness are discussed. Firstly, the results of our test simulations suggested that incorrect phylogeny could result in a moderate degree of error. Secondly, over evolutionary time, complex or stochastic events such as ecosystem change could radically alter the adaptive advantages of particular traits. 6. Synthesis. Since invasiveness has little phylogenetic component, I argue that it is less likely to be predictable from as yet unidentified traits in any simple way. Although trait syndromes could develop without leaving a phylogenetic pattern, its absence probably indicates that the dominant selective forces are responses to short-term ecological shifts, and a greater mechanistic understanding of these is needed. [ABSTRACT FROM AUTHOR]

We describe a model to predict the invasion success of alien plants on Mediterranean islands, according to their mode, frequency and time since introduction and simple species traits. The model was developed using canonical discriminant analysis to identify categories of low- and high-risk species. Whilst classifying ca 80% of the data set correctly, the type II error rate remained moderately high, which limits its value in practical terms. This level of accuracy is typical of similar models, and critical analysis of the weaknesses is necessary to develop long-term improvements in methodology. Sensitivity analysis indicates that, overall, mode of introduction had an important influence on invasiveness, with species introduced for public amenity being more likely to attain high-risk status than species introduced privately to gardens. Frequency and time since introduction had a relatively minor influence on the model outcome, but remained highly confounded with other variables. Although invasion success, as measured by the number of islands colonized, is expected to increase over time, it was not possible to estimate the rates of expansion from historical trends, which are complicated by changes in import fashions over the centuries. Many older introductions were crops, whereas there has been a recent tendency towards exotic ornamentals and weedy species. Despite a fundamental influence on the results, similar historical influences are seldom taken into account adequately during trait analyses. Unravelling such inter-correlations between predictors is therefore an important challenge for the future of screening protocols. [ABSTRACT FROM AUTHOR]

Aim We analyse modern patterns of richness, presence and extinction of birds of prey (Accipitriforms and Falconiforms) in the Mediterranean and Macaronesian islands, using an integrated approach involving both biogeographical and human-induced factors. Location Forty-three islands grouped into nine Mediterranean and Macaronesian archipelagos. Methods Information about 25 species breeding during the past century and their fate (permanence or extinction) was compiled from the literature and regional reports. Jaccard's similarity index and cluster analyses were applied to define island assemblages. In order to detect the factors driving richness, presence and extinction, generalized linear models (GLM) were applied to 32 explanatory variables, evaluating location, physiography, isolation of island, taxonomic affinities and life-history patterns of the raptor species. Results Islands belonging to the same archipelago clustered when raptor assemblages were compared, revealing a marked biogeographical signal. Species richness was influenced by island area and accessibility from the continent (explained deviance of 51% in the GLM). Models of the probability of presence (explained deviance of 32%) revealed positive influences of migratory patterns (maximum for partial migrants), size of distribution areas and proximity to main migration routes. The model for probability of extinction explained only 8% of the deviance. It revealed that populations living on islands with a high density of human population were more prone to disappear. Also, raptors depending on human resources had more risk of extinction. Main conclusions Basic predictions of island biogeography can explain current patterns of raptor richness in the study area despite millennia of intense humanization processes. Colonization success appears to depend on life-history traits linked to migratory and dispersal strategies, whereas body-size constraints are not influential. Additionally, our results reveal the importance of species-based analyses in studies of island biogeography. [ABSTRACT FROM AUTHOR]

Aim We looked at the biogeographical patterns of Oniscidean fauna from the small islands of the Mediterranean Sea in order to investigate the species–area relationship and to test for area-range effects . Location The Mediterranean Sea. Methods We compiled from the literature a data set of 176 species of Oniscidea (terrestrial isopods) distributed over 124 Mediterranean islands. Jaccard's index was used as input for a UPGMA cluster analysis. The species–area relationship was investigated by applying linear, semi-logarithmic, logarithmic and sigmoid models. We also investigated a possible ‘small island effect’ (SIE) by performing breakpoint regression. We used a cumulative and a sliding-window approach to evaluate scale-dependent area-range effects on the log S/log A regression parameters. Results Based on similarity indexes, results indicated that small islands of the Mediterranean Sea can be divided into two major groups: eastern and western. In general, islands from eastern archipelagos were linked together at similarity values higher than those observed for western Mediterranean islands. This is consistent with a more even distribution of species in the eastern Mediterranean islands. Separate archipelagos in the western Mediterranean could be discriminated, with the exception of islets, which tended to group together at the lowest similarity values regardless of the archipelago to which they belong. Islets were characterized by a few common species with large ranges. The species–area logarithmic model did not always provide the best fit. Most continental archipelagos showed very similar intercepts, higher than the intercept for the Canary island oceanic archipelago. Sigmoid regression returned convex curves. Evidence for a SIE was found, whereas area-range effects that are dependent on larger scale analyses were not unambiguously supported . Main conclusions The Oniscidea fauna from small islands of the Mediterranean Sea is highly structured, with major and minor geographical patterns being identifiable. Some but not all of the biogeographical complexity can be explained by interpreting the different shapes of species–area curves. Despite its flexibility, the sigmoid model tested did not always provide the best fit. Moreover, when the model did provide a good fit the curves looked convex, not sigmoid. We found evidence for a SIE, and minor support for scale-dependent area-range effects. [ABSTRACT FROM AUTHOR]