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Background: There is an unmet need for routine and accurate prognostication of older adults with end‐stage kidney disease (ESKD) and subsequently inadequate advance care planning. Frailty, a clinical syndrome of increased vulnerability, is predictive of adverse health outcomes in the renal population. We propose the Clinical Frailty Scale (CFS) as a feasible tool for routine use in the nephrology outpatient setting to address this unmet need. Aims: To assess feasibility and associations of incorporating CFS assessment into routine outpatient nephrology practice in the pre‐dialysis setting. Methods: CFS was integrated into the outpatient nephrology clinic proforma. A convenience sample of 138 patients aged >50 years, with estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2, attending the outpatient service between September 2018 and April 2019 was included. Results: Eighty‐one CFS assessments were completed by nephrologists, nephrology advanced trainees and clinical nurse specialists. CFS completion rates were 79% from the multidisciplinary Low Clearance Clinic and 41% from nurse‐led Pre‐dialysis Education Clinic. Planned modality of ESKD management varied with degree of frailty (P < 0.001). 21% of patients who had CFS completed were planned for Conservative Management of ESKD, in contrast to only 5% of those who did not have CFS assessment completed (P < 0.001). Conclusion: Frailty assessment via CFS was feasible in outpatient practice when integrated into routine clinical assessment in a dedicated clinic. Planned ESKD management varied with the degree of frailty. Completion of frailty assessment, when compared with non‐completion, appears to be associated with increased planned conservative management of ESKD. [ABSTRACT FROM AUTHOR]

Sound waves generated by erupting volcanoes can be used to infer important source dynamics, yet acoustic source‐time functions may be distorted during propagation, even at local recording distances (<15 km). The resulting uncertainty in source estimates can be reduced by improving constraints on propagation effects. We aim to quantify potential distortions caused by wave steepening during nonlinear propagation, with the aim of improving the accuracy of volcano‐acoustic source predictions. We hypothesize that wave steepening causes spectral energy transfer away from the dominant source frequency. To test this, we apply a previously developed single‐point, frequency domain, quadspectral density‐based nonlinearity indicator to 30 acoustic signals from Vulcanian explosion events at Sakurajima Volcano, Japan, in an 8‐day data set collected by five infrasound stations in 2013 with 2.3‐ to 6.2‐km range. We model these results with a 2‐D axisymmetric finite‐difference method that includes rigid topography, wind, and nonlinear propagation. Simulation results with flat ground indicate that wave steepening causes up to ∼2 dB (1% of source level) of cumulative upward spectral energy transfer for Sakurajima amplitudes. Correction for nonlinear propagation may therefore provide a valuable second‐order improvement in accuracy for source parameter estimates. However, simulations with wind and topography introduce variations in the indicator spectra on order of a few decibels. Nonrandom phase relationships generated during propagation or at the source may be misinterpreted as nonlinear spectral energy transfer. The nonlinearity indicator is therefore best suited to small source‐receiver distances (e.g., <2 km) and volcanoes with simple sources (e.g., gas‐rich strombolian explosions) and topography. Key Points: Acoustic wavefield simulations suggest significant spectral energy (2 dB) transfer during nonlinear propagationComplicated nonlinearity indicator spectra are obtained for observed Sakurajima Volcano infrasoundNonlinear signature is modified by spectral contributions from source and propagation complexity [ABSTRACT FROM AUTHOR]

Abstract: Aim: The Indonesian island of Sulawesi is home to thousands of endemic terrestrial animal species. Phylogeographical studies of some of these taxa revealed concordant distribution patterns (areas of endemism; AoEs), suggestive of a shared evolutionary or ecological mechanism driving divergence among various terrestrial taxa. Generally, AoEs have been attributed to Pleistocene marine incursions, geological fault zones and Sulawesi's history as an archipelago. We test, for the first time, the hypothesis that population divergences are associated with unsuitable climate spaces at the boundaries between these areas. Location: Sulawesi, Indonesia. Taxon: Maxomys musschenbroekii, a common murid rodent endemic to Sulawesi. Methods: We sequenced a mitochondrial gene, four nuclear protein‐coding genes and hundreds of ultraconserved elements from individuals sampled across the island, which we used to build intraspecific phylogenies and identify population structure. To test climate‐related hypotheses, we used multiple regression to assess the extent to which genetic distances, over‐land geographical distances, environmental distances (derived from ecological niche model resistance surfaces) and areas of endemism are correlated. Results: In all three genetic datasets, we inferred phylogeographical structure that is geographically concordant with previously defined AoEs. Ecological niche models showed a similar geography of suitability across the island since the Last Glacial Maximum, with varying levels of unsuitable climate space between AoEs. Genetic distances were more strongly correlated with environmental distances than geographical distances and interspecific divergences arose just in the past 1.5 Myr. Main Conclusions: Population divergences within M. musschenbroekii are consistent with AoE definitions from other taxa. Stable areas of unsuitable habitat near AoE boundaries probably supplemented marine incursions in generating population structure within M. musschenbroekii and other co‐distributed species. [ABSTRACT FROM AUTHOR]

Climate refugia management has been proposed as a climate adaptation strategy in the face of global change. Key to this strategy is identification of these areas as well as an understanding of how they are connected on the landscape. Focusing on meadows of the Sierra Nevada in California, we examined multiple factors affecting connectivity using circuit theory, and determined how patches have been and are expected to be affected by climate change. Connectivity surfaces varied depending upon the underlying hypothesis, although meadow area and elevation were important features for higher connectivity. Climate refugia that would promote population persistence were identified from downscaled climate layers, based on locations with minimal climatic change from historical conditions. This approach was agnostic to specific species, yielding a broad perspective about changes and localized habitats. Connectivity was not a consistent predictor of refugial status in the 20th century, but expected future climate refugia tended to have higher connectivity than those that recently deviated from historical conditions. Climate change is projected to reduce the number of refugial meadows on a variety of climate axes, resulting in a sparser network of potential refugia across elevations. Our approach provides a straightforward method that can be used as a tool to prioritize places for climate adaptation. [ABSTRACT FROM AUTHOR]

This study piloted a hospital-based delirium and falls education program to investigate the impacts on staff knowledge and practice plus patient falls. On a medical ward, staff knowledge was compared before and after education sessions. Other data - collected a day before and after program implementation - addressed documentation of patients' delirium and evidence of compliance with falls risk minimization protocols. These data, and numbers of patient falls, were compared before and after program implementation. Almost all ward staff members participated in education sessions (7 doctors, 7 allied health practitioners, and 45 nurses) and knowledge was significantly improved in the 22 who completed surveys both before and after session attendance. Patients assessed as having delirium (5 before implementation, 4 afterwards) were all documented as either confused or delirious. Small changes eventuated in adherence with falls risk management protocols for confused patients and the number of falls decreased. The program merits a stronger emphasis on staff activities relating to the detection, documentation, and management of delirium to inter-professional roles and communication. Evidence of practice enhancement from program implementation should precede rigorous testing of impacts upon falls. [ABSTRACT FROM AUTHOR]

Understanding recent biogeographic responses to climate change is fundamental for improving our predictions of likely future responses and guiding conservation planning at both local and global scales. Studies of observed biogeographic responses to 20th century climate change have principally examined effects related to ubiquitous increases in temperature - collectively termed a warming fingerprint. Although the importance of changes in other aspects of climate - particularly precipitation and water availability - is widely acknowledged from a theoretical standpoint and supported by paleontological evidence, we lack a practical understanding of how these changes interact with temperature to drive biogeographic responses. Further complicating matters, differences in life history and ecological attributes may lead species to respond differently to the same changes in climate. Here, we examine whether recent biogeographic patterns across California are consistent with a warming fingerprint. We describe how various components of climate have changed regionally in California during the 20th century and review empirical evidence of biogeographic responses to these changes, particularly elevational range shifts. Many responses to climate change do not appear to be consistent with a warming fingerprint, with downslope shifts in elevation being as common as upslope shifts across a number of taxa and many demographic and community responses being inconsistent with upslope shifts. We identify a number of potential direct and indirect mechanisms for these responses, including the influence of aspects of climate change other than temperature (e.g., the shifting seasonal balance of energy and water availability), differences in each taxon's sensitivity to climate change, trophic interactions, and land-use change. Finally, we highlight the need to move beyond a warming fingerprint in studies of biogeographic responses by considering a more multifaceted view of climate, emphasizing local-scale effects, and including a priori knowledge of relevant natural history for the taxa and regions under study. [ABSTRACT FROM AUTHOR]

1. Identifying the boundary of a species' niche from observational and environmental data is a common problem in ecology and conservation biology and a variety of techniques have been developed or applied to model niches and predict distributions. Here, we examine the performance of some pattern-recognition methods as ecological niche models (ENMs). Particularly, one-class pattern recognition is a flexible and seldom used methodology for modelling ecological niches and distributions from presence-only data. The development of one-class methods that perform comparably to two-class methods (for presence/absence data) would remove modelling decisions about sampling pseudo-absences or background data points when absence points are unavailable. 2. We studied nine methods for one-class classification and seven methods for two-class classification (five common to both), all primarily used in pattern recognition and therefore not common in species distribution and ecological niche modelling, across a set of 106 mountain plant species for which presence-absence data was available. We assessed accuracy using standard metrics and compared trade-offs in omission and commission errors between classification groups as well as effects of prevalence and spatial autocorrelation on accuracy. 3. One-class models fit to presence-only data were comparable to two-class models fit to presence-absence data when performance was evaluated with a measure weighting omission and commission errors equally. One-class models were superior for reducing omission errors (i.e. yielding higher sensitivity), and two-classes models were superior for reducing commission errors (i.e. yielding higher specificity). For these methods, spatial autocorrelation was only influential when prevalence was low. 4. These results differ from previous efforts to evaluate alternative modelling approaches to build ENM and are particularly noteworthy because data are from exhaustively sampled populations minimizing false absence records. Accurate, transferable models of species' ecological niches and distributions are needed to advance ecological research and are crucial for effective environmental planning and conservation; the pattern-recognition approaches studied here show good potential for future modelling studies. This study also provides an introduction to promising methods for ecological modelling inherited from the pattern-recognition discipline. [ABSTRACT FROM AUTHOR]

Geographic distributions of species are constrained by several factors acting at different scales, with climate assumed to be a major determinant at broad extents. Recent studies, however, have challenged this statement and indicated that climate may not dominate among the factors governing geographic distributions of species. Here, we argue that these results are misleading due to the lack of consideration of the geographic area that has been accessible to the species. North America. We generated null distributions for 75 North American endemic and 19 non-endemic bird species. For each species, climatic envelopes of observed and null distributions were modelled using neural networks and generalized linear models, and seven climatic predictors. Values of the area under the receiver-operating characteristic curve (AUC) based on models of observed distributions were compared with corresponding AUC values for the null distributions. More than 82% of the endemic species showed AUC higher for the observed than for the null distributions, while 63% of the non-endemic species showed such a pattern. We demonstrate a dominant climatic signal in shaping North American bird distributions. Our results attest to the importance of climate in determining species distributions and support the use of climate-envelope models for estimating potential distributional areas at the appropriate spatial scales. [ABSTRACT FROM AUTHOR]

Aim: We aimed to implement a systematic nurse–caregiver conversation, examining fidelity, dose and reach of implementation; how implementation strategies worked; and feasibility and mechanisms of the practice change. Background: Appropriate hospital care for people living with dementia may draw upon: information from the patient and family caregiver about the patient's perspective, preferences and usual support needs; nursing expertise; and opportunities the nurse has to share information with the care team. Within this context, planned nurse–caregiver communication merits further investigation. Methods: In Phase I, we established the ward staff's knowledge of dementia and Alzheimer's disease, prepared seven nurse change leaders, finalised the planned practice change and developed implementation plans. In Phase II, we prepared the ward staff during education sessions and leaders supported implementation. In Phase III, evaluations were informed by interviews with change leaders, follow‐up measures of staff knowledge and a nurse focus group. Qualitative data were thematically analysed. Statistical analyses compared nurses' knowledge over time. Results: Planned practice change included nurses providing information packs to caregivers, then engaging in, and documenting, a systematic conversation. From 32 caregivers, 15 received information packs, five conversations were initiated, and one was completed. Knowledge of dementia and Alzheimer's disease improved significantly in change leaders (n = 7) and other nurses (n = 17). Three change leaders were interviewed, and six other nurses contributed focus group data. These leaders reported feeling motivated and suitably prepared. Both nurses and leaders recognised potential benefits from the planned conversation but viewed it as too time‐consuming to be feasible. Conclusions: The communication initiative and implementation strategies require further tailoring to the clinical setting. A caregiver communication tool may be a helpful adjunct to the conversation. Implementation may be enhanced by more robust stakeholder engagement, change leader inclusion in the reference group and an overarching supportive framework within which change leaders can operate more effectively. Implications for Practice: Nurse‐caregiver communication in this context requires inititatives tailored to the clinical setting with input from all stakeholders. [ABSTRACT FROM AUTHOR]

The article discusses the highlights of the 2015 ASM Annual Scientific Meeting "Paradigms in Perth: Deconstructing Delirium and Engaging Elders." Keynote speakers included Professor Alasdair MacLullich from Edinburgh University discussed provision of better delirium services and associated professor Dina Lo Guidice from Melbourne Health shared her practical experience in providing services and managing dementia.

Presents a letter to the editor about the accuracy of telehealth community dementia assessments.