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Background: Falls are the leading cause of fatal injury, and the most common cause of nonfatal trauma, among older adults. However, patient perspectives on preferences for obtaining fall education are not well reported. Objective: To identify components of successful fall prevention education. Design: Prospective qualitative study. Setting: Tertiary care center; institutional. Participants: Adults aged 65 years or older with a history of falls who received services from inpatient trauma or outpatient geriatric services. Interventions: One-hour face-to-face semistructured interview. Main Outcome Measure: Semistructured interviews sought to determine participants' history of fall education and perceived strengths and weaknesses of various formats of fall education. Results: Nearly all participants (9/10) indicated they had not received fall prevention education of any kind. Many participants (6/10) reported that, despite not receiving any formal education about falls, they had either given or received information about falls from other older adults in their communities. Participants indicated that framing fall education as a part of healthy aging would be more desirable and mentioned involving participants' families as part of the education. The majority of participants (7/10) suggested fall education be delivered through in-person discussion with providers, and most (9/10) indicated this would provide a personalized approach with opportunity for questions. Participants specified fall education should consist of both environmental modifications (5/10) and awareness of one's surroundings (4/10). Conclusions: Despite histories of falls, nearly all participants reported they had not received formal fall education. However, many indicated they received fall information informally through their communities. Participants agreed successful fall prevention education would be delivered in an empowering way by a trusted member of the care team. [ABSTRACT FROM AUTHOR]

Objectives: Hypertension increases the risk of developing Alzheimer's disease or related dementias. This pilot study's purpose was to examine the feasibility and acceptability of a novel intervention, Mindfulness in Motion (MIM) and Dietary Approaches to Stop Hypertension DASH (MIM DASH), to improve diet, mindfulness, stress, and systolic blood pressure (BP) in older African Americans with mild cognitive impairment (MCI) and hypertension. Design: Cluster randomized controlled trial. Setting: Intergenerational community center in a large metropolitan area. Participants: African Americans with MCI and hypertension. Participants were divided into six groups randomized 1:1:1 to the MIM DASH group, attention only (non‐hypertensive education) group, or true control group. The MIM DASH and attention only interventions were delivered in 8‐weekly 2 hour group sessions. MIM included mindful movements from chair/standing, breathing exercises, and guided meditation. The DASH component used a critical thinking approach of problem solving, goal setting, reflection, and self‐efficacy. The true control group received a DASH pamphlet at the end. Measurements: Feasibility was tracked through enrollment and attendance records; acceptability was assessed through interviews. Blood pressure was measured using the Omron HEM‐907XL Monitor. Dietary intake was measured by DASH‐Q. Mindfulness was measured by the Cognitive and Affective Mindfulness Scale. Stress was measured by the Perceived Stress Scale. MCI was determined using the Self‐Administered Gerocognitive Examination. Data were collected at baseline and 3‐months. Results: Median session attendance was six for the MIM DASH group and six for the attention only group. There were no changes in diet, mindfulness, or stress. There was a clinically significant reduction in systolic BP in the MIM DASH group (−7.2 mmHg) relative to the attention only group (−.7), and no change between the MIM DASH and true control groups. Conclusion: Results indicate that the MIM DASH intervention was feasible and culturally acceptable in African Americans with hypertension and MCI. [ABSTRACT FROM AUTHOR]

Background: As older adults prolong working life and face age‐related health changes, insomnia symptoms and fatigue may jeopardize their ability to stay in the labor force. Our study explored the relationships between insomnia symptoms, fatigue, and job exit in workers aged 65 years and older. Methods: Data from the National Health and Aging Trends Study were used (2011–2017). The sample included 953 Medicare beneficiaries with paid work at the time of the interview. Workers were followed annually for 6 years to the time of job exit. Insomnia measures included the number and type of symptoms, and fatigue (measured as low energy). Crude and adjusted odds ratios and 95% confidence intervals were estimated within discrete‐time survival analysis. Models were adjusted for health, lifestyle, and sociodemographic characteristics. Results: At baseline, approximately 49% of workers had either one or two insomnia symptoms. Difficulty falling asleep and difficulty maintaining asleep were prevalent in 35% and 37% of the sample. Fatigue was common in <30% of the sample. Workers with difficulty falling asleep were 1.29 times at higher odds to have job exit when compared with workers with no insomnia (p = 0.033). Conversely, fatigued workers were 0.73–0.77 times at lower odds to have job exit when compared with nonfatigued workers (p < 0.05). Conclusion: Difficulty falling asleep negatively affects future work status, unlike feeling fatigued. Healthcare providers are encouraged to assess for insomnia and discuss treatments with workers, and workplaces should be flexible with the start of workdays to support worker longevity. [ABSTRACT FROM AUTHOR]

Background: This National Institutes on Aging study protocol (R21AG077069‐01 NIA) will test a behavioral intervention, Mindfulness in Motion plus the Dietary Approaches to Stop Hypertension (MIM DASH), to promote hypertension self‐care in African American women caregivers of people living with Alzheimer's disease and related dementias. Method: Twenty‐eight participants will be randomized to MIM DASH or Alzheimer's Association Caregiver Training groups, delivered 8 weekly, 1‐hour group sessions via telehealth (video and telephone access). Data are collected at baseline, 3 and 9 months that include a) psychosocial surveys and Healthy Eating Index—DASH score and b) blood pressure, hair cortisol, and an objective stress reactivity/stress resilience battery. Result: MIM DASH will be feasible and acceptable, and will decrease caregivers' stress and improve quality of life; higher stress resilience will enhance the relationship between MIM DASH and intervention adoption while higher stress reactivity will diminish this relationship. Conclusion: Substantive contributions to the science of behavior change, design of self‐care interventions, and the adoption of healthy behaviors will be achieved. Results will inform infrastructure for a larger trial to reduce health disparities among African Americans. [ABSTRACT FROM AUTHOR]

Objectives Residence-based primary care provides homebound frail patients with a care plan that is individually tailored to manage multiple chronic conditions and functional limitations using a variety of resources. We (1) examine the visit volume and Medicare payments for residence-based health care provided by nurse practitioners ( NPs) in the Medicare fee-for-service environment; (2) compare NP's residential visits to those of internists and family physicians; and (3) compare the geographical service area of full-time house call NPs versus NPs who make nursing facility visits a major portion of their work. Design An observational study using secondary data. Setting Medicare Provider Utilization and Payment Data. Participants Medicare beneficiaries. Measurements Medicare payments for home and domiciliary care visits, the number of residence-based medical visits, provider volume, geographical distribution of full-time house call providers. Results About 3,300 NPs performed over 1.1 million home and domiciliary care visits in 2013, accounting for 22% of all residential visits to Medicare fee-for-service beneficiaries. A total of 310 NPs individually made more than 1,000 residential visits (defined as a full-time house call provider); among full-time house call providers, including physicians, NPs are now the most common provider type. There are substantial variations in the geographic distribution of full-time house call NPs, internists, and family physicians. Full time NP's service area is about 30% larger than family physicians and internists. Nursing home residents are far more likely to receive NP visits than are homebound persons receiving home visits. Conclusion NPs are now the largest type of provider delivering residence-based care and NPs provide care over the largest geographical service area. However, the vast majority of frail Americans are more likely to receive NP's care in a nursing facility versus at home. [ABSTRACT FROM AUTHOR]

Background: Previous research shows that nonpharmacological strategies may effectively manage behavioral symptoms (agitation, wandering) in persons with dementia and improve caregiver wellbeing. However, strategies depend upon caregivers for their implementation. We examine the impact of caregiver readiness to use nonpharmacological strategies on treatment outcomes.Methods: Data were from a randomized trial involving 110 family caregivers in the treatment group which received nonpharmacologic strategies for managing behavioral symptoms. Interventionists rated caregiver readiness to use nonpharmacologic strategies as pre-action (precontemplation, contemplation, preparation) or action at treatment initiation and conclusion. Caregivers in pre-action and action stages by treatment conclusion (16 weeks) were compared on proximal (frequency of, and caregiver upset and confidence with targeted behaviors) and more distal (caregiver burden and wellbeing) outcomes at 16 and 24-week follow-ups.Results: By treatment conclusion, 28.2% (n = 31) and 71.8% (n = 79) of caregivers were rated at pre-action and action respectively. Means for proximal outcomes differed between the groups at 16 and 24 weeks; those at action showed greater improvement on all proximal and distal outcomes. Hierarchical regressions showed significant relationships of readiness to targeted outcomes. By 24 weeks, caregiver readiness predicted lower frequency estimates of targeted behaviors (β = -.180, p = .041) and higher confidence (β = .27, p = .009). Readiness was not a significant predictor of caregiver burden and wellbeing at 16 or 24 weeks.Conclusion: By treatment conclusion, >25% of participants were not activated to use nonpharmacologic strategies. Activated caregivers reported greater decline in distressing behavioral symptoms, and more confidence than non-activated participants. Activation is needed to impact behavioral management but not other caregiver outcomes. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

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Background Nonpharmacologic strategies to manage dementia-related behavioral symptoms depend upon caregiver implementation. Caregivers may vary in readiness to use strategies. We examined characteristics associated with readiness, extent readiness changed during intervention, and predictors of change in readiness. Methods Data came from a randomized trial involving 119 caregivers in a nonpharmacologic intervention for managing behavioral symptoms. Baseline measures included caregiver, patient, and treatment-related factors. At initial (2 weeks from baseline) and final (16 weeks) intervention sessions, interventionists rated caregiver readiness as pre-action (precontemplation = 1; contemplation = 2; preparation = 3) or action (= 4). Ordinal logistic regression identified baseline characteristics associated with initial readiness. Mc Nemar-Bowker test of symmetry described change in readiness; binary logistic regression identified baseline predictors of change in readiness (initial to final sessions). One-way multivariate analysis of variance identified treatment factors (dose/intensity, number of strategies used, perceived benefits, and therapeutic engagement) associated with change in readiness. Results At initial intervention session, 67.2% ( N = 80) of caregivers were in pre-action and 32.8% ( N = 39) in action. Initial high readiness was associated with better caregiver mood, less financial difficulty, lower patient cognition, and more behavioral symptoms. By final session, 72% ( N = 79) were in action and 28% ( N = 31) in pre-action; caregivers with less financial difficulty improved in readiness ( B = −0.70, p = 0.017); those in action were more therapeutically engaged ( F[2,107] = 3.61, p = 0.030) and perceived greater intervention benefits ( F[2, 88] = 6.06, p = 0.003). Conclusion Whereas patient and caregiver-related factors were associated with initial readiness, financial stability, therapeutic engagement, and perceived benefits enhanced probability of change. Understanding caregiver readiness and factors associated with its change may be important considerations in nonpharmacologic interventions. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Life history theory posits that slower-growing species should invest proportionally more resources to storage, structural (e.g. stems) or defence traits than fast-growing species. Previously, we showed that the slower-growing monocarpic plants had lower mortality rates and higher bolting probabilities after two defoliation events. Here, we consider a mechanistic explanation, that the slower-growing species invested relatively more resources to storage., We compared the relative levels of root storage compounds between eight monocarpic species using metabolomic profiling, and characterized plant growth using a size-corrected estimate of relative growth rate (RGR)., Growth rate was negatively correlated with the proportional allocation of root metabolites identified as sucrose, raffinose and stachyose and with amino acids known for their roles in nitrogen storage, particularly proline and arginine. The total amount and concentration of energy-corrected carbohydrates were also negatively correlated with RGR., Our results show for the first time that slower-growing species invest proportionally more of their total root metabolites in carbon- and nitrogen-storage compounds. We conclude that the increased investment in these reserves is an important resource allocation strategy underlying the growth-survival trade-off in plants. [ABSTRACT FROM AUTHOR]

Purpose: The proportion of people over 65 years of age is higher in rural areas than in urban areas, and their numbers are expected to increase in the next decade. This study used Andersen's behavioral model to examine quality of life (QOL) in a nationally representative sample of community-dwelling adults 65 years and older according to geographic location. Specifically, associations between 3 dimensions of QOL (health-related QOL [HQOL], social functioning, and emotional well-being) and needs and health behaviors were examined. Methods: The 2005-2006 National Health and Nutrition Examination survey was linked with the 2007 Area Resources File via the National Center for Health Statistics' remote access system. Frequencies and distribution patterns were assessed according to rural, adjacent, and urban locations. Findings: Older adults reported high levels of QOL; however, rural older adults had lower social functioning than their urban counterparts. Older blacks and Hispanics had lower scores than whites on 2 dimensions of QOL. Associations between QOL and needs and health behaviors varied. Although activities of daily living were associated with all 3 dimensions, others were associated with 1 or 2 dimensions. Conclusions: The lower scores on social functioning in rural areas suggest that rural older adults may be socially isolated. Older rural adults may need interventions to maintain physical and mental health, strengthen social relationships and support, and increase their participation in the community to promote QOL. In addition, older blacks and Hispanics seem more vulnerable than whites and may need more assistance. [ABSTRACT FROM AUTHOR]

Small-seeded plant species are often reported to have high relative growth rate or RGR. However, because RGR declines as plants grow larger, small-seeded species could achieve higher RGR simply by virtue of their small size. In contrast, size-standardized growth rate or SGR factors out these size effects. Differences in SGR can thus only be due to differences in morphology, allocation, or physiology. We used nonlinear regression to calculate SGR for comparison with RGR for 10 groups of species spanning a wide range of life forms. We found that RGR was negatively correlated with seed mass in nearly all groups, but the relationship between SGR and seed mass was highly variable. We conclude that small-seeded species only sometimes possess additional adaptations for rapid growth over and above their general size advantage. [ABSTRACT FROM AUTHOR]

To compare the effects of physical resistance strength training and walking (E), individualized social activity (SA), and E and SA (ESA) with a usual care control group on total nocturnal sleep time in nursing home and assisted living residents. Pretest-posttest experimental design with assignment to one of four groups for 7 weeks: E (n=55), SA (n=50), ESA (n=41), and usual care control (n=47). Ten nursing homes and three assisted living facilities. One hundred ninety-three residents were randomly assigned; 165 completed the study. The E group participated in high-intensity physical resistance strength training 3 days a week and on 2 days walked for up to 45 minutes, the SA group received social activity 1 hour daily 5 days a week, the ESA group received both E and SA, and the control group participated in usual activities provided in the homes. Total nocturnal sleep time was measured using 2 nights of polysomnography before and 2 nights of polysomnography after the intervention. Sleep efficiency (SE), non-rapid eye movement (NREM) sleep, rapid eye movement sleep, and sleep onset latency were also analyzed. Total nocturnal sleep time was significantly greater in the ESA group than in the control group (adjusted means 364.2 minutes vs 328.9 minutes), as was SE and NREM sleep. High-intensity physical resistance strength training and walking combined with social activity significantly improved sleep in nursing home and assisted living residents. The interventions by themselves did not have significant effects on sleep in this population. [ABSTRACT FROM AUTHOR]

Understanding spatial and temporal variation in factors influencing plant regeneration is critical to predicting plant population growth. We experimentally evaluated seed limitation, insect herbivory, and their interaction in the regeneration and density of tall thistle (Cirsium altissimum) across a topographic ecosystem productivity gradient in tallgrass prairie over two years. On ridges and in valleys, we used a factorial experiment manipulating seed availability and insect herbivory to quantify effects of: seed input on seedling density, insect herbivory on juvenile density, and cumulative impacts of both seed input and herbivory on reproductive adult density. Seed addition increased seedling densities at three of five sites in 2006 and all five sites in 2007. Insect herbivory reduced seedling survival across all sites in both years, as well as rosette survival from the previous year's seedlings. In both years, insecticide treatment of seed addition plots led to greater adult tall thistle densities in the following year, reflecting the increase in juvenile thistle densities in the experimental year. Seedling survival was not density dependent. Our analytical projection model predicts a significant long-term increase in adult densities from seed input, with a greater increase under experimentally reduced insect herbivory. While plant community biomass and water stress varied significantly between ridges and valleys, the effects of seed addition and insect herbivory did not vary with gradient position. These results support conceptual models that predict seedling and adult densities of short-lived monocarpic perennial plants should be seed limited. Further, the experiment demonstrates that even at high juvenile plant densities, at which density dependence potentially could have overridden herbivore effects on plant survival, insect herbivory strongly affected juvenile thistle performance and adult densities of this native prairie species. [ABSTRACT FROM AUTHOR]

Growth rates play a fundamental role in many areas of biology (Q. Rev. Biol., 67, 1992, 283; Life History Invariants. Some Explorations of Symmetry in Evolutionary Biology, 1993; Philos. Trans. R. Soc. Lond. B Biol. Sci., 351, 1996, 1341; Plant Strategies, Vegetation Processes, and Ecosystem Properties, 2002; Trends Ecol. Evol., 18, 2003, 471; Q. Rev. Biol., 78, 2003, 23; J. Ecol., 95, 2007, 926.) but the cost and benefits of different growth rates are notoriously difficult to quantify (Q. Rev. Biol., 72, 1997, 149; Funct. Ecol., 17, 2003, 328). This is because (1) growth rate typically declines with size and yet the most widely used growth measure – relative growth rate or RGR (conventionally measured as the log of the ratio of successive sizes divided by the time interval) – is not size-corrected and so confounds growth and size, (2) organisms have access to different amounts of resource and (3) it is essential to allow for the long-term benefits of larger size. Here we experimentally demonstrate delayed costs and benefits of rapid growth in seven plant species using a novel method to calculate size-corrected RGR. In control treatments, fast-growing plants benefited from increased reproduction the following year; however, fast-growing plants subjected to an experimental stress treatment (defoliation) showed strongly reduced survival and reproduction the following year. Importantly, when growth was estimated using the classical RGR measure, no costs or benefits were found. These results support the idea that life-history trade-offs have a dominant role in life-history and ecological theory and that the widespread failure to detect them is partly due to methodological shortcomings. [ABSTRACT FROM AUTHOR]

Understanding the role of consumers in. plant population dynamics is important, both conceptually and practically. Yet, while the negative effects of herbivory on plant performance have been well documented, we know much less about how individual- level damage translates to impacts on population growth or whether spatial variation in herbivory affects patterns of plant distribution. We studied the role of insect herbivory in the dynamics and distribution of the tree cholla cactus (Opuntia imbricata), a long-lived perennial plant, across an elevational gradient in central New Mexico, USA, from low-elevation grassland (1670 m) to a grassland-mountain transition zone (1720 m) to the rocky slopes of the Los Pinos Mountains (1790 m). Tree cholla density increased significantly with elevation, while abundance of and damage by a suite of native, cactus-feeding insects decreased. We combined field experiments and demographic models to test the hypothesis that systematic spatial variation in chronic insect herbivory limits the tree cholla distribution to a subset of suitable habitat across the gradient. Our results support this hypothesis. We found that key demographic functions (survival, growth, fecundity) and the responses of these functions to experimental reductions in insect herbivory varied across the gradient. The effects of insect exclusion on plant growth and seed production were strongest in the low- elevation grassland and decreased, in magnitude with increasing elevation. We used the experimental data to parameterize integral projection. models (1PM), which predict the asymptotic rate of population increase (λ). The modeling results showed that insect herbivory depressed λ and that the magnitude of this effect was context-dependent. The effect of insect herbivory on population growth was strongest at low elevation (Δλlow = 0.095), intermediate at mid elevation (ΔΔmjd = 0.046), and weakest at high elevation (Δλhigh = -0.0089). The total effect of insects on was due to a combination of reductions in growth and in fecundity and their combination; the relative contribution of each of these effects varied spatially. Our results, generated by experimental demography across a heterogeneous landscape, provide new insights into the role of native bonsumers in the population dynamics and distribution of abundance of long-lived native plants. [ABSTRACT FROM AUTHOR]

Invasive species have the potential to alter trade-offs leading to selection in the populations they invade. Here we quantify the demographic and selective effects of herbivory by native insects and the introduced floral feeder Rhinocyllus conicus on Platte thistle (Cirsium canescens), a sparse monocarpic thistle endemic to North America. Rhinocylus first invaded the Platte thistle population in 1993. Since then, its numbers have increased exponentially, while the Platte thistle population size has decreased. Data from 11 years were analyzed to determine how demographic rates varied with plant size and damage by native insects and Rhinocyllus. Individual growth, survival, flowering probability, and seed set were all size dependent. Damage to vegetative structures did not influence demographic rates; damage to flower heads did because Platte thistle is seed limited. These analyses were used to parameterize a series of integral projection models (IPMs) that investigated the effects of floral herbivory on the population growth rate &lamda;, equilibrium population size, and the evolutionary stable (ES) flowering strategy. The IPMs showed that native insects have significant impact on the equilibrium population size and &lamda;, but not the ES flowering strategy, because they use the flowers of different-sized plants indiscriminately. In contrast, Rhinocyilus has the potential to drive Platte thistle extinct. Rhinocylius preferentially fed and oviposited on the flowers of larger plants and therefore selected for a reduction in flowering size. However, as the thistle population went into decline, this pattern reversed. Thus, selection imposed by an invader may be complex and will reflect behavioral interactions between herbivore and host, as well as demographic changes in the host population. [ABSTRACT FROM AUTHOR]

The author reflects on the publication of pilot studies in the current journal. A pilot study is used to test the methods and other practical aspects of the proposed study. A list describing the main purposes of a pilot study as advocated by van Teijlingen and Hundley is presented. However, the author states that he is not attempting to downgrade the pilot studies.

Reports on the results of a survey on the percentage of local population willing to become eye donors in Manchester, England. Assessment of potential donors in the area; Knowledge on corneal transplants.