IMPORTANCE Mobility limitations are common in older adults, affecting the physical, psychological, and social aspects of an older adult’s life. OBJECTIVE To identify mobility risk factors, screening ...tools, medical management, need for physical therapy, and efficacy of exercise interventions for older primary care patients with limited mobility. EVIDENCE ACQUISITION Search of PubMed and PEDro from January 1985 to March 31, 2013, using the search terms mobility limitation, walking difficulty, and ambulatory difficulty to identify English-language, peer-reviewed systematic reviews, meta-analyses, and Cochrane reviews assessing mobility limitation and interventions in community-dwelling older adults. Articles not appearing in the search referenced by reviewed articles were also evaluated. FINDINGS The most common risk factors for mobility impairment are older age, low physical activity, obesity, strength or balance impairment, and chronic diseases such as diabetes or arthritis. Several tools are available to assess mobility in the ambulatory setting. Referral to physical therapy is appropriate, because physical therapists can assess mobility limitations and devise curative or function-enhancing interventions. Relatively few studies support therapeutic exercise to improve mobility limitation. Strong evidence supports resistance and balance exercises for improving mobility-limiting physical weakness and balance disorders. Assessing a patient’s physical environment and the patient’s ability to adapt to it using mobility devices is critical. CONCLUSIONS AND RELEVANCE Identification of older adults at risk for mobility limitation can be accomplished through routine screening in the ambulatory setting. Addressing functional deficits and environmental barriers with exercise and mobility devices can lead to improved function, safety, and quality of life for patients with mobility limitations.
Accurate and reliable predictions of invasive species distributions are urgently needed by land managers for developing management plans and monitoring new potential areas of establishment. ...Presence-only species distribution models are commonly used in these evaluations, however they are rarely tested with independent data over time or compared with presence-absence models fit with the same presence data. Using Maxent, we developed a presence-only model of invasive cheatgrass (Bromus tectorum L.) distribution in Rocky Mountain National Park, Colorado, USA in 2007 fit with limited data, and then tested the model with independent presence and absence data collected between 2008 and 2013. This model was verified using threshold dependent and threshold independent evaluation metrics. Next, we developed a Maxent model with cheatgrass presence data from 2007 through 2013 (i.e. Maxent 2013), and compared this model to a presence-absence method (i.e., generalized linear model; GLM 2013) using the same data. Threshold dependent and threshold independent evaluation metrics suggested Maxent 2013 outperformed GLM 2013, and a two-tailed Wilcoxon signed rank test indicated relative probability outputs were not significantly different between the models in geographic space. Based on known presences and absences of cheatgrass collected in the field, the Maxent 2013 and GLM 2013 relative probability outputs were highly correlated at absence locations but less correlated at presence locations. A Kappa comparison of Maxent 2007 and Maxent 2013 binary output provides evidence that Maxent is robust when fit with limited data. Our results indicate Maxent is an appropriate model for use when land management objectives are supported by limited resources and thus require a conservative, but highly accurate estimate of habitat suitability for invasive species on the landscape.
•A Maxent model fit with limited presence data is tested with independent test data.•Presence-only habitat suitability model is comparable to a presence-absence model.•A suite of model validation methods are highlighted, including comparisons in geographic space.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Hospital-associated disability (HAD), defined as loss of independence in activities of daily living (ADL) following acute hospitalization, is observed among older adults. The study objective is to ...determine overall prevalence of HAD among older adults hospitalized in acute care, and to assess the impact of study initiation year in moderation of prevalence.
Meta-analysis of data collected from randomized trials, quasi-experimental, and prospective cohort studies. English-language searches to identify included studies were completed February 2018 and updated May 2018 of electronic databases and reference lists of studies and reviews. Included studies were human subjects investigations that measured ADL ≥2 time points before or during and after hospitalization and reported prevalence of ADL decline among older adults.
Acute care hospital units.
Adults aged ≥65 years hospitalized in medical-surgical acute care; total sample size across all included studies was 7375.
Independence in ADL was assessed using the Katz Index of Independence in Activities of Daily Living and Barthel Index of Independence in Activities of Daily Living.
Random effects meta-analysis across included studies identified combined prevalence of HAD as 30% (95% CI 24%, 33%; P < .001). The effect of study initiation year on the prevalence rate was minimal. A large amount of heterogeneity was observed between studies, which may be due in part to nonstandardized measurement of ADL impairment or other methodological differences.
Hospitalization in acute care poses a significant risk to functional independence of older adults, and this risk is unchanged despite shorter lengths of stay. The evidence supports the continued need for hospital-based programs that provide assessment of functional ability and identification of at-risk older adults in order to better treat and prevent HAD.
OBJECTIVES: To examine the proportion of time spent in three levels of mobility (lying, sitting, and standing or walking) by a cohort of hospitalized older veterans as measured by validated wireless ...accelerometers.
DESIGN: A prospective, observational cohort study.
SETTING: One hundred fifty–bed Department of Veterans Affairs hospital.
PARTICIPANTS: Forty‐five hospitalized medical patients, aged 65 and older who were not delirious, did not have dementia, and were able to walk in the 2 weeks before admission were eligible.
MEASUREMENTS: Wireless accelerometers were attached to the thigh and ankle of patients for the first 7 days after admission or until hospital discharge, whichever came first. The mean proportion of time spent lying, sitting, and standing or walking was determined for each hour after hospital admission using a previously validated algorithm.
RESULTS: Forty‐five male patients (mean age 74.2) with a mean length of stay of 5.1 days generated 2,592 one‐hour periods of data. A baseline functional assessment indicated that 35 (77.8%) study patients were willing and able to walk a short distance independently. No patient remained in bed the entire measured hospital stay, but on average, 83% of the measured hospital stay was spent lying in bed. The average amount of time that any one individual spent standing or walking ranged from a low of 0.2% to a high of 21%, with a median of 3%, or 43 minutes per day.
CONCLUSION: This is the first study to continuously monitor mobility levels early during a hospital stay. On average, older hospitalized patients spent most of their time lying in bed, despite an ability to walk independently.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Cynthia J. Brown explains why the advent of print in the late medieval period brought about changes in relationships among poets, patrons, and printers which led to a new conception of authorship. ...Examining such paratextual elements of manuscripts as title pages, colophons, and illustrations as well as such literary strategies as experimentation with narrative voice, Brown traces authors' attempts to underscore their narrative presence in their works and to displace patrons from their role as sponsors and protectors of the book. Her accounts of the struggles of poets, including Jean Lemaire, Jean Bouchet, Jean Molinet, and Pierre Gringore, over the design, printing, and sale of their books demonstrate how authors secured the status of literary proprietor during the transition from the culture of script and courtly patronage to that of print capitalism.
In this letter to the editor, we report 82 persons with CF (PwCF) self‐reported changes in mental and physical health and potential attribution with either the COVID‐19 pandemic and the initiation ...elexacaftor/tezacaftor/ivacaftor (ETI). Emerging evidence has shown an association with ETI and mental health adverse events. The close proximity of ETI FDA approval and prescribing in PwCF and the COVID‐19 pandemic present a challenge in determining the cause of mental health decline. We report 33 (40%) of respondents felt that COVID‐19 contributed to a worsening of either their anxiety, depression, or both and 7 (9%) of respondents felt that ETI contributed to a worsening in their anxiety, depression, or both. Eighteen (23%) of respondents felt that ETI had contributed to improvement their mental health. This letter highlights multiple factors that could be impacting mental health beyond ETI. As the COVID‐19 pandemic is moving toward an endemic phase, future studies may have more success in deciphering ETI effects on mental health.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Background
Nurse educators in baccalaureate programs are charged with addressing student competence in public health nursing practice. These educators are also responsible for creating nursing ...student opportunities for civic engagement and development of critical thinking skills. The IOM report (2010) on the Future of Nursing emphasizes the nurse educator’s role in promoting collaborative partnerships that incorporate interdisciplinary and intraprofessional efforts to promote health.
Aim
The purpose of this article is to describe an innovative approach to address public health nursing competencies and to improve the health and well‐being of indigenous populations in a global setting through promotion of collaboration and service‐ learning principles.
Methods
As part of a hybrid elective course, baccalaureate nursing students from various nursing tracks participated in a 2 week immersion experience in Belize that included preimmersion preparation. These students were to collaborate among themselves and with Belizean communities to address identified health knowledge deficits and health‐related needs for school‐aged children and adult populations.
Results
Students successfully collaborated in order to meet health‐related needs and to engage in health promotion activities in the Toledo district of Belize. They also gained practice in developing public health nursing competencies for entry‐level nursing practice. Implementation of service‐learning principles provided students with opportunities for civic engagement and self‐reflection.
Discussion
Some challenges existed from the students’, faculty, and global community’s perspectives. Lack of culturally appropriate and country specific health education materials was difficult for students and the community. Faculty encountered challenges in communicating and collaborating with the Belizean partners.
Conclusion
Commonalities exist between entry‐level public health nursing competencies and service‐learning principles. Using service‐learning principles in the development of public health experiences increases the likelihood of success in achieving these competencies. While students demonstrated intraprofessional collaboration in a global setting, these same collaborative opportunities can occur in local communities.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Aims
Although leaf and root traits may change considerably throughout plant development, ontogenetic variation is rarely considered in trait-based ecology. Studies focused on how morphological root ...traits change throughout ontogeny are especially rare. Our objectives were to determine how ontogeny influences seedling traits to inform trait selection for future studies and to advance understanding of how traits at early developmental stages influence seedling growth.
Methods
We measured traits from eleven herbaceous species at several developmental stages. We used Bayesian random effects models to assess the effects and variation resulting from species identity and ontogeny for each trait. We used principal component analysis and multiple regression to identify which dominant axes of variation were correlated with future growth rates.
Results
Variation in traits resulting from ontogeny was greatest for growth rates and root elongation rates. Relationships among traits were similar at all ontogenetic stages, but which principal component axes were correlated with future growth depended on stage; at the earliest harvest, the axis related to tissue construction was linked to future growth rate, whereas, at the last harvest, three independent axes were related to future growth rate.
Conclusions
In our study, traits including leaf dry matter content, root tissue density, and root diameter varied little throughout seedling development and thus may be promising candidates for future trait-based studies. Linking suites of traits to growth strategies may be particularly fruitful for understanding plant strategies throughout early development, as multivariate relationships among traits appear to be more ontogenetically stable than individual traits.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UILJ, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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