Mapping and assessing clinical handover training interventions

BACKGROUND: The literature reveals a patchwork of knowledge about the effectiveness of handover and transfer of care-training interventions, their influence on handover practices and on patient outcomes. We identified a range of training interventions, defined their content, and then proposed practical measures for improving the training effectiveness of handover practices. METHODS: We applied the Group Concept Mapping approach to identify objectively the shared understanding of a group of experts about patient handover training interventions. We collected 105 declarative statements about handover training interventions from an exhaustive literature review, and from structured expert interviews. The statements were then given to 21 healthcare and training design specialists to sort the statements on similarity in meaning, and rate them on their importance and feasibility. RESULTS: We used multidimensional scaling and hierarchical cluster analysis to depict the following seven clusters related to various handover training issues: standardisation, communication, coordination of activities, clinical microsystem care, transfer and impact, training methods and workplace learning. CONCLUSIONS: Ideas on handover training interventions, grouped in thematic clusters, and prioritised on importance and feasibility creates a repository of approaches. This allows healthcare institutions to design and test concrete solutions for improving formal training and workplace learning related to handovers, and addressing informal social learning at the organisational level, with the aim of increasing impact on handover practice and patient outcomes. Measures need to be taken to assure a continuum of handover training interventions from formal training through workplace learning through less formal social learning, and to embed this training in the design of the clinical microsystem

A global database for metacommunity ecology, integrating species, traits, environment and space

The use of functional information in the form of species traits plays an important role in explaining biodiversity patterns and responses to environmental changes. Although relationships between species composition, their traits, and the environment have been extensively studied on a case-by-case basis, results are variable, and it remains unclear how generalizable these relationships are across ecosystems, taxa and spatial scales. To address this gap, we collated 80 datasets from trait-based studies into a global database for metaCommunity Ecology: Species, Traits, Environment and Space; “CESTES”. Each dataset includes four matrices: species community abundances or presences/absences across multiple sites, species trait information, environmental variables and spatial coordinates of the sampling sites. The CESTES database is a live database: it will be maintained and expanded in the future as new datasets become available. By its harmonized structure, and the diversity of ecosystem types, taxonomic groups, and spatial scales it covers, the CESTES database provides an important opportunity for synthetic trait-based research in community ecology

Cross-realm assessment of climate change impacts on species' abundance trends

Climate change, land-use change, pollution and exploitation are among the main drivers of species' population trends; however, their relative importance is much debated. We used a unique collection of over 1,000 local population time series in 22 communities across terrestrial, freshwater and marine realms within central Europe to compare the impacts of long-term temperature change and other environmental drivers from 1980 onwards. To disentangle different drivers, we related species' population trends to species- and driver-specific attributes, such as temperature and habitat preference or pollution tolerance. We found a consistent impact of temperature change on the local abundances of terrestrial species. Populations of warm-dwelling species increased more than those of cold-dwelling species. In contrast, impacts of temperature change on aquatic species' abundances were variable. Effects of temperature preference were more consistent in terrestrial communities than effects of habitat preference, suggesting that the impacts of temperature change have become widespread for recent changes in abundance within many terrestrial communities of central Europe.Additionally, we appreciate the open access marine data provided by the International Council for the Exploration of the Sea. We thank the following scientists for taxonomic or technical advice: C. Brendel, T. Caprano, R. Claus, K. Desender, A. Flakus, P. R. Flakus, S. Fritz, E.-M. Gerstner, J.-P. Maelfait, E.-L. Neuschulz, S. Pauls, C. Printzen, I. Schmitt and H. Turin, and I. Bartomeus for comments on a previous version of the manuscript. R.A. was supported by the EUproject LIMNOTIP funded under the seventh European Commission Framework Programme (FP7) ERA-Net Scheme (Biodiversa, 01LC1207A) and the long-term ecological research program at the Leibniz-Institute of Freshwater Ecology and Inland Fisheries (IGB). R.W.B. was supported by the Scottish Government Rural and Environment Science and Analytical Services Division (RESAS) through Theme 3 of their Strategic Research Programme. S.D. acknowledges support of the German Research Foundation DFG (grant DO 1880/1-1). S.S. acknowledges the support from the FP7 project EU BON (grant no. 308454). S.K., I.Kü. and O.S. acknowledge funding thorough the Helmholtz Association’s Programme Oriented Funding, Topic ‘Land use, biodiversity, and ecosystem services: Sustaining human livelihoods’. O.S. also acknowledges the support from FP7 via the Integrated Project STEP (grant no. 244090). D.E.B. was funded by a Landes–Offensive zur Entwicklung Wissenschaftlich–ökonomischer Exzellenz (LOEWE) excellence initiative of the Hessian Ministry for Science and the Arts and the German Research Foundation (DFG: Grant no. BO 1221/23-1).Peer Reviewe

Self-reported work productivity in people with multiple sclerosis and its association with mental and physical health

PURPOSE: This study aimed to identify mental health, physical health, demographic and disease characteristics relating to work productivity in people with multiple sclerosis (MS). METHODS: In this cross-sectional study, 236 employed people with MS (median age = 42 years, 78.8% female) underwent neurological and neuropsychological assessments. Additionally, they completed questionnaires inquiring about work productivity (presenteeism: reduced productivity while working, and absenteeism: loss of productivity due to absence from work), mental and physical health, demographic and disease characteristics. Multiple linear and logistic regression analyses were performed with presenteeism and absenteeism as dependent variables, respectively. RESULTS: A model with mental and physical health factors significantly predicted presenteeism F(11,202) = 11.33, p < 0.001, R2 = 0.38; a higher cognitive (p < 0.001) and physical impact (p = 0.042) of fatigue were associated with more presenteeism. A model with only mental health factors significantly predicted absenteeism; χ2(11)=37.72, p < 0.001, with R2 = 0.27 (Nagelkerke) and R2 = 0.16 (Cox and Snell). Specifically, we observed that more symptoms of depression (p = 0.041) and a higher cognitive impact of fatigue (p = 0.011) were significantly associated with more absenteeism. CONCLUSIONS: In people with MS, both cognitive and physical impact of fatigue are positively related to presenteeism, while symptoms of depression and cognitive impact of fatigue are positively related to absenteeism.Implications for rehabilitationMultiple sclerosis (MS) affects people of working age, significantly interfering with work productivity.Higher cognitive and physical impact of fatigue were associated with more presenteeism in workers with MS.A higher cognitive impact of fatigue and more depressive symptoms were associated with absenteeism in workers with MS.Occupational and healthcare professionals should be aware of the impact of both physical and mental health on work productivity in workers with MS

Continuous attractor network models of grid cell firing based on excitatory-inhibitory interactions

Neurons in the medial entorhinal cortex encode location through spatial firing fields that have a grid‐like organisation. The challenge of identifying mechanisms for grid firing has been addressed through experimental and theoretical investigations of medial entorhinal circuits. Here, we discuss evidence for continuous attractor network models that account for grid firing by synaptic interactions between excitatory and inhibitory cells. These models assume that grid‐like firing patterns are the result of computation of location from velocity inputs, with additional spatial input required to oppose drift in the attractor state. We focus on properties of continuous attractor networks that are revealed by explicitly considering excitatory and inhibitory neurons, their connectivity and their membrane potential dynamics. Models at this level of detail can account for theta‐nested gamma oscillations as well as grid firing, predict spatial firing of interneurons as well as excitatory cells, show how gamma oscillations can be modulated independently from spatial computations, reveal critical roles for neuronal noise, and demonstrate that only a subset of excitatory cells in a network need have grid‐like firing fields. Evaluating experimental data against predictions from detailed network models will be important for establishing the mechanisms mediating grid firing. [Image: see text

Brand Suicide? Memory and Liking of Negative Brand Names

Negative brand names are surprisingly common in the marketplace (e.g., Poison perfume; Hell pizza, and Monster energy drink), yet their effects on consumer behavior are currently unknown. Three studies investigated the effects of negative brand name valence on brand name memory and liking of a branded product. Study 1 demonstrates that relative to nonnegative brand names, negative brand names and their associated logos are better recognised. Studies 2 and 3 demonstrate that negative valence of a brand name tends to have a detrimental influence on product evaluation with evaluations worsening as negative valence increases. However, evaluation is also dependent on brand name arousal, with high arousal brand names resulting in more positive evaluations, such that moderately negative brand names are equally as attractive as some non-negative brand names. Study 3 shows evidence for affective habituation, whereby the effects of negative valence reduce with repeated exposures to some classes of negative brand name

Tree diversity and above-ground biomass in the South America Cerrado biome and their conservation implications

Less than half of the original two million square kilometers of the Cerrado vegetation remains standing, and there are still many uncertainties as to how to conserve and prioritize remaining areas effectively. A key limitation is the continuing lack of geographically-extensive evaluation of ecosystem-level properties across the biome. Here we sought to address this gap by comparing the woody vegetation of the typical cerrado of the Cerrado–Amazonia Transition with that of the core area of the Cerrado in terms of both tree diversity and vegetation biomass. We used 21 one-hectare plots in the transition and 18 in the core to compare key structural parameters (tree height, basal area, and above-ground biomass), and diversity metrics between the regions. We also evaluated the effects of temperature and precipitation on biomass, as well as explored the species diversity versus biomass relationship. We found, for the first time, both that the typical cerrado at the transition holds substantially more biomass than at the core, and that higher temperature and greater precipitation can explain this difference. By contrast, plot-level alpha diversity was almost identical in the two regions. Finally, contrary to some theoretical expectations, we found no positive relationship between species diversity and biomass for the Cerrado woody vegetation. This has implications for the development of effective conservation measures, given that areas with high biomass and importance for the compensation of greenhouse gas emissions are often not those with the greatest diversity

Neuronal modulation: The effect of agonists and inverse agonists on the cannabinoid system of a hippocampal primary cell culture

Ziel dieser Arbeit war es, die Wirkung von inversen Agonisten des CB1-Rezeptors anhand einer primären hippocampalen Neuronen-/Gliazellen- Kokultur zu untersuchen. Immuncytochemisch konnte gezeigt werden, dass in den kultivierten Neuronen die CB1-Rezeptoren in nachweisbaren Mengen exprimiert werden. Die aus Rattenembryonen erstellte Primärkultur wurde weiterhin auf elektrophysiologische Parameter untersucht um eine in vivo nahe in vitro Kultur zu gewährleisten. So reagieren die Neuronen auf TTX mit verminderter Spikeaktivität die auf die Blockierung der spannungsabhängigen Natriumkanäle zurückzuführen ist. Auch die Inhibition von AMPA Rezeptoren unter Verwendung von CNQX zeigte eine Reduktion der Spikefrequenz auf synaptischer Ebene. Analysen der Kinetik und der Frequenz der generierten Aktionspotentiale, sowie der AMPA- und NMDA EPSCs sind mit bereits publizierten in vitro und in vivo Daten weitgehend vergleichbar. Um die intrinsische Variabilität des verwendeten Assays zu verringern, wurde der für die pharmakologischen Untersuchungen des Cannabinoidsystems eingesetzte Messpuffer mit einer geringen Konzentration Magnesium versehen, um den NMDA-Rezeptorblock aufzuheben. Die daraus resultierenden Aktionspotential-Bursts sorgten einerseits für eine geringere Variabilität der Messungen, andererseits konnte durch erweiterte Analysen dieser Bursts die Auswirkungen der eingesetzten CB1-Agonisten und inversen CB1-Agonisten auf das Burstverhalten der gemessenen Neuronen ermittelt werden. Hierbei zeigte sich ein gegensätzliches Verhalten von Aktionspotentialfrequenz zur Modulation der generierten Aktionspotentiale pro Burst, Pausen zwischen den Bursts und Länge der Bursts. Auf der Basis der durch die Aktionspotential-Frequenzanalysen gewonnenen Daten konnte erstmals eine agonistische Komponente bei nanomolaren Dosen der inversen Agonisten gezeigt werden, was auf eine spezifische Interaktion mit einem beteiligten oder noch nicht bekannten Rezeptor hindeutet. Die Blockierung der Adenylatzyklase, eines Schlüsselenzyms in der Signaltransduktion des CB1-Rezeptors, hebt diesen Effekt auf, allerdings ist auch kein invers agonistischer Effekt mehr messbar. Des weiteren wurde auf eine Beteiligung des Opioidsystems an der agonistischen Wirkung des inversen Agonisten Rimonabant untersucht. In der vorliegenden Arbeit konnte keine der publizierten Wechselwirkungen dieser beiden Systeme im Bezug auf den agonistischen Effekt von Rimonabant beobachtet werden.The aim of this thesis was to investigate the effect of inverse agonists on the CB1-receptor with an established complex neuronal-/ glia- co culture obtained from hippocampi of embryonic rats. To provide evidence of the expression of the CB1-receptors in the established culture immunocytochemical studies have been used and showed a sufficient expression level of the CB1-receptors. The neuronal culture was further tested on various electrophysiological parameters to verify an in vitro assay that resembles in vivo characteristics. Thus the exposure of TTX to neurons lead to reduced spike activity which refers to the blocking of voltage gated sodium channels. Also the inhibition of AMPA receptors using CNQX showed a reduction of spike activity in respect of the reduced synaptic activity. Analyses of the kinetic and spike frequencies of the generated actionpotentials as well as the kinetics and frequencies of spontaneous AMPA- and NMDA epscs are to a large extent comparable to published data of in vitro and in vivo assays. To reduce the intrinsic variability of the established cannabinoid assay the method of induced burst activity under low magnesium conditions has been used. This method results indeed in a lower variability of the assay but also the analysis of the effect of cannabinoid agonists and inverse agonists on the evoked burst activity showed interesting inverse modulations of burst durations, event intervals and inter-event intervals compared to alterations of the spike frequencies. On the basis of the obtained data by the analyzed spike-frequencies an agonistic effect of nanomolar concentrations of the investigated inverse agonists could be shown for the first time. This observation could lead to the conclusion that this might be a specific interaction of the investigated inverse agonist with an other receptor. The inhibition of the adenylatcyclase, a key-enzyme of the CB1 signal transduction, neutralizes the agonistic effect, although the inverse agonistic effect dissapeard. In addition the interaction of the opioid system in respect to the observed agonistic effect of rimonabant has been investigated. However, non of the published interaction of this two systems in respect to the agonistic effect of rimonabant could be observed

Legislación, comunicación y autoridad: Como dar cuenta del carácter vinculante del derecho?

Translation of a chapter originally published in English