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Objective: To test the effect of a complex guideline-based intervention on agitation and psychotropic prescriptions.
Design, Setting, Participants: Cluster randomized controlled trial (VIDEANT) with blinded assessment of outcome in 18 nursing homes in Berlin, Germany, comprising 304 dementia patients.
Intervention: Training, support, and activity therapy intervention, delivered at the level of each nursing home, focusing on the management of agitation in dementia. Control group nursing homes received treatment as usual.
Measurements: Levels of agitated and disruptive behavior (Cohen-Mansfield agitation inventory [CMAI]) as the primary outcome. Number of neuroleptics, antidepressants, and cholinesterase inhibitors (ChEIs) prescribed in defined daily dosages (DDDs).
Results: Of 326 patients screened, 304 (93.3%) were eligible and cluster-randomized to 9 intervention (n = 163) and 9 control (n = 141) nursing homes. Data were collected from 287 (94.4%) patients at 10 months. At 10 months, compared with controls, nursing home residents with dementia in the intervention group exhibited significantly less agitation as measured with the CMAI (adjusted mean difference, 6.24; 95% CI 2.03-14.14; P = .009; Cohen's d = 0.43), received fewer neuroleptics (P < .05), more ChEIs (P < .05), and more antidepressants (P < .05).
Conclusion: Complex guideline-based interventions are effective in reducing agitated and disruptive behavior in nursing home residents with dementia. At the same time, increased prescription of ChEIs and antidepressants together with decreased neuroleptic prescription suggests an effect toward guideline-based pharmacotherapy.
Reporting Self-Made Errors - The Impact of Organizational Error-Management Climate and Error Type
(2013)
We study how an organization's error-management climate affects organizational members' beliefs about other members' willingness to report errors that they discover when chance of error detection by superiors and others is extremely low. An error-management climate, as a component of the organizational climate, is said to be "high" when errors are accepted as part of everyday life as long as they are learned from and not repeated. Alternatively, the error-management climate is said to be an "error averse" climate when discovery of errors invokes the laying of blame on those admitting to or found committing errors. We examine the effects of this error-management climate in a professional services environment where uncorrected errors may have severe consequences and discovery of work errors is crucial for organizational success. We find that error-management climate affects organizational members' beliefs about what other members will report about discovered self-made errors, with a high error-management (versus error averse) climate leading to greater reporting willingness. We also find a significant interaction with a key contextual variable, error type (conceptual or calculation), that suggests the effect is more significant for conceptual errors than calculation errors. Our findings suggest that an organization's error-management climate is an important factor in promoting ethical behavior of employees, especially junior employees, carrying out routine tasks whose failure to report errors discovered incidental to those tasks may have severe implications for their organizations.
Synchronization and emergence of a collective mode is a general phenomenon, frequently observed in ensembles of coupled self-sustained oscillators of various natures. In several circumstances, in particular in cases of neurological pathologies, this state of the active medium is undesirable. Destruction of this state by a specially designed stimulation is a challenge of high clinical relevance. Typically, the precise effect of an external action on the ensemble is unknown, since the microscopic description of the oscillators and their interactions are not available. We show that, desynchronization in case of a large degree of uncertainty about important features of the system is nevertheless possible; it can be achieved by virtue of a feedback loop with an additional adaptation of parameters. The adaptation also ensures desynchronization of ensembles with non-stationary, time-varying parameters. We perform the stability analysis of the feedback-controlled system and demonstrate efficient destruction of synchrony for several models, including those of spiking and bursting neurons.
We study a transition to hyperchaos in the two-dimensional incompressible Navier-Stokes equations with periodic boundary conditions and an external forcing term. Bifurcation diagrams are constructed by varying the Reynolds number, and a transition to hyperchaos (HC) is identified. Before the onset of HC, there is coexistence of two chaotic attractors and a hyperchaotic saddle. After the transition to HC, the two chaotic attractors merge with the hyperchaotic saddle, generating random switching between chaos and hyperchaos, which is responsible for intermittent bursts in the time series of energy and enstrophy. The chaotic mixing properties of the flow are characterized by detecting Lagrangian coherent structures. After the transition to HC, the flow displays complex Lagrangian patterns and an increase in the level of Lagrangian chaoticity during the bursty periods that can be predicted statistically by the hyperchaotic saddle prior to HC transition.
We explore the effect of cross-diffusion on pattern formation in the two-variable Oregonator model of the Belousov-Zhabotinsky reaction. For high negative cross-diffusion of the activator (the activator being attracted towards regions of increased inhibitor concentration) we find, depending on the values of the parameters, Turing patterns, standing waves, oscillatory Turing patterns, and quasi-standing waves. For the inhibitor, we find that positive cross-diffusion (the inhibitor being repelled by increasing concentrations of the activator) can induce Turing patterns, jumping waves and spatially modulated bulk oscillations. We qualitatively explain the formation of these patterns. With one model we can explain Turing patterns, standing waves and jumping waves, which previously was done with three different models.
Organic management is one of the most popular strategies to reduce negative environmental impacts of intensive agriculture. However, little is known about benefits for biodiversity and potential worsening of yield under organic grasslands management across different grassland types, i.e. meadow, pasture and mown pasture. Therefore, we studied the diversity of vascular plants and foliage-living arthropods (Coleoptera, Araneae, Heteroptera, Auchenorrhyncha), yield, fodder quality, soil phosphorus concentrations and land-use intensity of organic and conventional grasslands across three study regions in Germany. Furthermore, all variables were related to the time since conversion to organic management in order to assess temporal developments reaching up to 18 years. Arthropod diversity was significantly higher under organic than conventional management, although this was not the case for Araneae, Heteroptera and Auchenorrhyncha when analyzed separately. On the contrary, arthropod abundance, vascular plant diversity and also yield and fodder quality did not considerably differ between organic and conventional grasslands. Analyses did not reveal differences in the effect of organic management among grassland types. None of the recorded abiotic and biotic parameters showed a significant trend with time since transition to organic management, except soil organic phosphorus concentrations which decreased with time. This implies that permanent grasslands respond slower and probably weaker to organic management than crop fields do. However, as land-use intensity and inorganic soil phosphorus concentrations were significantly lower in organic grasslands, overcoming seed and dispersal limitation by re-introducing plant species might be needed to exploit the full ecological potential of organic grassland management. We conclude that although organic management did not automatically increase the diversity of all studied taxa, it is a reasonable and useful way to support agro-biodiversity.
Recovering interaction of endogenous rhythms from observations is challenging, especially if a mathematical model explaining the behaviour of the system is unknown. The decisive information for successful reconstruction of the dynamics is the sensitivity of an oscillator to external influences, which is quantified by its phase response curve. Here we present a technique that allows the extraction of the phase response curve from a non-invasive observation of a system consisting of two interacting oscillators-in this case heartbeat and respiration-in its natural environment and under free-running conditions. We use this method to obtain the phase-coupling functions describing cardiorespiratory interactions and the phase response curve of 17 healthy humans. We show for the first time the phase at which the cardiac beat is susceptible to respiratory drive and extract the respiratory-related component of heart rate variability. This non-invasive method for the determination of phase response curves of coupled oscillators may find application in many scientific disciplines.
Siberian larch forests and the ion content of thaw lakes form a geochemically functional entity
(2013)
Siberian larch forests growing on shallow permafrost soils have not, until now, been considered to be controlling the abiotic and biotic characteristics of the vast number of thaw-lake ecosystems. Here we show, using four independent data sets (a modern data set from 201 lakes from the tundra to taiga, and three lake-core records), that lake-water geochemistry in Yakutia is highly correlated with vegetation. Alkalinity increases with catchment forest density. We postulate that in this arid area, higher evapotranspiration in larch forests compared with that in the tundra vegetation leads to local salt accumulation in soils. Solutes are transported to nearby thaw lakes during rain events and snow melt, but are not fully transported into rivers, because there is no continuous groundwater flow within permafrost soils. This implies that potentially large shifts in the chemical characteristics of aquatic ecosystems to known warming are absent because of the slow response of catchment forests to climate change.
Natural and human-induced erosion supplies high amounts of soil organic carbon (OC) to terrestrial drainage networks. Yet OC fluxes in rivers were considered in global budgets only recently. Modern estimates of annual carbon burial in inland river sediments of 0.6 Gt C, or 22% of C transferred from terrestrial ecosystems to river channels, consider only lakes and reservoirs and disregard any long-term carbon burial in hillslope or floodplain sediments. Here we present the first assessment of sediment-bound OC storage in Central Europe from a synthesis of similar to 1500 Holocene hillslope and floodplain sedimentary archives. We show that sediment storage increases with drainage-basin size due to more extensive floodplains in larger river basins. However, hillslopes retain hitherto unrecognized high amounts of eroded soils at the scale of large river basins such that average agricultural erosion rates during the Holocene would have been at least twice as high as reported previously. This anthropogenic hillslope sediment storage exceeds floodplain storage in drainage basins <10(5) km(2), challenging the notion that floodplains are the dominant sedimentary sinks. In terms of carbon burial, OC concentrations in floodplains exceed those on hillslopes, and net OC accumulation rates in floodplains (0.70.2 g C m(-2)a(-1)) surpass those on hillslopes (0.40.1 g C m(-2)a(-1)) over the last 7500 years. We conclude that carbon burial in floodplains and on hillslopes in Central Europe exceeds terrestrial carbon storage in lakes and reservoirs by at least 2 orders of magnitude and should thus be considered in continental carbon budgets.
Introduction: Gait speed is one of the most commonly and frequently used parameters to evaluate gait development. It is characterized by high variability when comparing different steps in children. The objective of this study was to determine intra-individual gait speed variability in children.
Methods: Gait speed measurements (6-10 trials across a 3 m walkway) were performed and analyzed in 8263 children, aged 1-15 years. The coefficient of variation (CV) served as a measure for intra-individual gait speed variability measured in 6.6 +/- 1.0 trials per child. Multiple linear regression analysis was conducted to evaluate the influence of age and body height on changes in variability. Additionally, a subgroup analysis for height within the group of 6-year-old children was applied.
Results: A successive reduction in gait speed variability (CV) was observed for age groups (age: 1-15 years) and body height groups (height: 0.70-1.90 m). The CV in the oldest subjects was only one third of the CV (CV 6.25 +/- 3.52%) in the youngest subjects (CV 16.58 +/- 10.01%). Up to the age of 8 years (or 1.40 m height) there was a significant reduction in CV over time, compared to a leveling off for the older (taller) children.
Discussion: The straightforward approach measuring gait speed variability in repeated trials might serve as a fundamental indicator for gait development in children. Walking velocity seems to increase to age 8. Enhanced gait speed consistency of repeated trials develops up to age 15.