Publications by authors named "D Erik Everhart"

86 Publications

Behavioral and exercise interventions for sleep dysfunction in the elderly: a brief review and future directions.

Sleep Breath 2021 Feb 25. Epub 2021 Feb 25.

Department of Psychology, East Carolina University, Greenville, NC, 27858, USA.

Purpose: The impact of sleep-related changes and disorders in the geriatric populations are of utmost concern due to health consequences and increased risk of injury as well as injuring others as a result of poor sleep. The purpose of this paper is to provide a brief review of the current state of the literature with regard to sleep, aging, common non-pharmacological interventions, and the potential use of exercise in combination with behavioral interventions.

Methods: Initially, this manuscript focuses on a brief (nonsystematic) review of sleep parameters and physiology that are associated with the aging process. Subsequently, information regarding sleep disorders in the elderly in general, and insomnia in particular are discussed. Last, a brief review of current recommended interventions is provided.

Results: The current major nonpharmacological interventions are described including Cognitive Behavioral Therapy for Insomnia (CBT-I). The potential use of exercise as a safe intervention for poor sleep is discussed. Finally, a call is made for increased research that examines the combination of traditional behavioral interventions with exercise.
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http://dx.doi.org/10.1007/s11325-021-02329-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7905198PMC
February 2021

A Review of Neuronal Pathways Associated With Consciousness.

J Neurosci Nurs 2021 Feb;53(1):39-43

Abstract: INTRODUCTION: Accurate communication of information regarding fluctuations in level of consciousness is critical. It is, important for nurses to understand terms related to consciousness to appropriately assess and implement plans of care. CONTENT: Although the neurobiology of consciousness is complex and multifaceted, consciousness can be conceptualized as having 2 distinct but interrelated dimensions: arousal and awareness. The different levels of consciousness are thought to fall on a continuum ranging from being fully awake to coma. CONCLUSION: This article focuses on the terms of consciousness, awareness, and arousal along with nursing implications where appropriate.
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http://dx.doi.org/10.1097/JNN.0000000000000559DOI Listing
February 2021

Validating the Adolescent Sleep Wake Scale for use with young adults.

Sleep Med 2020 05 4;69:217-219. Epub 2020 Feb 4.

Department of Psychology, East Carolina University, Greenville, NC, USA.

Objective: There is a need for examination of sleep across the entire adolescence to young adulthood developmental period (AYA; ages 12-25 years). The Adolescent Sleep Wake Scale (ASWS) is a 28-item measure of overall subjective sleep quality, including five sleep behavior domains (difficulty going to bed, falling asleep, maintaining sleep, reinitiating sleep, and returning to wakefulness), and has been validated to assess overall sleep quality and insomnia symptoms in adolescents (12-18 years). The current study aimed to examine whether the ASWS could be used to assess sleep across the AYA period by investigating the validity of the measure in a national sample of young adults (ages 19-25) using validated adult sleep measures.

Materials And Methods: A national sample recruited through Amazon's MTurk (N = 332; Mean age = 23.37 (SD = 1.55); 53.8% female; 51.4% Caucasian) completed an online survey including the ASWS, the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). Bivariate correlational analyses were performed to explore convergent and discriminant validity.

Results: The ASWS total score was strongly correlated with both the PSQI total score (r = -0.68) and ISI (r = -0.71) total score. The subscales of the PSQI, including Sleep Latency, Sleep Disturbance, and Daytime Dysfunction were correlated with corresponding ASWS domains. There were weak correlations with other subscales. Internal consistency was good (α = 0.88).

Conclusions: Our results suggest that the ASWS measures areas of sleep problems in a manner consistent with the most frequently utilized self-report assessment in adults and supports the use of the ASWS across AYA.
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http://dx.doi.org/10.1016/j.sleep.2020.01.021DOI Listing
May 2020

Sedation selection to reduce delirium risk: Why dexmedetomidine may be a better choice.

J Am Assoc Nurse Pract 2020 Jan 16;33(4):266-270. Epub 2020 Jan 16.

Department of Psychology, East Carolina University Greenville, North Carolina.

Abstract: In 2018, the Society of Critical Care Medicine published the Pain Agitation Delirium Immobility and Sleep Disruption guidelines that recommend protocol assessment-based pain and sedation management. Since the publication of these guidelines, multiple studies and meta-analyses have been conducted comparing sedative options in the Intensive Care Unit (ICU) setting including dexmedetomidine and propofol. Sedatives are on a continuum when it comes to delirium risk. Propofol, like benzodiazepines, causes changes in sleep patterns by suppressing the rapid eye movement sleep stage not seen with dexmedetomidine, worsening the ICU patient's already poor sleep quality. This reduction in sleep quality increases the risk of delirium. As patient advocates, advanced practice nurses play a vital role in minimizing risk of patient harm. Sedative use and management are areas of opportunity for nurses to minimize this risk. When sedatives are needed, daily sedation vacations should be conducted to re-evaluate the minimum required dose. These practices can reduce sedation risks for delirium and allow for bedside screening and early detection.
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http://dx.doi.org/10.1097/JXX.0000000000000364DOI Listing
January 2020

Fronto-temporal dementia: a case study and strategies and support for caregivers.

Br J Community Nurs 2019 Nov;24(11):544-549

Dean and Professor, School of Nursing, University of Louisville, Louisville, Kentucky, USA.

Fronto-temporal dementia, also known as fronto-temporal lobular degeneration, is the second most common form of early-onset dementia with a prevalence equal to Alzheimer's dementia. Behavioural variant fronto-temporal dementia primarily involves the frontal and temporal lobes of the brain. Myelination of nerve fibres in these areas allow for highly synchronized action potential timing. Diagnosis is often significantly delayed because symptoms are insidious and appear as personality and behavioural changes such as lack of inhibition, apathy, depression, and being socially inappropriate rather than exhibiting marked memory reductions. In this article, a case study illustrates care strategies and family education. Management of severe behavioural symptoms requires careful evaluation and monitoring. Support is especially important and beneficial in the early to middle stages of dementia when nursing home placement may not be required based on the individual's condition.
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http://dx.doi.org/10.12968/bjcn.2019.24.11.544DOI Listing
November 2019

Detecting Delirium Using a Physiologic Monitor.

Dimens Crit Care Nurs 2019 Sep/Oct;38(5):241-247

Malissa A. Mulkey, MSN, APRN, CCNS, CCRN, CNRN, is a neuroscience clinical nurse specialist at Duke University Hospital, Durham, North Carolina; and PhD candidate at East Carolina University, Greenville, North Carolina. Daniel Erik Everhart, PhD, ABPP, is a professor at East Carolina University, Greenville, North Carolina. Sunghan Kim, PhD, is from East Carolina University, Greenville, North Carolina. DaiWai M. Olson, PhD, RN, CCRN, FNCS, is a professor at the University of Texas Southwestern, Dallas. Sonya R. Hardin, PhD, CCRN, ACNS-BC, NP-C, is a dean and professor at University of Louisville, Kentucky.

For the past 2500 years, delirium has been described based on the presence of behavioral symptoms. Each year, as many as 1 in 5 acute care and 80% of critically ill patients develop delirium. The United States spends approximately $164 million annually to combat the associated consequences of delirium. There are no laboratory tools available to assist with diagnosis and ongoing monitoring of delirium; therefore, current national guidelines for psychiatry, geriatrics, and critical care strongly recommend routine bedside screening. Despite the significance, health care teams fail to accurately identify approximately 80% of delirium episodes.The utility of conventional electroencephalogram (EEG) in the diagnosis and monitoring of delirium has been well established. Neurochemical and the associated neuroelectrical changes occur in response to overwhelming stress before behavioral symptoms; therefore, using EEG will improve early delirium identification. Adding EEG analysis to the current routine clinical assessment significantly increases the accuracy of detection. Using newer EEG technology with a limited number of leads that is capable of processing EEG may provide a viable option by reducing the cost and need for expert interpretation. Because EEG monitoring with automatic processing has become technically feasible, it could increase delirium recognition. Electroencephalogram monitoring may also provide identification before symptom onset when nursing interventions would be more effective, likely reducing the long-term ramifications. Having an objective method that nurses can easily use to detect delirium could change the standard of care and provide earlier identification.
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http://dx.doi.org/10.1097/DCC.0000000000000372DOI Listing
February 2020

Methods of identifying delirium: A research protocol.

Res Nurs Health 2019 08 30;42(4):246-255. Epub 2019 May 30.

Nursing Research, Neurology and Neurosurgery, University of Texas Southwestern, Dallas, Texas.

Delirium is an acute disorder affecting up to 80% of intensive care unit (ICU) patients. It is associated with a 10-fold increase in cognitive impairment, triples the rate of in-hospital mortality, and costs $164 billion annually. Delirium acutely affects attention and global cognitive function with fluctuating symptoms caused by underlying organic etiologies. Early detection is crucial because the longer a patient experiences delirium the worse it becomes and the harder it is to treat. Currently, identification is through intermittent clinical assessment using standardized tools, like the Confusion Assessment Method for ICU. Such tools work well in clinical research but do not translate well into clinical practice because they are subjective, intermittent and have low sensitivity. As such, healthcare providers using these tools fail to recognize delirium symptoms as much as 80% of the time. Delirium-related biochemical derangement leads to electrical changes in electroencephalographic (EEG) patterns followed by behavioral signs and symptoms. However, continuous EEG monitoring is not feasible due to cost and need for skilled interpretation. Studies using limited-lead EEG show large differences between patients with and without delirium while discriminating delirium from other causes. The Ceribell is a limited-lead device that analyzes EEG. If it is capable of detecting delirium, it would provide an objective physiological monitor to identify delirium before symptom onset. This pilot study was designed to explore relationships between Ceribell and delirium status. Completion of this study will provide a foundation for further research regarding delirium status using the Ceribell data.
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http://dx.doi.org/10.1002/nur.21953DOI Listing
August 2019

Choosing the Right Delirium Assessment Tool.

J Neurosci Nurs 2018 Dec;50(6):343-348

Questions or comments about this article may be directed to Malissa Mulkey, MSN APRN, at East Carolina University, Greenville, NC. Donna W. Roberson, PhD FNP-BC, East Carolina University, Greenville, NC. Erik Everhart, PhD ABPP, East Carolina University, Greenville, NC. Sonya R. Hardin, PhD CCRN NP-C FAAN, University of Louisville, Louisville, KY.

Delirium is an increasing concern with current combined annual costs for the United States and Europe of approximately $350 billion. Although standardized definitions and diagnostic criteria exist, more than 80% of delirium in the acute care setting is overlooked or misdiagnosed. Delays in identification result in increases in severity and mortality and a reduction in quality of life. Selecting an assessment tool is the first step toward improving recognition.
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http://dx.doi.org/10.1097/JNN.0000000000000403DOI Listing
December 2018

Neurocognitive outcomes after aneurysmal subarachnoid hemorrhage: Identifying inflammatory biomarkers.

J Neurol Sci 2018 11 25;394:84-93. Epub 2018 Jun 25.

Department of Neurosurgery, University of Louisville School of Medicine, 220 Abraham Flexner Way, Suite 1500, Louisville, KY 40202, United States. Electronic address:

Aneurysmal subarachnoid hemorrhage (aSAH) is a severe type of stroke which carries a high case-fatality rate. Those who survive the ictus of aneurysm rupture harbor substantial risks of neurological morbidity, functional disability, and cognitive dysfunction. Although the pervasiveness of cognitive impairment is widely acknowledged as a long-term sequela of aSAH, the mechanisms underlying its development are poorly understood. The onset of aSAH elicits activation of the inflammatory cascade, and ongoing neuroinflammation is suspected to contribute to secondary complications, such as vasospasm and delayed cerebral ischemia. In this review, we analyze the extant literature regarding the relationship between neuroinflammation and cognitive dysfunction after aSAH. Pro-inflammatory cytokines appear to play a role in maintaining normal cognitive function in adults unaffected by aSAH. However, in the setting of aSAH, elevated cytokine levels may correlate with worse neuropsychological outcomes. This seemingly dichotomous relationship between neuroinflammation and cognition suggests that the action of cytokines varies, depending on their physiologic environment. Experimental therapies which suppress the immune response to aSAH appear to have a beneficial effect on cognitive outcomes. However, further studies are necessary to determine the utility of inflammatory mediators as biomarkers of neurocognitive outcomes, as well as their role in the management of aSAH.
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http://dx.doi.org/10.1016/j.jns.2018.06.021DOI Listing
November 2018

The effects of emotional states and traits on time perception.

Brain Inform 2018 Aug 20;5(2). Epub 2018 Aug 20.

Department of Psychology, Rawl Building, East Carolina University, Greenville, NC, 27858, USA.

Background: Models of time perception share an element of scalar expectancy theory known as the internal clock, containing specific mechanisms by which the brain is able to experience time passing and function effectively. A debate exists about whether to treat factors that influence these internal clock mechanisms (e.g., emotion, personality, executive functions, and related neurophysiological components) as arousal- or attentional-based factors.

Purpose: This study investigated behavioral and neurophysiological responses to an affective time perception Go/NoGo task, taking into account the behavioral inhibition (BIS) and behavioral activation systems (BASs), which are components of reinforcement sensitivity theory.

Methods: After completion of self-report inventories assessing personality traits, electroencephalogram (EEG/ERP) and behavioral recordings of 32 women and 13 men recruited from introductory psychology classes were completed during an affective time perception Go/NoGo task. This task required participants to respond (Go) and inhibit (NoGo) to positive and negative affective visual stimuli of various durations in comparison to a standard duration.

Results: Higher BAS scores (especially BAS Drive) were associated with overestimation bias scores for positive stimuli, while BIS scores were not correlated with overestimation bias scores. Furthermore, higher BIS Total scores were associated with higher N2d amplitudes during positive stimulus presentation for 280 ms, while higher BAS Total scores were associated with higher N2d amplitudes during negative stimuli presentation for 910 ms.

Discussion: Findings are discussed in terms of arousal-based models of time perception, and suggestions for future research are considered.
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http://dx.doi.org/10.1186/s40708-018-0087-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6170941PMC
August 2018

Continuous infusion of low-dose unfractionated heparin after aneurysmal subarachnoid hemorrhage: a preliminary study of cognitive outcomes.

J Neurosurg 2018 May 11:1-8. Epub 2018 May 11.

8Neurosurgery.

OBJECTIVECognitive dysfunction occurs in up to 70% of aneurysmal subarachnoid hemorrhage (aSAH) survivors. Low-dose intravenous heparin (LDIVH) infusion using the Maryland protocol was recently shown to reduce clinical vasospasm and vasospasm-related infarction. In this study, the Montreal Cognitive Assessment (MoCA) was used to evaluate cognitive changes in aSAH patients treated with the Maryland LDIVH protocol compared with controls.METHODSA retrospective analysis of all patients treated for aSAH between July 2009 and April 2014 was conducted. Beginning in 2012, aSAH patients were treated with LDIVH in the postprocedural period. The MoCA was administered to all aSAH survivors prospectively during routine follow-up visits, at least 3 months after aSAH, by trained staff blinded to treatment status. Mean MoCA scores were compared between groups, and regression analyses were performed for relevant factors.RESULTSNo significant differences in baseline characteristics were observed between groups. The mean MoCA score for the LDIVH group (n = 25) was 26.4 compared with 22.7 in controls (n = 22) (p = 0.013). Serious cognitive impairment (MoCA ≤ 20) was observed in 32% of controls compared with 0% in the LDIVH group (p = 0.008). Linear regression analysis demonstrated that only LDIVH was associated with a positive influence on MoCA scores (β = 3.68, p =0.019), whereas anterior communicating artery aneurysms and fevers were negatively associated with MoCA scores. Multivariable linear regression analysis resulted in all 3 factors maintaining significance. There were no treatment complications.CONCLUSIONSThis preliminary study suggests that the Maryland LDIVH protocol may improve cognitive outcomes in aSAH patients. A randomized controlled trial is needed to determine the safety and potential benefit of unfractionated heparin in aSAH patients.
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http://dx.doi.org/10.3171/2017.11.JNS17894DOI Listing
May 2018

The impact of nurse practitioner regulations on population access to care.

Nurs Outlook 2018 Jul - Aug;66(4):379-385. Epub 2018 Mar 8.

Department of Behavioral Sciences & Social Medicine, College of Medicine, Florida State University, Tallahassee, FL.

Background: By 2025, experts estimate a significant shortage of primary care providers in the United States, and expansion of the nurse practitioner (NP) workforce may reduce this burden. However, barriers imposed by state NP regulations could reduce access to primary care.

Purpose: The objectives of this study were to examine the association between three levels of NP state practice regulation (independent, minimum restrictive, and most restrictive) and the proportion of the population with a greater than 30-min travel time to a primary care provider using geocoding.

Methods: Logistic regression models were conducted to calculate the adjusted odds of having a greater than 30-min drive time.

Findings: Compared with the most restrictive NP states, states with independent practice had 19.2% lower odds (p = .001) of a greater than 30-min drive to the closest primary care provider.

Discussion: Allowing NPs full autonomy to practice may be a relatively simple policy mechanism for states to improve access to primary care.
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http://dx.doi.org/10.1016/j.outlook.2018.03.001DOI Listing
February 2019

Retrospective analysis of outcomes following inferior vena cava (IVC) filter placement in a managed care population.

J Thromb Thrombolysis 2017 Aug;44(2):179-189

CarePlus Health Plans, Humana Inc., 11430 NW 20th Street, Suite 300, Miami, FL, USA.

The role of inferior vena cava filter (IVC) filters for prevention of pulmonary embolism (PE) is controversial. This study evaluated outcomes of IVC filter placement in a managed care population. This retrospective cohort study evaluated data for individuals with Humana healthcare coverage 2013-2014. The study population included 435 recipients of prophylactic IVC filters, 4376 recipients of therapeutic filters, and two control groups, each matched to filter recipients. Patients were followed for up to 2 years. Post-index anticoagulant use, mortality, filter removal, device-related complications, and all-cause utilization. Adjusted regression analyses showed a positive association between filter placement and anticoagulant use at 3 months: odds ratio (ORs) 3.403 (95% CI 1.912-6.059), prophylactic; OR, 1.356 (95% CI 1.164-1.58), therapeutic. Filters were removed in 15.67% of prophylactic and 5.69% of therapeutic filter cases. Complication rates were higher with prophylactic procedures than with therapeutic procedures and typically exceeded 2% in the prophylactic group. Each form of filter placement was associated with increases in all-cause hospitalization (regression coefficient 0.295 [95% CI 0.093-0.498], prophylactic; 0.673 [95% CI 0.547-0.798], therapeutic) and readmissions (OR 2.444 [95% CI 1.298-4.602], prophylactic; 2.074 [95% CI 1.644-2.616], therapeutic). IVC filter placement in this managed care population was associated with increased use of anticoagulants and greater healthcare utilization compared to controls, low rates of retrieval, and notable rates of device-related complications, with effects especially pronounced in assessments of prophylactic filters. These findings underscore the need for appropriate use of IVC filters.
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http://dx.doi.org/10.1007/s11239-017-1507-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5522518PMC
August 2017

Adherence, Persistence, and Health Care Costs for Patients Receiving Dipeptidyl Peptidase-4 Inhibitors.

J Manag Care Spec Pharm 2017 Mar;23(3):299-306

2 Comprehensive Health Insights, Humana, Louisville, Kentucky.

Background: The dipeptidyl peptidase-4 (DPP-4) inhibitors are among the newer, yet more established, classes of diabetes medications.

Objective: To compare adherence, persistence, and health care costs among patients taking DPP-4 inhibitors.

Methods: Claims were extracted from Humana Medicare Advantage Prescription Drug (MAPD) or commercial plans for patients aged > 18 years with ≥ 1 prescription filled for a DPP-4 inhibitor between July 1, 2011, and March 31, 2013. The first prescription claim for a DPP-4 inhibitor established the index date and index medication; 12-month pre-index and post-index data were analyzed. The Diabetes Complications Severity Index (DCSI) was used to assess a level of baseline diabetes-related comorbidities. Adherence (proportion of days covered [PDC] ≥ 80%) and persistence (< 31-day gap) measures were compared before and after, adjusting for DCSI, pre-index insulin, age, and gender. Post-index costs (in 2013 U.S. dollars) were compared using general linear modeling (GLM) to adjust for pre-index costs, DCSI, pre-index insulin, age, and gender.

Results: Based on study criteria, 22,860 patients with MAPD coverage (17,292 sitagliptin, 4,282 saxagliptin, and 1,286 linagliptin) and 3,229 patients with commercial coverage (2,368 sitagliptin, 643 saxagliptin, and 218 linagliptin) were included. For MAPD patients, the mean age was 70-72 years, and females represented 50%-52% of patients. For commercial patients, mean age was 55-56 years, and females represented 44% of patients. Clinical indicators for patients on linagliptin showed a higher comorbidity level than sitagliptin or saxagliptin cohorts (MAPD DCSI 3.0 vs 2.4 and 2.2, P < 0.001; commercial DCSI 1.2 vs. 0.9 and 0.9, P < 0.001); a higher use of pre-index insulin (MAPD 22% vs. 15% and 14%, P < 0.001; commercial 18% vs. 11% and 10%, P = 0.003); and higher mean pre-index costs (MAPD $14,448 vs. $11,818 and $10,399, P < 0.001; commercial $13,868 vs. $9,357 and $8,223, P = 0.016). For the MAPD cohort, the unadjusted PDC was lower for linagliptin patients (67%) compared with saxagliptin (72%) or sitagliptin (72%) patients (P < 0.001). Significant differences were still seen when adjusted for covariates. Linagliptin patients were more likely to be nonpersistent (73%) than those on saxagliptin (65%) or sitagliptin (67%; P < 0.01 for adjusted and unadjusted comparisons). For the commercial population, there were no significant differences in mean PDC between the 3 groups (linagliptin 70%, saxagliptin 72%, and sitagliptin 74%; P = 0.096). Dichotomized comparisons of nonpersistence were significantly different (linagliptin 65%, saxagliptin 62%, and sitagliptin 57%; P = 0.010), although upon adjustment using a Cox proportional hazard model, no significant differences were found. When controlling for other factors, post-index adjusted health care costs were similar between the medication cohorts (MAPD: sitagliptin = $13,913, saxagliptin = $13,651, and linagliptin = $13,859; commercial: sitagliptin = $11,677, saxagliptin = $12,059, and linagliptin = $11,163; all P > 0.25).

Conclusions: For MAPD and commercial populations, baseline patient demographics were similar between the 3 DPP-4 inhibitor groups, but the linagliptin group may have had more complex patients (higher pre-index costs, higher DCSI, and more use of insulin). For the MAPD population, patients on linagliptin were less adherent and persistent than patients taking sitagliptin or saxagliptin for all unadjusted and adjusted comparisons. For the commercial population, which was notably smaller, these differences were in the same direction, but not all were statistically significant. When controlling for baseline factors, 12-month post-index direct medical health care costs were similar between index DPP-4 inhibitors.

Disclosures: No external funding was provided for this research. The project was done as part of internal work by Humana employees. Rascati received no compensation. None of the authors have any financial disclosures or conflicts of interests to report. Worley and Everhart are employees of Comprehensive Health Insights, a subsidiary of Humana, and Meah is an employee of Humana. Discussion of the adherence and persistence data was presented as a poster at the Academy of Managed Care Pharmacy Nexus Conference, October 2015. Cost data were presented as a poster at the International Society for Pharmacoeconomics and Outcomes Research 18th Annual European Congress, November 2015. Study concept and design were contributed by Rascati, Worley, and Meah, along with Everhart. Rascati took the lead in data collection, assisted by Meah, and data interpretation was performed by all the authors. The manuscript was written primarily by Rascati, along with Worley, Everhart, and Meah, and revised by Rascati, Everhart, and Worley, with assistance from Meah.
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http://dx.doi.org/10.18553/jmcp.2017.23.3.299DOI Listing
March 2017

It's not what you expect: feedback negativity is independent of reward expectation and affective responsivity in a non-probabilistic task.

Brain Inform 2017 Mar 18;4(1):51-63. Epub 2016 Apr 18.

Department of Psychology, East Carolina University, 238 Rawl Building, East 5th St., Greenville, NC, 27858, USA.

ERP studies commonly utilize gambling-based reinforcement tasks to elicit feedback negativity (FN) responses. This study used a pattern learning task in order to limit gambling-related fallacious reasoning and possible affective responses to gambling, while investigating relationships between the FN components between high and low reward expectation conditions. Eighteen undergraduates completed measures of reinforcement sensitivity, trait and state affect, and psychophysiological recording. The pattern learning task elicited a FN component for both high and low win expectancy conditions, which was found to be independent of reward expectation and showed little relationship with task and personality variables. We also observed a P3 component, which showed sensitivity to outcome expectancy variation and relationships to measures of anxiety, appetitive motivation, and cortical asymmetry, although these varied by electrode location and expectancy condition. Findings suggest that the FN reflected a binary reward-related signal, with little relationship to reward expectation found in previous studies, in the absence of positive affective responses.
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http://dx.doi.org/10.1007/s40708-016-0050-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5319948PMC
March 2017

Right Temporal Lobe Atrophy: A Case That Initially Presented as Excessive Piety.

Clin Neuropsychol 2015 5;29(7):1053-67. Epub 2015 Nov 5.

a Department of Psychology , East Carolina University , Greenville , NC , USA.

Objective: Variants of frontotemporal lobar degeneration (FTLD) are associated with distinct clinical, pathological, and neuroanatomical profiles. Lines of emerging research indicate a rare variant with focal atrophy of the right temporal lobe (RTLA). The objective was to present case data and discussion of an individual with RTLA in order to assist with conceptualization of this variant.

Method: A 60-year-old, right-handed, college-educated Protestant minister with RTLA was evaluated. This patient presented with several hallmark behavioral and psychiatric features with personality changes, including hyper-religiosity, depression, and social disinhibition. Given the profession of the patient, the observed personality alterations (e.g., religiosity and pietism) were initially excused, which delayed diagnosis.

Results: In addition to cognitive deficits, an examination of affect processing within visual and auditory channels revealed severe impairment in emotion recognition with features of prosopagnosia. These impairments were in general more severe than the cognitive impairment observed on traditional neuropsychological measures.

Conclusions: This case provides support for an FTLD right temporal lobe variant. This case also illustrates the importance of neuropsychological evaluation of affect processing in the differential diagnosis and treatment planning for FTLD and its subtypes.
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http://dx.doi.org/10.1080/13854046.2015.1104387DOI Listing
September 2016

Empirical validation of a short version of the Adolescent Sleep-Wake Scale using a sample of ethnically diverse adolescents from an economically disadvantage community.

Sleep Med 2015 Oct 15;16(10):1204-6. Epub 2015 Jul 15.

Department of Psychology, East Carolina University, Greenville, NC 27858, USA.

Objective: There is a need for brief, psychometrically sound instruments to assess adolescent sleep, particularly for ethnic minority and economically disadvantaged adolescents. A 10-item short version of the Adolescent Sleep-Wake Scale was recently proposed based upon exploratory factor analysis with primarily Caucasian healthy adolescents from middle- to high-income families. The aim of this study was to expand the utility of the short version of the Adolescent Sleep-Wake Scale by investigating the empirical and construct validity of the measure on an ethnically diverse sample of adolescents from an economically disadvantaged community.

Materials And Methods: Participants included 467 adolescents (40% African American, 35.5% Caucasian, 16.5% Latino, and 7.9% multiethnic), aged 12-18 years (mean = 15.27 years, SD = 1.96 years), who completed the Adolescent Sleep-Wake Scale. A confirmatory factor analysis (CFA) was conducted with Mplus 7 based on the three-factor solution proposed by Essner et al. (2014).

Results: CFA indicated that the three-factor structure was a good fit for the data (χ(2) (29) = 52.053, p = 0.005, root mean square error of approximation (RMSEA) = 0.04, CFI = 0.98, TLI = 0.96, standardized root mean residuals (SRMR) = 0.03), and factor loadings for each item were >0.40. Cronbach's alphas by ethnicity indicated that the scale has acceptable reliability (0.70 ≤ α ≤ 0.90) for African American, Caucasian, and multiethnic adolescents, but not for Latino adolescents.

Conclusion: Our results support the use of the Adolescent Sleep-Wake Scale short form for the majority of ethnic minority and economically disadvantaged adolescents.
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http://dx.doi.org/10.1016/j.sleep.2015.07.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592519PMC
October 2015

Determinants of hospital fall rate trajectory groups: a longitudinal assessment of nurse staffing and organizational characteristics.

Health Care Manage Rev 2014 Oct-Dec;39(4):352-60

Damian Everhart, PhD, RN, is Assistant Professor, Brooks College of Health, University of North Florida, Jacksonville. E-mail: Jessica R. Schumacher, PhD, MS, is Associate Director of Analytics, Department of Population Health Sciences, University of Wisconsin-Madison. R. Paul Duncan, PhD, MS, is Malcom and Christine Randall Professor and Chair, Department of Health Services Research, Management and Policy, University of Florida, Gainesville. Allyson G. Hall, PhD, MBA, MHS, is Associate Professor, Department of Health Services Research, Management and Policy, University of Florida, Gainesville. Donna F. Neff, PhD, RN, DSNAP, is Associate Professor, College of Nursing, University of Central Florida, Orlando. Ronald I. Shorr, MD, MS, is Professor, Department of Epidemiology, University of Florida, Gainesville.

Background: Patient falls in acute care hospitals represent a significant patient safety concern. Although cross-sectional studies have shown that fall rates vary widely between acute care hospitals, it is not clear whether hospital fall rates remain consistent over time.

Purpose: The aim of this study was to determine whether hospitals can be categorized into fall rate trajectory groups over time and to identify nurse staffing and hospital characteristics associated with hospital fall rate trajectory groups.

Methodology/approach: We conducted a 54-month (July 2006-December 2010) longitudinal study of U.S. acute care general hospitals participating in the National Database for Nursing Quality Indicators (2007). We used latent class growth modeling to categorize hospitals into groups based on their long-term fall rates. Nurse staffing and hospital characteristics associated with membership in the highest hospital fall rate group were identified using logistic regression.

Findings: A sample of 1,529 hospitals (mean fall rate of 3.65 per 1,000 patient days) contributed data to the analysis. Latent class growth modeling findings classified hospital into three groups based on fall rate trajectories: consistently high (mean fall rate of 4.96 per 1,000 patient days), consistently medium (mean fall rate of 3.63 per 1,000 patient days), and consistently low (mean fall rate of 2.50 per 1,000 patient days). Hospitals with higher total nurse staffing (odds ratio [OR] = 0.92, 95% confidence interval [CI] [0.85, 0.99]), Magnet status (OR = 0.49, 95% CI [0.35, 0.70]), and bed size greater than 300 beds (OR = 0.70, 95% CI [0.51, 0.94]) were significantly less likely to be categorized in the "consistently high" fall rate group.

Practice Implications: Over this 54-month period, hospitals were categorized into three groups based on long-term fall rates. Hospital-level factors differed among these three groups. This suggests that there may be hospitals in which "best practices" for fall prevention might be identified. In addition, administrators may be able to reduce fall rates by maintaining greater nurse staffing ratios as well as fostering an environment consistent with that of Magnet hospitals.
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http://dx.doi.org/10.1097/HMR.0000000000000013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4277236PMC
June 2015

Posterior cortical atrophy: a case study of Benson's syndrome that initially presented as anxiety disorder.

Appl Neuropsychol Adult 2012 31;19(3):229-36. Epub 2012 May 31.

Department of Psychology, East Carolina University, Greenville, NC 27858, USA.

The postmortem pathology of posterior cortical atrophy (PCA) and Alzheimer's disease (AD) are often identical. In contrast to AD, PCA is clinically different in that visuoperceptual skills are severely impaired, yet memory is relatively intact. In addition, patients with PCA often report depression with preserved insight. The present case study is a 56-year-old female who initially presented with anxiety and panic-like symptoms. The neuropsychological evaluation and imaging studies were consistent with PCA. This case study is relatively unique in that symptom onset presented as an anxiety disorder, yet formal evaluation revealed severe visuospatial impairment with minimal insight into the severity of cognitive impairment. Anxiety was alleviated following cessation of employment. This case highlights the importance of differential diagnostic consideration of affective and mood disorders and early forms of dementia.
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http://dx.doi.org/10.1080/09084282.2012.686791DOI Listing
July 2013

The effects of nurse staffing on hospital financial performance: competitive versus less competitive markets.

Health Care Manage Rev 2013 Apr-Jun;38(2):146-55

Department of Health Services Research, Management and Policy, University of Florida, Gainesville, USA.

Background: Hospitals facing financial uncertainty have sought to reduce nurse staffing as a way to increase profitability. However, nurse staffing has been found to be important in terms of quality of patient care and nursing-related outcomes. Nurse staffing can provide a competitive advantage to hospitals and as a result of better financial performance, particularly in more competitive markets.

Purpose: In this study, we build on the Resource-Based View of the Firm to determine the effect of nurse staffing on total profit margin in more competitive and less competitive hospital markets in Florida.

Methodology/approach: By combining a Florida statewide nursing survey with the American Hospital Association Annual Survey and the Area Resource File, three separate multivariate linear regression models were conducted to determine the effect of nurse staffing on financial performance while accounting for market competitiveness. The analysis was limited to acute care hospitals.

Findings: Nurse staffing levels had a positive association with financial performance (β = 3.3, p = .02) in competitive hospital markets, but no significant association was found in less competitive hospital markets.

Practice Implications: Hospitals in more competitive hospital markets should reconsider reducing nursing staff, as these cost-cutting measures may be inefficient and negatively affect financial performance.
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http://dx.doi.org/10.1097/HMR.0b013e318257292bDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4543286PMC
September 2013

AAV-mediated cone rescue in a naturally occurring mouse model of CNGA3-achromatopsia.

PLoS One 2012 11;7(4):e35250. Epub 2012 Apr 11.

Department of Ophthalmology, College of Medicine, University of Florida, Gainesville, Florida, United States of America.

Achromatopsia is a rare autosomal recessive disorder which shows color blindness, severely impaired visual acuity, and extreme sensitivity to bright light. Mutations in the alpha subunits of the cone cyclic nucleotide-gated channels (CNGA3) are responsible for about 1/4 of achromatopsia in the U.S. and Europe. Here, we test whether gene replacement therapy using an AAV5 vector could restore cone-mediated function and arrest cone degeneration in the cpfl5 mouse, a naturally occurring mouse model of achromatopsia with a CNGA3 mutation. We show that gene therapy leads to significant rescue of cone-mediated ERGs, normal visual acuities and contrast sensitivities. Normal expression and outer segment localization of both M- and S-opsins were maintained in treated retinas. The therapeutic effect of treatment lasted for at least 5 months post-injection. This study is the first demonstration of substantial, relatively long-term restoration of cone-mediated light responsiveness and visual behavior in a naturally occurring mouse model of CNGA3 achromatopsia. The results provide the foundation for development of an AAV5-based gene therapy trial for human CNGA3 achromatopsia.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0035250PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3324465PMC
August 2012

Partial rescue of retinal function in chronically hypoglycemic mice.

Invest Ophthalmol Vis Sci 2012 Feb 21;53(2):915-23. Epub 2012 Feb 21.

Center for Vision Research and SUNY Eye Institute, Department of Ophthalmology, SUNY Upstate Medical University, Syracuse, New York 13210, USA.

Purpose: Mice rendered hypoglycemic by a null mutation in the glucagon receptor gene Gcgr display late-onset retinal degeneration and loss of retinal sensitivity. Acute hyperglycemia induced by dextrose ingestion does not restore their retinal function, which is consistent with irreversible loss of vision. The goal of this study was to establish whether long-term administration of high dietary glucose rescues retinal function and circuit connectivity in aged Gcgr-/- mice.

Methods: Gcgr-/- mice were administered a carbohydrate-rich diet starting at 12 months of age. After 1 month of treatment, retinal function and structure were evaluated using electroretinographic (ERG) recordings and immunohistochemistry.

Results: Treatment with a carbohydrate-rich diet raised blood glucose levels and improved retinal function in Gcgr-/- mice. Blood glucose increased from moderate hypoglycemia to euglycemic levels, whereas ERG b-wave sensitivity improved approximately 10-fold. Because the b-wave reflects the electrical activity of second-order cells, we examined for changes in rod-to-bipolar cell synapses. Gcgr-/- retinas have 20% fewer synaptic pairings than Gcgr+/- retinas. Remarkably, most of the lost synapses were located farthest from the bipolar cell body, near the distal boundary of the outer plexiform layer (OPL), suggesting that apical synapses are most vulnerable to chronic hypoglycemia. Although treatment with the carbohydrate-rich diet restored retinal function, it did not restore these synaptic contacts.

Conclusions: Prolonged exposure to diet-induced euglycemia improves retinal function but does not reestablish synaptic contacts lost by chronic hypoglycemia. These results suggest that retinal neurons have a homeostatic mechanism that integrates energetic status over prolonged periods of time and allows them to recover functionality despite synaptic loss.
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http://dx.doi.org/10.1167/iovs.11-8787DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3317429PMC
February 2012

Risk dishabituation: in repeated gambling, risk is reduced following low-probability "surprising" events (wins or losses).

Emotion 2012 Jun 24;12(3):495-502. Epub 2011 Oct 24.

Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA.

In path-dependent risk taking, like playing a slot machine, the wager on one trial may be affected by the outcome of the preceding trial. Previous studies have shown that a person's risk-taking preferences may change as a result of the preceding trial (win or loss). For example, the "house money effect" suggests that risk taking may increase after a win, whereas the "break even effect" posits that risk taking increases after a loss. Independent of those findings, a person's emotional state has been found to influence risk taking. For example, the "mood maintenance hypothesis" supports the notion that positive affect decreases risk taking, and related research finds that increased negative affect increases risk taking. Because winning and losing may influence one's emotional state, we sought to investigate how both previous outcomes, as well as a person's emotional responses to those outcomes, independently influence subsequent risk taking. To do this, data were collected using three simplified slot machines where the chance of winning each trial was set to 13%, 50%, and 87%, respectively. Evidence for the break even and house money effects were found on the 13% and 87% games, respectively. Likewise, emotional valence was found to predict risk taking on these two tasks, with emotional valence fully explaining the break even effect observed on the 13% game. In addition to these results, the present research revealed that risk taking is reduced following low-probability ("surprising") events (i.e., a win in the 13% condition or loss in the 87% condition). Dubbed "risk dishabituation," this phenomenon is discussed, along with its likely corresponding emotional experience--surprise.
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http://dx.doi.org/10.1037/a0025780DOI Listing
June 2012

Long-term retinal function and structure rescue using capsid mutant AAV8 vector in the rd10 mouse, a model of recessive retinitis pigmentosa.

Mol Ther 2011 Feb 7;19(2):234-42. Epub 2010 Dec 7.

Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical College, Wenzhou, Zhejiang, China.

The retinal degeneration 10 (rd10) mouse is a well-characterized model of autosomal recessive retinitis pigmentosa (RP), which carries a spontaneous mutation in the β subunit of rod cGMP-phosphodiesterase (PDEβ). Rd10 mouse exhibits photoreceptor dysfunction and rapid rod photoreceptor degeneration followed by cone degeneration and remodeling of the inner retina. Here, we evaluate whether gene replacement using the fast-acting tyrosine-capsid mutant AAV8 (Y733F) can provide long-term therapy in this model. AAV8 (Y733F)-smCBA-PDEβ was subretinally delivered to postnatal day 14 (P14) rd10 mice in one eye only. Six months after injection, spectral domain optical coherence tomography (SD-OCT), electroretinogram (ERG), optomotor behavior tests, and immunohistochemistry showed that AAV8 (Y733F)-mediated PDEβ expression restored retinal function and visual behavior and preserved retinal structure in treated rd10 eyes for at least 6 months. This is the first demonstration of long-term phenotypic rescue by gene therapy in an animal model of PDEβ-RP. It is also the first example of tyrosine-capsid mutant AAV8 (Y733F)-mediated correction of a retinal phenotype. These results lay the groundwork for the development of PDEβ-RP gene therapy trial and suggest that tyrosine-capsid mutant AAV vectors may be effective for treating other rapidly degenerating models of retinal degeneration.
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http://dx.doi.org/10.1038/mt.2010.273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3034861PMC
February 2011

Brain function with complex decision making using electroencephalography.

Int J Psychophysiol 2011 Feb 16;79(2):175-83. Epub 2010 Oct 16.

Pitt County Memorial Hospital Department of Psychology, 2100 Stantonsburg Road, PO Box 6028, Greenville, NC 27835-6028, USA.

A computer-administered assessment for decision making relevant to daily-living decisions, using the technique of complex decision making (CDM), has been previously developed and tested in our laboratory. The present study sought to identify unique patterns of brain activity in the alpha band associated with CDM. We recorded electroencephalogram (EEG) from 30 scalp sites, during a series of baseline, eyes open fixation tasks, and CDM tasks, in different contexts, in a group of 9 male and 7 female young healthy adults, aged 18 to 34. The decision making contexts, designed to simulate real-world, daily-living decisions, were about taking a bus, choosing a friend, job, medication, and participating in research. Electroencephalograms (EEGs) were divided into the frequency bands, alpha, beta, delta, theta, and gamma, though the primary focus of this paper is the alpha band. Analysis of mean EEG power spectra across the alpha bands - alpha1 (8-10 Hz), alpha2 (10-12 Hz), and alpha 3 (12-14 Hz) - showed significant decreases from baseline to the CDM task. In addition, we observed significant increases in delta, theta, beta, and gamma. There were also significant bivariate correlations between EEG spectra, mostly in low and mid alpha bands, behavioral performance on the CDM task, and scores on standardized measures of executive functioning, including the Trail-making Test and the Wisconsin Card Sorting Task. These results demonstrate how brain activity in complex decision making is distributed across alpha frequency bands and electrode regions and this activity relates to executive functioning.
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http://dx.doi.org/10.1016/j.ijpsycho.2010.10.004DOI Listing
February 2011

Personality correlates of adherence with continuous positive airway pressure (CPAP).

Sleep Breath 2011 Dec 28;15(4):687-94. Epub 2010 Sep 28.

Department of Psychology, East Carolina University, Greenville, NC 27834, USA.

Introduction: Adherence with continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) has been problematic. Understanding the factors associated with nonadherence may assist with psychosocial interventions.

Objective: The objective of this study was to examine the relationship between adherence and three measures of personality and coping strategies.

Methods: Ratings on the behavioral inhibition system/behavioral activation system (BIS/BAS) scales, the ways of coping inventory, and a broad personality measure (mini-IPIP) were analyzed with a binary logistic regression among 63 subjects, adult men (31) and women (32), diagnosed with OSA. Data from the CPAP device was obtained following initial 30 days at minimum, with adherence defined as >4 h/night on 70% of nights.

Results: Elevated BIS was the strongest predictor of nonadherence (r = -.452, p < .01), followed by neuroticism. The regression correctly classified 73% of participants as adherent or nonadherent.

Conclusion: Nonadherence is associated with elevated BIS scores and neuroticism, which indicates that personality factors play a role in determining adherence to CPAP. Although more research is needed to draw firm conclusions, the differences noted in BIS may also point toward differences in neurophysiological function. The BIS scale may be a useful tool for predicting nonadherence and assist with the development of intervention strategies that will increase adherence.
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http://dx.doi.org/10.1007/s11325-010-0422-8DOI Listing
December 2011

Functional and behavioral restoration of vision by gene therapy in the guanylate cyclase-1 (GC1) knockout mouse.

PLoS One 2010 Jun 25;5(6):e11306. Epub 2010 Jun 25.

Department of Ophthalmology, College of Medicine, University of Florida, Gainesville, Florida, United States of America.

Background: Recessive mutations in guanylate cyclase-1 (Gucy2d) are associated with severe, early onset Leber congenital amaurosis-1(LCA1). Gucy2d encodes guanylate cyclase (GC1) is expressed in photoreceptor outer segment membranes and produces cGMP in these cells. LCA1 patients present in infancy with severely impaired vision and extinguished electroretinogram (ERG) but retain some photoreceptors in both their macular and peripheral retina for years. Like LCA1 patients, loss of cone function in the GC1 knockout (GC1KO) mouse precedes cone degeneration. The purpose of this study was to test whether delivery of functional GC1 to cone cells of the postnatal GC1KO mouse could restore function to these cells.

Methodology/principal Findings: Serotype 5 AAV vectors containing either a photoreceptor-specific, rhodopsin kinase (hGRK1) or ubiquitous (smCBA) promoter driving expression of wild type murine GC1 were subretinally delivered to one eye of P14 GC1KO mice. Visual function (ERG) was analyzed in treated and untreated eyes until 3 months post injection. AAV-treated, isogenic wild type and uninjected control mice were evaluated for restoration of visual behavior using optomotor testing. At 3 months post injection, all animals were sacrificed, and their treated and untreated retinas assayed for expression of GC1 and localization of cone arrestin. Cone-mediated function was restored to treated eyes of GC1KO mice (ERG amplitudes were approximately 45% of normal). Treatment effect was stable for at least 3 months. Robust improvements in cone-mediated visual behavior were also observed, with responses of treated mice being similar or identical to that of wild type mice. AAV-vectored GC1 expression was found in photoreceptors and cone cells were preserved in treated retinas.

Conclusions/significance: This is the first demonstration of gene-based restoration of both visual function/vision-elicited behavior and cone preservation in a mammalian model of GC1 deficiency. Importantly, results were obtained using a well characterized, clinically relevant AAV vector. These results lay the ground work for the development of an AAV-based gene therapy vector for the treatment of LCA1.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0011306PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892468PMC
June 2010

Phylogenetic isolation of host trees affects assembly of local Heteroptera communities.

Proc Biol Sci 2010 Jul 24;277(1691):2227-36. Epub 2010 Mar 24.

UMR Ecosystèmes, Biodiversité, Evolution, Université de Rennes 1, 35042 Rennes Cedex, France.

A host may be physically isolated in space and then may correspond to a geographical island, but it may also be separated from its local neighbours by hundreds of millions of years of evolutionary history, and may form in this case an evolutionarily distinct island. We test how this affects the assembly processes of the host's colonizers, this question being until now only invoked at the scale of physically distinct islands or patches. We studied the assembly of true bugs in crowns of oaks surrounded by phylogenetically more or less closely related trees. Despite the short distances (less than 150 m) between phylogenetically isolated and non-isolated trees, we found major differences between their Heteroptera faunas. We show that phylogenetically isolated trees support smaller numbers and fewer species of Heteroptera, an increasing proportion of phytophages and a decreasing proportion of omnivores, and proportionally more non-host-specialists. These differences were not due to changes in the nutritional quality of the trees, i.e. species sorting, which we accounted for. Comparison with predictions from meta-community theories suggests that the assembly of local Heteroptera communities may be strongly driven by independent metapopulation processes at the level of the individual species. We conclude that the assembly of communities on hosts separated from their neighbours by long periods of evolutionary history is qualitatively and quantitatively different from that on hosts established surrounded by closely related trees. Potentially, the biotic selection pressure on a host might thus change with the evolutionary proximity of the surrounding hosts.
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http://dx.doi.org/10.1098/rspb.2010.0365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2880160PMC
July 2010

Self-complementary AAV-mediated gene therapy restores cone function and prevents cone degeneration in two models of Rpe65 deficiency.

Gene Ther 2010 Jul 18;17(7):815-26. Epub 2010 Mar 18.

Department of Ophthalmology and Powell Gene Therapy Center, University of Florida, Gainesville, FL 32610, USA.

To test whether fast-acting, self-complimentary (sc), adeno-associated virus-mediated RPE65 expression prevents cone degeneration and/or restores cone function, we studied two mouse lines: the Rpe65-deficient rd12 mouse and the Rpe65-deficient, rhodopsin null ('that is, cone function-only') Rpe65(-/-)::Rho(-/-) mouse. scAAV5 expressing RPE65 was injected subretinally into one eye of rd12 and Rpe65(-/-)::Rho(-/-) mice at postnatal day 14 (P14). Contralateral rd12 eyes were injected later, at P35. Rd12 behavioral testing revealed that rod vision loss was prevented with either P14 or P35 treatment, whereas cone vision was only detected after P14 treatment. Consistent with this observation, P35 treatment only restored rod electroretinogram (ERG) signals, a result likely due to reduced cone densities at this time point. For Rpe65(-/-)::Rho(-/-) mice in which there is no confounding rod contribution to the ERG signal, cone cells and cone-mediated ERGs were also maintained with treatment at P14. This work establishes that a self-complimentary AAV5 vector can restore substantial visual function in two genetically distinct models of Rpe65 deficiency within 4 days of treatment. In addition, this therapy prevents cone degeneration but only if administered before extensive cone degeneration, thus supporting continuation of current Leber's congenital amaurosis-2 clinical trials with an added emphasis on cone subtype analysis and early intervention.
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http://dx.doi.org/10.1038/gt.2010.29DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3014850PMC
July 2010

5HTTLPR predicts left fusiform gyrus activation to positive emotional stimuli.

Magn Reson Imaging 2009 May 11;27(4):441-8. Epub 2008 Oct 11.

Department of Psychology, Case Western Reserve University, Cleveland, OH 44106-7123, USA.

This study was designed to replicate and extend past research examining the impact of the serotonin transporter gene-linked polymorphic region (5HTTLPR) on neural activation during emotional processing. Six women with at least one short allele were compared to six age-matched women with long/long alleles of the 5HTTLPR. Participants were shown 36 positive and 36 negative slides from the International Affective Picture Set, while functional images were acquired using a 4-T magnetic resonance imaging scanner. Although we were unable to replicate past research demonstrating relatively increased amygdala activation among individuals with an "s" allele to negative stimuli, women with an s allele evidenced decreased left fusiform gyrus activation to positive emotional stimuli (as expected). We suggest that women with a short allele may be either less attentive or less "expert" with regard to positive emotional stimuli, and ideas for future research are presented.
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http://dx.doi.org/10.1016/j.mri.2008.08.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3087948PMC
May 2009