Aboriginal community understandings of dementia and responses to dementia care.

OBJECTIVE: Aboriginal people and Torres Strait Islanders are impacted by dementia at higher rates and at a younger age of onset than the broader Australia population. Public health strategies to support this population require a thorough understanding of how Aboriginal people perceive dementia and dementia care support needs. The aim of this study was to investigate Aboriginal community understandings of dementia and their responses to dementia care. STUDY DESIGN: This study is a community participatory action research partnership. METHODS: The mixed method study was undertaken in 2017 with members of a discrete Aboriginal community from rural Tasmania, Australia. Participants were older than 18 years, self-identified as an Aboriginal person and were living or had lived in the community studied. Data were derived from 50 participants who completed the 27-item Dementia Knowledge Assessment Scale (DKAS). Twelve of these participants also shared their dementia care experiences in individual interviews. RESULTS: The DKAS results showed a low overall level of dementia knowledge, with a total mean score of 27.73 (scoring 51% on average) of a possible score of 54. The salient interview theme was the cultural obligation to care for family members living with dementia. Dementia care metaphors represented ways to protect family members living with dementia and maintain their ongoing connections to home and community. However, limited understandings of dementia affected their capacity to provide quality care. CONCLUSION: The findings contribute to public health scholarship involving Aboriginal community responses to dementia care. The study has resulted in important initiatives including a community-based dementia education program to ensure Aboriginal people impacted by dementia are provided with effective and culturally appropriate care.

Casein kinase 1-epsilon deletion increases mu opioid receptor-dependent behaviors and binge eating1.

Genetic and pharmacological studies indicate that casein kinase 1 epsilon (Csnk1e) contributes to psychostimulant, opioid, and ethanol motivated behaviors. We previously used pharmacological inhibition to demonstrate that Csnk1e negatively regulates the locomotor stimulant properties of opioids and psychostimulants. Here, we tested the hypothesis that Csnk1e negatively regulates opioid and psychostimulant reward using genetic inhibition and the conditioned place preference assay in Csnk1e knockout mice. Similar to pharmacological inhibition, Csnk1e knockout mice showed enhanced opioid-induced locomotor activity with the mu opioid receptor agonist fentanyl (0.2 mg/kg i.p.) as well as enhanced sensitivity to low-dose fentanyl reward (0.05 mg/kg). Interestingly, female knockout mice also showed a markedly greater escalation in consumption of sweetened palatable food - a behavioral pattern consistent with binge eating that also depends on mu opioid receptor activation. No difference was observed in fentanyl analgesia in the 52.5°C hot plate assay (0-0.4 mg/kg), naloxone conditioned place aversion (4 mg/kg), or methamphetamine conditioned place preference (0-4 mg/kg). To identify molecular adaptations associated with increased drug and food behaviors in knockout mice, we completed transcriptome analysis via mRNA sequencing of the striatum. Enrichment analysis identified terms associated with myelination and axon guidance and pathway analysis identified a differentially expressed gene set predicted to be regulated by the Wnt signaling transcription factor, Tcf7l2. To summarize, Csnk1e deletion increased mu opioid receptor-dependent behaviors, supporting previous studies indicating an endogenous negative regulatory role of Csnk1e in opioid behavior.

The murine long-term multi-lineage renewal marrow stem cell is a cycling cell.

Prevailing wisdom holds that hematopoietic stem cells (HSCs) are predominantly quiescent. Although HSC cycle status has long been the subject of scrutiny, virtually all marrow stem cell research has been based on studies of highly purified HSCs. Here we explored the cell cycle status of marrow stem cells in un-separated whole bone marrow (WBM). We show that a large number of long-term multi-lineage engraftable stem cells within WBM are in S/G2/M phase. Using bromodeoxyuridine, we show rapid transit through the cell cycle of a previously defined relatively dormant purified stem cell, the long-term HSC (LT-HSC; Lineage(-)/c-kit(+)/Sca-1(+)/Flk-2(-)). Actively cycling marrow stem cells have continually changing phenotype with cell cycle transit, likely rendering them difficult to purify to homogeneity. Indeed, as WBM contains actively cycling stem cells, and highly purified stem cells engraft predominantly while quiescent, it follows that the population of cycling marrow stem cells within WBM are lost during purification. Our studies indicate that both the discarded lineage-positive and lineage-negative marrow cells in a stem cell separation contain cycling stem cells. We propose that future work should encompass this larger population of cycling stem cells that is poorly represented in current studies solely focused on purified stem cell populations.

Reduction of immunosuppression as initial therapy for posttransplantation lymphoproliferative disorder(☠).

Reduction of immunosuppression (RI) is commonly used to treat posttransplant lymphoproliferative disorder (PTLD) in solid organ transplant recipients. We investigated the efficacy, safety and predictors of response to RI in adult patients with PTLD. Sixty-seven patients were managed with RI alone and 30 patients were treated with surgical excision followed by adjuvant RI. The response rate to RI alone was 45% (complete response-37%, partial response-8%). The relapse rate in complete responders was 17%. Adjuvant RI resulted in a 27% relapse rate. The acute rejection rate following RI-containing strategies was 32% and a second transplant was feasible without relapse of PTLD. The median survival was 44 months in patients treated with RI alone and 9.5 months in patients who remained on full immunosuppression (p = 0.07). Bulky disease, advanced stage and older age predicted lack of response to RI. Survival analysis demonstrated predictors of poor outcome-age, dyspnea, B symptoms, LDH level, hepatitis C, bone marrow and liver involvement. Patients with none or one of these factors had a 3-year overall survival of 100% and 79%, respectively. These findings support the use of RI alone in low-risk PTLD and suggest factors that predict response and survival.

Tacrolimus with mycophenolate mofetil (MMF) or sirolimus vs. cyclosporine with MMF in cardiac transplant patients: 1-year report.

The most advantageous combination of immunosuppressive agents for cardiac transplant recipients has not yet been established. Between November 2001 and June 2003, 343 de novo cardiac transplant recipients were randomized to receive steroids and either tacrolimus (TAC) + sirolimus (SRL), TAC + mycophenolate mofetil (MMF) or cyclosporine (CYA) + MMF. Antilymphocyte induction therapy was allowed for up to 5 days. The primary endpoint of >/=3A rejection or hemodynamic compromise rejection requiring treatment showed no significant difference at 6 months (TAC/MMF 22.4%, TAC/SRL 24.3%, CYA/MMF 31.6%, p = 0.271) and 1 year (p = 0.056), but it was significantly lower in the TAC/MMF group when compared only to the CYA/MMF group at 1 year (23.4% vs. 36.8%; p = 0.029). Differences in the incidence of any treated rejection were significant (TAC/SRL = 35%, TAC/MMF = 42%, CYA/MMF = 59%; p < 0.001), as were median levels of serum creatinine (TAC/SRL = 1.5 mg/dL, TAC/MMF = 1.3 mg/dL, CYA/MMF = 1.5 mg/dL; p = 0.032) and triglycerides (TAC/SRL = 162 mg/dL, TAC/MMF = 126 mg/dL, CYA/MMF = 154 mg/dL; p = 0.028). The TAC/SRL group encountered fewer viral infections but more fungal infections and impaired wound healing. These secondary endpoints suggest that the TAC/MMF combination appears to offer more advantages than TAC/SRL or CYA/MMF in cardiac transplant patients, including fewer >/=3A rejections or hemodynamic compromise rejections and an improved side-effect profile.

Analyses of Digman's child-personality data: derivation of Big-Five factor scores from each of six samples.

One of the world's richest collections of teacher descriptions of elementary-school children was obtained by John M. Digman from 1959 to 1967 in schools on two Hawaiian islands. In six phases of data collection, 88 teachers described 2,572 of their students, using one of five different sets of personality variables. The present report provides findings from new analyses of these important data, which have never before been analyzed in a comprehensive manner. When factors developed from carefully selected markers of the Big-Five factor structure were compared to those based on the total set of variables in each sample, the congruence between both types of factors was quite high. Attempts to extend the structure to 6 and 7 factors revealed no other broad factors beyond the Big Five in any of the 6 samples. These robust findings provide significant new evidence for the structure of teacher-based assessments of child personality attributes.

Lexical studies of indigenous personality factors: premises, products, and prospects.

The rationale for lexical studies rests on the assumption that the most meaningful personality attributes tend to become encoded in language as single-word descriptors. We articulate some key premises of the lexical approach and then review a number of studies that have been conducted examining the factor structure of personality descriptors extracted from dictionaries. We compare lexical studies in English and 12 other languages, with attention to delineating consistencies between the structures found in diverse languages. Our review suggests that the Anglo-Germanic Big Five is reproduced better in some languages than in others. We propose some organizing rules for lexical factor structures that may be more generalizable than the contemporary Big-Five model. And, we propose several candidate structural models that should be compared with the Big Five in future studies, including structures with one, two, and three very broad factors, an alternative five-factor structure identified in Italian and Hungarian studies, and a seven-factor structure represented in Hebrew and Philippine studies. We recommend that in future studies more attention be paid to middle-level personality constructs and to examining the effects of methodological variations on the resulting factor structures.

The structure of Turkish trait-descriptive adjectives.

This description of the Turkish lexical project reports some initial findings on the structure of Turkish personality-related variables. In addition, it provides evidence on the effects of target evaluative homogeneity vs. heterogeneity (e.g., samples of well-liked target individuals vs. samples of both liked and disliked targets) on the resulting factor structures, and thus it provides a first test of the conclusions reached by D. Peabody and L. R. Goldberg (1989) using English trait terms. In 2 separate studies, and in 2 types of data sets, clear versions of the Big Five factor structure were found. And both studies replicated and extended the findings of Peabody and Goldberg; virtually orthogonal factors of relatively equal size were found in the homogeneous samples, and a more highly correlated set of factors with relatively large Agreeableness and Conscientiousness dimensions was found in the heterogeneous samples.

A dystrophin missense mutation showing persistence of dystrophin and dystrophin-associated proteins yet a severe phenotype.

A muscle biopsy from an X-linked muscular dystrophy pedigree showed normal dystrophin and dystrophin-associated proteins. Linkage to multiple markers within the dystrophin gene (LOD=2.7, theta=0) indicated a primary dystrophinopathy. Sequencing of the entire dystrophin RNA revealed a single missense mutation (D3335H) in the unique carboxyl-terminal domain. This is the first report showing that a relatively severe dystrophinopathy can occur despite the correct localization of dystrophin and dystrophin-associated proteins.

What is beyond the big five?

Previous investigators have proposed that various kinds of person-descriptive content--such as differences in attitudes or values, in sheer evaluation, in attractiveness, or in height and girth--are not adequately captured by the Big Five Model. We report on a rather exhaustive search for reliable sources of Big Five-independent variation in data from person-descriptive adjectives. Fifty-three candidate clusters were developed in a college sample using diverse approaches and sources. In a nonstudent adult sample, clusters were evaluated with respect to a minimax criterion: minimum multiple correlation with factors from Big Five markers and maximum reliability. The most clearly Big Five-independent clusters referred to Height, Girth, Religiousness, Employment Status, Youthfulness and Negative Valence (or low-base-rate attributes). Clusters referring to Fashionableness, Sensuality/Seductiveness, Beauty, Masculinity, Frugality, Humor, Wealth, Prejudice, Folksiness, Cunning, and Luck appeared to be potentially beyond the Big Five, although each of these clusters demonstrated Big Five multiple correlations of .30 to .45, and at least one correlation of .20 and over with a Big Five factor. Of all these content areas, Religiousness, Negative Valence, and the various aspects of Attractiveness were found to be represented by a substantial number of distinct, common adjectives. Results suggest directions for supplementing the Big Five when one wishes to extend variable selection outside the domain of personality traits as conventionally defined.

Adverse events after protamine administration in patients undergoing cardiopulmonary bypass: risks and predictors of under-reporting.

A retrospective cohort study of patients undergoing cardiopulmonary bypass over 2 years at a single hospital was performed to determine the rate and predictors of attributing events to protamine and reporting them to a well-developed, hospital-based adverse drug reaction (ADR) program. Overall, 123 (12.9%) of 952 procedures were associated with an adverse event. Thirteen percent of these events were attributed to protamine in the medical record and 2.4% were reported to the ADR program. Only 19% of events attributed to protamine were reported. Even after excluding events with other measurable etiologies, the incidence of adverse events (2.6%) was still higher than that of attributed (0.8%) or reported (0.3%) events. Events that manifest as pulmonary hypertension occurred sooner after protamine, or were severe were significantly more likely to be attributed to protamine. These predictors demonstrated similar relationships with the probability of reporting events. Reliance on reporting of adverse events could not only underestimate the risk of these events, but might bias studies by identifying non-representative events.

The Big-Five factor structure as an integrative framework: an analysis of Clarke's AVA model.

Using a large (N = 3,629) sample of participants selected to be representative of U.S. working adults in the year 2,000, we provide links between the constructs in 2 personality models that have been derived from quite different rationales. We demonstrate the use of a novel procedure for providing orthogonal Big-Five factor scores and use those scores to analyze the scales of the Activity Vector Analysis (AVA). We discuss the implications of our many findings both for the science of personality assessment and for future research using the AVA model.

So what do you propose we use instead? A reply to Block.

Unfortunately, Block's brilliant critique is terribly biased, much like a legal brief that presents only one side of the issues at suit. It does not distinguish between the Big Five model of phenotypic personality attributes from alternative models of the causal underpinnings of personality differences. Ironically, it attempts to explain away the extensive evidence for the Big Five model as largely the result of data prestructuring, with no acknowledgement of the unique contribution of the lexical approach to minimizing such problems. Even more seriously, it omits a good deal of crucial evidence favorable to the Big Five model, including studies of Block's own Q-set and independent investigations of personality-related terms in other languages. Sadly, Block's closing suggestions provide little in the way of specific proposals for alternatives that he would have us use instead.

The structure of phenotypic personality traits.

This personal historical article traces the development of the Big-Five factor structure, whose growing acceptance by personality researchers has profoundly influenced the scientific study of individual differences. The roots of this taxonomy lie in the lexical hypothesis and the insights of Sir Francis Galton, the prescience of L. L. Thurstone, the legacy of Raymond B. Cattell, and the seminal analyses of Tupes and Christal. Paradoxically, the present popularity of this model owes much to its many critics, each of whom tried to replace it, but failed. In reaction, there have been a number of attempts to assimilate other models into the five-factor structure. Lately, some practical implications of the emerging consensus can be seen in such contexts as personnel selection and classification.

Integration of the big five and circumplex approaches to trait structure.

To integrate the 5-dimensional simple-structure and circumplex models of personality, the Abridged Big Five Dimensional Circumplex (AB5C) taxonomy of personality traits was developed, consisting of the 10 circumplexes that can be formed by pitting each of the Big Five factors against one another. The model maps facets of the Big Five dimensions as blends of 2 factors. An application to data consisting of 636 self-ratings and peer ratings on 540 personality trait adjectives yielded 34 well-defined facets out of a possible 45. The AB5C solution is compared with simple-structure and lower dimensional circumplex solutions, and its integrative and corrective potential are discussed, as well as its limitations.

The basic level in personality-trait hierarchies: studies of trait use and accessibility in different contexts.

A person's behavior and experiences can be described at different levels of abstraction. For example, a person might be described as charitable, as generous, as kind, or as good. Is there a level in such a trait hierarchy that is particularly useful in personality descriptions? The present 4 studies show that there is indeed a general preference for a particular level; the size of this preference depends on the familiarity and likability of the target people, which included various others and the self. These findings suggest that in trait hierarchies, people prefer the highest level of abstraction that is still descriptive of behavior (e.g., kind) over more descriptive subordinate levels (e.g., charitable and generous) and over an even broader level devoid of descriptive meaning (e.g., good). This level is basic in that it represents the optimal resolution of the trade-off between bandwidth and fidelity that characterizes all hierarchies.

An alternative "description of personality": the big-five factor structure.

In the 45 years since Cattell used English trait terms to begin the formulation of his "description of personality," a number of investigators have proposed an alternative structure based on 5 orthogonal factors. The generality of this 5-factor model is here demonstrated across unusually comprehensive sets of trait terms. In the first of 3 studies, 1,431 trait adjectives grouped into 75 clusters were analyzed; virtually identical structures emerged in 10 replications, each based on a different factor-analytic procedure. A 2nd study of 479 common terms grouped into 133 synonym clusters revealed the same structure in 2 samples of self-ratings and in 2 samples of peer ratings. None of the factors beyond the 5th generalized across the samples. In the 3rd study, analyses of 100 clusters derived from 339 trait terms suggest their potential utility as Big-Five markers in future studies.