Stressors, mediators, and health care outcomes of home enteral nutrition in family caregivers and their older adult care recipients

Family caregivers manage home enteral nutrition (HEN) for over 77% of an estimated 1 of every 400 Medicare recipients. Increasing usage of HEN in older adults combined with reliance on family caregivers raises concerns for the quality, outcomes, and costs of care. These concerns are relevant in light of Medicare limitations on nursing assistance and non-reimbursement for nutrition services, despite annual costs of over $600 million. This study applied stress process theories to assess stressor, mediator, and outcome variables salient to HEN and caregiving. In-home structured interviews occurred with a multi-ethnic sample of 30 caregiving dyads at 1–3 months after discharge on HEN. Care recipients were aged ≥60 (M = 68.4 years) and did not have dementia. Caregivers were aged ≥21, unpaid, and lived within 45 minutes of care recipients. Caregivers performed an average of 19.7 tasks daily for 61.9 hours weekly. Training needs were identified for 33 functional, care management, technical, and nutritional tasks. Preparedness scores were low (M = 1.73/4.0), and positively correlated with competence, self-rated quality of care and positive feelings, and negatively with overload, role captivity, and negative feelings (Ps < .05). Caregivers had multiple changes in lifestyle and dietary behaviors. Lifestyle changes positively correlated with overload, and negatively with preparedness and positive feelings. Dietary changes positively correlated with number of tasks, overload, role captivity and negative feelings, and negatively with preparedness (Ps < .01). Fifty-seven percent of caregivers aged >50 were at nutrition risk. Care recipients fared worse. Average weight change was −4.35 pounds (P < .001). Physical complications interrupted daily enteral infusions. Water intake was half of fluid need and associated with signs of dehydration (P < .001). Physical and social function was poor, with older subjects more impaired ( P < .04). Those with better prepared or less overloaded caregivers had higher functionality and QOL (P < .002). Complications, type of feeding tube, and caregiver preparedness correlated with frequency of health care utilization (Ps < .05). Efficacy of HEN in older adults requires specialized caregiver training, attention to caregivers' needs, and frequent monitoring from a highly skilled multidisciplinary team including dietitians. ^

Influence of gender and life stressors on longitudinal depression treatment outcomes among older primary care patients

Purpose: Depression in older females is a significant and growing problem. Females who experience life stressors across the life span are at higher risk for developing problems with depression than their male counterparts. The primary aim of this study was (a) to examine gender-specific differences in the correlates of depression in older primary care patients based on baseline and longitudinal analyses; and (b) to examine the longitudinal effect of biopsychosocial risk factors on depression treatment outcomes in different models of behavioral healthcare (i.e., integrated care and enhanced referral). Method: This study used a quantitative secondary data analysis with longitudinal data from the Primary Care Research in Substance Abuse and Mental Health for Elderly (PRISM-E) study. A linear mixed model approach to hierarchical linear modeling was used for analysis using baseline assessment, and follow-up from three-month and six-month. Results: For participants diagnosed with major depressive disorder female gender was associated with increased depression severity at six-month compared to males at six-month. Further, the interaction between gender and life stressors found that females who reported loss of family and friends, family issues, money issues, medical illness was related to higher depression severity compared to males whereas lack of activities was related to lower depression severity among females compared to males. Conclusion: These findings suggest that gender moderated the relationship between specific life stressors and depression severity similar to how a protective factor can impact a person's response to a problem and reduce the negative impact of a risk factor on a problem outcome. Therefore, life stressors may be a reliable predictor of depression for both females and males in either behavioral health treatment model. This study concluded that life stressors influence males basic comfort, stability, and survival whereas life stressors influence females' development, personal growth, and happiness; therefore, life stressors may be a useful component to include in gender-based screening and assessment tools for depression. ^

Teacher-student relationships and the link to academic adjustment and emotional well-being in early adolescence

The role of support from teachers on the academic and emotional adjustment of a ethnically and economically diverse sample of adolescents was examined. Analyses were conducted on data from a larger study examining social networks across the transition to junior high school. Participants in the current study included 694 African-American, Hispanic-American and European-American students in grades 6 and 8 from public elementary schools in South Florida. Some of these schools are located in economically distressed areas and some are in middle income areas. Children were interviewed, and information on teacher social support resources, school stressors, risk and academic and emotional adjustment was obtained. Several significant findings emerged from the analyses. First, overall teacher support was a significant predictor of a wide range of academic and emotional adjustment outcomes. Second, teacher support compensated for low peer support on teacher rated behavior problems. Third, teacher support interacted with school stress to predict depressed affect and self esteem. Fourth, teacher support interacted with low ecological risk conditions to predict feelings of loneliness. ^

Patterns of acculturative stress: Continuity, discontinuity, and adjustment among Latino youth

This study evaluated inter- and intra-individual changes in acculturation, acculturative stress, and adaptation experiences, as well as their associations with adjustment outcomes among a group of Latino adolescents in South Florida. Specifically, the current study investigated the incidence, changes, and effects of stressors that arise from acculturation experiences (e.g., related to culture, discrimination, language difficulties) among Latino youth by employing a person-centered approach and a longitudinal research design. Four separate groups of analyses were conducted to investigate (a) within-group differences in levels of reported acculturative stress, (b) patterns of continuity and discontinuity in levels of acculturative stress across time, (c) adjustment outcomes associated with distinct patterns of acculturative stress within each measurement occasion, and (d) predictive relations between longitudinal acculturative stress trajectories in early adolescence and psychosocial adjustment outcomes in young adulthood. ^ Results from the multivariate analyses indicated great within group heterogeneity in acculturative stress among Latino youth during early adolescence, as well as significant continuity and discontinuity in the patterns of shifts among acculturative stress profiles between contiguous measurement occasions. Within each developmental period, membership in acculturative stress clusters was significantly and differentially associated with multiple adjustment outcomes, suggesting that maladaptive outcomes are more likely to occur among Latino adolescents experiencing high levels of psychological distress across multiple acculturative domains. In general, Latino youth acculturation is best understood as multi-dimensional, to be variable across time, and to be fluid and responsive to multiple factors and influences. Implications for preventive strategies are discussed with regard to acculturation and developmental psychology research literatures. ^

Enigmatic faunal declines at La Selva, Costa Rica: Patterns and processes in a collapsing neotropical herpetofauna

Amphibian populations are declining even in pristine areas in many parts of the world, and in the Neotropics most such enigmatic amphibian declines have occurred in mid- to high-elevation sites. However, amphibian populations have also declined at La Selva Biological Station in the lowlands of Costa Rica, and similar declines in populations of lizards have occurred at the site as well. To set the stage for describing amphibian declines at La Selva, I thoroughly review knowledge of amphibian decline and amphibian conservation in Central America: I describe general patterns in biodiversity, evaluate major patterns in and ecological correlates of threat status, review trends in basic and applied conservation literature, and recommend directions for future research. I then synthesize data on population densities of amphibians, as well as ecologically similar reptiles, over a 35-year periods using quantitative datasets from a range of studies. This synthesis identifies assemblage-wide declines of approximately 75% for both amphibians and reptiles between 1970 and 2005. Because these declines defy patterns most commonly reported in the Neotropics, it is difficult to assess causality evoking known processes associated with enigmatic decline events. I conduct a 12-month pathogen surveillance program to evaluate infection of frogs by the amphibian chytrid fungus, an emerging pathogen linked to decline events worldwide Although lowland forests are generally believed to be too warm for presence or adverse population effects of chytridiomycosis, I present evidence for seasonal patterns in infection prevalence with highest prevalence in the coolest parts of the year. Finally, I conducted a 16-month field experiment to explore the role of changes to dynamics of leaf litter, a critical resource for both frogs and lizards. Population responses by frogs and lizards indicate that litter regulates population densities of frogs and lizards, particularly those species with the highest decline rate. My work illustrates that sites that are assumed to be pristine are likely impacted by a variety of novel stressors, and that even fauna within protected areas may be suffering unexpected declines.

Physiological responses of red mangroves to the climate in the Florida Everglades

This manuscript reports the findings of physiological studies of red mangrove (Rhizophora mangle L.) conducted from June to August 2001 and from May to June 2003 in the Florida Everglades. In situ physiological measurements were made using environmentally controlled gas exchange systems. The field investigations were carried out to define how regional climate constrains mangrove physiology and ecosystem carbon assimilation. In addition, maximum carboxylation and photosynthetic active radiation (PAR) limited carbon assimilation capacities were investigated during the summer season to evaluate whether ecophysiological models developed for mesophyte plant species can be applied to mangroves. Under summertime conditions in the Florida Everglades, maximum foliar carbon dioxide (CO2) assimilation rates reached 18 μmol CO2 m−2 s−1. Peak molar stomatal conductance to water vapor (H2O) diffusion reached 300 mmol H2O m−2 s−1. Maximum carboxylation and PAR‐limited carbon assimilation rates at the foliage temperature of 30°C attained 76.1 ± 23.4 μmol CO2 m−2 s−1 and 128.1 ± 32.9 μmol (e−) m−2 s−1, respectively. Environmental stressors such as the presence of hypersaline conditions and high solar irradiance loading (>500 W m−2 or >1000 μmoles of photons m−2 s−1 of PAR) imposed sharp reductions in carbon assimilation rates and suppressed stomatal conductance. On the basis of both field observations and model analyses, it is also concluded that existing ecophysiological models need to be modified to consider the influences of hypersaline and high radiational loadings on the physiological responses of red mangroves.

Phytoplankton bloom status: Chlorophyll a biomass as an indicator of water quality condition in the southern estuaries of Florida, USA

Altered freshwater inflows have affected circulation, salinity, and water quality patterns of Florida Bay, in turn altering the structure and function of this estuary. Changes in water quality and salinity and associated loss of dense turtle grass and other submerged aquatic vegetation (SAV) in Florida Bay have created a condition in the bay where sediments and nutrients have been regularly disturbed, frequently causing large and dense phytoplankton blooms. These algal and cyanobacterial blooms in turn often cause further loss of more recently established SAV, exacerbating the conditions causing the blooms. Chlorophyll a (CHLA) was selected as an indicator of water quality because it is an indicator of phytoplankton biomass, with concentrations reflecting the integrated effect of many of the water quality factors that may be altered by restoration activities. Overall, we assessed the CHLA indicator as being (1) relevant and reflecting the state of the Florida Bay ecosystem, (2) sensitive to ecosystem drivers (stressors, especially nutrient loading), (3) feasible to monitor, and (4) scientifically defensible. Distinct zones within the bay were defined according to statistical and consensual information. Threshold levels of CHLA for each zone were defined using historical data and scientific consensus. A presentation template of condition of the bay using these thresholds is shown as an example of an outreach product.

Developing performance measures of mangrove wetlands using simulation models of hydrology, nutrient biogeochemistry, and community dynamics

The goal of mangrove restoration projects should be to improve community structure and ecosystem function of degraded coastal landscapes. This requires the ability to forecast how mangrove structure and function will respond to prescribed changes in site conditions including hydrology, topography, and geophysical energies. There are global, regional, and local factors that can explain gradients of regulators (e.g., salinity, sulfides), resources (nutrients, light, water), and hydroperiod (frequency, duration of flooding) that collectively account for stressors that result in diverse patterns of mangrove properties across a variety of environmental settings. Simulation models of hydrology, nutrient biogeochemistry, and vegetation dynamics have been developed to forecast patterns in mangroves in the Florida Coastal Everglades. These models provide insight to mangrove response to specific restoration alternatives, testing causal mechanisms of system degradation. We propose that these models can also assist in selecting performance measures for monitoring programs that evaluate project effectiveness. This selection process in turn improves model development and calibration for forecasting mangrove response to restoration alternatives. Hydrologic performance measures include soil regulators, particularly soil salinity, surface topography of mangrove landscape, and hydroperiod, including both the frequency and duration of flooding. Estuarine performance measures should include salinity of the bay, tidal amplitude, and conditions of fresh water discharge (included in the salinity value). The most important performance measures from the mangrove biogeochemistry model should include soil resources (bulk density, total nitrogen, and phosphorus) and soil accretion. Mangrove ecology performance measures should include forest dimension analysis (transects and/or plots), sapling recruitment, leaf area index, and faunal relationships. Estuarine ecology performance measures should include the habitat function of mangroves, which can be evaluated with growth rate of key species, habitat suitability analysis, isotope abundance of indicator species, and bird census. The list of performance measures can be modified according to the model output that is used to define the scientific goals during the restoration planning process that reflect specific goals of the project.

Climatic Controls on Phytoplankton Biomass in a Sub-tropical Estuary, Florida Bay, USA

The extraction of climatic signals from time series of biogeochemical data is further complicated in estuarine regions because of the dynamic interaction of land, ocean, and atmosphere. We explored the behavior of potential global and regional climatic stressors to isolate specific shifts or trends, which could have a forcing role on the behavior of biogeochemical descriptors of water quality and phytoplankton biomass from Florida Bay, as an example of a sub-tropical estuary. We performed statistical analysis and subdivided the bay into six zones having unique biogeochemical characteristics. Significant shifts in the drivers were identified in all the chlorophyll a time series. Chlorophyll a concentrations closely follow global forcing and display a generalized declining trend on which seasonal oscillations are superimposed, and it is only interrupted by events of sudden increase triggered by storms which are followed by a relatively rapid return to pre-event conditions trailing again the long-term trend.

A conceptual model of ecological interactions in the mangrove estuaries of the Florida Everglades

A brackish water ecotone of coastal bays and lakes, mangrove forests, salt marshes, tidal creeks, and upland hammocks separates Florida Bay, Biscayne Bay, and the Gulf of Mexico from the freshwater Everglades. The Everglades mangrove estuaries are characterized by salinity gradients that vary spatially with topography and vary seasonally and inter-annually with rainfall, tide, and freshwater flow from the Everglades. Because of their location at the lower end of the Everglades drainage basin, Everglades mangrove estuaries have been affected by upstream water management practices that have altered the freshwater heads and flows and that affect salinity gradients. Additionally, interannual variation in precipitation patterns, particularly those caused to El Nin˜o events, control freshwater inputs and salinity dynamics in these estuaries. Two major external drivers on this system are water management activities and global climate change. These drivers lead to two major ecosystem stressors: reduced freshwater flow volume and duration, and sea-level rise. Major ecological attributes include mangrove forest production, soil accretion, and resilience; coastal lake submerged aquatic vegetation; resident mangrove fish populations; wood stork (Mycteria americana) and roseate spoonbill (Platelea ajaja) nesting colonies; and estuarine crocodilian populations. Causal linkages between stressors and attributes include coastal transgression, hydroperiods, salinity gradients, and the ‘‘white zone’’ freshwater/estuarine interface. The functional estuary and its ecological attributes, as influenced by sea level and freshwater flow, must be viewed as spatially dynamic, with a possible near-term balancing of transgression but ultimately a long-term continuation of inland movement. Regardless of the spatio-temporal timing of this transgression, a salinity gradient supportive of ecologically functional Everglades mangrove estuaries will be required to maintain the integrity of the South Florida ecosystem.

A conceptual ecological model to facilitate understanding the role of invasive species in large-scale ecosystem restoration

We developed a conceptual ecological model (CEM) for invasive species to help understand the role invasive exotics have in ecosystem ecology and their impacts on restoration activities. Our model, which can be applied to any invasive species, grew from the eco-regional conceptual models developed for Everglades restoration. These models identify ecological drivers, stressors, effects and attributes; we integrated the unique aspects of exotic species invasions and effects into this conceptual hierarchy. We used the model to help identify important aspects of invasion in the development of an invasive exotic plant ecological indicator, which is described a companion paper in this special issue journal. A key aspect of the CEM is that it is a general ecological model that can be tailored to specific cases and species, as the details of any invasion are unique to that invasive species. Our model encompasses the temporal and spatial changes that characterize invasion, identifying the general conditions that allow a species to become invasive in a de novo environment; it then enumerates the possible effects exotic species may have collectively and individually at varying scales and for different ecosystem properties, once a species becomes invasive. The model provides suites of characteristics and processes, as well as hypothesized causal relationships to consider when thinking about the effects or potential effects of an invasive exotic and how restoration efforts will affect these characteristics and processes. In order to illustrate how to use the model as a blueprint for applying a similar approach to other invasive species and ecosystems, we give two examples of using this conceptual model to evaluate the status of two south Florida invasive exotic plant species (melaleuca and Old World climbing fern) and consider potential impacts of these invasive species on restoration.

Surprises and Insights from Long-Term Aquatic Data Sets and Experiments

long-term research on freshwater ecosystems provides insights that can be difficult to obtain from other approaches. Widespread monitoring of ecologically relevant water-quality parameters spanning decades can facilitate important tests of ecological principles. Unique long-term data sets and analytical tools are increasingly available, allowing for powerful and synthetic analyses across sites. long-term measurements or experiments in aquatic systems can catch rare events, changes in highly variable systems, time-lagged responses, cumulative effects of stressors, and biotic responses that encompass multiple generations. Data are available from formal networks, local to international agencies, private organizations, various institutions, and paleontological and historic records; brief literature surveys suggest much existing data are not synthesized. Ecological sciences will benefit from careful maintenance and analyses of existing long-term programs, and subsequent insights can aid in the design of effective future long-term experimental and observational efforts. long-term research on freshwaters is particularly important because of their value to humanity.

Florida Bay: Water quality status and trends, historic and emerging algal bloom problems

Florida Bay is a unique subtropical estuary that while historically oligotrophic, has been subjected to both natural and anthropogenic stressors, including hurricanes, coastal eutrophication and other impacts. These stressors have resulted in degradation of water quality in the past several decades, most evidenced by reoccurring blooms of the picocyanobacterium Synechococcus spp. Major nutrient inputs consist of freshwater flows to the eastern region from runoff and regulated canal releases, inputs from the Everglades to the central region via Taylor Slough, exchanges with the Gulf of Mexico, which include intermittent Shark River inputs to the western region, stormwater and wastewater from the Florida Keys, and atmospheric deposition. These nutrient inputs have resulted in a transition from strong phosphorus (P) limitation of phytoplankton in the eastern bay to nitrogen (N) limitation in the western bay. Large blooms of Synechococcus were most pronounced in the central bay region, in the area of transition between P and N limitation, in the mid-1990s. Although non-toxic, these blooms, which have continued intermittently through the early 2000s, resulted in significant sea-grass and benthic organism mortalities. A new suite of stressors in 2005, including the passages of Hurricanes Katrina, Rita, and Wilma, additional canal releases, and the initiation of road construction to widen the main roadway leading to the Keys, were correlated with a large Synechococcus bloom in the previously clear, strongly P- limited, northeastern region of the bay. Sustained for 3 years, this bloom was accompanied by a shift from P limitation to N limitation during its course. Nutrient bioassay experiments suggest that this bloom persisted due to the ability of Synechococcus to access organic N and P sources, microbial and geochemical cycling of organic and inorganic nutrients in the water column and between the water column and sediments (both suspended particles and benthos), and decreased grazing by benthic fauna due to their die-off.

Herbivore and nutrient impact on primary producer assemblages in a tropical marine environment

Globally, human populations are increasing and coastal ecosystems are becoming increasingly impacted by anthropogenic stressors. As eutrophication and exploitation of coastal resources increases, primary producer response to these drivers becomes a key indicator of ecosystem stability. Despite the importance of monitoring primary producers such as seagrasses and macroalgae, detailed studies on the response of these benthic habitat components to drivers remain relatively sparse. Utilizing a multi-faceted examination of turtle-seagrass and sea urchin-macroalgae consumer and nutrient dynamics, I elucidate the impact of these drivers in Akumal, Quintana Roo, Mexico. In Yal Ku Lagoon, macroalgae bioindicators signified high nutrient availability, which is important for further studies, but did not consistently follow published trends reflecting decreased δ 15N content with distance from suspected source. In Akumal Bay, eutrophication and grazing by turtles and fishes combine to structure patches within the seagrass beds. Grazed seagrass patches had higher structural complexity and productivity than patches continually grazed by turtles and fishes. Results from this study indicate that patch abandonment may follow giving-up density theory, the first to be recorded in the marine environment. As Diadema antillarum populations recover after their massive mortality thirty years ago, the role these echinoids will have in reducing macroalgae cover and altering ecosystem state remains to be clear. Although Diadema antillarum densities within the coral reef ecosystem were comparable to other regions within the Caribbean, the echinoid population in Akumal Bay was an insufficient driver to prevent dominance of a turf-algal-sediment (TAS) state. After a four year study, declining coral cover coupled with increased algal cover suggests that the TAS-dominated state is likely to persist over time despite echinoid recovery. Studies on macroalgal diversity and nutrients within this same region of echinoids indicated diversity and nutrient content of macroalgae increased, which may further increase the persistence of the algal-dominated state. This study provides valuable insight into the variable effects of herbivores and nutrients on primary producers within a tropical coastal ecosystem. Results from this work challenge many of the currently accepted theories on primary producer response to nutrients and herbivory while providing a framework for further studies into these dynamics.

Science behind management of Shark Bay and Florida Bay, two P-limited subtropical systems with different climatology and human pressures

This special issue on ‘Science for the management of subtropical embayments: examples from Shark Bay and Florida Bay’ is a valuable compilation of individual research outcomes from Florida Bay and Shark Bay from the past decade and addresses gaps in our scientific knowledge base in Shark Bay especially. Yet the compilation also demonstrates excellent research that is poorly integrated, and driven by interests and issues that do not necessarily lead to a more integrated stewardship of the marine natural values of either Shark Bay or Florida Bay. Here we describe the status of our current knowledge, introduce the valuable extension of the current knowledge through the papers in this issue and then suggest some future directions. For management, there is a need for a multidisciplinary international science program that focusses research on the ecological resilience of Shark Bay and Florida Bay, the effect of interactions between physical environmental drivers and biological control through behavioural and trophic interactions, and all under increased anthropogenic stressors. Shark Bay offers a ‘pristine template’ for this scale of study.