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Functional homogenisation occurs across many areas and organism groups, thereby seriously affecting biodiversity loss and ecosystem functioning. In this study, we examined how functional features of aquatic macrophytes have changed during a 70-year period at community and species levels in a boreal lake district. At the community level, we examined if aquatic macrophyte communities showed different spatial patterns in functional composition and functional richness in relation to main environmental drivers between the time periods. We also observed each species in functional space to assess if species with certain sets of traits have become more common or rare in the 70-year study period. We found changes in the relationship between functional community composition and the environment. The aquatic macrophyte communities showed different patterns in functional composition between the two time periods, and the main environmental drivers for these changes were partly different. Temporal changes in functional richness were only partially linked to concomitant changes in the environment, while stable factors were more important. Species’ functional traits were not associated with commonness or rarity patterns. Our findings revealed that functional homogenisation has not occurred across these boreal lakes, ranging from small oligotrophic forest lakes to larger lakes affected by human impacts.

We studied community–environment relationships of lake macrophytes at two metacommunity scales using data from 16 regions across the world. More specifically, we examined (a) whether the lake macrophyte communities respond similar to key local environmental factors, major climate variables and lake spatial locations in each of the regions (i.e., within-region approach) and (b) how well can explained variability in the community–environment relationships across multiple lake macrophyte metacommunities be accounted for by elevation range, spatial extent, latitude, longitude, and age of the oldest lake within each metacommunity (i.e., across-region approach). In the within-region approach, we employed partial redundancy analyses together with variation partitioning to investigate the relative importance of local variables, climate variables, and spatial location on lake macrophytes among the study regions. In the across-region approach, we used adjusted R2 values of the variation partitioning to model the community–environment relationships across multiple metacommunities using linear regression and commonality analysis. We found that niche filtering related to local lake-level environmental conditions was the dominant force structuring macrophytes within metacommunities. However, our results also revealed that elevation range associated with climate (increasing temperature amplitude affecting macrophytes) and spatial location (likely due to dispersal limitation) was important for macrophytes based on the findings of the across-metacommunities analysis. These findings suggest that different determinants influence macrophyte metacommunities within different regions, thus showing context dependency. Moreover, our study emphasized that the use of a single metacommunity scale gives incomplete information on the environmental features explaining variation in macrophyte communities.

Community ecology has had a strong focus on single snapshots of species compositional variation in time. However, environmental change often occurs slowly at relatively broad spatio-temporal scales, which requires historically explicit assessments of long-term metacommunity dynamics, such as the order of species arrival during community assembly (i.e., priority effects), a theme that merits further empirical quantification. In this study, we applied the Bayesian inference scheme of Hierarchical Modeling of Species Communities together with information on functional traits and evolutionary dependencies to efficiently explore the question of how ecological communities are organized in space and time. To do this, we used a comprehensive time-series dataset from boreal lake plants and adopted the perspective that more sound conclusions on metacommunity dynamics can be gained from studies that consider a historically integrative approach over long timeframes. Our findings revealed that historical contingency via priority effects can profoundly shape community assembly under the influence of environmental change across decades (here, from the 1940s to the 2010s). Similarly, our results supported the existence of both positive and negative species-to-species associations in lake plants, suggesting that functional divergence can switch the inhibition–facilitation balance at the metacommunity level. Perhaps more importantly, this proof-of-concept study supports the notion that community ecology should include a historical perspective and suggests that ignoring priority effects may risk our ability to identify the true magnitude of change in present-day biotic communities.

Recently, community ecology has emphasized the multi-facetted aspects of biological diversity by linking species traits and the environment. Here, we explored environmental correlates of taxonomically-based and traits-based compositional distances using a comprehensive data set of diatom and macroinvertebrate communities. We also explored the responses of different beta diversity components (i.e., overall beta diversity, turnover, and nestedness) of beta diversity facets (i.e., taxonomically and traits-based beta diversity) to environmental distances. Partial Mantel tests were used to test the relationships between beta diversity and environmental distance (while controlling for spatial distances). Taxonomically-based beta diversity varied much more than traits-based beta diversity, indicating strong functional convergence. We found that taxonomicallybased beta diversity was largely driven by the turnover component. However, the nestedness component contributed more to overall traits-based beta diversity than the turnover component. Taxonomically-based beta diversity was significantly correlated with environmental distances for both diatoms and macroinvertebrates. Thus, we found support for the role of environmental filtering as a driver of community dissimilarities of rather different biological groups. However, the strength of these relationships between beta diversity and environmental distances varied depending on the biological group, facet, component, and the way which the environmental variables were selected to calculate the explanatory (distance) matrix. Our results indicated that both taxonomically and traits-based approaches are still needed to better understand patterns and mechanisms affecting the organization of biological communities in streams. This is because different facets of biological communities may be driven by different mechanisms.

Understanding the drivers of community structure is an important topic in ecology. We examined whether different species trait groups of stream diatoms (ecological guilds and specialization groups) show divergent responses to spatial and environmental factors in a subarctic drainage basin. We used local- and catchment-scale environmental and spatial variables in redundancy analysis and variation partitioning to examine community structuring. Local and catchment conditions and spatial variables affected diatom community structure with different relative importance. Local-scale environmental variables explained most of the variation in the low-profile and motile guilds, whereas local and spatial variables explained the same amount of the variation in the high-profile guild. The variations in the planktic guild and the specialist species were best explained by spatial variables, and catchment variables explained most variation only in generalist species. Our study showed that diatom communities in subarctic streams are a result of both environmental filtering and spatial processes. Our findings also suggested that dividing whole community into different groups by species traits can increase understanding of metacommunity organization.

The regional occupancy and local abundance of species are thought to be strongly correlated to their body size, niche breadth and niche position. The strength of the relationships among these variables can also differ between different organismal groups. Here, we analyzed data on stream diatoms and insects from a high-latitude drainage basin to investigate these relationships. To generate measures of niche position and niche breadth for each species, we used sets of local environmental and catchment variables separately, applying the outlying mean index analysis. Beta regression and negative binomial generalized linear models were run to predict regional occupancy and mean local abundance, respectively. We found a positive occupancy–abundance relationship in both diatoms and insects, and that niche-based variables were the main predictors of variation in regional occupancy and local abundance. This finding was mainly due to local environmental niche position, whereas the effects of niche breadth on regional occupancy and local abundance were less important. We also found a relationship between body size and local abundance or regional occupancy of diatoms. Our results thus add to current macroecological research by emphasizing the strong importance of niche position rather than niche breadth and body size for regional occupancy and local abundance in rarely studied organisms (e.g., diatoms and insects) and ecosystems (i.e., wilderness streams).

Poor data transfer and interoperability between electronic health record (EHR) systems has been a challenge hindering availability and usability of patient information in clinical practice and evidence-based decision-making. To improve data transfer and interoperability, patient information should be documented in a structured format. This also applies to medication-related patient information and results of the interventions, such as medication reviews (MRs), to individually optimize medication regimens, especially in older adults. This study aimed to identify what information obtained from MRs should be documented in a structured form in EHRs at a national and organizational level. The study was conducted as a 3-round Delphi consensus survey in 2020. The electronic survey was based on a comprehensive inventory of international and national MR procedures in various settings. Expert panelists (N=41) independently assessed which topics should be documented in a structured form in EHRs. The interprofessional panel (N=41) consisted of 12 physicians, 13 pharmacists, 10 nurses, and 6 information management professionals (participation rate 66%-76% in rounds 1-3; consensus limit set at 80%). The responses were analyzed quantitatively and qualitatively. Consensus was reached on 97.3% (108/111) of predetermined topics to be documented in a structured form in EHRs. Of these, 39 concerned the MR process, 25 related to potentially drug-induced symptoms, 11 related to burden of risks for adverse drug effects, 12 related to laboratory tests and other test results, 12 related to medication adherence, and 9 related to the use of intoxicants. The patient's blood pressure (mean 4.85, SD 0.53; on a Likert scale 1-5), kidney function (mean 4.81, SD 0.56), and risk of bleeding (mean 4.81, SD 0.56) were ranked as the 3 most important topics to be documented in a structured form. The panel reached a consensus that the information obtained from MRs should be made available to all health care professionals in the national digital repository for patient data and to patients to some extent. The interprofessional expert panel strongly agreed on the results of the MRs that should be documented in a structured form in EHRs and made available to both health professionals involved in care teams and patients themselves.

Background New competence requirements have emerged for pharmacists as a result of changing societal needs towards more patient-centred practices. Today, medication review competence can be considered as basic pharmaceutical competence. Medication review specific competence criteria and tools for self-assessing the competence are essential in building competences and a shared understanding of medication reviews as a collaborative practice. The aim of this study was to develop and pilot a self-assessment tool for medication review competence among practicing pharmacists in Finland. Methods The development of the self-assessment tool was based on the national medication review competence criteria for pharmacists established in Finland in 2017 and piloting the tool among practicing pharmacists in a national online survey in October 2018. The pharmacists self-assessed their medication review competence with a five-point Likert scale ranging from 1 for “very poor/not at all” to 5 for “very good”. Results The internal consistency of the self-assessment tool was high as the range of the competence areas’ Cronbach’s alpha was 0.953–0.973. The competence areas consisted of prescription review competence (20 items, Cronbach’s alpha 0.953), additional statements for medication review competence (11 additional items, Cronbach’s alpha 0.963) and medication review as a whole, including both the statements of prescription review and medication review competence (31 items, Cronbach’s alpha 0.973). Competence items closely related to routine dispensing were most commonly self-estimated to be mastered by the practicing pharmacists who responded ( n  = 344), while the more clinical and patient-centred competence items had the lowest self-estimates. This indicates that the self-assessment tool works logically and differentiates pharmacists according to competence. The self-assessed medication review competence was at a very good or good level among more than half (55%) of the respondents ( n  = 344). Conclusion A self-assessment tool for medication review competence was developed and validated. The piloted self-assessment tool can be used for regular evaluation of practicing pharmacists’ medication review competence which is becoming an increasingly important basis for their contribution to patient care and society.

Common Missense Variant in the Glucokinase Regulatory Protein Gene Is Associated With Increased Plasma Triglyceride and C-Reactive Protein but Lower Fasting Glucose Concentrations Marju Orho-Melander 1 , Olle Melander 1 , Candace Guiducci 2 , Pablo Perez-Martinez 3 4 5 , Dolores Corella 5 , Charlotta Roos 1 , Ryan Tewhey 2 , Mark J. Rieder 6 , Jennifer Hall 7 , Goncalo Abecasis 8 , E. Shyong Tai 9 , Cullan Welch 7 , Donna K. Arnett 10 , Valeriya Lyssenko 1 , Eero Lindholm 1 , Richa Saxena 2 , Paul I.W. de Bakker 2 , Noel Burtt 2 , Benjamin F. Voight 2 , Joel N. Hirschhorn 2 , Katherine L. Tucker 11 , Thomas Hedner 12 , Tiinamaija Tuomi 13 14 , Bo Isomaa 14 , Karl-Fredrik Eriksson 1 , Marja-Riitta Taskinen 13 , Björn Wahlstrand 12 , Thomas E. Hughes 15 , Laurence D. Parnell 4 , Chao-Qiang Lai 4 , Göran Berglund 16 , Leena Peltonen 17 , Erkki Vartiainen 18 , Pekka Jousilahti 18 , Aki S. Havulinna 18 , Veikko Salomaa 18 , Peter Nilsson 1 , Leif Groop 1 13 , David Altshuler 2 19 20 , Jose M. Ordovas 4 and Sekar Kathiresan 2 21 1 Department of Clinical Sciences, University Hospital Malmö, Clinical Research Center, Lund University, Malmö, Sweden 2 Program in Medical and Population Genetics, Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts 3 Lipids and Atherosclerosis Research Unit, Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain 4 Nutrition and Genomics Laboratory, Jean Mayer-U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts 5 Genetic and Molecular Epidemiology Unit and CIBER Fisiopatología de la Obesidad y Nutrición, School of Medicine University of Valencia, Valencia, Spain 6 Department of Genome Sciences, University of Washington, Seattle, Washington 7 Lillehei Heart Institute, Department of Medicine, University of Minnesota, Minneapolis, Minnesota 8 Center for Statistical Genetics, Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan 9 Department of Endocrinology, Singapore General Hospital, Singapore 10 Dietary Assessment and Epidemiology Research Program, Jean Mayer-U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts 11 Department of Epidemiology, University of Alabama, Birmingham, Alabama 12 Department of Clinical Pharmacology, Sahlgrenska Academy, Göteborg, Sweden 13 Department of Medicine, Helsinki University Hospital, University of Helsinki, Helsinki, Finland 14 Folkhälsan Research Center, Helsinki, Finland 15 Novartis Institutes for BioMedical Research, Cambridge, Massachusetts 16 Department of Clinical Sciences, Medicine, Lund University, Malmö, Sweden 17 Department of Molecular Medicine, National Public Health Institute, Biomedicum, Helsinki, Finland 18 Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland 19 Center for Human Genetic Research and Department of Molecular Biology, Massachusetts General Hospital, Boston, Massachusetts 20 Department of Genetics, Harvard Medical School, Boston, Massachusetts 21 Cardiovascular Disease Prevention Center, Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts Corresponding author: Marju Orho-Melander, marju.orho-melander{at}med.lu.se Abstract OBJECTIVE— Using the genome-wide association approach, we recently identified the glucokinase regulatory protein gene ( GCKR , rs780094) region as a novel quantitative trait locus for plasma triglyceride concentration in Europeans. Here, we sought to study the association of GCKR variants with metabolic phenotypes, including measures of glucose homeostasis, to evaluate the GCKR locus in samples of non-European ancestry and to fine- map across the associated genomic interval. RESEARCH DESIGN AND METHODS— We performed association studies in 12 independent cohorts comprising >45,000 individuals representing several ancestral groups (whites from Northern and Southern Europe, whites from the U.S., African Americans from the U.S., Hispanics of Caribbean origin, and Chinese, Malays, and Asian Indians from Singapore). We conducted genetic fine-mapping across the ∼417-kb region of linkage disequilibrium spanning GCKR and 16 other genes on chromosome 2p23 by imputing untyped HapMap single nucleotide polymorphisms (SNPs) and genotyping 104 SNPs across the associated genomic interval. RESULTS— We provide comprehensive evidence that GCKR rs780094 is associated with opposite effects on fasting plasma triglyceride ( P meta = 3 × 10 −56 ) and glucose ( P meta = 1 × 10 −13 ) concentrations. In addition, we confirmed recent reports that the same SNP is associated with C-reactive protein (CRP) level ( P = 5 × 10 −5 ). Both fine-mapping approaches revealed a common missense GCKR variant (rs1260326, Pro446Leu, 34% frequency, r 2 = 0.93 with rs780094) as the strongest association signal in the region. CONCLUSIONS— These findings point to a molecular mechanism in humans by which higher triglycerides and CRP can be coupled with lower plasma glucose concentrations and position GCKR in central pathways regulating both hepatic triglyceride and glucose metabolism. Footnotes Published ahead of print at http://diabetes.diabetesjournals.org on 4 August 2008. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. Accepted July 29, 2008. Received April 17, 2008. DIABETES

Blood O 2 carrying capacity affects aerobic capacity ( V O 2max ). Patients with type 1 diabetes have a risk for anaemia along with renal impairment, and they often have low V O 2max . We investigated whether total haemoglobin mass (tHb-mass) and blood volume (BV) differ in men with type 1 diabetes (T1D, n  = 12) presently without complications and in healthy men (CON, n  = 23) (age-, anthropometry-, physical activity-matched), to seek an explanation for low V O 2max . We determined tHb-mass, BV, haemoglobin concentration ([Hb]), and V O 2max in T1D and CON. With similar (mean ± SD) [Hb] (144 vs. 145 g l −1 ), T1D had lower tHb-mass (10.1 ± 1.4 vs. 11.0 ± 1.1 g kg −1 , P  < 0.05), BV (76.8 ± 9.5 vs. 83.5 ± 8.3 ml kg −1 , P  < 0.05) and V O 2max (35.4 ± 4.8 vs. 44.9 ± 7.5 ml kg −1  min −1 , P  < 0.001) than CON. V O 2max correlated with tHb-mass and BV both in T1D ( r  = 0.71, P  < 0.01 and 0.67, P  < 0.05, respectively) and CON ( r  = 0.54, P  < 0.01 and 0.66, P  < 0.001, respectively), but not with [Hb]. Linear regression slopes were shallower in T1D than CON both between V O 2max and tHb-mass (2.4 and 3.6 ml kg −1  min −1 vs. g kg −1 , respectively) and V O 2max and BV (0.3 and 0.6 ml kg −1  min −1 vs. g kg −1 , respectively), indicating that T1D were unable to reach similar V O 2max than CON at a given tHb-mass and BV. In conclusion, low tHb-mass and BV partly explained low V O 2max in T1D and may provide early and more sensitive markers of blood O 2 carrying capacity than [Hb] alone.