Introduction: Interprofessional collaboration is crucial to the optimization of patient care.Aim: This paper aims to provide recommendations for implementing an innovative constructivist educational concept with the core element of video-based self-assessment.Methodology: A course for students in medicine, physiotherapy, and nursing was developed through interprofessional, cross-institutional collaboration. The course consisted of drawing on prior knowledge about the work done by each professional group in regard to a specific clinical scenario and an interprofessional treatment situation, filming a role play of this treatment situation, and a structured self-assessment of the role play.We evaluated the preparation and implementation of the three courses conducted thus far. Concrete recommendations for implementation were made based on evaluation sheets (students), open discussions  and recorded meeting minutes .Results: Basic recommendations for implementation include: selecting appropriate criteria for self-assessment and a simulated situation that offers members of each professional group an equal opportunity to act in the role play. In terms of administrative implementation we recommend early coordination among the professions and educational institutions regarding the target groups, scheduling and attendance policy to ensure participant recruitment across all professions. Procedural planning should include developing teaching materials, such as the case vignette and treatment scenario, and providing technical equipment that can be operated intuitively in order to ensure efficient recording.Conclusion: These recommendations serve as an aid for implementing an innovative constructivist educational concept with video-based self-assessment at its core. Progress in the medical field has been contributing to a rapid increase in the complexity and specialization of patient care . Ac. AcProgrent care .Reducing interface problems through interprofessional collaboration requires awareness of the problem . Fr. FrReduc problem . In this problem .The main areas in interprofessional teaching and learning are knowledge of the responsibilities  of one’s own and the cooperating professions, mastery of occupation-specific and cross-occupational competencies and https://www.cornelsen.de/bgd/97/83/06/45/03/20/5/9783064503205_x1SE_S138-143.pdf].adopting and exhibiting a professional attitude as the foundation for respectful interaction on equal footing , . F. FAn innThe goal of this paper is to provide recommendations based on our experiences for implementing this approach to interprofessional education using video-based self-assessment.When developing this educational concept into a course, we raised curricular, administrative and process-based questions both prior to and during implementation. In this paper, we wish to share key insights on successful implementation of this educational concept.The constructivist approach , 19] in in19] inTurning the concept into a course required interprofessional and cross-institutional coordination and the development of four areas: curriculum, administration, procedural planning, and evaluation.Curricular coordination included the definition of learning objectives and content, as well as teaching methods.Learning objectives: We defined three general learning objectives for participants: describing the tasks of one’s own and other professions and explaining the occupation-specific relevant aspects of the clinical picture(knowledge), acting and communicating in an interprofessional manner appropriate to the situation (application), and reflecting on one’s attitude and actions in interprofessional situations (reflection).Instructional content: A practice-relevant situation was selected for the recorded role play; in this case, the situation simulated the initial mobilization of a stroke patient and subsequent handover. For this purpose, a case vignette .To multi-dimensional self-assessment, we chose the format of a moderated group discussion. The discussion was preceded by a phase of individual work in which students were able to map out their perceptions of the learning situation using a multi-dimensional list of criteria for action, interaction, and communication.For the Cross-institutional administrative coordination included the coordination of all necessary measures between the participating institutions. This concerned the selection of the professional groups, the desired level of experience , the attendance policy for the course (required), the appropriate timeframe for course [16 course units on two consecutive days], as well as scheduling.The coordination of procedural planning included planning the details for practical implementation  and developing an individual questionnaire to better capture participants’ subjective experiences).The key concept of quality management. In the meetings held before and after, requirements were compiled for each aspect relevant to implementation. Afterwards, the plan was drafted (“plan”), measures were implemented (“do”), evaluated after each round and compared in terms of target/performance analysis (“check”), and the necessary improvements were identified (“act”).The recommendations described here result from the intense preparation and continual optimization of three cycles of the course with a total of 54 participants. The first course included 28 units and two simulated scenarios  for the video-recorded role playing. The course was continually improved through an iterative process. The course was shortened to 16 units and focus was placed on a single complex simulated situation, instead of on two. The optimization process followed the PDCA (plan-do-check-act) principle, the Each of the three courses was evaluated extensively by both participants and instructors. The participants evaluated the course using pre-defined or specially developed evaluation instruments, while the instructors evaluated the sessions in semi-structured, open discussions. We derived recommendations for curricular and administrative implementation, procedural planning and evaluation based on the evaluation results (students), the open discussions , and the recorded minutes of meetings .Defining learning objectives and contents and selecting teaching methods occurred as part of curricular planning.Requirement: The interprofessional learning objectives must be clearly defined and communicated to the participants in advance.Experience and recommendation: Based on the general learning objectives, we defined specific learning objectives in the following areas: occupational knowledge and basic communication, pathophysiology, diagnostics, and therapeutic measures for the selected clinical case in a professional and interprofessional context. The definition of the learning objectives was taxonomically refined and enhanced throughout the course. Further specification of the learning objectives enabled both participants and instructors to experience the video-based self-assessment as being even more constructive.We recommend defining the following specific learning objectives. Participants should be able to describe the range of competencies of their own and the other professions, understand the clinical case and treatment scenario and explain them competently and accurately from the perspective of their own profession, develop their own professional problem-objectives-measures plan, act and communicate interprofessionally and in a manner appropriate to the situation, recognize, name, and communicate errors in the intra/interprofessional treatment process, conduct a patient-centered, disease-specific handover between professional groups, and reflect on their own attitude and actions.Requirement: The educational situation and the resulting occupation-specific learning content should be selected with the specific interprofessional learning objectives, participants and their prior experiences in mind. The learning situation should reflect an authentic, complex scenario relevant to practice that facilitates interaction between the professional groups and with the patient.Experience and recommendation: In the first three sessions, two treatment situations were used for the role-play activity: early mobilization of a patient who was subjected to a hip-TEP and the initial mobilization and rehabilitation of a patient in a post-stroke state. These situations were chosen because the necessary interprofessional collaboration for the initial mobilization of a patient requires coordination and close cooperation among the care givers. During role playing and the subsequent assessment, many participants experienced moments of revelation . Both the occupation-specific and the interprofessional measures were discussed and expanded on in a large group discussion and then combined into an overall plan for taking action. Initially, we had selected a lecture block format with six units to teach the clinical, physiotherapeutic and nursing knowledge relevant for both clinical cases. However, discussions with the participants revealed that the lecture format was perceived as tedious, rather than helpful. In contrast, the development of a problem-objectives-measures plan enabled students to apply their prior knowledge to the specific clinical case. This stimulated the interprofessional discussion among the participants. For this reason, we highly recommend a student-centered format to tap into prior knowledge.re-activate specific skills and impart the ability to engage in interprofessional interaction, we encouraged peer-teaching among the participants during the preparation for the video-recorded role play. This instructional style was very well received by the participants and is therefore recommended To Learning experience: A core element of a constructivist instructional approach is facilitating learning in a specific situation: in our case, a documented small-group simulation of a hospital scenario, initially without and then with an exchange of roles. We also conducted a role-play activity simulating an interprofessional patient handover during a large group discussion. Participants were divided into small interprofessional groups of four to five participants, with at least one student from each professional group. The participants received the case vignette, the treatment scenario, and the assignment to create a video demonstrating the ideal procedure  for interprofessional collaboration in this situation. To make the treatment situation more realistic, it was based on the previously developed problem-objectives-measures plan. Participants worked independently on how to present the treatment situation. For instance, they could choose whether they wanted to practice individual steps of giving treatment before taping, or record the entire situation without rehearsal. In the first round of the role play, participants assumed their own professional roles as physician, physiotherapist or nurse, with another participant acting as the patient, and yet another participant recorded the video. In the second round and the second session (after improvements were made), the participants exchanged professional roles giving all a chance to experience the scenario from a different vantage point. We recommend holding the role play twice to allow the participants to become acquainted with the situation from the perspective of their own profession and that of another.Reflection: One crucial part of this teaching strategy is to foster extensive reflection by the participants on their performance. The task of the teacher is to discreetly facilitate the discussion from the background, without disrupting the participants’ articulation of their experiences.structured reflection, we developed a list of criteria based on our experiences . Main topics included the selection of the professional groups and the length of the course. The length of the course dictates the requisite leave of absence from practical duties and the extent to which other courses need to be changed. Just as important was the coordination of schedules in order to avoid conflicts with tests, exams or other mandatory courses. We also met with staff from the institutions involved to coordinate other important details, such as room scheduling, technical equipment and medical props. This process began five months before the first course session and continued over multiple team meetings. The planning of the subsequent courses was much simpler: this merely required telephone calls with the staff in charge and one or two team meetings , the attendance policy for the course, the selection of an appropriate timeframe, and scheduling are closely interconnected. In order to provide a clear overview, we present these considerations separately.Requirement: The target groups should be determined during the first planning stage. Based on the definition of interprofessionalism at least two professions should be involved, although three professions are preferable: physicians and members of the health professions. Identification of the requisite educational level should take place at the beginning of the planning phase. Ideally, the course should target participants with some experience in interprofessional contexts.Experiences and recommendations: The decision regarding the three target groups of nursing professionals, physiotherapists, and physicians was done prior to entering the planning and preparation stage. This decision determined the selection of the two clinical cases and other learning content. Making these decisions early proved to be crucial and is highly recommended because they serve as the foundation for all subsequent planning and preparation. The involvement of three professional groups has also proven to be valuable and is recommended.Based on the types of professional groups and the focus on mobilizing a patient in the context of early post-stroke rehab, we sought to involve participants with basic experience in patient care and treatment. In cooperation with the nursing staff management at Jena University Hospital and the administrators at SBBS, we decided to involve second-year students from the health care and nursing program and from physiotherapy. Starting with the second cohort, the course was offered as a mandatory course for medical students in their sixth of formal study. We recommend recruiting participants at a more advanced level, since sufficient prior experience is needed for meaningful participation in discussions.Requirement: The duration of the course and whether it is optional, elective or mandatory should be determined in the early planning phase in compliance with program rules and regulations.Experience and recommendations: At first, the course was offered as an elective for medical students in their eighth and tenth semester with 28 units on five different days. It became evident that unavoidable scheduling conflicts on several days of the course made attendance by the medical students impossible due to the very individual nature of students’ course schedules. In contrast, the course was part of the mandatory coursework for students in the nursing and physiotherapy programs since these programs do not have elective courses.As a result, the course was shortened to two days and offered as a mandatory course for sixthyear medical students in geriatrics, neurology, and physiotherapy. This decision turned out to be very reasonable not only in respect to ensuring attendance, but also to the desired level of professional experience. Therefore, we recommend designing the interprofessional course to be as compact as possible and integrating it into the required curriculum to lower the incidence of scheduling conflicts and reduce the need for extra organizational efforts.Requirement: Scheduling the class must be done in close coordination with all institutions, study programs, and instructors and should take place in the very early phase of planning.Experience and recommendation: Immediately after scheduling and recruiting the instructors, we started determining the target group and the duration of the course. The first offering of the course was held as part of the theoretical phase of the vocational programs, which turned out to be suboptimal for the health care students since they had to spend time catching up on the regular course content. After a discussion with the instructors, subsequent courses were held during the practical phase of study. Since scheduling had to accommodate the practical phases of two vocational programs, a planning time of four to six months proved valuable. The instructors also considered found this time period appropriate. For this reason, we recommend implementation during the practical phase of the vocational programs with the requisite long-term planning.Procedural planning requires the determination of all details of practical implementation.Requirements: Planning and developing content for the course sessions, as well as concrete lesson plans should be done after initial cross-institutional coordination and take place in interprofessional dialogue. Course planning should be continuously optimized.Experiences and recommendations: We determined the learning objectives and teaching tools for the individual sessions during interprofessional project meetings. Concrete details were planned by the staff involved with the project. The resulting plans were discussed in the project meetings and modified if necessary.To optimize the course based on the PDCA cycle, all content-related and procedural details, as well as participant feedback  were examined critically and used as the basis for improvement. The results were incorporated into the planning of the subsequent semesters.This kind of critical interactive work made it possible to quickly identify and address weak points, such as time management for certain units (e.g. reduction of the time provided for group discussions about occupations), the comparison of instructional content with prior knowledge and experiences of the participants (e.g. reduction of content on basic communication), the extent of tutor intervention during role playing (e.g. reduction of support and correction through tutors).We recommend reserving time for multiple sessions to prepare the initial course. For later optimization, we recommend two meetings: one to analyze the previous session and determine changes and another to approve planned changes.Requirement: The desired number of participants should be determined before the course is offered since it determines the required resources  and the number of groups for the group activities. When forming small groups, it should be ensured that each profession is represented.Experiences and recommendation: We limited the number of participants to a maximum of 15 per course (five students from each profession) to create the space for cooperative collaboration and in-depth group discussion. The videos were recorded in small groups of four to five participants . Participants responded positively to the numbers and groupings. For this reason, we recommend this size and composition for the small groups.Requirement: The instructional materials aimed to prepare participants for the simulated scenario and to support them in the role play and their reflections on it.Experience and recommendations: We designed the following instructional materials: case vignette, treatment scenario and assignments for compiling the tasks and responsibilities of specific collaborating professional groups, experiences in interprofessional collaboration, problem-objectives-measures plan, recording, and criteria for reflection. We will now describe the materials and the sequence of their use in the teaching sessions.To address the topic, we invited participants to report on their own interprofessional experiences and to share their ideas about the other two professional groups in the form of written assignments.To prepare participants for the treatment scenario, we developed a case vignette (stroke patient) in collaboration with a neurologist. In monoprofessional small groups, the participants received the task of creating a problem-objectives-measures plan for the clinical case of a stroke patient. Based on this task, they were asked to review their knowledge and apply it to the case. The results of all three small groups were shared in a large group discussion to establish an overview of the situation. Their performance showed that the participants collectively possessed solid prior knowledge that they were able to apply. This assignment was evaluated positively by the participants.Prior to recording their video, participants received a short description of the treatment scenario with an overview of the individual steps to be taken and the assignment to create an ideal “instructional video” within 90 minutes. The resulting videos were sound in terms of quality and demonstrated a great degree of interprofessionalism in the interaction between the professional groups. During this intense and highly motivated small-group activity, spontaneous “cross-peer-teaching” took place for the purpose of giving instructions. We were able to observe in-depth and supportive collaboration in interprofessional dialogue.Requirement: Instructors should be selected with respect to their expert knowledge and competency, as well as their communication and media skills. They should be assisted by well-trained tutors. The number of instructors and tutors should be adjusted for the small-group format.Experience and recommendation: We developed the course as a team consisting of a representative from physiotherapy, academic administrators at SBBS, an expert in pedagogy, a physiotherapist, and nursing professionals in cooperation with additional experts in neurology, orthopedics and psychology. The implementation of the course required one instructor for each session to lead the large group activities and discussions. The instructor was supported by a tutor who, for instance, wrote down comments made during discussions, operated technical equipment for presentations, and supported small-group activities, especially filming the role-play activity in the case of medical or technical questions).To implement a course of this nature, we recommend involving at least one instructor and one tutor. Determining the appropriate amount of intervention during the role play was of the utmost importance. A complete lack of intervention in the case of incorrect actions during interprofessional teamwork leads to incorrect engrams. Too much intervention disrupts the participants’ creative process during their engagement with the content and interprofessional dialogue. For this reason, we recommend that instructors and tutors assume the following tasks: moderating group discussions based on their own knowledge and communicative abilities, supporting small-group activities upon request and in the case of technical difficulties.Requirement: The specific requirements of the instructional methods must be taken into account when planning the required space.Experience and recommendations: Spatial requirements depend on the teaching method . Since we conducted role-play scenarios in three small groups, we needed three clinical nursing labs with basic equipment . A seminar room with technical equipment was needed for the short presentations and group discussions. The initial conferences about classroom requirements  and their availability occurred among the participating educational institutions about six months before the course was held. Against this backdrop of cross-institutional coordination, the facilities were examined in terms of their suitability .Due to the high demand for classroom space and the resulting difficulty in obtaining these spaces, we recommend discussing the issue of space as early as possible, via resources such as SkillsLab, practice facilities at medical schools or nursing labs at vocational schools.Requirements: Electronic devices for recording videos and giving presentations should be easy to operate so that technical difficulties are ruled out. Each instructor and tutor should be able to operate the devices without problem.Experiences and recommendations: We used a laptop and projector for lectures and short presentations, as well as tablet for filming videos. For the self-assessment and reflection on the videos in the large group discussion, we connected the tablets to the laptop and presented them using the projector amplifying the sound with additional loud speakers. The use of tablets enabled us to play the videos on a large screen and watch particular scenes multiple times in order to best evaluate them. This was highly appreciated by the participants. At the beginning we used digital cameras with a small screen which were much more difficult to operate. In addition, it was more difficult to show the material immediately.For this reason we recommend the use of tablets to film role-play activities.Requirements: Authentic representation of practice-relevant treatment situations should be made possible through the use of real, hospital-sourced equipment. These materials should be acquired in a timely manner, and their acquisition should be discussed with the people in charge.Experience and recommendation: In addition to the hospital bed including sheets, we used occupation-specific materials, such as a stethoscope, blood pressure cuff and a reflex hammer. We also used professional and patient clothing to distinguish between the professions and to identify the patient. We recommend the use of original aids and equipment from clinical practice for authentic representation of practice-relevant treatment situations.Requirements: Educational interventions should be s to be evaluated ..The consLearning by doing requires an appropriate and controlled learning environment. Based on our experience, the selection of an appropriate learning situation is the decisive factor for a sustainable learning experience. This insight is also confirmed by other working groups . P. PLearnig groups , [23]. POur participants reported an increase in the moments of revelation when they changed perspectives. In the scientific literature, changing perspectives during role play is hardly discussed , 25]. T. T25]. TLearning is supported by conscious reflection on one’s own actions. We sought to intensify the self-reflection by documenting the role-play activity on film.We used video recording as a means for participants to experience and reflect on their actions in the role of their own and another profession. Using video recordings facilitated the criteria-based, structured reflection since key scenes could be reviewed repeatedly for more precise analysis, if needed. The participants could watch themselves and witness their effect on the others (self-perception), and they received feedback from their colleagues (perception by others).Video recording has not been used extensively in medical education. Its use varies greatly: Instructional videos are often shown to teach practical skills and demonstrate ideal procedures . In inteHowever, video recordings are not typically used to recognize one’s own mistakes and to develop strategies to avoid them. Based on our positive experiences with the routine use of video recordings of each activity during the teaching of surgical skills , we adapPositive experiences and student feedback have encouraged us to recommend and use this teaching tool more widely in interprofessional teaching and learning.In our hands the constructivist approach was very successful in supporting and reinforcing the development of interprofessional skills. Drawing on our experience, we have made recommendations for transferring this strategy to other interprofessional teaching situations. In our opinion, these recommendations are also helpful for implementing video-based self-assessment as a teaching tool in interprofessional courses.The project is received a grant from the Robert Bosch Stiftung (project number 32.5.1316.0008.0).The authors declare that they have no competing interests.


N = 170), Facebook likes do not predict traditional impact indicators, for manuscripts with one or more Facebook likes (n = 95), our results indicate that the more Facebook likes a manuscript receives, the more journal article citations the manuscript receives. In additional analyses , we found that the significant prediction of citations stems from the psychological and not the non-psychological manuscripts. In Study 2, we observed that Facebook likes (N = 270) and non-zero Facebook likes (n = 84) do not predict traditional impact indicators. Taken together, our findings indicate an interdisciplinary difference in the predictive value of Facebook likes, according to which Facebook likes only predict citations in the psychological area but not in the non-psychological area of business or in the field of life sciences. Our paper contributes to understanding the possibilities and limits of the use of social media indicators as potential early indicators of the impact of scientific work.Due to the increasing amount of scientific work and the typical delays in publication, promptly assessing the impact of scholarly work is a huge challenge. To meet this challenge, one solution may be to create and discover innovative indicators. The goal of this paper is to investigate whether Facebook likes for unpublished manuscripts that are uploaded to the Internet could be used as an early indicator of the future impact of the scientific work. To address our research question, we compared Facebook likes for manuscripts uploaded to the Harvard Business School website (Study 1) and the bioRxiv website (Study 2) with traditional impact indicators  for those manuscripts that have been published as a journal article. Although based on our full sample of Study 1 ( Assessing and evaluating the impact of research articles is a fundamental process in science that serves the advancement of knowledge in our society . FindingTraditional indicators have severe disadvantages with respect to the assessment of scholar’s past and future performance  and the The aforementioned shortcomings of traditional indicators and the multitude of scientific performance dimensions ,14,15 leadvance journal publication and traditional indicators. Another limitation of the study by Thelwall et al. [depict a positive attitude of the reader . Previous research is further limited because it seldom went beyond journal article citations by taking into account additional traditional impact indicators  [The study by Thelwall et al.  appears l et al. , which i Factor) .These oversights are noteworthy for the following reasons. First, early predictive indicators of the impact of scholars’ unpublished manuscripts are important, for example, for recruitment decisions on a practical level and the dynamic advancements of science. Early indicators could prevent (1) unknown parallel research agendas and 2) the delayed incorporation of important findings in current studies (note that much research is not (yet) available for all researchers because it is unpublished and thus cannot be taken into account by other researchers). Although one might argue that current parallel research agendas could generally be prevented by uploading manuscripts to the Internet, solely uploading manuscripts appears to be inefficient due to the massive amount of research that exists. Rather, the huge amount of new publications requires a filter [ the delaAlthough such a filter cannot replace the critical reflection of scholars themselves, of course, it might be a helpful tool to find impactful research in one’s field more quickly and to build on the extant research in one’s own studies. Second, having early indicators with a clear positive semantic meaning appears to be inevitable to filter the vast amount of research. Only if an indicator has a clear positive semantic meaning can it be easily used in automatized ways to quickly filter articles. Third, scientific performance is multidimensional, and the impact on internal and external stakeholders in science cannot be equated . Hence, Facebook likes as a potential early indicator of the impact of unpublished scientific manuscripts that are uploaded on the Internet but not yet published in a journal. To date, social media features have not been widely used and accepted as alternative impact measures of scientific work. However, social media  could provide valuable information to the multitude of scientific performance dimensions and could act as an information filter [To address the aforementioned research gap, we analyze n filter . A startn filter ; thus, FWe address the research gaps by (1) comparing traditional indicators of impact based on a thorough theoretical comparison and (2) using matched samples for which data on the Harvard Business School (HBS) and the bioRxiv websites, as well as from the Web of Science, were collected. The results partly support Facebook likes as an early indicator of the impact of scientific work.The paper is structured as follows: First, we present the theoretical background. Second, we present our method and analyses of Studies 1 and 2. Finally, in the general discussion section, we note the theoretical and practical implications of our study and limitations and future research avenues.Bibliometrics are used to evaluate scientific research output and to facilitate decision making for different stakeholders in science. Although the (current) (mis)use of bibliometrics is criticized in the literature ,9,29,30,Given the mass of scholarly work, a thorough investigation of indicators that are used to determine the impact of scientific articles  rather than an investigation of indicators that determine the impact of authors  appears to be particularly relevant. Therefore, in the following, we focus on citations, the Impact Factor, and the Immediacy Index (a variation of the Impact Factor), which are all easily accessible, for example, via the Web of Science website.scholars may not have referred to or used the article, but it does not mean that the article is useless to other stakeholders.Citations are carefully selected posts left behind after the information of an article has been retrieved and used . Thus, oIn addition to citations, the impact of journal articles is often estimated based on journal indicators . A widely used indicator for journal quality and impact that is easy to understand and to interpret , is the Impact Factor . The ImpHowever, there have been an increasing number of arguments against the Impact Factor ,4,5,9. FAnother journal-level indicator is the Immediacy Index, which is calculated similarly to the Impact Factor; however, it is based on the articles published by the journal during the preceding year and not the preceding two years ,38. Due The Impact Factor and the Immediacy Index have been investigated in the (bibliometric) literature as scientometric indicators. Research about the Impact Factor and Immediacy Index has, for example, found that the journal Impact Factor is a strong predictor for citations . FurtherBecause academic performance is multidimensional ,14, receThe literature has revealed that crowds can give valuable information, also known as collective wisdom ,19. FaceIn addition to the fact that Facebook likes convey a clearly positive semantic meaning, Facebook likes offer a number of further advantages compared to traditional indicators. An advantage that appears to be of utmost importance is that Facebook likes could indicate the impact of a manuscript before it undergoes the time-consuming publication process. In addition, Facebook likes could provide direct feedback to authors regarding the rate and magnitude of the impact of their current work, in other words, whether their present work might become a raving success. Prior to the publication of an article in a journal, no Impact Factor or Immediacy Index is available. Facebook likes represent a form of open review for a broad scientific and non-scientific audience. Specifically, Facebook likes can recommend scientific manuscripts to a broad audience, even if this audience does not go on to cite the manuscript in a scientific article themselves . Facebook likes thus allow for a broader inclusion of perspectives of various research stakeholders and additionally make the evaluation of science available to non-researchers.Therefore, using Facebook likes as one potential indicator could better address the multidimensionality of scientific performance, as well as considering the impact on, for example, practice and society. Aside from a broader audience, the manuscripts uploaded on the Internet might also be broader and of a larger variety. Such manuscripts may cover non-mainstream research or studies with non-significant results that are generally more difficult to publish. The fact that a wider range of manuscripts will be available in a timely manner and that different stakeholders in science can contribute to filtering the increasing amount of scholarly work can facilitate the search for red-hot manuscripts. Additionally, Facebook likes may reduce self-interested referencing habits. Because it cannot be determined who liked a manuscript, there is no need to like a well-known author’s manuscript to flatter her/him. Furthermore, Facebook likes are independent from limited databases, such as Web of Science or Scopus. Unlike such databases, Facebook likes are not limited to specific journals, timeframes or work written in English. That is, contrary to such databases, Facebook likes do not neglect a great amount of scientific work, which is especially important for certain subjects such as legal sciences.However, Facebook likes as an impact measure of scientific work also have disadvantages see . FacebooBased on the reflections above, one might assume that the Facebook likes for uploaded manuscripts that have not been published in a journal predict traditional measures of impact . One might argue that citations and Facebook likes are positively related to one another because both are scientific output indicators on the article level and both may assess some form of publicity and attention that a manuscript/article receives. One might also assume a positive relationship between Facebook likes and the Impact Factor, as well as the Immediacy Index, as research has revealed that article and journal measures can be related . Howevehttp://hbswk.hbs.edu/workingpapers). The HBS website provides the opportunity for advance online publishing of innovative manuscripts to enable the use of the manuscript’s content before it enters mainstream management practice. Information about the manuscript is provided on this website, and the manuscript is usually directly accessible via a link. We hereby confirm that we adhered to the terms of use for the HBS website and Facebook when conducting Study 1. Subsequent to the collection of the Facebook likes for the manuscripts, we checked whether the manuscripts that we identified on the HBS website were listed in the Web of Science database from Thomson Reuters. From the Web of Science, we collected the number of journal article citations, the Impact Factor of the journal in which the article is published, and the Immediacy Index. To determine whether the manuscript on the HBS website was the same as the journal article, we screened the author names, titles and abstracts of the manuscripts and journal articles. If the published journal article was exactly the same (n = 81) or the same with minor changes, for example, in terms of wording (n = 99), we included the respective manuscript in our analyses. If the manuscript uploaded on the HBS website was not found to be listed as such in the Web of Science database (n = 120), we dropped the manuscript from our sample prior to analysis.For our matched sample, we first collected the number of Facebook likes for 300 manuscripts on the HBS Working Knowledge website (n = 9), for example, when the Immediacy Index was not available for a journal on the Web of Science. Finally, we deleted one manuscript from our dataset because the respective manuscript was published in a journal in the year prior to its upload on the HBS website, meaning that the number of Facebook likes on the HBS website cannot serve as a potential predictor of subsequent journal article citations (n = 1). This procedure left us with a final sample of N = 170 manuscripts. The data were collected in August 2013.Additionally, datasets with missing values in the variables under investigation were excluded . The reason for introducing this second operationalization was that a high number of zero-values in Facebook likes might distort potential relationships. In addition, it is unclear what zero-likes precisely means . Previous research in the field [he field  has exclControl variable: For each manuscript collected on the HBS website, we noted the year in which the manuscript was uploaded. Controlling for the upload date on the HBS website appears to be inevitable because manuscripts were uploaded in different years, and thus, the time to collect Facebook likes and citations varied between manuscripts. Controlling for time when analyzing altmetrics is also suggested in the literature [terature ,59.Criteria: We collected bibliometric data from the Web of Science for the journal articles (published between 2004 and 2013) that were able to be matched to the collected manuscripts from the HBS website. In particular, we assessed the number of journal article citations, the two-year Impact Factor of the journals in which the articles were published and the journal Immediacy Index. The Impact Factor and the Immediacy Index were retrieved from the Journal Citation Reports Social Sciences Edition in the Web of Science.r = .07, ns), the Impact Factor , or the Immediacy Index . Similarly, non-zero Facebook likes did not correlate with citations , the Impact Factor , or the Immediacy Index .Descriptive statistics and correlations are displayed in β = .13, ns), nor the Impact Factor , nor the Immediacy Index . The control variable upload date negatively predicted citations ; however, neither predicted the Impact Factor  nor the Immediacy Index . An overview of the results of our regression analyses is presented in Prior to our regression analyses, we z-standardized our variables. We first report the results for the predictor Facebook likes and then for the predictor non-zero Facebook likes. We observed that, when controlling for the upload date, the Facebook likes of manuscripts uploaded on the HBS website neither predicted citations . However, non-zero Facebook likes neither predicted the Impact Factor of the journal the article was published in  nor the Immediacy Index . The control variable upload date negatively predicted journal article citations , but this was not the case for either the Impact Factor  or the Immediacy Index . An overview of our regression analyses results for non-zero Facebook likes is presented in Based on our regression analyses with non-zero Facebook likes as the predictor and controlling for the upload date, we observed that non-zero Facebook likes positively predicted journal article citations (N = 170). In particular, two raters and one judge (who decided on the categorization in case of different categorizations between the raters) categorized the manuscripts into psychological (45.9%) and non-psychological manuscripts (54.1%).To test whether the results reported above can be generalized across scientific disciplines, we reran the regression analyses for two subsamples of the manuscripts from the HBS website that were included in our full sample , whereas they neither predicted the Impact Factor  nor the Immediacy Index . The control variable upload date negatively predicted citations  but neither predicted the Impact Factor  nor the Immediacy Index .For the psychological manuscripts, when controlling for the upload date, the regression analyses revealed that Facebook likes positively predicted citations  nor the Immediacy Index ; however, they negatively predicted the Impact Factor . The control variable upload date negatively predicted citations ; however, it neither predicted the Impact Factor  nor the Immediacy Index .For non-psychological manuscripts, when controlling for the upload date, we observed that Facebook likes neither predicted citations , while they neither predicted the Impact Factor  nor the Immediacy Index . The control variable upload date negatively predicted citations  but neither predicted the Impact Factor  nor the Immediacy Index .Rerunning the regression analyses with the predictor non-zero Facebook likes, when controlling for the upload date, we found that non-zero Facebook likes for psychological manuscripts positively predicted citations , nor the Impact Factor , nor the Immediacy Index . The control variable upload date negatively predicted citations ; however, it neither predicted the Impact Factor  nor the Immediacy Index .For non-psychological manuscripts, when controlling for the upload date, the regression analyses revealed that non-zero Facebook likes neither predicted citations  might be a potential explanation for the different findings based on the model using Facebook likes as the predictor versus using non-zero Facebook likes as the predictor. Zero Facebook likes could have different meanings: on one hand, zero Facebook likes might indicate that a manuscript was not approved of (and thus not liked) by readers; on the other hand, zero Facebook likes might indicate that a manuscript was never or seldom read, for example, due to the title selection or external reasons . Thus, zero Facebook likes can have different semantic meanings and can result in a noisy measure. This unclear semantic meaning of zero Facebook likes might have undermined a relationship in our analyses including zero Facebook likes. Additionally, this unclear semantic meaning of zero Facebook likes emphasizes the importance of being critical about the meaning and use of zero Facebook likes.Our results furthermore show that the number of (non-zero) Facebook likes a manuscript received was neither related to the Impact Factor nor the Immediacy Index. An explanation for this finding could be the fact that the traditional impact indicators are measured on different levels: Facebook likes (as well as citations) represent an article-level metric, while the Impact Factor and the Immediacy Index are journal-based metrics. There are studies that report a significant relationship between article and journal-level metrics . AlthougAdditional analyses show that the predictive value of Facebook likes and non-zero Facebook likes only holds true for psychological manuscripts and not for non-psychological manuscripts on the HBS website. We suppose that there might be a difference in the acceptance of social media features, such as Facebook likes, across scientific disciplines . However, it could also be the case that the readership of non-psychological manuscripts on the HBS website compared to non-psychological business journal articles differs, and their concept of influential scientific work varies, making predictions of citations by Facebook likes impossible. Accordingly, the results could indicate different stakeholders and the multitude of definitions of scientific performance.Notably, in our additional analyses, we also observed that Facebook likes of non-psychological HBS manuscripts negatively predict the Impact Factor of the journal in which the manuscript is published. This result might be explained by the fact that what is liked on this more practical website  does not necessarily reflect what is published in influential business journals. A deviance between practice and science in business has been mentioned in the literature .While additional analyses in Study 1 have shown that there are differences across disciplines in the predictive value of (non-zero) Facebook likes for citations, Study 1 is limited in its generalizability because the data were collected on one particular website. Therefore, in Study 2, we collected new data from a website in the life sciences.http://biorxiv.org/). On this website, unpublished manuscripts in the life sciences can be posted to make the study outcomes available to and receive feedback from the scientific community. Thus, bioRxiv represents a suitable website for Study 2 as it resembles the HBS website; however, it comprises manuscripts from another discipline, namely, the field of life sciences. On the bioRxiv pages, there are often links to the journal articles posted once the manuscript has been published in a journal. To determine whether the published journal article was identical (n = 145) or the same with minor changes (n = 189), we screened the author names, titles and abstracts of the manuscripts and journal articles. When no matching publication was found in the Web of Science, we dropped the manuscript from our dataset prior to the analyses (n = 266). Additionally, datasets with missing values in the variables under investigation were excluded (n = 62). Finally, prior to our analyses, we dropped two manuscripts from our sample because the respective manuscripts were published in a journal in the year prior to its upload on the bioRxiv website, meaning that the number of Facebook likes on the bioRxiv website cannot serve as a potential predictor of subsequent journal article citations (n = 2). We retained a final sample of N = 270 manuscripts. The data on bioRxiv and Web of Science were collected in April 2015. We hereby confirm that we adhered to the terms of use for Facebook and for the bioRxiv website when conducting Study 2.The data collection procedure corresponds to the procedure described in Study 1, except for the fact that we collected the data on the bioRxiv website (rather than on the HBS website). More precisely, we collected the number of Facebook likes of 600 manuscripts on bioRxiv , nor the Impact Factor , nor the Immediacy Index , as displayed in r = .01, ns), nor the Impact Factor , nor the Immediacy Index .Facebook likes neither correlated with citations , nor the Impact Factor , nor the Immediacy Index . The control variable upload date neither predictd citations , nor the Impact Factor  nor the Immediacy Index . The results are presented in We z-standardized the variables prior to performing the regression analyses. When controlling for the upload date, Facebook likes of manuscripts uploaded on the bioRxiv website neither predicted citations , nor the Impact Factor , nor the Immediacy Index . The control variable upload date neither predicted journal article citations , nor the Impact Factor , nor the Immediacy Index . The results for non-zero Facebook likes are presented in With non-zero Facebook likes as the predictor and controlling for the upload date, we find that non-zero Facebook likes neither predicted journal article citations (n = 84). However, taking into account that the other regression analyses (N = 270) were also non-significant, the results indicate that (non-zero) Facebook likes of manuscripts uploaded on websites in the life sciences, such as bioRxiv, do not predict traditional impact indicators. One explanation for this finding could be that social media, such as Facebook likes, are not accepted for expressing whether one perceives a manuscript as influential. Another explanation is that the readership on the bioRxiv website versus the readership of life science journal articles differs and that their concept of influential scientific work differs, which makes predictions of citations impossible. Accordingly, the results may indicate different stakeholders and the multitude of definitions of scientific performance. A further explanation for the non-significant regression analyses on the Impact Factor and Immediacy Index may be that these indicators are journal-level metrics that do not relate to article-level metrics.One explanation for the non-significant regression of non-zero Facebook likes on citations could be the relatively small sample size (N = 170) that we categorized as being psychological in our study (45.9%) received 68.2% of the Facebook likes, whereas the manuscripts that we categorized as being non-psychological (54.1%) received 31.8% of the Facebook likes . Furthermore, interdisciplinary differences in social media behavior, i.e., uploading of papers [This study set out to investigate Facebook likes as a potential early predictor of the impact of scientific work. Across both studies reported in this paper, we observed that Facebook likes of manuscripts cannot predict the journal-level indicators Immediacy Index or the Impact Factor, except for Facebook likes of non-psychological manuscripts from the HBS website, which negatively predict the Impact Factor. Another outcome of this paper is that citations are predicted by Facebook likes for psychological manuscripts from the HBS website. As indicated in our additional analyses, the significant prediction of citations by non-zero Facebook likes of manuscripts from the HBS website stems from the psychological and not from the non-psychological manuscripts on the HBS website. In Study 2, we observed no significant predictions of citations by Facebook likes of the manuscripts uploaded on bioRxiv. These outcomes demonstrate that Facebook likes may only have a predictive value in some disciplines. The data suggests that Facebook likes predict citations in the field of psychology but that they do not predict citations in, for example, life sciences. This interdisciplinary difference is also reflected in the fact that the HBS manuscripts  impact of an article depends on the discipline. In accordance with the literature, our findings demonstrate  that socOur findings also provide several practical implications. First, our findings suggest that Facebook likes can in some disciplines be a modern and prompt way of measuring and predicting the impact of a variety of (fresh) unpublished scientific work (that may not be covered in the Web of Science or other databases). Using Facebook likes of unpublished manuscripts reduces the problems of the publication delay and the citation gap. Hence, Facebook likes enable a rapid advancement of science and can better prevent parallel research on the same topic. Although indicators generally can also have disadvantages as exemplified by the performance paradox , FacebooN = 913), we observed that almost one-third of our participants (29.9%) answered the question positively ”; 30.6% of our participants answered “no”, and 39.5% answered that the question was not applicable to them. Based on these findings, we argue that almost two-thirds of our respondents were obviously aware of the Facebook likes that their manuscripts received (or not) and that therefore, Facebook likes appear to be considered by scholars a legitimate source of information. Third, our study might be limited with respect to the predictive value of the collected Facebook likes. The collected Facebook likes might not have been given when the manuscript was just uploaded on the HBS website and could have been given anytime later, for example, after the publication of the manuscript in a journal. Thus, the predictive value of the Facebook likes might be reduced. Due to data constraints, it was not possible to control for the time when the Facebook likes were given. However, because research indicates that social media (Facebook shares and Tweets) has a quick uptake in the first few days after publication [Our study is limited with regard to four aspects. First, Facebook likes represent an indicator that, as with other impact measures, can have shortcomings. According to the performance paradox, measuring performance based on specific indicators can lead to perverse learning and/or the neglect of unmeasured performance aspects ,63. Nonelication , it is sFuture research should address the following avenues of research. First, future research should investigate the reasons for differences between disciplines in the predictive value of Facebook likes, in other words, whether the interdisciplinary differences in the usage of Facebook likes arise from, for example, a differing acceptance of social media features or whether the differences emanate from a different readership of the uploaded manuscripts than those who read and cite scientific journal articles. Thus, it would be important as a first step to analyze those who give likes and then survey these people in terms of their attitudes toward social media. Second, tracking the exact date when a Facebook like was given to a manuscript would provide useful knowledge for the investigation of Facebook likes as an early indicator of the success and impact of one’s scientific work. Such tracking would enable researchers, for example, to control for whether a Facebook like has been given prior to or after the journal publication. Third, it would be interesting to investigate to what degree editors and journal reviewers, as well as scientists in general, (consciously) track Facebook likes for manuscripts and whether they are influenced by the Facebook likes of a manuscript with regard to quality ascription and, for example, the acceptance decisions of reviewers prior to the publication of a manuscript in a journal. In other words, does social media have an impact on the decision makers in science? A study that conducted similar research is the recently published work by Schulz and Nicolai . In theiIn summary, our paper contributes to the assessment of the impact of scientific work via social media indicators. We compared Facebook likes for manuscripts with traditional indicators of success and find that Facebook likes may be used as an addmetric and early impact indicator of psychological manuscripts, not, however, manuscripts from non-psychological areas of business or the area of life sciences. In light of the discipline-depending results, Facebook likes at least in part resemble something other than the impact measured by traditional impact measures. Thus, we are convinced that science would benefit from an open-minded allowance of diverse indicators to assess the multitude of aspects of scientific performance observed from the angle of different stakeholders. However, applying diverse indicators and assessment methods should be performed in a reflective manner, keeping the shortcomings of these indicators in mind. The contributions of our paper are relevant for scholars themselves and for the governance of academia,  media, society and other stakeholders. Future research in this direction is desirable to clarify the specific type of impact that Facebook likes measure and also who likes manuscripts in different disciplines. Our study is also conducive to elucidating the validity and reliability of Facebook likes as an addmetric.


N = 1814 participants (German sample). An English translated version of the new measure is also presented and tested in N = 299 English language participants. A large number of German participants (N = 1090) also filled in the BIS/BAS scales by Carver and White (Jeffrey Gray's Reinforcement Sensitivity Theory (RST) represents one of the most influential biologically-based personality theories describing individual differences in approach and avoidance tendencies. The most prominent self-report inventory to measure individual differences in approach and avoidance behavior to date is the BIS/BAS scale by Carver and White . As Graynd White  and the  The Reinforcement Sensitivity Theory (RST) of personality has in recent years become one of the most prominent biologically oriented theories in personality psychology Corr, . At the all rewarding and appetitive stimuli, while the FFFS is proposed to be responsive to all punishing and threatening stimuli. Conversely, the BIS is now thought to be activated by instances of goal conflict, such as when a threatening stimulus must be approached, or when mixed signals of reward and punishment are present. In rodent models, such conflict is well represented by a rodent being placed in an experimental setting prepared with cat odor. While the visual information clearly indicates that no cat is in close proximity, the olfactory senses of the rodent suggest otherwise. Such experiments have been conducted in a setting called the visible burrow system by Blanchard and Blanchard , measuring the revised RST, but the items were only published in a Serbian book chapter and not in English language. However, the authors have published an article on validation data of their RSQ where the principles of the questionnaire construction are described  and the FFFS (reflecting fear) in terms of the changes made to the theory. There already exists a first questionnaire, the On this basis, the first aim of the present study is to provide a new measurement tool for the revised RST, with a particular focus on disentangling measurement of the BIS and FFFS constructs. In this initial investigation, we employ molecular genetic methods to investigate the validity of our new measure.Of particular importance to the present study is that the emotion of anxiety is influenced by a large number of neurotransmitters, including gamma amino butyric acid , but should not be associated with our measure of FFFS. We focused on the single nucleotide polymorphism (SNP) rs11174811 on the AVPR1a gene (located on chromosome 12q), because not only has it been associated with phenotypes related to anxiety/negative emotionality . As both of the BIS dimensions correlated with age , and with gender, with females having significantly higher scores , we undertook additional analyses, including gender as a second independent variable and age as a covariate. No gender by gene interaction effects could be observed on the BIS scales. The inclusion of age as a covariate did not change the significant influence of rs11174811 on the BIS. A post-hoc test revealed that the contrast for the genotypes CC vs. CA was significant. The group consisting of AA carriers was excluded from further interpretation at this point, because of the small group showing no clear trend in either the AA or AC direction  and for the FFFS (reflecting the emotion of fear). Of note, we designed the BIS scale to measure hesitation and cautious behavior in conflict situations, such as deciding between two  options . As well as difficulties in behavioral choice, cognitions related to tolerance of uncertainty are also reflected in the revised BIS in our questionnaire . The scale for the FFFS, measuring individual differences in fear tendencies, comprises the most important classes of behavioral fear responses, namely Fight, Flight, and Freezing. Finally, the BAS scale is designed to measure individual differences in reward-seeking, drive and energy .This study had three key aims. First, we sought to develop a new self-report measure for the revised RST in order to better distinguish between aspects of personality concerned with fear and anxiety. The most widely used self-report measure in RST research, the RSQ by Smederevac et al. . In line with this, both the BIS and the FFFS are positively correlated and can be positioned on the side of negative emotionality. Importantly, from a psychometric point of view, our new inventory shows good internal consistencies across the scales and good model fit when using CFA to model the latent variables of the questionnaire. It should be noted that the internal consistencies of the Flight and Freezing subscales are potentially a little lower than ideal, however they are each comprised of only several items, and so this may be expected.The correlations between the dimensions within Reuter and Montag's rRST-Q with the Carver and White BIS/BAS scale. The results of this cross validation show that both the classic BAS and revised BAS, and also the classic BIS and revised BIS scale, correlate to about.50—hence 25% of the variance of these constructs overlap. This obviously also makes clear that a large portion of the variance does not overlap (75%), and so as a consequence the Reuter and Montag's rRST-Q are clearly measuring something related to yet distinct from the Carver and White dimensions. Future studies including both Carver and White's BIS/BAS scale and Reuter and Montag's rRST-Q are needed, particularly studies examining processes related to fear and anxiety in the context of revised RST, but also those studies examining BAS-related processes and functions. Establishing whether the Reuter and Montag's rRST-Q has incremental and/or divergent validity in relation to existing RST-related measures is clearly an important next step.The second aim of the study was to cross validate The final aim of this study was to examine individual differences of the BIS in relation to a genetic variation on the AVPR1a gene. In line with the previous literature, we showed that the gene coding for vasopressin 1a receptor is involved in human anxiety. Carriers of the CC variant of rs11174811 showed significantly elevated anxiety scores, measured in terms of Gray's Behavioral Inhibition System. As already described above, expression levels in homozygous C-allele carriers (genotype CC) have been reported to be significantly lower compared to carriers of at least one minor A-allele , to restlessness when being confronted with an unpleasant event . In contrast, the revised BIS scale of our newly designed questionnaire includes no item explicitly referring to feeling anxious. Instead, Reuter and Montag's revised BIS scale describes being unable to bear uncertainty or often being indecisive, which targets one major issue in the revised RST. From our point of view, the overlap between the scales (and the genetic effect targeting the shared variance) could possibly be explained by the aspect of restlessness when being confronted with an unpleasant event (in the Carver and White questionnaire), which is close to our concept of being indecisive or overly careful when confronted with uncertainty.Interestingly, rs11174811 showed a significant effect on both the BIS measured with the Carver and White scale, as well as on the revised BIS measured with Reuter and Montag's rRST-Q. This finding supports the divergent validity of the BIS and FFFS dimensions in the rRST-Q, a key aim in the development of this questionnaire, and is potentially of wider importance for the revised model of RST, in terms of identifying neurobiological markers that reliably distinguish between trait measures of these constructs. Clearly, the genetic finding in this study represents a beginning point in this process, but an important beginning point nonetheless.Importantly, the genetic effect of rs11174811 was only significant in the context of BIS sensitivity; no significant effect was observed on the FFFS scale, measuring individual differences in fear and avoidance tendencies, nor any other RST scales on either of the questionnaires administered. The genetic variant investigated in this study seems to target anxiety, but not fear, in terms of the conceptualization of It should be noted that there are existing attempts to develop self-report measures in the context of revised RST  and the BIS. The genetic association was shown with respect to the BIS dimension in both the Carver and White BIS/BAS questionnaire and in the rRST-Q. Further, the genetic association was not shown for the FFFS dimension in the rRST-Q, supporting the divergent validity of the BIS and FFFS dimensions in this scale, and highlighting a potentially useful genetic marker that could be used to evaluate existing or new measures developed under the revised RST. This study should clearly be seen as a first step in the validation of this new revised RST measure. In particular, no validation of the revised BAS scale was attempted in this study, and this may be a focus for future work on this scale. More broadly, future studies will be needed to search for further genetic, endocrinological and brain imaging validation of this new inventory. In addition, this new tool will also need to be further evaluated in relation to other self-report measures and using theoretically relevant behavioral and experimental laboratory tasks.on's RST . The psyThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Behavioral traits are likely to influence species vulnerability to anthropogenic threats and in consequence, their risk of extinction. Several studies have addressed this question and have highlighted a correlation between reproductive strategies and different viability proxies, such as introduction success and local extinction risk. Yet, very few studies have investigated the effective impact of social behaviour, and evidence regarding global extinction risk remains scant. Here we examined the effects of three main behavioral factors: the group size, the social and reproductive system, and the strength of sexual selection on global extinction risk. Using Primates as biological model, we performed comparative analysis on 93 species. The conservation status as described by the IUCN Red List was considered as a proxy for extinction risk. In addition, we added previously identified intrinsic factors of vulnerability to extinction, and a measure of the strength of the human impact for each species, described by the human footprint. Our analysis highlighted a significant effect of two of the three studied behavioral traits, group size and social and reproductive system. Extinction risk is negatively correlated with mean group size, which may be due to an Allee effect resulting from the difficulties for solitary and monogamous species to find a partner at low densities. Our results also indicate that species with a flexible mating system are less vulnerable. Taking into account these behavioral variables is thus of high importance when establishing conservation plans, particularly when assessing species relative vulnerability. There is increasing evidence that we may be facing a sixth mass extinction in the near future ,2. SpeciWhile many studies have investigated the impact of life history and ecological characteristics on the extinction risk, very few have focused on the potential influence of behavioral variables. Yet, the idea that behavior could have an important role in the extinction risks of many species is quite old, and has often been raised –24. SociThe main aim of this study is to examine the role of three major behavioral components in the extinction risk in Primate species: group size, social and mating system, and sexual dimorphism. The choice of Primates as study model was made for three reasons. First, they present a large variety of social systems  and a wihttp://www.iucnredlist.org/). The IUCN status of threat downloaded from the IUCN Red List are part of a qualitative nominal variable with five modalities: “Least Concern”, “Near Threatened”, “Vulnerable”, “Endangered” and “Critical” . For our analysis we transformed the IUCN status into an ordinal variable . This type of transformation is commonly used in other studies using the IUCN status of threat as a proxy of species extinction risk [We chose the IUCN status from the IUCN Red List (2013) as a proxy of extinction risk  as an indicator of the strength of the extrinsic factors of vulnerability. The human footprint index measures the impact of human societies at the surface of Earth . It combhttp://sedac.ciesin.columbia.edu/). Polygons representing Primate species distribution range were downloaded from the IUCN website, as ESRI shapefiles format. Polygons result from the liaison of occurrence points of the species, expended to take into account species habitat preference, where unsuitable habitats are removed. Thus, polygons provide the information that species probably occurs within it, but do not mean that it is distributed equally or occurs everywhere within that polygon.In this study, we focused on the mean human footprint in species distribution range. Data on the worldwide human footprint was downloaded from the NASA SocioEconomic Data and Applications Center (SEDAC) website . This variable will be referred as the Social and Mating System. The modalities were defined as follow: solitary, monogamous, polygynous, promiscuous, and polygynous-promiscuous species . Those categories are adapted from Eisenberg and colleagues work on Primate social systems . The aveSpecies life history traits included in our analysis were gestation length and body mass. As ecological variables, we selected the percentage of frugivory (i.e. the percentage of fruits in the diet of a species) and the mean home range . Three climatic variables indicating the ecological flexibility of a species were also added in the models: the annual temperature range, the mean annual precipitations, and the annual precipitation range. Data concerning these climatic variables were collated on the NASA website. The annual temperature and precipitation ranges were calculated as the difference between the mean highest annual temperatures/precipitations over the distribution area with the mean lowest annual temperatures/precipitations among this same area. The mean annual precipitations were measured as the mean of all mean annual precipitation pixels among the distribution area.Data were collated from peer-reviewed articles and online scientific databases. In order to minimise the bias due to multiple sources of information, data for each variable was collected from comparative analysis published in scientific articles and scientific databases . Because the gestation length and the female body mass were highly correlated , we performed a linear regression between those two variables. Instead of the log(body mass), we used the residuals of this regression in our models, which correspond to the part of the female body mass that is not explained by the gestation. The same method was used to obtain a variable indicating the weight sexual dimorphism : we took the residuals corresponding to the part of the male body mass not explained by the female body mass .A common issue in comparative analysis is that compared species are not phylogenetically independent. This can introduce an error in the analysis when the response variable is not explained by the explicative variables, but by species proximity in the phylogeny. To prevent this error, it is necessary to test for the presence of a significant phylogenetic signal in the response variable, before starting the analysis. The presence of a phylogenetic signal in the status of threat was tested by measuring Pagel’s lambda , one of As we measured a significant positive phylogenetic signal in the response variable (i.e. transformed extinction risk), we performed models correcting for the phylogenetic inertia –61. We cSeveral models can be considered as the best model, since five models had a ΔAICc < 2. The five models were relatively consistent, and most variables were significant in all the best models . All modConcerning the behavioural traits, all models pointed out to a significant impact of the mean group size in the vulnerability to extinction. According to our results, species with a higher mean group size presented a lower extinction risk. Interestingly, two of the models selected incorporated the social and mating system as an explicative variable, but this variable was not significant. Finally, the model with the lowest AICc among our 5 best models also included sexual dimorphism, even though this variable was not significant.This study is one of the first to highlight the existence of a behavioural dimension in species’ intrinsic vulnerability factors, and this while controlling for the intensity of extrinsic factors of vulnerability. More precisely, the average group size of Primate species has an impact on the conservation status, with species living in small groups being more vulnerable to extinction than those living in large groups. This result is consistent with the pattern highlighted by Davidson and colleagues , when coWe also identified various additional intrinsic factors of vulnerability, and that included previously identified ecological and life-history traits ,35,67. AIn some of the 5 selected models, gestation length had a significant impact on the extinction risk, while the part of female body mass unexplained by gestation length had a trend to be higher with higher extinction risks. The higher vulnerability to extinction of species with higher gestation length is well-known and often highlighted in field studies Click here for additional data file.


Epidemiologic features of prion diseases in Japan, in particular morbidity and mortality, have not been clarified.Since 1999, the Research Committee has been conducting surveillance of prion diseases, and the surveillance data were used to assess incident cases of prion diseases. For the observation of fatal cases, vital statistics were used.Both incidence and mortality rates of prion diseases increased during the 2000s in Japan. However, this increase was observed only in relatively old age groups.The increased number of patients among old age groups might be due to increased recognition of the diseases. If so, the number of cases should plateau in the near future. While the reason for this increase is unclear, epidemiologists must consider that increased recognition of the disease may lead to a subsequent increase in the number of patients. In other words, whether prevalence has truly increased or whether some other factors have made the number merely seem increased should be clarified. Detailed observation of the epidemiologic features of prion diseases might shed light on this apparent increase in prevalence.We conducted this descriptive epidemiologic research with two purposes: to clarify the recent epidemiologic features of prion diseases in Japan and to obtain some hints about the cause of increasing incidence of the diseases in Japan.3 The system was first implemented in April 1999. There are several routes to obtain information about the existence of potential patients with prion diseases: a mandatory reporting system from physicians, the public-aid-for-treatment system, and clinical examinations.We used two data sets in this study. One was the registry data of prion diseases in Japan obtained through the surveillance system conducted by the Surveillance Committee, which is financially supported by the Ministry of Health, Labour and Welfare of the Japanese government.First, since 1999, prion diseases have been designated as reportable diseases by the Prevention of Infectious Diseases and Medical Care for Infectious Patients Act (Act No. 114 of 1998). When a physician diagnoses a patient as having a prion disease, he or she must report the fact to a local public health center.Second, prion diseases are designated as diseases qualifying for public aid. Patients with one of the designated diseases receive treatment from a hospital with public aid, and he or she is not required to pay any fee. The aid is based on a claim made by the patient or his or her family to a public health center, so information on the patient is obtained when making the claim.Lastly, the Surveillance Committee conducts human prion protaineous gene analyses at Tohoku University and cerebrospinal fluid analyses  at Nagasaki University. Physicians who suspect that a patient has a prion disease or who want to certify the diagnosis of a prion disease may send blood or cerebrospinal fluid to these universities with a patient’s informed consent. The cost is covered by research funds from the national government, and the patient and physician are not responsible for paying any fees.When the Surveillance Committee obtains information about a potential patient through one of these three routes, one of the committee members, who is a neurologist or a psychiatrist familiar with prion diseases, obtains detailed data about the patient by meeting the patient if possible or using hospital records. Based on the obtained data, the Committee members discuss whether or not the patient has a prion disease, and patients recognized to have a prion disease are registered anonymously.In the present study, we used only data of registered patients with disease onset from 1999 through 2012. We observed epidemiologic features of prion diseases in Japan calculated standardized morbidity rates by prefecture and secular trends of age-specific incidence rates. As shown in Figure http://www.e-stat.go.jp/SG1/estat/GL08020101.do?_toGL08020101_&tstatCode=000001028897&requestSender=dsearch). Since 1999, the statistics presented the numbers of fatal cases with prion diseases  by prefecture as an infectious disease as well as the fatal numbers by age and sex. Therefore, we calculated standardized mortality ratios by prefecture in addition to age-specific mortality rates in Japan. For calculating 95% confidence intervals (CIs) of standardized morbidity and mortality ratios, we used the table presented by Schoenberg.4We also used data on vital statistics in Japan from 1999 through 2012 (http://www.kktcs.co.jp/jsn-senmon/secure/senmon.aspx) per population by prefecture.In addition to these analyses, standardized morbidity and mortality ratios—the former of which were based on the surveillance data and the latter of which were based on the vital statistics—were compared with the number of neurologists authorized by the Societas Neurologica Japonoca  from 1999 through 2012 and 2334 fatal cases  from 1999 through 2012 according to vital statistics in Japan. The average annual incidence rate was 1.09 cases per 1 million population  and average annual mortality rates were 1.32 per 1 million population .5The results below are described according to the three major characteristic headings of descriptive epidemiology: persons, place, and time.Table The standardized morbidity and mortality ratios for each prefecture are shown in Table Figure In the present study, we described the epidemiologic features of prion diseases in Japan using two data sources—the prion disease surveillance system and vital statistics—from three descriptive epidemiologic viewpoints: persons, place, and time.The prion disease surveillance system in Japan intends to collect information when a person receives a prion disease. The vital statistics comprise the data when the patient dies. According to the natural history of the disease, which is that patients with prion diseases die within a few years of disease onset, the numbers of incident patients and deceased ones should be similar, although they were not identical because of the time lag between onset and death. We recognized 2026 incident cases and 2334 fatal cases in this study for the observed 14 years. There are several possible explanations for the difference between the two figures (308 cases). First, as mentioned before, a time lag exists between onset and death. Second, the surveillance data were incomplete for recent calendar years  had familial CJD, although only 15% of prion disease patients had familial CJD in Japan as a whole, as shown in Table Although there was no geographical clustering of prefectures with high incidence rates or mortality rates, some prefectures presented high rates. For example, both incidence and mortality rates were high in Yamanashi prefecture. There have been several articles about familial clustering of prion diseases in this prefecture.20 The increase in number of fatal cases was reflected in the increase in number of incident cases in our study. As shown in Figures The numbers of incident and fatal patients increased in Japan during the last decade, as shown in Figure The Surveillance Committee has publicized the system not only to neurologists but also to general physicians. A patient with rapidly progressive dementia dying before diagnosis might be diagnosed with a prion disease through these gene and/or cerebrospinal fluid analyses. If a physician uses these systems, the Surveillance Committee is automatically notified of the existence of a potential patient, starts getting information about the patient, and discusses whether or not the patient has a prion disease. Further dissemination of information about the analytic system might increase the rate of identification of such patients, particularly among older patients.The number of gene analyses conducted at Tohoku University increased from 132 cases in 1999 to 273 in 2012. Given that relatively young patients  with rapidly progressing dementia are rare, such patients are typically referred to specialists in dementia (including prion diseases), so any issues with recognition have been negligible. If knowledge of the gene and spinal fluid analyses system is propagated to all physicians in this country, the issue of recognition should be diminished even further, and the chronological increase of the incidence rate should plateau. However, despite this expected plateau in the near future, the number of patients may still increase because of the growing number of old people in Japan.Selection bias and information bias may have affected this study. The Surveillance Committee has made an effort to obtain information for all patients with prion diseases in Japan, but the database is not complete. Similar selection bias may be present in the vital statistics data as well; those with prion diseases whose deaths were attributed to conditions other than prion diseases would not be counted as prion disease deaths. Information bias may also exist on the vital statistics data; we were unable to clarify the validity of the diagnosis on death certificates, whereas diagnoses obtained through the surveillance system were validated by the Committee members, including neurologists and neuropathologists.In conclusion, we showed here the epidemiologic features of prion diseases in Japan. Increased recognition of prion diseases may account for the observation of chronological increases in the number of patients with prion diseases, and the increasing trend of numbers of patients might soon plateau.Abstract in Japanese.


According to demographic projections, a significant increase in the proportion of the elderly population is anticipated worldwide. This aging of the population will lead to an increase in the prevalence of chronic diseases and functional impairment. This expected increase will result in growing use of the health care system that societies are largely unprepared to address. General practitioners (GPs) are at the front line of this huge epidemiological challenge, but appropriate tools to diagnose and manage elderly patients in routine general practice are lacking. Indeed, while primary prevention and the management of common chronic diseases, such as hypertension, diabetes, or cardiac ischemic diseases, are routinely and mostly adequately performed in primary care, the management of geriatric syndromes is often incomplete. In order to address these shortcomings, this theoretical work aims to first develop, based on the best available evidence, a brief assessment tool (BAT) specifically designed for geriatric syndromes identification in general practice and, second, to propose a conceptual framework for the management of elderly patients in general practice that integrates the BAT instrument into the usual care of GPs. To avoid proposing unachievable goals for the care of elderly patients in general practice , this work proposes an innovative way to combine geriatric assessment with the management of common chronic diseases. According to demographic projections, a significant increase in the proportion of the elderly population is anticipated worldwide. By 2030, in industrialized countries, the proportion of persons over the age of 65 years will increase from 15% at present to 22%  are in the front line of this huge epidemiological challenge. Interventions should therefore focus on the prevention  of health problems, especially those most frequently associated with functional impairment.multifactorial health conditions that occur when the accumulated effects of impairments in multiple systems render [an older] person vulnerable to situational challenges”  specifically designed for GPs, and, third, to propose a conceptual framework for the management of elderly patients in general practice that integrates the BAT into the usual care of GPs.The present work is a theoretical development performed by both a GP and a geriatrician with the aim of developing the BAT for the early diagnosis of geriatric syndromes in general practice. Based on this evidence, a conceptual framework for its integration into the daily practice of GPs will be proposed. Identification of geriatric syndromes and screening tests relevant in PC was based on a scoping literature review. The following research terms (MESH terms) were used alone and in sensible combinations to select relevant publications for the identification of geriatric syndromes and their clinical tests: elderly, old, geriatric syndromes, geriatric conditions, frailty, primary care, general practice, family medicine, quality of life, screening instruments, screening tests, screening tool, early diagnosis, test, functional impairment, functional decline, cognitive impairment, affective disorder, depression, mood disorder, gait and balance disorder, falls, sleep problems, visual and hearing impairment, visual and hearing loss, pain, nutrition, osteoporosis, urinary incontinence, activity of day life (ADL), instrumental ADL (IADL), interpersonal relationship, safety, and elder mistreatment, finances.An initial listing of potential syndromes was made based on a literature review. Five inclusion criteria were used to select geriatric syndromes: (1) the syndrome is prevalent in the elderly population; (2) a relationship exists between the syndrome and functional decline and/or QOL in the elderly population; (3) the syndrome is clinically relevant in general practice ; (4) screening is feasible in general practice ; andThe second part of the work was aimed at identifying tests for geriatric syndromes. We defined three criteria that needed to be present to retain a test: (1) the test was validated in elderly patients; (2) performances of the tests were assessed and considered acceptable; (3) the test was developed for general practice or at least is feasible in general practice (time/infrastructures).A BAT instrument was developed based on the geriatric syndromes and best corresponding tests were retained.Following the initial identification of geriatric syndromes and tests, a conceptual framework within which the BAT should be performed in general practice was elaborated. This framework was developed by taking into consideration the following questions: (1) When should a BAT be performed in general practice? (2) For which patients? and (3) How should a BAT be integrated into GPs practices? To answer this last question, the authors took into consideration the following specificities of the general practice context: (1) GPs have a comprehensive approach to patients  and are, thus, able not only to make decisions on the management of single diseases but also to adopt a more global and individualized approach to complex situations; (2) by managing patients on the long term , GPs are the health care providers best able to anticipate functional decline; (3) the usual time for one consultation is short, but the patient may be seen frequently; (4) during routine consultations, GPs have to balance the current health problems of the patient (including medication prescription) into proactive interventions such as prevention or, in this case, a BAT for geriatric syndromes screening.The five conditions most commonly considered as geriatric syndromes are cognitive impairment, pressure ulcers, incontinence, falls, functional decline, and delirium , 20–22. For the present work, eight geriatric syndromes were retained: Cognitive impairment, mood disorder, urinary incontinence, malnutrition, gait and balance impairment and falls, osteoporosis, hearing loss, and visual impairment. The Data Sheet S1 in Supplementary Material provides a detailed references narrative report that justifies the selection geriatric syndromes. Table Table The Data Sheet S2 in Supplementary Material describes the different tests developed for geriatric syndromes.The Table Figure Functional performances should be routinely assessed in elderly patients in general practice, independently of the realization of a BAT. Thus, the first essential element that needs to be determined before to proceed to the screening of geriatric syndromes is the state of functional dependency of the patient. In that perspective, we did not include functional dependency as a geriatric syndrome but as an entry point to the assessment of the geriatric patient.Few instruments have been developed to specifically assess functional dependency in the elderly. All rely on the measure of activities of daily life (ADL) to perform basic activities or instrumental activities. The two most well known are the score developed by Katz (or Katz index) for basic ADL that comprises six items   and the Surprisingly, no studies were found that assessed screening tools for functional decline in general practice. One study performed in general practice compared self-reporting of risk to standardized tools and concluded that reliability was high .Because IADL items are lost first, we propose to keep four main basic and intermediate items of IADL as assessment of functional decline: dressing, cooking, shopping, and ability to handle financing. This choice is based on “what is lost first” in order to identify early enough patients with functional inability. Usually IADL items are more complex and usually first to be lost. Furthermore, there is a hierarchy in the loss of IADL, what guided our choice . One of According to different recommendations such as the ACOVE guidelines (Assessing Care of the Vulnerable Elders) , a BAT sThis work describes the development of a comprehensive tool for the management of elderly patients in general practice. It encompasses the selection of the eight most relevant geriatric syndromes, the development of a brief geriatric assessment tool (BAT tool) for geriatric syndromes identification and a conceptual framework that integrates this geriatric assessment into routine general practice.This work combines scientific evidence  and a pragmatic approach to elderly care in general practice. Rather than proposing unachievable goals for elderly patients’ care in general practice , this work suggests an innovative way to combine geriatric assessment with the management of common chronic diseases.One of the key elements of this integrative approach is its emphasis on the importance of assessing the functional ability of community-dwelling adults on a regular basis prior to systematically screening for geriatric syndromes. This is a crucial step as the measure of the level of functional dependency is essential in the perspective of a longitudinal follow-up of patients over time and provides physicians with a more global overview of the health status and its evolution over time. Furthermore, a better recognition of geriatric syndromes and functional status of patients in addition to existing comorbidities is likely to modify the health priorities and medication prescription that a physician sets in partnership with the patient. We can indeed postulate that for an old diabetic patient, it might be more important to enjoy good food and avoid malnutrition than having strict control of glycemia. Similarly, rigid control of hypertension often leads to orthostatic hypotension in elderly persons with an associated high risk of falls and secondary functional decline.Within the described conceptual framework, polypharmacy is also seen in light of multimorbidity and functional impairment. Rather than only considering medication prescription according to the management of specific diseases, this framework forces the consideration of the potential impact of medications on other syndromes .To the best of our knowledge, this is one of the first attempts to comprehensively redesign the assessment of elderly patients in general practice rather than adding another layer of tests to usual practice. This work is therefore in line with recent work performed by the American Geriatric Society  and addThis work contributes to design novel strategies for a high quality of care for elderly persons within the general practice context. Nevertheless, more work needs to be done to influence the quality of care in general practice setting. One component is that the education of health professionals working in GP practices should be reoriented toward the teaching of chronic diseases and geriatric syndromes management . SpecialOther external factors related to the system may also play a role such as the mode of remuneration. It is not yet defined how GPs can both provide good care for chronic diseases and simultaneously take into account the care of geriatric conditions. This requires rethinking the way medical consultations are performed for elderly in general practice, including the consideration of interdisciplinary approaches with the integration of other health professionals such as nurses or physical therapists. The present work might contribute to this reflection.One of the weaknesses of this work is that it remains theoretical and needs to be tested in practice to assess if the tool can impact the quality of care of elderly patients. A study is already underway to assess the performance of the BAT in general practice. This study precedes a planned larger-scale cluster randomized trial that aims at investigating the benefits of this comprehensive tool when implemented into routine care. Another critique may be the selection of geriatric syndromes. Other geriatric conditions could have been included in the brief BAT tool . However, the choice was made through explicit criteria such as prevalence, impact on functional decline, and QOL.We believe, however, that the development of a more comprehensive, integrated, and concise screening tool for geriatric syndromes associated with a functional assessment of elderly patients and adequate management strategies has the potential to improve the quality of care to old patients in general practice.NS and SM designed and performed together this work and designed the conceptual frame work. NS wrote the first draft of the manuscript.All authors declare having no conflict of interest. The study was internally funded by the institutions.