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OBJECTIVES/SPECIFIC AIMS: Background: Delirium is a well described form of acute brain organ dysfunction characterized by decreased or increased movement, changes in attention and concentration as well as perceptual disturbances (i.e., hallucinations) and delusions. Catatonia, a neuropsychiatric syndrome traditionally described in patients with severe psychiatric illness, can present as phenotypically similar to delirium and is characterized by increased, decreased and/or abnormal movements, staring, rigidity, and mutism. Delirium and catatonia can co-occur in the setting of medical illness, but no studies have explored this relationship by age. Our objective was to assess whether advancing age and the presence of catatonia are associated with delirium. METHODS/STUDY POPULATION: Methods: We prospectively enrolled critically ill patients at a single institution who were on a ventilator or in shock and evaluated them daily for delirium using the Confusion Assessment for the ICU and for catatonia using the Bush Francis Catatonia Rating Scale. Measures of association (OR) were assessed with a simple logistic regression model with catatonia as the independent variable and delirium as the dependent variable. Effect measure modification by age was assessed using a Likelihood ratio test. RESULTS/ANTICIPATED RESULTS: Results: We enrolled 136 medical and surgical critically ill patients with 452 matched (concomitant) delirium and catatonia assessments. Median age was 59 years (IQR: 52–68). In our cohort of 136 patients, 58 patients (43%) had delirium only, 4 (3%) had catatonia only, 42 (31%) had both delirium and catatonia, and 32 (24%) had neither. Age was significantly associated with prevalent delirium (i.e., increasing age associated with decreased risk for delirium) (p=0.04) after adjusting for catatonia severity. Catatonia was significantly associated with prevalent delirium (p<0.0001) after adjusting for age. Peak delirium risk was for patients aged 55 years with 3 or more catatonic signs, who had 53.4 times the odds of delirium (95% CI: 16.06, 176.75) than those with no catatonic signs. Patients 70 years and older with 3 or more catatonia features had half this risk. DISCUSSION/SIGNIFICANCE OF IMPACT: Conclusions: Catatonia is significantly associated with prevalent delirium even after controlling for age. These data support an inverted U-shape risk of delirium after adjusting for catatonia. This relationship and its clinical ramifications need to be examined in a larger sample, including patients with dementia. Additionally, we need to assess which acute brain syndrome (delirium or catatonia) develops first.
The ecological value of the stranding record is often challenged due to the complexity in quantifying the biases associated with multiple components of the stranding process. There are biological, physical and social aspects that complicate the interpretation of stranding data particularly at a population level. We show how examination of baseline variability in the historical stranding record can provide useful insights into temporal trends and facilitate the detection of unusual variability in stranding rates. Seasonal variability was examined using harbour porpoise strandings between 1992 and 2014 on the east coast of Scotland. Generalized Additive Mixed modelling revealed a strong seasonal pattern, with numbers increasing from February towards a peak in April. Profiling seasonality this way facilitates detection of unusual variations in stranding frequencies and permits for any change in the incidence of strandings to be quantified by evaluation of the normalized model residuals. Consequently, this model can be used to identify unusual mortality events, and quantify the degree to which they deviate from baseline. With this study we demonstrate that a described baseline in strandings allows the detection of abnormalities at an early stage and can be used as a regional framework of reference for monitoring. This methodology provides means to quantify and partition the variability associated with strandings data and is a useful first step towards improving the stranding record as a management resource.
Dietary advice is fundamental in the prevention and management of type 2 diabetes (T2DM). Advice is improved by individual assessment but existing methods are time-consuming and require expertise. We developed a twenty-five-item questionnaire, the UK Diabetes and Diet Questionnaire (UKDDQ), for quick assessment of an individual’s diet. The present study examined the UKDDQ’s repeatability and relative validity compared with 4 d food diaries.
The UKDDQ was completed twice with a median 3 d gap (interquartile range=1–7 d) between tests. A 4 d food diary was completed after the second UKDDQ. Diaries were analysed and food groups were mapped on to the UKDDQ. Absolute agreement between total scores was examined using intra-class correlation (ICC). Agreement for individual items was tested with Cohen’s weighted kappa (κw).
South West of England.
Adults (n 177, 50·3 % women) with, or at high risk for, T2DM; mean age 55·8 (sd 8·6) years, mean BMI 34·4 (sd 7·3) kg/m2; participants were 91 % White British.
The UKDDQ showed excellent repeatability (ICC=0·90 (0·82, 0·94)). For individual items, κw ranged from 0·43 (‘savoury pastries’) to 0·87 (‘vegetables’). Total scores from the UKDDQ and food diaries compared well (ICC=0·54 (0·27, 0·70)). Agreement for individual items varied and was good for ‘alcohol’ (κw=0·71) and ‘breakfast cereals’ (κw=0·70), with no agreement for ‘vegetables’ (κw=0·08) or ‘savoury pastries’ (κw=0·09).
The UKDDQ is a new British dietary questionnaire with excellent repeatability. Comparisons with food diaries found agreements similar to those for international dietary questionnaires currently in use. It targets foods and habits important in diabetes prevention and management.
Weight loss is crucial for treating type 2 diabetes mellitus (T2DM). It remains unclear which dietary intervention is best for optimising glycaemic control, or whether weight loss itself is the main reason behind observed improvements. The objective of this study was to assess the effects of various dietary interventions on glycaemic control in overweight and obese adults with T2DM when controlling for weight loss between dietary interventions. A systematic review of randomised controlled trials (RCT) was conducted. Electronic searches of Medline, Embase, Cinahl and Web of Science databases were conducted. Inclusion criteria included RCT with minimum 6 months duration, with participants having BMI≥25·0 kg/m2, a diagnosis of T2DM using HbA1c, and no statistically significant difference in mean weight loss at the end point of intervention between dietary arms. Results showed that eleven studies met the inclusion criteria. Only four RCT indicated the benefit of a particular dietary intervention over another in improving HbA1c levels, including the Mediterranean, vegan and low glycaemic index (GI) diets. However the findings from one of the four studies showing a significant benefit are questionable because of failure to control for diabetes medications and poor adherence to the prescribed diets. In conclusion there is currently insufficient evidence to suggest that any particular diet is superior in treating overweight and obese patients with T2DM. Although the Mediterranean, vegan and low-GI diets appear to be promising, further research that controls for weight loss and the effects of diabetes medications in larger samples is needed.
The behavior of marine-terminating ice sheets, such as the West Antarctic ice sheet, is of interest due to the possibility of rapid grounding-line retreat and consequent catastrophic loss of ice. Critical to modeling this behavior is a choice of basal rheology, where the most popular approach is to relate the ice-sheet velocity to a power-law function of basal stress. Recent experiments, however, suggest that near-grounding line tills exhibit Coulomb friction behavior. Here we address how Coulomb conditions modify ice-sheet profiles and stability criteria. The basal rheology necessarily transitions to Coulomb friction near the grounding line, due to low effective stresses, leading to changes in ice-sheet properties within a narrow boundary layer. Ice-sheet profiles ‘taper off’ towards a flatter upper surface, compared with the power-law case, and basal stresses vanish at the grounding line, consistent with observations. In the Coulomb case, the grounding-line ice flux also depends more strongly on flotation ice thickness, which implies that ice sheets are more sensitive to climate perturbations. Furthermore, with Coulomb friction, the ice sheet grounds stably in shallower water than with a power-law rheology. This implies that smaller perturbations are required to push the grounding line into regions of negative bed slope, where it would become unstable. These results have important implications for ice-sheet stability in a warming climate.
Using spectroscopic observations and photometric light curves of 280 nearby M dwarfs from the MEarth exoplanet transit survey, we examine the relationships between magnetic activity (quantified by Hα emission), rotation period, and stellar age (derived from three-dimensional space velocities). Although we have known for decades that a large fraction of mid-late-type M dwarfs are magnetically active, it was not clear what role rotation played in the magnetic field generation (and subsequent chromospheric heating). Previous attempts to investigate the relationship between magnetic activity and rotation in mid-late-type M dwarfs were hampered by the limited number of M dwarfs with measured rotation periods (and the fact that vsini measurements only probe rapid rotation). However, the photometric data from the MEarth survey allows us to probe a wide range of rotation periods for hundreds of M dwarf stars (from less than one to over 100 days). Over all M spectral types we find that magnetic activity decreases with longer rotation periods, including late-type, fully convective M dwarfs. We find that the most magnetically active (and hence, most rapidly rotating) stars are consistent with a kinematically young population, while slow-rotators are less active or inactive and appear to belong to an older, dynamically heated stellar population.
Parasites are increasingly recognized for their profound influences on individual, population and ecosystem health. We provide the first report of gastrointestinal parasites in gray wolves from the central and north coasts of British Columbia, Canada. Across 60 000 km2, wolf feces were collected from 34 packs in 2005–2008. At a smaller spatial scale (3300 km2), 8 packs were sampled in spring and autumn. Parasite eggs, larvae, and cysts were identified using standard flotation techniques and morphology. A subset of samples was analysed by PCR and sequencing to identify tapeworm eggs (n=9) and Giardia cysts (n=14). We detected ⩾14 parasite taxa in 1558 fecal samples. Sarcocystis sporocysts occurred most frequently in feces (43·7%), followed by taeniid eggs (23·9%), Diphyllobothrium eggs (9·1%), Giardia cysts (6·8%), Toxocara canis eggs (2·1%), and Cryptosporidium oocysts (1·7%). Other parasites occurred in ⩽1% of feces. Genetic analyses revealed Echinococcus canadensis strains G8 and G10, Taenia ovis krabbei, Diphyllobothrium nehonkaiense, and Giardia duodenalis assemblages A and B. Parasite prevalence differed between seasons and island/mainland sites. Patterns in parasite prevalence reflect seasonal and spatial resource use by wolves and wolf-salmon associations. These data provide a unique, extensive and solid baseline for monitoring parasite community structure in relation to environmental change.
The formal commissioning of the IRWG occurred at the 1991 Buenos Aires General Assembly, following a Joint Commission meeting at the IAU GA in Baltimore in 1988 that identified the problems with ground-based infrared photometry. The meeting justification, papers, and conclusions, can be found in Milone (1989). In summary, the challenges involved how to explain the failure to achieve the milli-magnitude precision expected of infrared photometry and an apparent 3% limit on system transformability. The proposed solution was to redefine the broadband Johnson system, the passbands of which had proven so unsatisfactory that over time effectively different systems proliferated, although bearing the same “JHKLMNQ” designations; the new system needed to be better positioned and centered in the spectral windows of the Earth's atmosphere, and the variable water vapour content of the atmosphere needed to be measured in real time to better correct for atmospheric extinction.
Kings, besides the Care of their own Kingdom, have lying upon them the Care of human society: Hence it is, that the Powers of the Earth enter into Alliances and Leagues to guard Men against the Oppression of their own Governours and others. And this accounts for the Original of a Guarantee, whose Office is, not only to see Articles perform'd in Treaties between Princes and Princes, but between Princes and their Subjects.
Charles Owen (1725)
Historians enjoy speculating on the past. There is a certain satisfaction in showing that ideas and developments that are more generally deemed to be novel and radical have a longer history than is generally accepted. The longevity of ideas of humanitarian intervention is something that a number of chapters in this volume seek to demonstrate and the present contribution concentrates attention on the late seventeenth and early eighteenth centuries. It considers how concern for oppressed peoples was articulated in the diplomatic and public discourse and practice of the period. Some of the techniques adopted and the problems faced have a surprisingly modern ring about them. This is not necessarily that surprising. Yet it is still worth recalling this history during discussions about the legitimacy or otherwise of humanitarian interventionism today.
Despite some of the similarities between the worlds of the eighteenth century and now, some substantial differences are apparent. The figures with whom this chapter is primarily concerned were very rarely motivated by a concern for common humanity.