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Delirium is heterogeneous and can vary by etiology.
We sought to determine how delirium subtyped by etiology affected six-month function and cognition.
Prospective cohort study.
Tertiary care, academic medical center.
A total of 228 hospitalized patients > 65 years old were admitted from the emergency department (ED).
The modified Brief Confusion Assessment Method was used to determine delirium in the ED. Delirium etiology was determined by three trained physician reviewers using a Delirium Etiology checklist. Pre-illness and six-month function and cognition were determined using the Older American Resources and Services Activities of Daily Living (OARS ADL) questionnaire and the short-form Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Multiple linear regression was performed to determine if delirium etiology subtypes were associated with six-month function and cognition adjusted for baseline OARS ADL and IQCODE. Two-factor interactions were incorporated to determine pre-illness function or cognition-modified relationships between delirium subtypes and six-month function and cognition.
In patients with poorer pre-illness function only, delirium secondary to metabolic disturbance (β coefficient = −2.9 points, 95%CI: −0.3 to −5.6) and organ dysfunction (β coefficient = −4.3 points, 95%CI: −7.2 to −1.4) was significantly associated with poorer six-month function. In patients with intact cognition only, delirium secondary to central nervous system insults was significantly associated with poorer cognition (β coefficient = 0.69, 95%CI: 0.19 to 1.20).
Delirium is heterogeneous and different etiologies may have different prognostic implications. Furthermore, the effect of these delirium etiologies on outcome may be dependent on the patient's pre-illness functional status and cognition.
An unprecedented outbreak of Ebola virus diseases (EVD) occurred in West Africa from March 2014 to January 2016. The French Institute for Public Health implemented strengthened surveillance to early identify any imported case and avoid secondary cases.
Febrile travellers returning from an affected country had to report to the national emergency healthcare hotline. Patients reporting at-risk exposures and fever during the 21st following day from the last at-risk exposure were defined as possible cases, hospitalised in isolation and tested by real-time polymerase chain reaction. Asymptomatic travellers reporting at-risk exposures were considered as contact and included in a follow-up protocol until the 21st day after the last at-risk exposure.
From March 2014 to January 2016, 1087 patients were notified: 1053 were immediately excluded because they did not match the notification criteria or did not have at-risk exposures; 34 possible cases were tested and excluded following a reliable negative result. Two confirmed cases diagnosed in West Africa were evacuated to France under stringent isolation conditions. Patients returning from Guinea (n = 531; 49%) and Mali (n = 113; 10%) accounted for the highest number of notifications.
No imported case of EVD was detected in France. We are confident that our surveillance system was able to classify patients properly during the outbreak period.
Terrestrial radar interferometry (TRI) is a new technique for studying ice motion and volume change of glaciers. TRI is especially useful for temporally and spatially dense measurements of highly dynamic glacial termini. We conducted a TRI survey of Breiðamerkurjökull, a marine-terminating glacier in Iceland, imaging its terminus near the end of the melt season in 2011, 2012 and 2013. The ice velocities were as high as 5 m d−1, with the fastest velocities near the calving front. Retreat of the glacier over the 3 year observation period was accompanied by strong embayment formation. Iceberg tracking with the radar shows high current velocities near the embayment, probably indicating strong meltwater outflow and mixing with relatively warm lagoon water.
The present triennial commission report embraces mainly activities in wide angle, optical astrometry. With the successful development and application of new techniques from Earth (e.g. optical interferometry, CCD’s) and space (Hipparcos mission and new projects) the sub-division between Commissions 8 (Positional Astrometry) and 24 (Photographic Astrometry) has become questionable. During the GA at Kyoto in 1997 all steps for a merger of both commissions have been taken. The final merging will take place at the forthcoming GA in Manchester. For a more complete overview on astrometrical work done in the past triennium the reader should also take notice of the report of Commission 24.
Infants in the neonatal intensive care unit (NICU) are at increased risk for methicillin-resistant Staphylococcus aureus (MRSA) acquisition. Outbreaks may be difficult to identify due in part to limitations in current molecular genotyping available in clinical practice. Comparison of genome-wide single nucleotide polymorphisms (SNPs) may identify epidemiologically distinct isolates among a population sample that appears homogenous when evaluated using conventional typing methods.
To investigate a putative MRSA outbreak in a NICU utilizing whole-genome sequencing and phylogenetic analysis to identify recent transmission events.
Clinical and surveillance specimens collected during clinical care and outbreak investigation.
A total of 17 neonates hospitalized in a 43-bed level III NICU in northeastern Florida from December 2010 to October 2011 were included in this study.
We assessed epidemiological data in conjunction with 4 typing methods: antibiograms, PFGE, spa types, and phylogenetic analysis of genome-wide SNPs.
Among the 17 type USA300 isolates, 4 different spa types were identified using pulsed-field gel electrophoresis. Phylogenetic analysis identified 5 infants as belonging to 2 clusters of epidemiologically linked cases and excluded 10 unlinked cases from putative transmission events. The availability of these results during the initial investigation would have improved infection control interventions.
Whole-genome sequencing and phylogenetic analysis are invaluable tools for epidemic investigation; they identify transmission events and exclude cases mistakenly implicated by traditional typing methods. When routinely applied to surveillance and investigation in the clinical setting, this approach may provide actionable intelligence for measured, appropriate, and effective interventions.
Infect. Control Hosp. Epidemiol. 2015;36(7):777–785
We compare forests dominated by Gilbertiodendron dewevrei at the Dja Biosphere Reserve (Cameroon) with adjacent high-diversity mixed forests in terms of tree-species composition and stand structure, in order to understand the co-occurrence of mixed forest tree species in the monodominant forest. A total of 18 1-ha permanent plots were established in the two forest types. In each plot, all trees with dbh ≥10 cm were identified as were those <10 cm dbh within a subsample of 300 m2. Species richness was significantly different between the two forest types. Mixed forest had an average of 109 species ha−1 for trees ≥10 cm dbh and 137 species for trees <10 cm dbh. By contrast, G. dewevrei-dominated forest had an average of 47 species ha−1 (≥10 cm dbh) and 92 species (<10 cm dbh). There was no significant difference in terms of stem density of the trees with dbh <10 cm between the two forests (mixed: 3.7 stems m−2; monodominant: 3.1 stems m−2). As G. dewevrei is a shade-tolerant species that can regenerate under its own shade, its higher stem density and basal area can reduce species richness of an area.
A process for the review of significant trade in species listed in CITES Appendix II was established to address problems with the application of CITES Article IV. Article IV states that international trade in Appendix II species requires a Scientific Authority of the state of export to determine that such trade will not be detrimental to the species’ survival in the wild. Such a review process was initiated for the plant species Galanthus woronowii Losinsk. as a result of continuing uncertainty over the sustainability of international exports of the plant from wild populations in Georgia, and the Georgian Management Authority was tasked with determining and reporting whether export levels conformed to Article IV. Here we report on the project that was established to address that task. Nationwide field surveys conducted in 2009 led to the recommendation of a conservative annual export quota of 15 million plants for the sites surveyed. Cultivated populations held significant stocks of harvestable plants but with varied cultivation histories, especially in relation to the extent and nature of supplementary planting. Future work should continue to monitor harvesting from wild populations and identify solutions for local communities wishing to cultivate the plant for international trade.
As the twentieth century opened, numbers of American businessmen, spurred in part by the forceful persuasions of American diplomats, hoped to profit from the legendary China market by taking on Chinese partners. At the same time, groups of Chinese entrepreneurs, struck by the success and wealth of the United States, hoped to take advantage of American capital by launching joint ventures with the Americans. Such enterprises generally proved difficult to form, however, and once organized, tended to see the Americans predominate and the Chinese relegated to distinctly secondary roles. But there were exceptions, as Professor Pugach points out in this essay on the Chinese-American Bank of Commerce. While the founding of this firm provides ample proof that joint Sino-American companies had to overcome large hurdles to come into being, the formation of the bank suggests that mutual self-interest, ideal circumstances, and perhaps good luck could overcome the problems inherent in creating joint ventures in which both sides could share roughly equal positions.
Despite the efforts of American government officials, attempts to establish a joint Chinese-American company to develop China's petroleum potential met with failure during the initial years of the Wilson administration. Duplicity and misunderstanding on the part of Standard Oil and of the Chinese government added another chapter to the dismal history of American business in China.