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Introduction: Delirium is a dreadful complication in seniors’ acute care. Many studies are available on the incidence of delirium, however ED-induced delirium is far less studied. We aim to evaluate the incidence and impact of ED-induced delirium among older non-delirious admitted ED patients who have prolonged ED stays (≥ 8 hours). Methods: This prospective INDEED study phase 1 included patients recruited from 4 Canadian EDs. Inclusion criteria: 1) Patients aged 65 and over; 2) ED stay ≥ 8 hours; 3) Patient is admitted to the hospital; 4) Patient is non-delirious upon arrival and at the end of the first 8 hours; 5) Independent or semi-independent patient. Eligible patients were assessed by a research assistant after an 8 hour exposition to the ED and evaluated twice a day up to 24h after ward admission. Patients’ functional and cognitive status were assessed using validated OARS and TICS-m tools. The Confusion Assessment Method was used to detect incident delirium. Hospital length of stays (LOS) were obtained. Univariate and multivariate analyses were conducted to evaluate outcomes. Results: Of the 380 patients prospectively followed, mean age was 76.5 (± 8.9), male represent 50% and 16.5% very old seniors (> 85 y.o.). The overall incidence of ED-induced delirium was 8.4%. Distribution by the 4 sites was: 10%, 13.8%, 5.5% & 13.4%. The mean ED LOS varied from 29 to 48 hours. The mean hospital LOS was increase by 6.1 days in the delirious patients compared to non-delirious patient (p<0.05). Increase mean hospital LOS distribution by site was by: 6.9, 8.5, 4.3 and 5.2 days for the ED-induced delirium patients. Conclusion: ED-induced delirium was recorded in nearly one senior out of ten after a minimal 8 hour exposure in the ED environment. An episode of delirium increases hospital LOS by about a week and therefore could contribute to ED overcrowding.
Introduction: Delirium is a frequent complication among seniors in the emergency department (ED). This condition is often underdiagnosed by ED professionals even though it is associated with functional & cognitive decline, longer hospital length of stay, institutionalization and death. Frailty is increasingly recognized as an independent predictor of adverse events in seniors and screening for frailty in EDs has recently been recommended. The aim of this study was to assess if screening seniors for frailty in EDs could help identify those at risk of ED-induced delirium. Methods: This study is part of the Incidence and Impact measurement of Delirium Induced by ED-Stay study, an ongoing multicenter prospective cohort study in 5 Quebec EDs. Patients were recruited after 8 hours in the ED exposure & followed up to 24h after ward admission. Frailty was assessed at ED admission using the Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) which classified seniors from robust (1/7) to severely frail (7/7). Seniors with CSHA-CFS ≥ 5/7 were considered frail. Delirium was assessed using the Confusion assessment method and Delirium Index. Results: Of the 380 patients recruited, mean age was 76.5 (±8.9). Male were 50%. Mean stay in the ED was 1.4 day (±0.82). Preliminary data show an incidence of ED-induced delirium of 8.4%. Average frailty score at baseline was 3.5/7. 72 patients were considered frail, while 289 were considered robust. Among the frail seniors, there were 48.4% (30-66%) patients with ED-induced delirium vs 17.9% (13.7-22.0] in the non-frail ones (p<0.0001). Conclusion: Increased frailty appears to be associated with increased ED-induced delirium. Screening for frailty at emergency triage could help ED professionals identify seniors at higher risk of ED-induced delirium. Further studies are required to confirm the importance of the association between frailty and ED-induced delirium
Introduction: Delirium is a common medical complication among seniors in hospital setting. In the emergency department (ED), its prevalence varies between 7 & 14%. Delirium is associated with increased mortality & longer hospital stay. This condition is also associated with functional & cognitive decline in hospitalized seniors and higher risk of institutionalization up to 2 years after their discharge. However, no data is currently available for ED patients. The aim of this study was to evaluate the association between ED-induced delirium and functional & cognitive decline in seniors at 60 days. Methods: This study is part of the Incidence and Impact measurement of Delirium Induced by ED-Stay (INDEED) study, an ongoing multicenter prospective cohort study in 5 Quebec EDs. Patients were recruited after 8 hours in the ED and followed up to 24h after admission. A 60-day follow-up phone assessment was also conducted. Delirium was measured by the validated Confusion Assessment Method & the Delirium Index. Functional status was measured by the validated OARS. Cognitive status was measured using the validated TICS-M. Functional and cognitive decline were obtained by comparing the baseline and 60-days follow-up scores. Results: 380 seniors were recruited and 280 had 60-day follow-up data available. ED-induced delirium was 8.4% of seniors. There was a difference in mean functional decline among seniors with and without ED-induced delirium 2.95(1.23-4.67) vs 1.55(1.20-1.91, pwlicoxon= 0.05] Proportion of seniors showing a decline ≥2 points on the OARS was significantly higher In those with ED-induced delirium (65,0 % vs 40.18 %, p=0.03). Seniors with ED-induced delirium also showed a significant decline in mean TICS scores [3.31 (0,82-5.84) vs -0.01((-.071-0.75)), pwlicoxon =0.009]. There was no significant difference in the proportions of seniors showing a decline ≥ 3 OARS points between those with or without delirium (p=0.06). Conclusion: ED-induced delirium seems to be associated with poor functional and cognitive outcomes in older patients 60 days after discharge from the hospital. Further studies are required to confirm clinical importance ED-induced delirium delayed complication.
PLATO is a fully-robotic observatory designed for operation in
Antarctica. It generates its own electricity (about 1 kW), heat
(sufficient to keep two 10-foot shipping containers comfortably above
0°C when the outside temperature is at -70°C), and
connects to the internet using the Iridium satellite system (providing
~30 MB/day of data transfer). Following a successful first year of
operation at Dome A during 2008, PLATO was upgraded with
new instruments for 2009.
In January 2005, members of a Chinese expedition team were the first
humans to visit Dome A on the Antarctic plateau, a site
predicted to be one of the very best astronomical sites on earth. In 2006, the Chinese Center for Antarctic Astronomy (CCAA) was founded
to promote the development of astronomy in Antarctica, especially at
Dome A. CCAA has since taken part in two traverses to Dome A, organized
by the Polar Research Institute of China (PRIC), in the austral
summers of 2007/2008 and 2008/2009. These traverses resulted in the
installation of many site-testing and science instruments, supported
by the PLATO observatory. The Chinese Small Telescope ARray (CSTAR)
has produced excellent results from Dome A. Our future plans include further site-testing work, and the following
full-scale science instruments: three 0.5-m Antarctic Schmidt
Telescopes (AST3), and a proposed 4-m telescope for wide-field
infrared high spatial-resolution surveys. The first AST3 telescope is
under construction and is scheduled for installation in 2011.
Dome A, the summit of the Antarctic plateau, is expected to have even
better atmospheric conditions for ground-based astronomy than Dome C.
Instruments to evaluate and exploit Dome A's astronomical potential
must operate within logistical constraints, which are currently
very stringent. Instrumentation now at Dome A exemplifies the
techniques and solutions required by this environment. Future
instrumentation and infrastructure will allow the qualities of the site
to be exploited much more fully.
We present the results of 3-d numerical simulations of galactic dynamos. Using reasonably justifiable parameters, kinematic dynamo models are shown to reproduce the gross features of galaxy magnetic fields. The central field morphology is suggestive of an embryonic jet generator.
We describe here the results of 3-D numerical simulations of an αω-dynamo in galaxies with differential rotation, small scale turbulence, and a shock wave induced by a stellar density wave. A non-linear quenching mechanism for the dynamo instability is used, and with the model parameters employed the field achieves a steady state which closely resembles observed fields in galaxies. The magnetic field vectors are parallel to the plane in the disc, with the magnetic intensity decreasing away from the plane. The vectors are also nearly parallel to the spiral arms in the disc, and the field direction is axisymmetric about the galactic centre, but with significant increase of intensity in the arms. The magnetic intensity rises steeply towards the centre of the galaxy, where the field becomes dominated by the vertical component. Nowhere in the parameter range covered is the bi-symmetric field mode dominant.
Lead monoxide (PbO) is a potential solid lubricant for use at elevated temperatures in oxidizing environments. The objective of this research was to grow thin films of PbO by Pulsed Laser Deposition (PLD). Film stoichiometry, crystallinity, and chemistry were adjusted by varying substrate temperature and O2 partial pressure during deposition and the effects of changes in film properties on friction coefficients and wear lives were investigated. Chemistry and crystallinity were evaluated using X-ray photoelectron spectroscopy (XPS), Raman spectroscopy, and glancing angle X-ray diffraction (XRD). Friction coefficients and wear lives were measured in dry nitrogen and at room temperature using a ball-on-flat tribometer. Films deposited at room temperature retained the crystal structure of the target material, but were oxygen deficient. The O/Pb ratio was increased by raising the O2 partial pressure and by increasing the substrate temperature during deposition; the crystal structure and orientation changed with stoichiometry. Friction coefficients ranged from 0.20 - 0.45 and the wear lives were typically less than those obtained from MoS2 films.
Phlebotomus perfiliewi perfiliewi Parrott and Phlebotomus perniciosus Newstead (Diptera: Psychodidae,) known vectors of Leishmania infantum were caught in light traps in five different sites in Italy. Sandflies were cryopreserved and transported to the laboratory where they were thawed and aqueous extracts of the crushed flies were analysed for their carbohydrate content using high performance liquid chromatography. Several sugars were detected, including significant amounts of the trisaccharide melezitose, known to be available as a natural source from aphid or coccid honeydew. There was no difference between the analyses of sugar meals of P. p. perfiliewi from different sites within its range, or between P. p. perfiliewi and P. perniciosus. The results indicate that both males and females of P. p. perfiliewi and P. perniciosus feed on honeydew.
Although the Domesday survey has long been used effectively to illuminate many aspects of English history in the eleventh century, attempts to use it for reconstructing the contemporary rural landscape and structure of landholding have been less frequent and less successful. This has partly been caused by the fact that most commentators since the days of Maitland and Vinogradoff have concentrated on the making of Domesday rather than on its actual contents. However, even the series of Domesday Geographies by Professor Darby and his collaborators is marred by the failure to determine the meaning of the formula terra unius carucae or its equivalents. This expression has been translated in the present paper as ‘teamland’, rather than the ‘ploughland’ favoured by most modern writers on Domesday, because use of the latter synonym would prejudice the later argument by presupposing the argued identification of the Domesday ‘land for one plough’ with the field-hide or carucate found in later manorial records.
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