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Cognitive and functional impairment increase risk for post-coronary artery bypass graft (CABG) surgery delirium (PCD), but how much impairment is necessary to increase PCD risk remains unclear.
The Neuropsychiatric Outcomes After Heart Surgery (NOAHS) study is a prospective, observational cohort study of participants undergoing elective CABG surgery. Pre-operative cognitive and functional status based on Clinical Dementia Rating (CDR) scale and neuropsychological battery are assessed. We defined mild cognitive impairment (MCI) based on either (1) CDR global score 0.5 (CDR-MCI) or (2) performance 1.5 SD below population means on any cognitive domain on neurocognitive battery (MCI-NC). Delirium was assessed daily post-operative day 2 through discharge using the confusion assessment method (CAM) and delirium index (DI). We investigate whether MCI – either definition – predicts delirium or delirium severity.
So far we have assessed 102 participants (mean age 65.1 ± 9; male: 75%) for PCD. Twenty six participants (25%) have MCI-CDR; 38 (62% of those completing neurocognitive testing) met MCI-NC criteria. Fourteen participants (14%) developed PCD. After adjusting for age, sex, comorbidity, and education, MCI-CDR, MMSE, and Lawton IADL score predicted PCD on logistic regression (OR: 5.6, 0.6, and 1.5, respectively); MCI-NC did not (OR [95% CI]: 11.8 [0.9, 151.4]). Using similarly adjusted linear regression, MCI-CDR, MCI-NC, CDR sum of boxes, MMSE, and Lawton IADL score predicted delirium severity (adjusted R2: 0.26, 0.13, 0.21, 0.18, and 0.32, respectively).
MCI predicts post-operative delirium and delirium severity, but MCI definition alters these relationships. Cognitive and functional impairment independently predict post-operative delirium and delirium severity.
Robert Kagan has been at the forefront of sociolegal research into regulation for more than thirty years. His work addresses in general the extent to which law fosters or impedes economic activity, and the conditions under which people and organizations both comply with the law and sometimes fail to comply with it. This article analyzes his contributions and suggests some questions for further inquiry prompted by Kagan's work. The survey takes as its starting point Kagan's books Regulatory Encounters (ed. with Axelrad 2000) and Shades of Green (with Gunningham and Thornton 2003), before going on to consider his more recent research, which probes in some detail into the impact of enforcement and the ideas of compliance and deterrence.
Microlensing searches for planets are sensitive to small, cold exoplanets from 1–6 AU from their host stars and therefore probe an important part of parameter space. Other techniques would require many years of observations, often from space, to detect similar systems. Microlensing events can be characterised from only ground-based observations over a relatively short (≤100d) timescales. LCOGT and SUPA/St Andrews are building a robotic global network of telescopes that will be well suited to follow these events. Here we present preliminary results of the Galactic Bulge observing season 2010 March–October.
Research studies for the treatment of the putative prodromal phase of
psychotic disorders have begun to appear
To obtain preliminary evidence of the short-term efficacy and safety of
aripiprazole treatment in people with the psychosis prodrome
Fifteen participants meeting prodrome criteria (mean age 17.1 years,
s.d.=5.5) enrolled in an open-label, single-site trial with
fixed-flexible dosing of aripiprazole (5–30 mg/day) for 8 weeks
In the mixed-effects repeated-measures analysis, improvement from
baseline on the Scale of Prodromal Symptoms total score was statistically
significant by the first week. No participant converted to psychosis and
13 completed treatment. Neuropsychological measures showed no consistent
improvement; mean weight gain was 1.2 kg. Akathisia emerged in 8
participants, but the mean Barnes Akathisia Scale score fell to baseline
levels by the final visit. Adverse events were otherwise minimal
Aripiprazole shows a promising efficacy and safety profile for the
psychosis prodrome. Placebo-controlled studies are indicated
A tendency to extract spurious, message-like meaning from meaningless noise was assessed as a risk factor leading to shizophrenia-spectrum disorders by assessing word length of speech illusions elicited by multispeaker babble in 43 people with prodromal symptoms. These individuals were randomised to olanzapine v. placebo groups during year 1 followed by no pharmacological treatment for those with no disorder conversion during year 2. A time-dependent Cox regression analysis of conversion to schizophrenia-spectrum disorder revealed a significant interaction between condition (olanzapine v. no drug) and length of speech illusion, with the latter strongly predicting subsequent conversion during medication-free intervals but not during olanzapine treatment.
Since memory performance expectations may be IQ-based,
unidirectional base rate data for IQ-Memory Score discrepancies
are provided in the WAIS–III/WMS–III Technical
Manual. The utility of these data partially rests on the
assumption that discrepancy base rates do not vary across ability
levels. FSIQ stratified base rate data generated from the
standardization sample, however, demonstrate substantial
variability across the IQ spectrum. A superiority of memory
score over FSIQ is typical at lower IQ levels, whereas the converse
is true at higher IQ levels. These data indicate that the use
of IQ–memory score unstratified “simple
difference” tables could lead to erroneous conclusions
for clients with low or high IQ. IQ stratified standardization
base rate data are provided as a complement to the “predicted
difference” method detailed in the Technical Manual.
(JINS, 2001, 7, 875–880.)
The aim was to determine the extent, characteristics and timing of suicide in Oxford University students.
Students who died from suicide or undetermined cause between October 1976 and September 1990 were identified through University records and individual colleges. Information about each student was sought from coroners, college staff, general practitioners and hospital case notes.
There were 21 suicides (16 men and 5 women) and one open verdict (female). The observed number of suicides (0) was greater than the number expected (E = 11.09) on the basis of mortality statistics for England and Wales (O/E = 1.89; 95% CI 1.17 to 2.90). When deaths due to undetermined cause were included, however, the difference between O and E (17.03) was much reduced (O/E = 1.29; 95% CI 0.81 to 1.95). There was no evidence of an association with the Finals examination but two-thirds of the students had been worried about academic achievement or their courses. Nearly half appeared to have had a psychiatric disorder (mostly depression).
The much publicised apparent excess of Oxford University student suicides may be partly artefactual. Measures for preventing student suicides include careful induction upon arrival at university, means of alleviating academic stress and worries, and readily available and closely associated student counselling and psychiatric services.