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To study the long term effects of delirium in elderly hip-surgery patients on cognitive mortality.
This is a prospective study. Medical school-affiliated general hospital in Alkmaar, The Netherlands. Participants (n=603) from the €Haloperidol Prophylaxis for Elderly Hip-Surgery Patients at Risk for Delirium. A Randomized Placebo-Controlled Study (Kalisvaart et al., 2005). Patients with and without post-operative delirium were followed for 2 years. Mortality risk associated with delirium was estimated using a Cox proportional hazards regression model; the outcome was time to death.
A total of 75/603 patients (12.4%) died during the study period (table 1). Incidence of delirium was higher in patients who died compared with those who survived (HR 2.16, CI 1.30-3.58). They were more often at risk for delirium as indicated by higher rates of cognitive impairment and visual impairment.
Delirium after hip-surgery and delirium risk factors are associated with long-term follow-up mortality.
To study the long term effects of delirium in elderly hip-surgery patients on cognitive outcome.
Prospective matched controlled cohort study. Medical school-affiliated general hospital in Alkmaar, The Netherlands.
Hip-surgery patients (n=112) aged 70 and older who participated in a controlled clinical trial of haloperidol prophylaxis for delirium, were followed for an average of 30 months after discharge. Patients with a diagnosis of dementia or mild cognitive impairment (MCI) were identified based on psychiatric interviews. Proportions of patients with dementia or MCI were compared across patients who had postoperative delirium and selected control patients matched for preoperatively assessed risk factors who had not developed delirium during hospitalization. Other outcomes were mortality rate and rate of institutionalization.
During follow-up 54.9% of delirium patients had died compared to 34.1% controls (relative risk = 1.5, 95% CI = 1.04-2.1). Dementia or MCI was diagnosed in 77.8% of the surviving patients with postoperative delirium and in 40.1% of control patients (relative risk = 2.7, 95% CI = 1.2-5.8). Group differences for rate of institutionalization were not significant.
The risk of dementia or MCI at follow-up is more than doubled in elderly hip-surgery patients with postoperative delirium compared with patients without delirium.
Since the implementation of the Clinical Learning Environment Review by the Accreditation Council for Graduate Medical Education, there has been an emphasis on training residents in health care quality as well as patient safety. As such, psychiatry residency training programs have had to incorporate quality improvement (QI) projects into their training. We developed a QI curriculum, which not only included resident and faculty participation, but also encouraged other staff in our department to focus on patient safety as well as improving their performance and the quality of care provided to the patients.
In this poster, we present the development of our curriculum and will include a successful QI project to highlight this. This project focused on creating an algorithm to help assign patient risk level, which is based on evidence based risk factors. This project was created due to a survey conducted in our clinic which demonstrated that clinicians, and in residency training in particular, identifying and managing high risk patients can be anxiety provoking for trainees. We will present the specifics of this QI project, and additionally outline the steps that were taken to develop and integrate the QI project into clinical practice.
(1) Learn how to successfully incorporate a QI project and curriculum into a psychiatry residency training program.
(2) Understand both resident and faculty perspectives on what resources facilitated participation in QI.
(3) Present the development of a quality improvement project focused on risk assessment of outpatient psychiatric patients.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The principles of the Armed Forces Covenant state that Armed Forces Veterans should be at no disadvantage resulting from their service compared with a general adult population. However, despite being at increased risk of experiencing common mental health difficulties, evidence indicates that 82% of Armed Forces Veterans receive no treatment, compared with 63% of the general adult population.
To gain a better appreciation of factors that inform the type of adaptations to cognitive behavioural therapy (CBT) interventions for depression and mainstream service promotion materials to enhance acceptability for Armed Forces Veterans.
This is a qualitative study employing a focus group of 12 participants to examine the main impacts of depression on Armed Forces Veterans alongside attitudes towards terminology and visual imagery. Thematic analysis was used to identify themes and sub-themes with rigour established through two researchers independently developing thematic maps to inform a final agreed thematic map.
A behavioural activation intervention supporting re-engagement with activities to overcome depression had good levels of acceptability when adapted to reflect an Armed Forces culture. Preferences regarding terminology commonly used within CBT adapted for Armed Forces Veterans were identified. Concerns were expressed with respect to using imagery that emphasized physical rather than mental health difficulties.
There is the need to consider the Armed Forces community as a specific institutional culture when developing CBT approaches with potential to enhance engagement, completion and recovery rates. Results have potential to inform the practice of CBT with Armed Forces Veterans and future research.
The present qualitative study was conducted with 20 women with serious mental illness (SMI) in order to better characterise their romantic and intimate relationship experiences. Grounded theory methodology directed the identification of intimate and romantic relationships themes for women with SMI, which included the following: function matching, pathologising problems, symptom interference, dating deal breakers, sexual foreclosure, dating deprioritised, and relational resilience strategies. Clinical implications and future research directions are discussed.
Time-resolved planar particle image velocimetry was used to analyse the structuring of a turbulent boundary layer into uniform momentum zones (UMZs). The instantaneous peak-detection method employed by Adrian et al. (J. Fluid Mech., vol. 422, 2000, pp. 1–54) and de Silva et al. (J. Fluid Mech., vol. 786, 2016, pp. 309–331) is extended to account for temporal coherence of UMZs. The resulting number of zones detected appears to follow a normal distribution at any given instant. However, the extreme cases in which the number of zones is either very high or very low, are shown to be linked with two distinct flow states. A higher than average number of zones is associated with a large-scale
event in the log region which creates increased small-scale activity within that region. Conversely, a low number of zones corresponds to a large-scale
event in the log region and decreased turbulent activity away from the wall. The residence times, within the measurement plane, of zones belonging to the latter scenario are shown to be on average four times larger than those of zones present during higher than average zone structuring states. For both cases, greater residence times are observed for zones of higher momentum that are generally closer to the free stream.
Spectral content and spatial organization of momentum transport events are investigated in a turbulent boundary layer at the Reynolds number
, with time-resolved planar particle image velocimetry. The spectral content of the Reynolds-shear-stress fluctuations reveals that the largest range of time and length scales can be observed in proximity to the wall, while this range becomes progressively more narrow when the wall distance increases. Farther from the wall, longer time and larger length scales exhibit an increasing spectral content. Wave velocities of transport events are estimated from wavenumber–frequency power spectra at different wall-normal locations. Wave velocities associated with ejection events (Q2) are lower than the local average streamwise velocity, while sweep events (Q4) are characterized by wave velocities larger than the local average velocity. These velocity deficits are almost insensitive to the wall distance, which is also confirmed from time tracking the intense transport events. The vertical advection velocities of the intense ejection and sweep events are on average a small fraction of the friction velocity
, different from previous observations in a channel flow. In the range of wall-normal locations
, sweeps are considerably larger than ejections, which could be because the ejections are preferentially located in between the legs of hairpin packets. Finally, it is observed that negative quadrant events of the same type tend to appear in groups over a large spatial streamwise extent.
Australia's correctional and prison services are governedby each of the eight States and Territories. There are no Commonwealth prisons or facilities in Australia, and persons who have been sentenced to a period of imprisonment from breaching Commonwealth legislation are sent to State or Territory correctional centers. There is no common legislation that applies to all of the country's prisons. Each jurisdiction enacts legislation and regulations for governance of its correctional centers that are applicable to both men and women. Nationwide there are 113 public and private prisons in Australia, with 38 detaining women. Like other countries, Australia has experienced an increase in the rate of female imprisonment greater than that of male imprisonment. The average daily number of women held in these facilities in 2013 was 2,260, comprising 7.6% of the total Australian prison population. While their proportion of the prison population has been steadily increasing, Australia's correctional centers are still, for the most part, male systems that have been (somewhat) adjusted to suit the needs of women. Australia has begun to make progress in taking a more gendered approach to female imprisonment, but still has a long way to go to properly address the specific needs of women in prison and to realize and/or adopt the Rules contained in the Bangkok Rules.
The following chapter of work provides a thorough insight into women's imprisonment throughout Australia. Section 2 will explore the international and human rights framework within which Australia operates. The most striking aspect is the lack of a central domestic human rights charter, as Australia remains the only Western democratic nation without such an instrument. Section 3 will provide statistics and analysis on Australia's approach to women in prison. It will explore the backgrounds of the women who come into contact with Australia's criminal justice system, and the various factors that may provide a useful place for authorities to consider when seeking to prevent and deter women from making that initial contact with the system. Section 4 will consider the deprivation of liberty phase, exploring the conditions under which women are held in in prison in Australia.
INTERNATIONAL AND HUMAN RIGHTS FRAMEWORK
Australia was a founding member of the United Nations (UN). Australia held the first Presidency of the Security Council in 1946, and was a member last in 2013 and 2014.
Whiteley et al. criticize our re-analysis of the valence model of party choice. In reply, we argue that they are mistaken with regard to their understanding of some of the claims made in our paper and, in one instance, the variables included in the analysis. We also point to flaws in their interpretation of the distinction between weak and contemporaneous endogeneity and the assumptions of their vector error correction model. Their argument privileging aggregate analysis introduces predictable inferential problems and also, it might be suggested, potentially casts doubt on their own research, which uses individual-level analysis to make the case for the valence model. For these reasons, we see no reason to moderate the negative implications of our analysis for the validity of the model.
The influential valence model of voting developed over the last decade by the British Election Study (BES) team assumes that party and leadership performance evaluations have a causal impact on party choice. An alternative perspective argues that such performance evaluations are instead the consequences of party choice. This article examines the analytical and empirical underpinnings of the BES valence model and compares it to the party-driven approach. To do so, it estimates cross-lagged structural equation models of the association between Labour Party preference and evaluations of the Labour government's performance during the 2005–10 British electoral cycle. It shows that party preference has a stronger effect on performance evaluations than vice versa; performance evaluations have no significant effect on party preference toward the end of the electoral cycle. The study also finds that, contrary to claims made concerning their merits as simplifying heuristics, performance assessments have no impact on short-term movements in party choice for less politically attentive voters. To a substantial degree, evaluations of party performance express—rather than explain—party choice, and would appear to have limited merit as simplifying heuristics.
Spatial turbulence spectra for high-Reynolds-number shear flows are usually obtained by mapping experimental frequency spectra into wavenumber space using Taylor’s hypothesis, but this is known to be less than ideal. In this paper, we propose a cross-spectral approach that allows us to determine the entire wavenumber–frequency spectrum using two-point measurements. The method uses cross-spectral phase differences between two points – equivalent to wave velocities – to reconstruct the wavenumber–frequency plane, which can then be integrated to obtain the spatial spectrum. We verify the technique on a particle image velocimetry (PIV) data set of a turbulent boundary layer. To show the potential influence of the different mappings, the transfer functions that we obtained from our PIV data are applied to hot-wire data at approximately the same Reynolds number. Comparison of the newly proposed technique with the classic approach based on Taylor’s hypothesis shows that – as expected – Taylor’s hypothesis holds for larger wavenumbers (small spatial scales), but there are significant differences for smaller wavenumbers (large spatial scales). In the range of Reynolds number examined in this study, double-peaked spectra in the outer region of a turbulent wall flow are thought to be the result of using Taylor’s hypothesis. This is consistent with previous studies that focused on examining the limitations of Taylor’s hypothesis (del Álamo & Jiménez, J. Fluid Mech., vol. 640, 2009, pp. 5–26). The newly proposed mapping method provides a data-driven approach to map frequency spectra into wavenumber spectra from two-point measurements and will allow the experimental exploration of spatial spectra in high-Reynolds-number turbulent shear flows.
Neuropsychiatric symptoms (NPS) are highly prevalent in dementia. The recently developed Neuropsychiatric Inventory – Clinician rating scale (NPI-C) includes clinical judgment and new symptom domains. Our objective was to evaluate NPI-C reliability and to compare caregiver and clinician ratings across the range of mild to severe cognitive impairment.
This is a cross-sectional observational study. Participants were geriatric memory clinic patients and nursing-home residents (n = 30) with an established diagnosis of dementia or Mild Cognitive Impairment (MCI). A psychiatrist (MK) interviewed caregiver–patient dyads using the NPI-C. Neuropsychological tests and Mini-Mental State Examination (MMSE) were used to assess cognitive impairment. Two NPI-C caregiver interviews were videotaped and rated by psychologists and geriatricians. Intra-class correlations (ICCs) were used to examine inter-rater agreement. Correlation coefficients were calculated to evaluate caregiver and psychiatrist NPI-C ratings. Disagreement between caregiver and clinician was expressed in delta scores and examined across the range of mild to severe cognitive impairment, using Levene's homogeneity of variances tests.
Inter-rater agreement on ratings of two caregiver videos was high (ICC = 0.99–1.0). Clinician–caregiver concordance on NPI-C total severity ratings was high (r = 0.77). Variability in clinician–caregiver concordance was associated with cognitive impairment: MMSE (P = 0.02), CAMCOG-R (Cambridge Cognitive Examination-revised) total scores (P = 0.02), CAMCOG-R Memory scores (P = 0.04) and Language scores (P = 0.01).
The NPI-C is a reliable measure of NPS in patients with MCI or dementia. Clinician–caregiver agreement on NPS severity may vary with cognitive impairment, underlining the importance of clinician-based measures of NPS.
Despite the fact that California Indians lived, gathered, hunted, and managed lowland oak ecosystems for millennia, the land was productive enough in the 1860s to support a new and very intensive land use: modern agriculture. Drawing from an existing legacy of the Indian era – its fertile soils, biodiversity, conserved water, and abundant timber resources – modern agriculture flourished. This chapter characterizes the indigenous food cultivation and management systems that were in place in California's lowland oak ecosystems at European contact.
Harlan (1992:242) reminds us that to develop a sustainable agriculture, “We need to approach the daunting tasks ahead with more humility and take a broader view of the ecosystems we must manage”. Following Harlan, we suggest that indigenous manipulation of plants for food not be viewed in isolation, but rather in a broader context of prehistoric subsistence systems and how these systems fit within and impact dynamic and diverse ecosystems. For example, wildlands contain plant resources for fuel, weapons, clothing, basketry, cordage, tools, dyes, and medicines. Yet vegetation manipulation to augment wild plant populations for these needs is seldom considered in tandem with food getting. By focusing upon one cultural use category, we argue that the multi-dimensionality of human traditional ecological knowledge remains obscured. Native people are viewed as preoccupied with ???getting food???, rather than understanding the structure and function of ecosystems and how they can be modified to provide for all of their needs.
The subaqueous margins of calving glaciers have the potential to make significant contributions to glacier mass loss. However, to date, very little is known about the morphology and development of subaqueous margins. A unique combination of sub-bottom profile and bathymetric data collected between 2008 and 2010 in proglacial lakes at Mueller, Hooker and Tasman glaciers in New Zealand’s Southern Alps reveal subaqueous ice ramps extending up to 510 m from the terminus of each glacier. Ice ramp surfaces are undulating and covered with a thick layer (up to 10 m) of unsorted sediment derived from supraglacial and englacial debris, lateral moraines and deltaic deposits. A cyclic calving pattern, relatively stable lake level and the debris cover appear to control the development and maintenance of these ice ramps. High subaerial retreat rates generally correspond to high subaqueous calving rates, although the highest subaerial retreat rates are not associated with the largest ice ramp. Debris mantling the subaqueous ice ramp surfaces insulates the ice from melting and also reduces buoyant forces acting on the terminus. Comparisons with previous studies show that the ice ramps evolve over time with changes in glacier dynamics and water-body properties.
The anthropogenic accidents in the world (including the underground emergency nuclear explosion at the site “Kraton-3” (Yakutiya) and also the recent Fukushima accident) resulted in significant environmental pollution by radionuclides, mainly long-lived 90Sr and 137Cs. One of the ways to solve this problem is the creation of “permeable reactive barriers” (PRBs). High selectivity of clinoptilolite-containing tuffs (CLT) towards Sr2+ and Cs+ radionuclides, together with their availability and reasonable cost, make possible their use as PRBs. The scales of the ion-exchange processes taking place on PRBs indicate the necessity of mathematical modelling. In this connection, Sr2+ and Cs+ ion-exchange sorption on Khonguruu CLT (Yakutiya) from solutions of various mineralizations was studied under equilibrium and non-equilibrium conditions. The physicochemical and mathematical models of the dynamic ion-exchange process and also the computer program considering both structural features of CLT (two-stage particle diffusion kinetics) and possible periodic interruptions of the process were developed. The breakthrough time of CLT as a geochemical barrier was calculated by such mathematical modelling.
When examining how emotions are evoked through music, the role of musical expectancy is often surprisingly under-credited. This mechanism, however, is most strongly tied to the actual structure of the music, and thus is important when considering how music elicits emotions. We briefly summarize Leonard Meyer's theoretical framework on musical expectancy and emotion and cite relevant research in the area.