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Introduction: Prevalence and incidence of delirium in older patients admitted to acute and long-term care facilities ranges between 9.6% and 89% but little is known in the context of emergency department (ED) incident delirium. Literature regarding the incidence of delirium in the ED and its potential impacts on hospital length of stay (LOS), functional status and unplanned ED readmissions is scant, its consequences have yet to be clearly identified in order to orient modern acute medical care. Methods: This study is part of the multicenter prospective cohort INDEED study. Three Canadian EDs completed the two years prospective study (March-July 2015 and Feb-May 2016). Patients aged 65 years old, initially free of delirium with an ED stay 8hours were followed up to 24h after ward admission. Patients were assessed 2x/day during their entire ED stay and up to 24 hours on hospital ward by research assistants (RA). The primary outcome of this study was incident delirium in the ED or within 24 h of ward admission. Functional and cognitive status were assessed using validated Older Americans’ Resources and Services and the Telephone Interview for Cognitive Status- modified tools. The Confusion Assessment Method (CAM) was used to detect incident delirium. ED and hospital administrative data were collected. Inter-observer agreement was realized among RA. Results: Incident delirium was not different between sites, nor between phases, nor between times from one site to another. All phases confounded, there is between 7 to 11% of ED related incident delirious episodes. Differences were seen in ED LOS between sites in non-delirious patients, but also between some sites for delirious participants (p<0.05). Only one site had a difference in ED LOS between their delirious and non-delirious patients, respectively of 52.1 and 40.1 hours (p<0.05). There is also a difference between sites in the time between arrival to the ED and the incidence of delirium (p=0.003). Kappa statistics were computed to measure inter-rater reliability of the CAM. Based on an alpha of 5%, 138 patients would allow 80% power for an estimated overall incidence proportion of 15 % with 5% precision.. Other predictive delirium variables, such as cognitive status, environmental factors, functional status, comorbidities, physiological status, and ED and hospital length of stay were similar between sites and phases. Conclusion: The fact that incidence of delirium was the same for all sites, despite the differences of ED LOS and different time periods suggest that many other modifiable and non-modifiable factors along LOS influenced the incidence of ED induced delirium. Emergency physician should concentrate on improving senior-friendly environment for the ED.
Introduction: It is documented that physicians and nurses fail to detect delirium in more than half of cases from various clinical settings, which could have serious consequences for seniors and for our health care system. The present study aimed to describe the rate of documented incident delirium in 5 Canadian Emergency departments (ED) by health professionals (HP). Methods: This study is part of the multicenter prospective cohort INDEED study. Patients aged 65 years old, initially free of delirium with an ED stay 8hours were followed up to 24h after ward admission. Delirium status was assessed twice daily using the Confusion Assessment Method (CAM) by trained research assistants (RA). HP reviewed patient charts to assess detection of delirium. HP had no specific routine detection of delirious ED patients. Inter-observer agreement was realized among RA. Comparison of detection between RA and HP was realized with univariate analyses. Results: Among the 652 included patients, 66 developed a delirium as evaluated with the CAM by the RA. Among those 66 patients, only 10 deliriums (15.2%) were documented in the patients medical file by the HP. 54 (81.8%) patients with a CAM positive for delirium by the RA were not recorded by the HP, 2 had incomplete charts. The delirium index was significantly higher in the HP reported group compared to the HP not reported, respectively 7.1 and 4.5 (p<0.05). Other predictive delirium variables, such as cognitive status, functional status, comorbidities, physiological status, and ED and hospital length of stay were similar between groups. Conclusion: It seems that health professionals missed 81.8% of the potential delirious ED patients in comparison to routine structured screening of delirium. HP could identify patients with a greater severity of symptoms. Our study points out the need to better identify elders at risk to develop delirium and the need for fast and reliable tools to improve the screening of this disorder.
Coinfection with human immunodeficiency virus (HIV) and viral hepatitis is associated with high morbidity and mortality in the absence of clinical management, making identification of these cases crucial. We examined characteristics of HIV and viral hepatitis coinfections by using surveillance data from 15 US states and two cities. Each jurisdiction used an automated deterministic matching method to link surveillance data for persons with reported acute and chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections, to persons reported with HIV infection. Of the 504 398 persons living with diagnosed HIV infection at the end of 2014, 2.0% were coinfected with HBV and 6.7% were coinfected with HCV. Of the 269 884 persons ever reported with HBV, 5.2% were reported with HIV. Of the 1 093 050 persons ever reported with HCV, 4.3% were reported with HIV. A greater proportion of persons coinfected with HIV and HBV were males and blacks/African Americans, compared with those with HIV monoinfection. Persons who inject drugs represented a greater proportion of those coinfected with HIV and HCV, compared with those with HIV monoinfection. Matching HIV and viral hepatitis surveillance data highlights epidemiological characteristics of persons coinfected and can be used to routinely monitor health status and guide state and national public health interventions.
The two manners to improve the knowledge of the motions of the galilean satellites are the elaboration of a new theory and the use of high precision observations. In this paper, we present new results on these subjects.
We have applied the Sagnier's method in order to get a new theory of the motions and we describe here the second approximation which leads to a third order solution. In this solution appear coupled terms in longitude of the perijoves and longitudes of the nodes. The de Haerdtl's inequalities, which come from the 3-7 commensurability between satellites 3 and 4 are included in this solution. These developments, first computed by de Heardtl, have been improved by Lieske (1973). In our solution we introduce the use of the variables in inclination, and some new terms appear.
In order to get the best precision for the final ephemerides, the accuracy of the observations have to be improved: best results may be obtained with the use of the observations of mutual events. Simulations have shown the interest to take into account the variations of the albedo as a function of geographic longitudes and latitudes on the satellites themselves. So, the theoretical flux of light is closer to the observed one and the accuracy is improved. In 1985, mutual events occur and we have organized a campaign in order to obtain results of high precision.
Information about viral acute respiratory infections (ARIs) is essential for prevention, diagnosis and treatment, but it is limited in tropical developing countries. This study described the clinical and epidemiological characteristics of ARIs in children hospitalized in Vietnam. Nasopharyngeal samples were collected from children with ARIs at Ho Chi Minh City Children's Hospital 2 between April 2010 and May 2011 in order to detect respiratory viruses by polymerase chain reaction. Viruses were found in 64% of 1082 patients, with 12% being co-infections. The leading detected viruses were human rhinovirus (HRV; 30%), respiratory syncytial virus (RSV; 23·8%), and human bocavirus (HBoV; 7·2%). HRV was detected all year round, while RSV epidemics occurred mainly in the rainy season. Influenza A (FluA) was found in both seasons. The other viruses were predominant in the dry season. HRV was identified in children of all age groups. RSV, parainfluenza virus (PIV) 1, PIV3 and HBoV, and FluA were detected predominantly in children aged <6 months, 6–12 months, 12–24 months, and >24 months, respectively. Significant associations were found between PIV1 with croup (P < 0·005) and RSV with bronchiolitis (P < 0·005). HBoV and HRV were associated with hypoxia (P < 0·05) and RSV with retraction (P < 0·05). HRV, RSV, and HBoV were detected most frequently and they may increase the severity of ARIs in children.
Hyperemesis gravidarum (HG), severe nausea and vomiting of pregnancy, is characterized by prolonged maternal stress, undernutrition and dehydration. Maternal stress and malnutrition of pregnancy are linked to poor neonatal outcome and associated with poor adult health, and we recently showed that in utero exposure to HG may lead to increased risks of psychological and behavioral disorders in the offspring. In addition, we have shown familial aggregation of HG, which is strong evidence for a genetic component to the disease. In this study, we compare the rates of psychological and behavioral disorders in 172 adults with and 101 adults without a sibling with HG. The rate of emotional/behavioral disorders is identical (15%) in both groups. The results suggest that the etiology of HG is not likely to include genetic factors associated with emotional and behavioral disorders. In addition, this study provides evidence that the increased incidence of psychological/behavioral disorders among offspring of women with HG is attributable to the HG pregnancy itself, rather than to confounding genetic factors linked to HG.
In the solid-state field-controlled emitter (SSE), the emission barrier, which is the factor of utmost importance for surface electron emission, is tailored by a controlled extrinsic parameter like the injected space charge located near the surface. This is done by depositing an ultra-thin wide band-gap semiconductor layer on a metallic surface. It is an alternative approach to the thermionic or field emission for which the work function value is intrinsic to the material used. The emission current measurements from the SSE cold cathodes show stable emission, at low applied field (≈50 V/μm) and in poor vacuum (≈10−7 Torr). The new emission mechanism has been modeled, the calculations and the theoretical analysis confirm the experimental results. The fabrication of the SSE, either by a sputter deposition in vacuum or by a sol-gel technique, meets most of the demands specific to high throughput fabrication of cold cathodes with large emitting area dedicated to applications in vacuum microelectronics.
A pilot production Zone-melting Recrystallization system was designed and built with a capability to handle 25 wafer batches of 4“, 5“and 6“wafers. The design addresses several production requirements including high throughput, batch processing and automation. Measurements on product wafers indicate that material quality was not sacrificed to achieve production throughput levels. Exceptional structural quality and good electrical properties have been obtained on SOI wafers produced within this system. Specifically, defect densities as low as 5 X 104 /cm2 a level an order of magnitude lower than previously reported, have been achieved while the minority carrier lifetime of up to 30 microseconds, intrinsic dopant level < 2 X 1015 /cm3 and junction leakage below 1 X 1016 amperes/cm2 are either as good as or better than previously reported values. We believe that defect free ZMR material will become a reality.
We have characterized the Al/RuO2 interface after annealing at temperatures in the range 450° C-550° C for durations up to several hours by backscattering spectrometry, cross-sectional transmission electron microscopy, and electrical four point probe measurement of specially designed structures. The electrical measurement yields the specific contact resistance of the interface by applying a transmission line type model developped for this purpose. An interfacial aluminum-oxygen polycrystalline compound is shown to grow with annealing temperature and duration, with a concurrent reduction of a thin layer of RuO2. However, the specific contact resistance between Al and RuO2 is found to decrease with annealing duration at 500°C. This last result indicates that the interfacial reaction does not lead to an insulating interface as could have been expected if the growth were pure and dense A12O3.
Isolated silicon epitaxy (ISE) is a proven method of producing single crystalline silicon-on-insulator (SOI) material with excellent electrical properties. The presence of the remaining isolated dislocation trails in the epitaxial silicon has led to this investigation of the crystallinity throughout the ISE SOI layer and across the isolated dislocations. The structural perfection of these layers has been examined by defect etching, Nomarski optical microscopy, electron channeling patterns, and with more sensitivity using double crystal synchrotron X-ray diffraction and topography. Defect etching reveals the dislocation density within the layers of production ISE SOI material to be ~5×l0 5 /cm2. Electron channeling pattern techniques have reached the resolution limit of angular orientation resolution for the isolated silicon layer. Finally, synchrotron studies have shown that orientation homogeneity across 5" wafers are preserved to 0.006° and the variation in orientation across the defect trails to be, in general, less than 10 arcsec (0.003°), indicating single crystalline ISE SOI production material.
Thin films of amorphous TiP and TiPN2 alloys were deposited by sputtering of a TiP target in an Ar and N2/Ar mixture, respectively. These alloy films were tested as diffusion barriers between Al and Si as well as between Cu and Si and also in metallizations which included TiSi2 as the contacting layer. Rutherford backscattering spectrometry, x-ray diffraction and electrical measurements were used to determine the barrier effectiveness. We find that TiP and TiPN2 films prevent the interdiffusion and reaction between Al and Si up to 500°C and 600°C for 30 minutes annealing, respectively, and between Cu and Si up to 600°C and 700°C, respectively.
We study the properties of CuInSe2 thin films grown on glass and on Mo substrates. The investigation is carried out with X-ray diffraction, RBS, XTEM and SEM.
CuInSe2/Mo contact stability is investigated after annealing at 600°C. RBS reveals that this treatment induces an interdiffusion between the metal and the chalcopyrite. To clarify this reaction, we have investigated the individual thin-film couples upon annealing. RBS and X-ray diffraction reveal insignificant interaction between Mo/Cu and Mo/In, but Se reacts with Mo.
Non-linear optical second harmonic generation (SHG) from bulk silicon is very weak because of the inversion symmetry of the silicon lattice structure. However, when silicon material is subjected to the ion implantation and thermal annealing processes, the inversion symmetry will be broken. As a result, the optical second harmonic generation from the material will increase, and the characteristics of the second harmonic signal are related to the material conditions. In this study, we compare SHG results with Transmission Electron Microscope (TEM) observations for silicon material that has been treated with phosphorous ion implantation and rapid thermal annealing, and suggest that the SHG method may be used for the detection and monitoring of impurities and defects during ion implantation and thermal annealing processes.
Explosive crystallisation induced by an electron beam and by a CW Ar+ laser operating in fast scanning mode is observed for the first time on amorphized silicon layers created by implantation on either polycrystalline films deposited on Si02 or single crystal silicon substrates. The grain structure in the explosive crescents is studied by preferential chemical etching in conjunction with Nomarski optical microscopy, SEM and TEM. The results are similar to the so-called solid-phase explosive crystallization previously observed in a-Si films deposited on glass substrates.
A high proportion of plant nutrients present in animal feed are excreted and therefore animal manure can be an important source of nitrogen (N) for crop production if losses of plant nutrients to the environment during storage and processing are minimized. The present study examines gaseous N losses from stored pig slurry and during composting of solid manure as affected by protein and fibre content in the feed and manure management. Two slurry storage treatments (with and without cover) and three additives to solid manure composting (straw only, straw+lime and straw+superphosphate) were examined for three common types of pig feed in Vietnam (low-protein high-fibre, medium-protein medium-fibre and high-protein low-fibre).
Feed type was found to affect the N content in pig slurry or manure and thus potential N losses. The fraction of N loss caused by N emission from covered slurry storage was 0·25–0·30 of initial N content, while that from uncovered slurry was 0·60–0·70. After 90 days of storage, 1·15–1·20 times the initial ammonium-N (NH4-N) was found in the covered slurry and 0·40–0·50 in the uncovered. The fraction of N lost during composting with superphosphate was 0·25–0·35 of initial total N, while with lime or straw the total N loss was 0·45–0·55. With added superphosphate, 1·25–1·60 times the initial NH4-N in manure was found in the compost after 80 days compared with only 0·11–0·22 for lime and 0·22–0·36 for straw only. Covering stored slurry and addition of superphosphate when composting solid pig manure are thus important methods for Vietnamese farmers to minimize N losses and produce compost with a high content of plant-available N.
In the aftermath of Hurricane Katrina, a significant number of faith-based organizations (FBOs) that were not a part of the formal National Response Plan (NRP) initiated and sustained sheltering operations.
The objective of this study was to examine the sheltering opera-tions of FBOs, understand the decision-making process of FBO shelters, and identify the advantages and disadvantages of FBO shelters.
Verbal interviews were conducted with FBO shelter leaders. Inclusion criteria were: (1) opening in response to the Katrina disaster; (2) oper-ating for more than three weeks; and (3) being a FBO. Enrolled shelters were examined using descriptive data methods.
The majority of shelters operating in Mississippi up to three weeks post-Katrina were FBO-managed. All of the operating FBO shelters in Mississippi that met the inclusion criteria were contacted with a response rate of 94%. Decisions were made by individuals or small groups in most shelters regarding opening, operating procedures, and closing. Most FBOs provided at least one enabling service to evacuees, and all utilized informal networks for sheltering operations. Only 25% of FBOs had disaster plans in place prior to Hurricane Katrina.
Faith-based organization shelters played a significant role in the acute phase of the Katrina disaster. Formal disaster training should be ini-tiated for these organizations. Services provided by FBOs should be standard-ized. Informal networks should be incorporated into national disaster planning.
Invasive pneumococcal disease (IPD) notifications are used to monitor IPD vaccination programmes. We conducted sequential deterministic data-linkage between IPD notifications and hospitalization data in Victoria, Australia, in order to determine whether all diagnosed cases were being reported. The proportion of each relevant hospital admission ICD-10-AM code that could be linked to notified cases was calculated. Total and age-specific annual rates were calculated and compared for notified and non-notified cases. Total incidence was estimated using data-linkage results and application of a two-source capture–recapture method. The first 2 years of IPD surveillance in Victoria missed at least one-sixth of laboratory-confirmed IPD cases. Estimated annual IPD rate increased from 9·0 to 10·7/100 000 and rose even higher, to 11·5/100 000, with age-specific rates possibly reaching 90·0/100 000 children aged <2 years, when using capture–recapture. Strategies to improve notification and coding of hospitalized cases of IPD are required.