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Many patients with advanced serious illness or at the end of life experience delirium, a potentially reversible form of acute brain dysfunction, which may impair ability to participate in medical decision-making and to engage with their loved ones. Screening for delirium provides an opportunity to address modifiable causes. Unfortunately, delirium remains underrecognized. The main objective of this pilot was to validate the brief Confusion Assessment Method (bCAM), a two-minute delirium-screening tool, in a veteran palliative care sample.
This was a pilot prospective, observational study that included hospitalized patients evaluated by the palliative care service at a single Veterans’ Administration Medical Center. The bCAM was compared against the reference standard, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Both assessments were blinded and conducted within 30 minutes of each other.
We enrolled 36 patients who were a median of 67 years (interquartile range 63–73). The primary reasons for admission to the hospital were sepsis or severe infection (33%), severe cardiac disease (including heart failure, cardiogenic shock, and myocardial infarction) (17%), or gastrointestinal/liver disease (17%). The bCAM performed well against the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, for detecting delirium, with a sensitivity (95% confidence interval) of 0.80 (0.4, 0.96) and specificity of 0.87 (0.67, 0.96).
Significance of Results
Delirium was present in 27% of patients enrolled and never recognized by the palliative care service in routine clinical care. The bCAM provided good sensitivity and specificity in a pilot of palliative care patients, providing a method for nonpsychiatrically trained personnel to detect delirium.
Despite the transition from apartheid to democracy, South Africa is the most unequal country in the world. Its extremes of wealth and poverty undermine intensifying struggles for a better life for all. The wide-ranging essays in this sixth volume of the New South African Review demonstrate how the consequences of inequality extend throughout society and the political economy, crippling the quest for social justice, polarising the politics, skewing economic outcomes and bringing devastating environmental consequences in their wake. Contributors survey the extent and consequences of inequality across fields as diverse as education, disability, agrarian reform, nuclear geography and small towns, and tackle some of the most difficult social, political and economic issues. How has the quest for greater equality affected progressive political discourse? How has inequality reproduced itself, despite best intentions in social policy, to the detriment of the poor and the historically disadvantaged? How have shifts in mining and the financialisation of the economy reshaped the contours of inequality? How does inequality reach into the daily social life of South Africans, and shape the way in which they interact? How does the extent and shape of inequality in South Africa compare with that of other major countries of the global South which themselves are notorious for their extremes of wealth and poverty? South African extremes of inequality reflect increasing inequality globally, and The Crisis of Inequality will speak to all those – general readers, policy makers, researchers and students – who are demanding a more equal world.
The objective of this work is to identify synthetic pathways for materials useful in the effective repair of the skeletal system. Ideally a universal artificial bone would be identified that can function as a cementitious, pseudoplastic, or structural material. The cementitious form would be very important for bone adhesives that repair bone fractures and restore bone defects. The pseudoplastic form would aid in the in situ reconstruction of anatomical defects and the structural material could be used to prefabricate prostheses. It is critical of course for all these forms of the artificial bone to have strongly regenerative properties so that as implants they would integrate microscopically with natural bone.
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