Delirium frequently occurs among hospital in-patients, with significant attributable healthcare costs. It is associated with long-term adverse outcomes, including an eightfold increased risk of subsequent dementia. The purpose of this article is to inform clinicians of the best practices for spotting, stopping and treating delirium and provide guidance on common challenging clinical dilemmas. For spotting delirium, suggested screening tools are the 4 ‘A's Test (in general medical settings) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Prevention is best achieved with multicomponent interventions and targeted strategies focusing on: (a) avoiding iatrogenic causes; (b) brain optimisation by ensuring smooth bodily functioning; (c) maintaining social interactions and normality. Non-pharmacological approaches are the first line for treatment; they largely mirror prevention strategies, but the focus of empirical evidence is on prevention. Although sufficient evidence is lacking for most pharmacological approaches, an antipsychotic at low doses for short durations may be of utility for highly distressing or high-risk situations, particularly in hyperactive delirium, but only as a last resort.

Among nursing home outbreaks of coronavirus disease 2019 (COVID-19) with ≥3 breakthrough infections when the predominant severe acute respiratory coronavirus virus 2 (SARS-CoV-2) variant circulating was the SARS-CoV-2 δ (delta) variant, fully vaccinated residents were 28% less likely to be infected than were unvaccinated residents. Once infected, they had approximately half the risk for all-cause hospitalization and all-cause death compared with unvaccinated infected residents.

We report daptomycin minimum inhibitory concentrations (MICs) for vancomycin-resistant Enterococcus faecium isolated from bloodstream infections over a 4-year period. The daptomycin MIC increased over time hospital-wide for initial isolates and increased over time within patients, culminating in 40% of patients having daptomycin-nonsusceptible isolates in the final year of the study.

Infect Control Hosp Epidemiol 2018;39:226–228

Herbicide resistance is the heritable ability of a weed biotype or population to survive a herbicide application that would effectively kill a susceptible population of the weed. In the U.K. the most widespread and financially important herbicide-resistant weed is blackgrass. Investigations to elucidate the molecular mechanisms conferring herbicide resistance to blackgrass populations have been ongoing for two decades. Although the identification of target site–resistant populations has proved to be relatively straightforward (using, for example, target site assays in vitro), the study and understanding of resistance mechanisms involved in enhanced metabolism has proven to be more problematic. Research has focused on the cytochrome P450 monooxygenase and glutathione S-transferase (GST) enzyme families, both of which have been shown to be important in herbicide metabolism in many weed and crop species. GST activity and abundance are greater in a selection of herbicide-resistant blackgrass biotypes, and herbicide treatment of field populations of blackgrass results in the survival of the proportion of population possessing the greatest GST activity and abundance. In addition, GST activity in the field increases between winter and spring, and this coincides with reduced efficacy of important blackgrass herbicides. GST activities within field populations of blackgrass are highly varied, and this plasticity is discussed in relation to the development of resistant populations in field situations. This article describes research results in blackgrass and compares them with GST studies in other weed species as well as with other mechanisms for enhanced metabolism-based resistance.

XMM-Newton performs a survey of the sky in the 0.2-12 keV X-ray band while slewing between observation targets. The sensitivity in the soft X-ray band is comparable with that of the ROSAT all-sky survey, allowing bright transients to be identified in near real-time by a comparison of the flux in both surveys. Several of the soft X-ray flares are coincident with galaxy nuclei and five of these have been interpreted as candidate tidal disruption events (TDE). The first three discovered had a soft X-ray spectrum, consistent with the classical model of TDE, where radiation is released during the accretion phase by thermal processes. The remaining two have an additional hard, power-law component, which in only one case was accompanied by radio emission. Overall the flares decay with the classical index of t −5/3 but vary greatly in the early phase.

The present study is the first record of twinning in Lagenorhynchus acutus and indeed any Lagenorhynchus sp. Both foetuses were male and located in the left uterine horn, had distinct grossly normal placentas and amniotic sacs, and were therefore likely dizygotic twins. The twins were an incidental finding in an animal that died of a systemic Brucella ceti infection.

Infection caused by parasitic nematodes of humans and livestock can have significant health and economic costs. Treatments aimed at alleviating these costs, such as chemotherapy and vaccination, alter parasite survival and reproduction, the main selective pressures shaping life-history traits such as age to maturity, size and fecundity. Most authors have argued that the life-history evolution prompted by animal and public health programmes would be clinically beneficial, generating smaller, less fecund worms, and several mathematical models support this view. However, using mathematical models of long-lasting interventions, such as vaccination, and regularly repeated short interventions, such as drenching, we show here that the expected outcome actually depends on how mortality rates vary as a function of worm size and developmental status. Interventions which change mortality functions can exert selection pressure to either shorten or extend the time to maturity, and thus increase or decrease worm fecundity and size. The evolutionary trajectory depends critically on the details of the mortality functions with and without the intervention. Earlier optimism that health interventions would always prompt the evolution of smaller, less fecund and hence clinically less damaging worms is premature.

From a Chandra survey of nine interacting galaxy systems the evolution of X-ray emission during the merger process has been investigated. From comparing LX/LK and LFIR/LB it is found that the X-ray luminosity peaks ∼300 Myr before nuclear coalescence, even though we know that rapid and increasing star formation is still taking place at this time. It is likely that this drop in X-ray luminosity is a consequence of outflows breaking out of the galactic discs of these systems. At a time ∼1 Gyr after coalescence, the merger-remnants in our sample are X-ray dim when compared to typical X-ray luminosities of mature elliptical galaxies. However, we do see evidence that these systems will start to resemble typical elliptical galaxies at a greater dynamical age, given the properties of the 3 Gyr system within our sample, indicating that halo regeneration will take place within low LX merger-remnants.

I review here the current ideas regarding the origin, evolution, and physical nature of hot diffuse gas in normal, starburst, interacting and merging galaxies, using recent X-ray observations with XMM-Newton and Chandra. Many types of diffuse X-ray structures, including winds, bubbles, halos, chimneys and fountains, can be formed in galaxies, and can enrich the intergalactic medium with mass, energy and metals. This has profound implications as regards galactic formation and evolution, and the enrichment and evolution of galaxy groups and clusters.

We report on the results of XMM-Newton observations of nearby starburst galaxies that form part of a multi-wavelength study of all phases of extraplanar gas in external galaxies, which is conducted in order to assess the importance of halos as repositories of a metal-enriched medium and their significance in terms of galactic chemical evolution and possible metal enrichment of the intergalactic medium (IGM). XMM-Newton observations of the starburst galaxy NGC 1511 revealed e.g. the presence of a previously unknown extended hot gaseous phase of its interstellar medium (ISM), which partly extends out of the disk plane. We also present preliminary results based on XMM-Newton observations of NGC 1808, NGC 4666 and NGC 3628.

Disparity-tuned cells in primary visual cortex (V1) are thought to play a significant role in the processing of stereoscopic depth. The disparity-specific responses of these neurons have been previously described by an energy model based on local, feedforward interactions. This model fails to predict the response to binocularly anticorrelated stimuli, in which images presented to left and right eyes have opposite contrasts. The original energy model predicts that anticorrelation should invert the disparity tuning curve (phase difference π), with no change in the amplitude of the response. Experimentally, the amplitude tends to be reduced with anticorrelated stimuli and a spread of phase differences is observed, although phase differences near π are the most common. These experimental observations could potentially reflect a modulation of the V1 signals by feedback from higher visual areas (because anticorrelated stimuli create a weaker or nonexistent stereoscopic depth sensation). This hypothesis could explain the effects on amplitude, but the spread of phase differences is harder to understand. Here, we demonstrate that changes in both amplitude and phase can be explained by a straightforward modification of the energy model that involves only local processing. Input from each eye is passed through a monocular simple cell, incorporating a threshold, before being combined at a binocular simple cell that feeds into the energy computation. Since this local feedforward model can explain the responses of complex cells to both correlated and anticorrelated stimuli, there is no need to invoke any influence of global stereoscopic matching.