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Delirium is common in hospital settings, with approximately 3% to 45% of older patients in hospitals developing delirium during their stay. Among the elderly and those with severe or advanced medical conditions, the reported percentage of patients with delirium is over 56%. The three motor subtypes of delirium are hyperactive, hypoactive, and mixed. Another way to characterize delirium is based on whether it is reversible, irreversible, or terminal.
Objectives
Identifying appropriate pharmacological treatment options among antipsychotics and their correlation with various precipitating and predisposing factors in the in-hospital context
Methods
This was a retrospective, cross-sectional, observational study that utilized a database created by the psychiatry department at the National Medical Center 20 de Noviembre, with data collected from April 2021 to April 2022. The database contains anonymized administrative and clinical data of patients who were seen in the psychiatry department for the diagnosis of any type of delirium, using the CAM scale for classification. The database includes records and data of hospitalized patients, encompassing all specialties at this medical center
Results
A total of 139 patients were included in the study, of which 39% were female and 61% were male, with a mean age of 67 and a median age of 68 years. It was observed that the average duration of delirium symptoms, from receiving the consultation to remission, was approximately 6 days (p <0.005) (OR 5.12-6.62), and the average length of hospital stay was approximately 20 days (OR 17.3-22.09). Among the patients, 50.39% were overweight, 63% had hypertension (HTA), 29% had chronic kidney injury, 24% had a history of delirium, and 73% had recent surgical interventions. Patients with diabetes mellitus had a 3.1 times higher risk, those with HTA had a 2.8 times higher risk, and those with kidney injury had a 3.8 times higher risk of having a positive CAM result. It was observed that haloperidol, used in 84% of the patients, showed the highest percentage reduction in CAM scores
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Conclusions
The results of this study emphasize the importance of identifying risk factors associated with delirium and implementing effective treatment for this condition. It was observed that the average duration of delirium symptoms was approximately 6 days, which is relevant for understanding the course and management of this illness. Furthermore, it was found that the average hospital stay was 20 days, underscoring the burden that delirium can place on healthcare systems.
In conclusion, this study highlights the importance of identifying risk factors and providing appropriate treatment, such as the use of haloperidol, to improve outcomes in patients with delirium.
Elimination disorders (ED) include enuresis, defined as wetting from 5 years, and encopresis, defined as soiling from 4 years onwards after organic causes are excluded. They are highly prevalent in childhood and often associated with clinically relevant comorbid psychological disorders. However, no systematic review or meta-analysis examines their co-occurrence with internalizing and externalizing problems in children.
Objectives
The aim of this study is to determine if, and to what extent, children with ED show higher internalizing and externalizing problems than their healthy peers.
Methods
A multistep literature search was performed from database inception until May 1st, 2022. PRISMA/MOOSE-compliant systematic review (PROSPERO: CRD42022303555) were used to identify studies reporting on internalizing and/or externalizing symptoms in children with an ED and a healthy control (HC) group. First, a systematic review was provided. Second, where data allowed for it, a quantitative meta-analysis using random effects model was conducted to analyze the differences between the ED and the HC groups for internalizing and externalizing symptoms. Effect size was standardized mean difference. Meta-regression analyses were conducted to examine the effect of sex, age, and study quality. Funnel plots were used to detect a publication bias. Where found, the trim and fill method was used to correct it.
Results
36 articles were included, 32 of them reporting on enuresis (n=3244; mean age=9.4; SD=3.4; 43.84% female) and 7 of them on encopresis (n=214; mean age=8.6; SD=2.3; 36.24% female) [Image 1]. The ED group presented significantly lower self-concept (ES:0.42; 95%CI: [0.08;9.76]; p=0.017) and higher symptom scores for thought problems (ES:-0.26; 95%CI: [-0.43;-0.09]; p=0.003), externalizing symptoms (ES:-0.20; 95%CI: [-0.37;-0.03]; p=0.020), attention problems (ES:-0.37; 95%CI: [-0.51;-0.22]; p=0.0001), aggressive behaviour (ES:-0.33; 95%CI: [-0.62;-0.04]; p=0.025) and social problems (ES: 0.39; 95%CI: [-0.58;-0.21]; p=0.0001) [Image 2]. Significant publication biases were found across several of the studied domains [Image 3]. No significant effect of sex, age or quality of the study score was found.
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Conclusions
Children with an elimination disorder may have significant internalizing and externalizing problems, as well as impaired self-concept. It is recommendable to screen for them in children with ED and provide interventions as appropriate.
The shallow-water hydrothermal system of Punta Mita in Banderas Bay is located on the fault called Fisura de las Coronas off Punta Pantoque beach. In this area, three sites with hydrothermal vents were studied at a depth of 9 m. This study aimed to characterize the structure of the benthic infauna communities that coexist in this hydrothermal system; therefore, physicochemical parameters were measured and the organisms found in the sediment samples were identified up to the class taxonomic level. The highest temperatures (89°C) were recorded within the hydrothermal influence area, which was reflected in an inverse relationship with pH, conductivity and salinity. Sediment temperature profiles increased at greater depth. A total of 371 individuals were found and these were grouped into eight classes: Malacostraca, Maxillopoda, Gastropoda, Bivalvia, Scaphopoda, Polychaeta, Leptocardii and Stenolaemata. The Malacostraca class was the most abundant with 240 individuals, while the Scaphopoda was the lowest with 3. The organic matter contents in the sediments were higher in the areas adjacent to the hydrothermal activity. The high temperature of the hydrothermal discharges structures the benthic community since it was the factor that differed most significantly in the study sites, causing lower abundances in the area of hydrothermal influence compared with the more distant areas. Despite the above, it is concluded that the benthic community of the area with hydrothermal activity is part of the community adjacent to this influence, only in lower numbers.
A fundamental question for theories of massive star formation is whether OB stars can form in isolation. We assess the contribution of any in-situ OB star formation by using 210 field OB stars in the Small Magellanic Cloud (SMC) from the Runaways and Isolated O-Type Star Spectroscopic Survey of the SMC (RIOTS4). We search for tiny, sparse clusters around our target OB stars using cluster-finding algorithms. Employing statistical tests, we compare these observations with random-field data sets. We find that ∼5% of our target fields do show evidence of higher central stellar densities, implying the presence of small clusters. This frequency of small clusters is low and within errors, it is also consistent with the field OB population being composed entirely of runaway and walkaway stars. Assuming this small cluster fraction is real, it implies that some OB stars may form in highly isolated conditions. The low frequency could be caused by these clusters evaporating on a short timescale. However, another interpretation is that the low fraction of small clusters is observed because these form rarely, or not at all, implying a higher cluster lower-mass limit and generally consistent with a relationship between maximum stellar mass (mmax) and the cluster mass (Mcl).
Longitudinal data on the mental health impact of the coronavirus disease 2019 (Covid-19) pandemic in healthcare workers is limited. We estimated prevalence, incidence and persistence of probable mental disorders in a cohort of Spanish healthcare workers (Covid-19 waves 1 and 2) -and identified associated risk factors.
Methods
8996 healthcare workers evaluated on 5 May–7 September 2020 (baseline) were invited to a second web-based survey (October–December 2020). Major depressive disorder (PHQ-8 ≥ 10), generalised anxiety disorder (GAD-7 ≥ 10), panic attacks, post-traumatic stress disorder (PCL-5 ≥ 7), and alcohol use disorder (CAGE-AID ≥ 2) were assessed. Distal (pre-pandemic) and proximal (pandemic) risk factors were included. We estimated the incidence of probable mental disorders (among those without disorders at baseline) and persistence (among those with disorders at baseline). Logistic regression of individual-level [odds ratios (OR)] and population-level (population attributable risk proportions) associations were estimated, adjusting by all distal risk factors, health care centre and time of baseline interview.
Results
4809 healthcare workers participated at four months follow-up (cooperation rate = 65.7%; mean = 120 days s.d. = 22 days from baseline assessment). Follow-up prevalence of any disorder was 41.5%, (v. 45.4% at baseline, p < 0.001); incidence, 19.7% (s.e. = 1.6) and persistence, 67.7% (s.e. = 2.3). Proximal factors showing significant bivariate-adjusted associations with incidence included: work-related factors [prioritising Covid-19 patients (OR = 1.62)], stress factors [personal health-related stress (OR = 1.61)], interpersonal stress (OR = 1.53) and financial factors [significant income loss (OR = 1.37)]. Risk factors associated with persistence were largely similar.
Conclusions
Our study indicates that the prevalence of probable mental disorders among Spanish healthcare workers during the second wave of the Covid-19 pandemic was similarly high to that after the first wave. This was in good part due to the persistence of mental disorders detected at the baseline, but with a relevant incidence of about 1 in 5 of HCWs without mental disorders during the first wave of the Covid-19 pandemic. Health-related factors, work-related factors and interpersonal stress are important risks of persistence of mental disorders and of incidence of mental disorders. Adequately addressing these factors might have prevented a considerable amount of mental health impact of the pandemic among this vulnerable population. Addressing health-related stress, work-related factors and interpersonal stress might reduce the prevalence of these disorders substantially. Study registration number: NCT04556565
During the COVID-19 pandemic, the use of telemedicine as a way to reduce COVID-19 infections was noted and consequently deregulated. However, the degree of telemedicine regulation varies from country to country, which may alter the widespread use of telemedicine. This study aimed to clarify the telepsychiatry regulations for each collaborating country/region before and during the COVID-19 pandemic.
Methods
We used snowball sampling within a global network of international telepsychiatry experts. Thirty collaborators from 17 different countries/regions responded to a questionnaire on barriers to the use and implementation of telepsychiatric care, including policy factors such as regulations and reimbursement at the end of 2019 and as of May 2020.
Results
Thirteen of 17 regions reported a relaxation of regulations due to the pandemic; consequently, all regions surveyed stated that telepsychiatry was now possible within their public healthcare systems. In some regions, restrictions on prescription medications allowed via telepsychiatry were eased, but in 11 of the 17 regions, there were still restrictions on prescribing medications via telepsychiatry. Lower insurance reimbursement amounts for telepsychiatry consultations v. in-person consultations were reevaluated in four regions, and consequently, in 15 regions telepsychiatry services were reimbursed at the same rate (or higher) than in-person consultations during the COVID-19 pandemic.
Conclusions
Our results confirm that, due to COVID-19, the majority of countries surveyed are altering telemedicine regulations that had previously restricted the spread of telemedicine. These findings provide information that could guide future policy and regulatory decisions, which facilitate greater scale and spread of telepsychiatry globally.
Methane (CH4) is a greenhouse gas (GHG) produced and released by eructation to the atmosphere in large volumes by ruminants. Enteric CH4 contributes significantly to global GHG emissions arising from animal agriculture. It has been contended that tropical grasses produce higher emissions of enteric CH4 than temperate grasses, when they are fed to ruminants. A number of experiments have been performed in respiration chambers and head-boxes to assess the enteric CH4 mitigation potential of foliage and pods of tropical plants, as well as nitrates (NO3−) and vegetable oils in practical rations for cattle. On the basis of individual determinations of enteric CH4 carried out in respiration chambers, the average CH4 yield for cattle fed low-quality tropical grasses (>70% ration DM) was 17.0 g CH4/kg DM intake. Results showed that when foliage and ground pods of tropical trees and shrubs were incorporated in cattle rations, methane yield (g CH4/kg DM intake) was decreased by 10% to 25%, depending on plant species and level of intake of the ration. Incorporation of nitrates and vegetable oils in the ration decreased enteric CH4 yield by ∼6% to ∼20%, respectively. Condensed tannins, saponins and starch contained in foliages, pods and seeds of tropical trees and shrubs, as well as nitrates and vegetable oils, can be fed to cattle to mitigate enteric CH4 emissions under smallholder conditions. Strategies for enteric CH4 mitigation in cattle grazing low-quality tropical forages can effectively increase productivity while decreasing enteric CH4 emissions in absolute terms and per unit of product (e.g. meat, milk), thus reducing the contribution of ruminants to GHG emissions and therefore to climate change.
In response to the rapid spread of novel coronavirus disease 2019 (COVID-19), health-care systems should establish procedures for early recognition and management of suspected or confirmed cases. We describe the various steps taken for the development, implementation, and dissemination of the interdisciplinary COVID-19 protocol at Jackson Health System (JHS), a complex tertiary academic health system in Miami, Florida. Recognizing the dynamic nature of COVID-19, the protocol addresses the potential investigational treatment options and considerations for special populations. The protocol also includes infection prevention and control measures and routine care for suspected or proven COVID-19 patients.
Increasing clinical and experimental evidence accumulated during the past few decades supports an important role for dietary advanced glycation endproducts (AGE) in the pathogenesis of many chronic non-infectious diseases, such as type 2 diabetes, CVD and others, that are reaching epidemic proportions in the Western world. Although AGE are compounds widely recognised as generated in excess in the body in diabetic patients, the potential importance of exogenous AGE, mostly of dietary origin, has been largely ignored in the general nutrition audience. In the present review we aim to describe dietary AGE, their mechanisms of formation and absorption into the body as well as their main mechanisms of action. We will present in detail current evidence of their potential role in the development of several chronic non-infectious clinical conditions, some general suggestions on how to restrict them in the diet and evidence regarding the potential benefits of lowering their consumption.
The fabrication of bimetallic magnetic nanoparticles (NPs) smaller than the size of single magnetic domain is very challenging because of the agglomeration, non-uniform size, and possible complex chemistry at nanoscale. In this paper, we present an alloyed ferromagnetic 4 ± 1 nm thiolated Au/Co magnetic NPs with decahedral and icosahedral shape. The NPs were characterized by Cs-corrected scanning transmission electron microscopy (STEM) and weretheoretically studied by Grand Canonical Monte Carlo simulations. Comparison of Z-contrast imaging and energy dispersive x-ray spectroscopy used jointly with STEM simulated images from theoretical models uniquely showed an inhomogeneous alloying with minor segregation. The magnetic measurements obtained from superconducting quantum interference device magnetometer exhibited ferromagnetic behavior. This magnetic nanoalloy in the range of single domain is fully magnetized and carries significance as a promising candidate for magnetic data recording, permanent magnetization, and biomedical applications.
Species distribution modelling has been a powerful tool to explore the potential distribution of parasites in wildlife, being the basis of studies on biogeography. Vexillata spp. are intestinal nematodes found in several species of mammalian hosts, such as rodents (Geomyoidea) and hares (Leporidae) in the Nearctic and northern Neotropical regions. In the present study, we modelled the potential distribution of Vexillata spp. and their hosts, using exclusively species from the Geomyidae and Heteromyidae families, in order to identify their distributional patterns. Bioclimatic and topographic variables were used to identify and predict suitable habitats for Vexillata and its hosts. Using these models, we identified that temperature seasonality is a significant environmental factor that influences the distribution of the parasite genus and its host. In particular, the geographical distribution is estimated to be larger than that predicted for its hosts. This suggests that the nematode has the potential to extend its geographical range and also its spectrum of host species. Increasing sample size and geographical coverage will contribute to recommendations for conservation of this host–parasite system.
We determined the rate of nosocomial viral respiratory infection in infants and the effect of an infection control program during 4 winter seasons. The rate of nosocomial viral respiratory infection decreased from 6.09 episodes per 100 patients admitted during the first study year to 1.46 episodes per 100 patients admitted during the last study year.
A retrospective population-based study was conducted between January 1990 and December 1998 to investigate the incidence of Mycobacterium kansasii disease and the heterogeneity of the isolates in a well-defined geographical area in Catalonia, Spain. A total of 136 patients were identified. Overall incidence and incidence in AIDS patients was 1·5 (95% CI 1·2–1·8) and 1089·6 (95% CI 689–1330) cases/100000 persons per year respectively, which is comparable to that reported from most of other geographical areas. Surprisingly, although 7 subtypes of M. kansasii have been consistently reported, in the present study 91 of the 93 isolates (97·8%) tested for genotype were subtype I, regardless of HIV status of the patients. In conclusion, the high rate of infection observed in the AIDS population contributes significantly to the burden of the M. kansasii disease in our area. M. kansasii disease in our geographical area was almost exclusively caused by subtype I regardless of HIV status.
The effects on rabbit welfare of transport in two seasons (summer and winter) and at two stocking densities (high stocking density: 12 rabbits per cage; low stocking density: 8 rabbits per cage) were studied. The loss of live weight during transport was calculated. At slaughter, blood samples were obtained and some physiological parameters related to stress were analysed: cortisol, creatine kinase (CK), lactate dehydrogenase (LDH), lactate, glucose, packed cell volume (PCV), osmolarity, and albumin and globulin concentrations. In addition, liver and muscle samples were taken and immediately frozen in liquid nitrogen for subsequent glycogen measurements.
Season significantly affected the live-weight losses and plasma concentrations of cortisol (P < 0.01), CK, LDH, lactate (P < 0.001) and glucose (P < 0.01), as well as osmolarity (P < 0.001). Liver and muscle glycogen concentration were also affected by the season (P < 0.001). The loss of live weight was higher in rabbits transported in winter than in summer. The plasma concentrations of cortisol, lactate and glucose, CK and LDH activity, and osmolarity, as well as liver and muscle glycogen concentrations were higher in rabbits transported in summer than in winter. Stocking density had no effect on the analysed parameters. The high levels of the analysed blood parameters, which are related to stress, lead to the conclusion that the welfare of the rabbits transported in summer was more affected than those transported in winter.
Let X be a locally compact metric absolute neighbourhood retract for metric spaces, U ⊂ X be an open subset and f: U → X be a continuous map. The aim of the paper is to study the fixed point index of the map that f induces in the hyperspace of X. For any compact isolated invariant set, K ⊂ U, this fixed point index produces, in a very natural way, a Conley-type (integer valued) index for K. This index is computed and it is shown that it only depends on what is called the attracting part of K. The index is used to obtain a characterization of isolating neighbourhoods of compact invariant sets with non-empty attracting part. This index also provides a characterization of compact isolated minimal sets that are attractors.
The immunohistochemical location of glial fibrillary acidic protein (GFAP) was used to study the state of maturation of retinal astrocytes from an 18-mo-old infant and to compare it with the situation in the adult. Infant astrocytes showed intense GFAP immunoreactivity in the perikarya and possessed spindle-like enlargements in their processes, while in the adult immunoreactivity in the perikarya was scarce and the spindle-like enlargements were not evident. Two types of astrocyte were observed in adult and child retinas: elongated and star-shaped. In the adult, the star-shaped type tend to be more stylised and to have longer processes than in the infant. In the infant, numerous astrocyte cell bodies were observed over vessels, while in the adult these were scarce. In the infant, the star-shaped astrocytes made up a honeycomb plexus, but this was not fully developed. These results suggest that at 18 mo of postnatal development the retinal astrocytes are still increasing and growing into the astroglial structure found in adults.
This paper describes the microstructural characterization, using transmission electron microscopy (TEM), of the solid-state, diffusion-bonded interfaces generated in a SiC whisker-reinforced, aluminum composite. Diffusion bonding was carried out using an aluminum-lithium alloy as the bonding interlayer. Two kinds of bonded interface were studied: those generated between the composite matrix and the metallic interlayer (metallic-metallic) and other ceramic-metallic interfaces formed between the interlayer and the SiC whiskers. The first showed the formation of zones of recrystallization across the original bond interface, and the second generally presented a high degree of continuity without the formation of interface reaction layers between the SiC whiskers and the interlayer. However, the formation of a degradation oxide layer was detected in some of the whisker/interlayer diffusion bonds. Its presence is due to the reaction between the alloying elements of the Al–Li interlayer and the SiO2 layer which surround some of the whiskers of the parent composite.
Thin films of (Y0.92Eu0.08)2O3 were synthesized through chemical vapor deposition of β-diketonate precursors onto glass and sapphire substrates. The films were weakly luminescent in the as-deposited condition and were composed of spherical particles 3 μm in diameter. A KrF laser was pulsed for 25 ns from 1–3 times on the surface of the films. One pulse was sufficient to melt the film and repeated pulses caused ablation of the material. Melting of the film smoothed the surface, increased the density, and increased the photoluminescent emission intensity.