Association between frailty and delirium in older adult patients discharged from hospital.

BACKGROUND: Delirium and frailty - both potentially reversible geriatric syndromes - are seldom studied together, although they often occur jointly in older patients discharged from hospitals. This study aimed to explore the relationship between delirium and frailty in older adults discharged from hospitals. METHODS: Of the 221 patients aged >65 years, who were invited to participate, only 114 gave their consent to participate in this study. Delirium was assessed using the confusion assessment method, in which patients were classified dichotomously as delirious or nondelirious according to its algorithm. Frailty was assessed using the Edmonton Frailty Scale, which classifies patients dichotomously as frail or nonfrail. In addition to the sociodemographic characteristics, covariates such as scores from the Mini-Mental State Examination, Instrumental Activities of Daily Living scale, and Cumulative Illness Rating Scale for Geriatrics and details regarding polymedication were collected. A multidimensional linear regression model was used for analysis. RESULTS: Almost 20% of participants had delirium (n=22), and 76.3% were classified as frail (n=87); 31.5% of the variance in the delirium score was explained by frailty (R (2)=0.315). Age; polymedication; scores of the Confusion Assessment Method (CAM), instrumental activities of daily living, and Cumulative Illness Rating Scale for Geriatrics; and frailty increased the predictability of the variance of delirium by 32% to 64% (R (2)=0.64). CONCLUSION: Frailty is strongly related to delirium in older patients after discharge from the hospital.

Effect of Cumulating Exposure to Abacavir on the Risk of Cardiovascular Disease Events in Patients From the Swiss HIV Cohort Study.

BACKGROUND: Patients with HIV exposed to the antiretroviral drug abacavir may have an increased risk of cardiovascular disease (CVD). There is concern that this association arises because of a channeling bias. Even if exposure is a risk, it is not clear how that risk changes as exposure cumulates. METHODS: We assess the effect of exposure to abacavir on the risk of CVD events in the Swiss HIV Cohort Study. We use a new marginal structural Cox model to estimate the effect of abacavir as a flexible function of past exposures while accounting for risk factors that potentially lie on a causal pathway between exposure to abacavir and CVD. RESULTS: A total of 11,856 patients were followed for a median of 6.6 years; 365 patients had a CVD event (4.6 events per 1000 patient-years). In a conventional Cox model, recent--but not cumulative--exposure to abacavir increased the risk of a CVD event. In the new marginal structural Cox model, continued exposure to abacavir during the past 4 years increased the risk of a CVD event (hazard ratio = 2.06; 95% confidence interval: 1.43 to 2.98). The estimated function for the effect of past exposures suggests that exposure during the past 6-36 months caused the greatest increase in risk. CONCLUSIONS: Abacavir increases the risk of a CVD event: the effect of exposure is not immediate, rather the risk increases as exposure cumulates over the past few years. This gradual increase in risk is not consistent with a rapidly acting mechanism, such as acute inflammation.

The analgesic efficacy of ultrasound-guided transversus abdominis plane block (TAP Block) in adult patients : a meta-analysis

Introduction : Le bloc transverse de l'abdomen (bloc TAP, Transversus Abdominis Plane) échoguidé consiste en l'injection d'anesthésique local dans la paroi abdominale entre les muscles oblique interne et transverse de l'abdomen sous contrôle échographique. Ceci permet de bloquer l'innervation sensitive de la paroi antérolatérale de l'abdomen afin de soulager la douleur après des interventions chirurgicales. Auparavant, cette procédure reposait sur une technique dite « à l'aveugle » qui utilisait des repères anatomiques de surface. Depuis quelques années, cette technique est effectuée sous guidage échographique ; ainsi, il est possible de visualiser les structures anatomiques, l'aiguille et l'anesthésique local permettant ainsi une injection précise de l'anesthésique local à l'endroit désiré. Les précédentes méta- analyses sur le bloc TAP n'ont inclus qu'un nombre limité d'articles et n'ont pas examiné l'effet analgésique spécifique de la technique échoguidée. L'objectif de cette méta-analyse est donc de définir l'efficacité analgésique propre du bloc TAP échoguidé après des interventions abdominales chez une population adulte. Méthode : Cette méta-analyse a été effectuée selon les recommandations PRISMA. Une recherche a été effectuée dans les bases de donnée MEDLINE, Cochrane Central Register of Controlled Clinical Trials, Excerpta Medica database (EMBASE) et Cumulative Index to Nursing and Allied Health Literature (CINAHL). Le critère de jugement principal est la consommation intraveineuse de morphine cumulée à 6 h postopératoires, analysée selon le type de chirurgie (laparotomie, laparoscopie, césarienne), la technique anesthésique (anesthésie générale, anesthésie spinale avec/ou sans morphine intrathécale), le moment de l'injection (début ou fin de l'intervention), et la présence ou non d'une analgésie multimodale. Les critères de jugement secondaires sont, entre autres, les scores de douleur au repos et à l'effort à 6 h postopératoires (échelle analogique de 0 à 100), la présence ou non de nausées et vomissements postopératoires, la présence ou non de prurit, et le taux de complications de la technique. Résultats : Trente et une études randomisées contrôlées, incluant un total de 1611 adultes ont été incluses. Indépendamment du type de chirurgie, le bloc TAP échoguidé réduit la consommation de morphine à 6 h postopératoires (différence moyenne : 6 mg ; 95%IC : -7, -4 mg ; I =94% ; p<0.00001), sauf si les patients sont au bénéfice d'une anesthésie spinale avec morphine intrathécale. Le degré de réduction de consommation de morphine n'est pas influencé par le moment de l'injection (I2=0% ; p=0.72) ou la présence d'une analgésie multimodale (I2=73% ; p=0.05). Les scores de douleurs au repos et à l'effort à 6h postopératoire sont également réduits (différence moyenne au repos : -10 ; 95%IC : -15, -5 ; I =92% ; p=0.0002; différence moyenne en mouvement : -9 ; 95%IC : -14, -5 ; I2=58% ; p<0. 00001). Aucune différence n'a été retrouvée au niveau des nausées et vomissements postopératoires et du prurit. Deux complications mineures ont été identifiées (1 hématome, 1 réaction anaphylactoïde sur 1028 patients). Conclusions : Le bloc TAP échoguidé procure une analgésie postopératoire mineure et ne présente aucun bénéfice chez les patients ayant reçu de la morphine intrathécale. L'effet analgésique mineure est indépendant du moment de l'injection ou de la présence ou non d'une analgésie multimodale.

Predicted decrease in global climate suitability masks regional complexity of invasive fruit fly species response to climate change

Climate change affects the rate of insect invasions as well as the abundance, distribution and impacts of such invasions on a global scale. Among the principal analytical approaches to predicting and understanding future impacts of biological invasions are Species Distribution Models (SDMs), typically in the form of correlative Ecological Niche Models (ENMs). An underlying assumption of ENMs is that species-environment relationships remain preserved during extrapolations in space and time, although this is widely criticised. The semi-mechanistic modelling platform, CLIMEX, employs a top-down approach using species ecophysiological traits and is able to avoid some of the issues of extrapolation, making it highly applicable to investigating biological invasions in the context of climate change. The tephritid fruit flies (Diptera: Tephritidae) comprise some of the most successful invasive species and serious economic pests around the world. Here we project 12 tephritid species CLIMEX models into future climate scenarios to examine overall patterns of climate suitability and forecast potential distributional changes for this group. We further compare the aggregate response of the group against species-specific responses. We then consider additional drivers of biological invasions to examine how invasion potential is influenced by climate, fruit production and trade indices. Considering the group of tephritid species examined here, climate change is predicted to decrease global climate suitability and to shift the cumulative distribution poleward. However, when examining species-level patterns, the predominant directionality of range shifts for 11 of the 12 species is eastward. Most notably, management will need to consider regional changes in fruit fly species invasion potential where high fruit production, trade indices and predicted distributions of these flies overlap.

The influence of genetic and environmental factors among MDMA users in cognitive performance

This study is aimed to clarify the association between MDMA cumulative use and cognitive dysfunction, and the potential role of candidate genetic polymorphisms in explaining individual differences in the cognitive effects of MDMA. Gene polymorphisms related to reduced serotonin function, poor competency of executive control and memory consolidation systems, and high enzymatic activity linked to bioactivation of MDMA to neurotoxic metabolites may contribute to explain variations in the cognitive impact of MDMA across regular users of this drug. Sixty ecstasy polydrug users, 110 cannabis users and 93 non-drug users were assessed using cognitive measures of Verbal Memory (California Verbal Learning Test, CVLT), Visual Memory (Rey-Osterrieth Complex Figure Test, ROCFT), Semantic Fluency, and Perceptual Attention (Symbol Digit Modalities Test, SDMT). Participants were also genotyped for polymorphisms within the 5HTT, 5HTR2A, COMT, CYP2D6, BDNF, and GRIN2B genes using polymerase chain reaction and TaqMan polymerase assays. Lifetime cumulative MDMA use was significantly associated with poorer performance on visuospatial memory and perceptual attention. Heavy MDMA users (>100 tablets lifetime use) interacted with candidate gene polymorphisms in explaining individual differences in cognitive performance between MDMA users and controls. MDMA users carrying COMT val/val and SERT s/s had poorer performance than paired controls on visuospatial attention and memory, and MDMA users with CYP2D6 ultra-rapid metabolizers performed worse than controls on semantic fluency. Both MDMA lifetime use and gene-related individual differences influence cognitive dysfunction in ecstasy users.

Distribuição de compostos organoclorados nas águas e sedimentos da bacia do rio Piracicaba/SP - Brasil

The great utilization of synthetic and persistent xenobiotic cumulative compounds is the main causes of the deterioration of aquatic ecosystems. The one of objective of this work was the determination of the organochlorine levels in the Piracicaba river basin, situated at the center of São Paulo state. Four PCBs congeners, PCP and HCB were determined by GC-ECD in two different matrices: water and sediments. The pattern of the compound distribution indicated a dominance of PCP, HCB and PCB-200. The results indicated contamination in the sampling points located in Campinas, Piracicaba, Santa Bárbara d'Oeste and Sumaré cities.

Winner-Loser Performance and Macroeconomic Effects during three last Economic Crises in Finnish Stock Market

The main purpose of this thesis is to investigate winner-loser performance when financial markets are facing crisis. This is examined through the idea that does the prior loser portfolios outperform the prior winner portfolios during the three major crises: The depression of the 1990s, the IT-Bubble and the Subprime -crisis. Firstly, the winner and loser portfolios superiority is counted by using the cumulative excess returns from the examination period. The portfolios were formed by counting the excess returns and locating them in to the order of superiority. The excess returns are counted by using one year pre-data before the actual examination period. The results of this part did not support the results of De Bondt & Thaler’s (1985) paper. Secondly, it is investigated how the Finnish and the US macroeconomic factors are seen to be affecting the stock market valuation in Finnish Stock Markets during economic crises. This is done to explain better the changes in the successes of the winner-loser performance. The crises included different amount of selected macro factors. Two latest crises involved as well few selected US macro factors. Exclusively the IT-Bubble -crisis had the most statistically significant results with the US factors. Two other crises did not receive statistically significant results. An extra research was produced to study do the US macro factors impact more significantly on Finnish stock exchange after lags. The selected lags were three, six, nine and twelve months. Three and six month lagged US macro factors during the IT-Bubble -crisis improved the results. The extra research did not improve the results of the Subprime -crisis.

Osakekurssin reagointi tulosvaroitukseen nousu- ja laskumarkkinoilla

Tutkimuksen tavoitteena on selvittää tapahtuuko tulosvaroituksen yhteydessä yli- tai alireagointia nousu- ja laskumarkkinoiden aikana. Tutkimus tehdään tapahtumatutkimuksena, jossa tarkoituksena on tutkia osakkeiden epänormaaleja tuottoja tulosvaroituspäivän ympärillä. Tapahtumaikkunan pituus on yhteensä 11 päivää [-5, +5]. Aineisto koostuu Helsingin pörssin OMXH25 indeksin yritysten julkaisemista tulosvaroituksista vuosien 1997–2009 välillä. Tälle aikavälille osuu 200 päivän liukuvalla keskiarvolla mitattuna kaksi nousu- ja kaksi laskumarkkinaa. Tutkimuksessa ei havaittu selvää yli- tai alireagointia nousu- tai laskumarkkinoilla. Sen sijaan tietty säännöllisyys reagoinnissa tulosvaroituksiin löydettiin: Nousumarkkinoilla, tulosvaroituspäivän jälkeen näkyy selvä positiivinen tuotto kahden päivän ajalta tulosvaroituksen jälkeen, riippumatta siitä onko kyseessä positiivinen vai negatiivinen tulosvaroitus. Vastaavasti laskumarkkinoilla löydettiin selvä negatiivinen epänormaali tuotto kahden päivän ajalta tulosvaroituksen jälkeen.

La evaluación del estrés y del trauma: presentación de la versión española de la escala de trauma acumulativo (CTS)

This paper reviews some of the most usual definitions of stress and trauma including the notion of accumulative trauma. Then, the Spanish version of the Cumulative Trauma Scale by Kira et al (2008) is presented. It has been developed by following a process of translation and by applying it to two small groups of subjects to test it for comprehension (pilot test).

Estimaciones de segunda generación del PIB de la Europa Latina: España, Francia, Italia, Portugal (1950-2013)

Los cambios conceptuales y metodológicos en los sistemas empleados para la construcción de la Contabilidad Nacional de todos los países, especialmente a causa de la implantación en la UE del SEC 95, así como la revisión y corrección de los datos de población más actuales obligan a introducir modificaciones muy sustanciales en las series históricas de Cuentas Nacionales por medio de la técnica de la retropolación. La realización de los nuevos cálculos, que pueden ser calificados de auténticas estimaciones de segunda generación, ofrece para España, Francia, Italia y Portugal resultados muy interesantes. Las tasas de crecimiento acumulativo anual para el conjunto del período son muy semejantes entre sí, aunque identifican a la economía española como la que más creció, tanto en la producción de bienes y servicios como en la dimensión demográfica y también en PIB por habitante.

Uptake and translocation of nitrogen, phosphorus and calcium in soybean infected with Meloidogyne incognita and M. javanica

Two soybean (Glycine max) cultivars were used in this study, Ocepar 4, rated as moderately resistant to Meloidogyne incognita race 3 but susceptible to M. javanica, and 'BR 16', susceptible to both nematodes. The effect of nematodes infection on the uptake and transport of N, P and Ca to the shoot was studied in plants growing in a split root system. The upper half was inoculated with 0, 3,000, 9,000 or 27,000 eggs/plant while the lower half received 15N, 32P or 45Ca. Infected plants showed an increase of root but a decrease of shoot mass with increasing inoculum levels. In general, total endogenous nutrients increased in the roots and tended to decrease in the shoots with increasing inoculum levels. When concentrations were calculated, there was an increase in the three nutrients in the roots, and an increase of Ca but no significant variation of N and P was observed in the shoots. The total amount of 15N in the roots increased at the highest inoculum levels but 32P and 45Ca decreased. In the shoots there was a reduction of 32P and 45Ca. The specific concentrations of the labelled nutrients (abundance or radioactivity/tissue mass) also showed a decrease of 32P and 45Ca in the shoots and roots of infected plants and an increase of 15N in the shoots. Considering that overall nutrient concentrations reflect cumulative nutrient uptake and the data from labelled elements gave information at a specific moment of the infection, thus nematodes do interfere with nutrient uptake and translocation.

Progress of Asian soybean rust and airborne urediniospores of Phakopsora pachyrhizi in southern Brazil

Asian soybean rust, caused by the fungus Phakopsora pachyrhizi, was reported at epidemic levels in 2003/2004 and is the main soybean disease in Brazil. The aim of this study was to investigate the spread of Asian soybean rust and to quantify airborne urediniospores in the region of Campo Mourão, Paraná State, Brazil. Three experiments were conducted under field conditions during the 2007/08 and 2008/09 crop seasons. Using the disease gradient method, provided by the application of increasing levels of the fungicide tebuconazole, four Asian soybean rust epidemics at different intensities were obtained in each experiment. To quantify the urediniospores, weathercock-type spore collectors were installed during and between the two crop seasons. Disease progress curves were plotted for each epidemic, and maximum severity was estimated. The curves were fit to the logistic model, which provided higher coefficients of determination and more randomly distributed residuals plotted over time. Analyses of the area under the disease progress curve showed that the largest epidemics occurred in the 2007/2008 crop season and that the progress rates were higher for severity, even among plants protected with the fungicide. The number of urediniospores collected in the air was related to the presence of soybean plants in the cultivated crops. The quantity of urediniospores was also positively correlated to the disease severity and incidence, as well as to cumulative rainfall and favorable days for P. Pachyrhizi infection.

Application and validation of a warning system for grapevine downy mildew controlusing fungicides

Most warning systems for plant disease control are based on Vinho, in Bento Gonçalves - RS, during the growing seasons 2000/ weather models dependent on the relationships between leaf wetness 01, 2002/03 and 2003/2004, using the grape cultivar Isabel. The duration and mean air temperature in this period considering the conventional system used by local growers was compared with the target disease intensity. For the development of a warning system to new warning system by using different cumulative daily disease severity control grapevine downy mildew, the equation generated by Lalancette values (CDDSV) as the criterion to schedule fungicide application and et al. (7) was used. This equation was employed to elaborate a critical reapplication. In experiments conducted in 2003/04, CDDSV of 12 - period table and program a computerized device, which records, though 14 showed promising to schedule the first spraying and the interval electronic sensors, leaf wetness duration, mean temperature in this between fungicide applications, reducing by 37.5% the number of period and automatically calculates the daily value of probability of applications and maintaining the same control efficiency in leaves infection occurrence. The system was validated at Embrapa Uva e and bunches, similarly to the conventional system.

Fractures in older people - incidence, predictors and consequences

In older populations, fractures are common and the consequences of fractures may be serious both for an individual and for society. However, information is scarce about the incidence, predictors and consequences of fractures in population-based unselected cohorts including both men and women and a long follow-up. The objective of this study was to analyse the incidence and predictors of fractures as well as functional decline and excess mortality due to fractures, among 482 men and 695 women aged 65 or older in the municipality of Lieto, Finland from 1991 until 2002. In analyses, Poisson’s, Cox proportional Hazards and Cumulative Logistic regression models were used for the control of several confounding variables. During the 12-year follow-up with a total of 10 040 person-years (PY), 307 (26%) persons sustained altogether 425 fractures of which 77% were sustained by women. The total incidence of fractures was 53.4 per 1000 PY (95% confidence intervals [95% CI]: 47.9 - 59.5) in women and 24.9 per 1000 PY (95% CI: 20.4 - 30.4) in men. The incidence rates of fractures at any sites and hip fractures were associated with increasing age. No significant changes in the ageadjusted incidence rates of fractures were found in either gender during the 12-year follow-up. The predictors of fractures varied by gender. In multivariate analyses, reduced handgrip strength and body mass index (BMI) lower than 30 in women and a large number of depressive symptoms in men were independent predictors of fractures. A compression fracture in one or more thoracic or upper lumbar vertebras on chest radiography at baseline was associated with subsequent fractures in both genders. Lower body fractures independently predicted both short- (0-2 years) and long-term (up to 8 years) functional decline in mobility and activities of daily living (ADL) performance during the 8-year follow-up. Upper body fractures predicted decline in ADL performance during longterm follow-up. In the 12-year follow-up, hip fractures in men (Hazard Ratio [HR] 8.1, 95% CI: 4.4-14.9) and in women (HR 3.0, 95% CI: 1.9-4.9), and fractures at the proximal humerus in men (HR 5.4, 95% CI: 1.6-17.7) were independently associated with excess mortality. In addition, leisure time inactivity in physical exercise predicted independently both functional decline and excess mortality. Fractures are common among older people posing serious individual consequences. Further studies about the effectiveness of preventing falls and fractures as well as improving care and rehabilitation after fractures are needed.

Costs and Benefits of a Shared Digital Long-Term Preservation System

Paper presented at the 40th Annual Conference of LIBER (Ligue des Bibliothèques Européennes de Recherche - Association of European Research Libraries) on July 1st, 2011; with the slides used at the presentation.