Early detection of delirium in older medical inpatients: prodrome, predictors and motor subtyping

Background Delirium is highly prevalent, especially in older patients. It independently leads to adverse outcomes, but remains under-detected, particularly hypoactive forms. Although early identification and intervention is important, delirium prevention is key to improving outcomes. The delirium prodrome concept has been mooted for decades, but remains poorly characterised. Greater understanding of this prodrome would promote prompt identification of delirium-prone patients, and facilitate improved strategies for delirium prevention and management. Methods Medical inpatients of ≥70 years were screened for prevalent delirium using the Revised Delirium Rating Scale (DRS--‐R98). Those without prevalent delirium were assessed daily for delirium development, prodromal features and motor subtype. Survival analysis models identified which prodromal features predicted the emergence of incident delirium in the cohort in the first week of admission. The Delirium Motor Subtype Scale-4 was used to ascertain motor subtype. Results Of 555 patients approached, 191 patients were included in the prospective study. The median age was 80 (IQR 10) and 101 (52.9%) were male. Sixty-one patients developed incident delirium within a week of admission. Several prodromal features predicted delirium emergence in the cohort. Firstly, using a novel Prodromal Checklist based on the existing literature, and controlling for confounders, seven predictive behavioural features were identified in the prodromal period (for example, increasing confusion; and being easily distractible). Additionally, using serial cognitive tests and the DRS-R98 daily, multiple cognitive and other core delirium features were detected in the prodrome (for example inattention; and sleep-wake cycle disturbance). Examining longitudinal motor subtypes in delirium cases, subtypes were found to be predominantly stable over time, the most prevalent being hypoactive subtype (62.3%). Discussion This thesis explored multiple aspects of delirium in older medical inpatients, with particular focus on the characterisation of the delirium prodrome. These findings should help to inform future delirium educational programmes, and detection and prevention strategies.

Reconstructions of eolian dust accumulation in northwest African margin sediments

Reconstructions of eolian dust accumulation in northwest African margin sediments provide important continuous records of past changes in atmospheric circulation and aridity in the region. Existing records indicate dramatic changes in North African dust emissions over the last 20 ka, but the limited spatial extent of these records and the lack of high-resolution flux data do not allow us to determine whether changes in dust deposition occurred with similar timing, magnitude and abruptness throughout northwest Africa. Here we present new records from a meridional transect of cores stretching from 31°N to 19°N along the northwest African margin. By combining grain size endmember modeling with 230Th-normalized fluxes for the first time, we are able to document spatial and temporal changes in dust deposition under the North African dust plume throughout the last 20 ka. Our results provide quantitative estimates of the magnitude of dust flux changes associated with Heinrich Stadial 1, the Younger Dryas, and the African Humid Period (AHP; ~11.7-5 ka), offering robust targets for model-based estimates of the climatic and biogeochemical impacts of past changes in North African dust emissions. Our data suggest that dust fluxes between 8 and 6 ka were a factor of ~5 lower than average fluxes during the last 2 ka. Using a simple model to estimate the effects of bioturbation on dust input signals, we find that our data are consistent with abrupt, synchronous changes in dust fluxes in all cores at the beginning and end of the AHP. The mean ages of these transitions are 11.8±0.2 ka (1Sigma) and 4.9±0.2 ka, respectively.

Trace elements in benthic foraminifera of sediment core V30-49

Eastern tropical Atlantic benthic foraminiferal Ba/Ca and Cd/Ca data from core V30-949 (3093 m) reveal large inferred changes in nutrient concentrations of deep Atlantic waters during the last 250 kyr. Relative changes in North Atlantic Deep Water contribution to this site are estimated by scaling the V30-49 Cd/Ca record to values of modern end-member water masses; these estimates agree well with the relative structure and timing of circulation changes in the eastern tropical Atlantic reconstructed from a d13C record-based mixing model (Raymo et al., 1997, doi:10.1029/97PA01019). Temporal differences between V30-49 Cd/Ca and Ba/Ca records suggest that the Ba/Ca record reflects changes in circulation with an additional increase in the Ba composition of deep Atlantic water masses during glacial episodes, possibly resulting from increased productivity. Similarity between the d13C and Ba/Ca records suggests that carbon isotopes in the deep glacial Atlantic also reflect productivity increases.

Enviromagnetic, major element, and grain-size analyses of surface sediment samples along the continental margin between East Brazil and Patagonia

Continental margin sediments of SE South America originate from various terrestrial sources, each conveying specific magnetic and element signatures. Here, we aim to identify the sources and transport characteristics of shelf and slope sediments deposited between East Brazil and Patagonia (20°-48°S) using enviromagnetic, major element, and grain-size data. A set of five source-indicative parameters (i.e., chi-fd%, ARM/IRM, S0.3T, SIRM/Fe and Fe/K) of 25 surface samples (16-1805 m water depth) was analyzed by fuzzy c-means clustering and non-linear mapping to depict and unmix sediment-province characteristics. This multivariate approach yields three regionally coherent sediment provinces with petrologically and climatically distinct source regions. The southernmost province is entirely restricted to the slope off the Argentinean Pampas and has been identified as relict Andean-sourced sands with coarse unaltered magnetite. The direct transport to the slope was enabled by Rio Colorado and Rio Negro meltwaters during glacial and deglacial phases of low sea level. The adjacent shelf province consists of coastal loessoidal sands (highest hematite and goethite proportions) delivered from the Argentinean Pampas by wave erosion and westerly winds. The northernmost province includes the Plata mudbelt and Rio Grande Cone. It contains tropically weathered clayey silts from the La Plata Drainage Basin with pronounced proportions of fine magnetite, which were distributed up to ~24° S by the Brazilian Coastal Current and admixed to coarser relict sediments of Pampean loessoidal origin. Grain-size analyses of all samples showed that sediment fractionation during transport and deposition had little impact on magnetic and element source characteristics. This study corroborates the high potential of the chosen approach to access sediment origin in regions with contrasting sediment sources, complex transport dynamics, and large grain-size variability.

The Debate on First Nations Education Funding: Mind the Gap (Working Paper 49)

It is at long last becoming part of the public discourse that improving living conditions and opportunities for First Nations communities in Canada is a national imperative. It is also widely recognized that the education is critical to fostering a better future for First Nations people. Yet, for many First Nations youth, particularly those on reserve, completing even high school is well beyond reach. The graduation rate of First Nations people living on reserve was 35.3 per cent as recently as 2011 compared with 78 per cent for the population as a whole. At the same time, the First Nations population is young and growing fast - in First Nations communities 49 per cent of the population is under 24 years of age compared to 30 per cent of the general population. Despite some incremental improvements in education success rates for First Nations students in recent years, the education gap between First Nations and the rest of the country is increasing. The concerns expressed in the 2011 Auditor General report continue to hold weight: "In 2004, we noted that at existing rates, it would take 28 years for First Nations communities to reach the national average. More recent trends suggest that the time needed may still be longer.

Estimate of the (R)USLE rainfall erosivity factor from monthly precipitation data in mainland Spain

The need for continuous recording rain gauges makes it difficult to determine the rainfall erosivity factor (R-factor) of the (R)USLE model in areas without good temporal data coverage. In mainland Spain, the Nature Conservation Institute (ICONA) determined the R-factor at few selected pluviographs, so simple estimates of the R-factor are definitely of great interest. The objectives of this study were: (1) to identify a readily available estimate of the R-factor for mainland Spain; (2) to discuss the applicability of a single (global) estimate based on analysis of regional results; (3) to evaluate the effect of record length on estimate precision and accuracy; and (4) to validate an available regression model developed by ICONA. Four estimators based on monthly precipitation were computed at 74 rainfall stations throughout mainland Spain. The regression analysis conducted at a global level clearly showed that modified Fournier index (MFI) ranked first among all assessed indexes. Applicability of this preliminary global model across mainland Spain was evaluated by analyzing regression results obtained at a regional level. It was found that three contiguous regions of eastern Spain (Catalonia, Valencian Community and Murcia) could have a different rainfall erosivity pattern, so a new regression analysis was conducted by dividing mainland Spain into two areas: Eastern Spain and plateau-lowland area. A comparative analysis concluded that the bi-areal regression model based on MFI for a 10-year record length provided a simple, precise and accurate estimate of the R-factor in mainland Spain. Finally, validation of the regression model proposed by ICONA showed that R-ICONA index overpredicted the R-factor by approximately 19%.

The Pico de Navas slump (Burgos, Spain): a large rocky landslide caused by underlying clayey sand fluidification

The Pico de Navas landslide was a large-magnitude rotational movement, affecting 50x106m3 of hard to soft rocks. The objectives of this study were: (1) to characterize the landslide in terms of geology, geomorphological features and geotechnical parameters; and (2) to obtain an adequate geomechanical model to comprehensively explain its rupture, considering topographic, hydro-geological and geomechanical conditions. The rupture surface crossed, from top to bottom: (a) more than 200 m of limestone and clay units of the Upper Cretaceous, affected by faults; and (b) the Albian unit of Utrillas facies composed of silty sand with clay (Kaolinite) of the Lower Cretaceous. This sand played an important role in the basal failure of the slide due to the influence of fine particles (silt and clay), which comprised on average more than 70% of the sand, and the high content presence of kaolinite (>40%) in some beds. Its geotechnical parameters are: unit weight (δ) = 19-23 KN/m3; friction angle (φ) = 13º-38º and cohesion (c) = 10-48 KN/m2. Its microstructure consists of accumulations of kaolinite crystals stuck to terrigenous grains, making clayey peds. We hypothesize that the presence of these aggregates was the internal cause of fluidification of this layer once wet. Besides the faulted structure of the massif, other conditioning factors of the movement were: the large load of the upper limestone layers; high water table levels; high water pore pressure; and the loss of strength due to wet conditions. The 3D simulation of the stability conditions concurs with our hypothesis. The landslide occurred in the Recent or Middle Holocene, certainly before at least 500 BC and possibly during a wet climate period. Today, it appears to be inactive. This study helps to understand the frequent slope instabilities all along the Iberian Range when facies Utrillas is present.

"Paseo por una guerra antigua" (Juan Antonio Bardem, 1948-49): una contramemoria de la Guerra Civil

Este artículo pretende demostrar en qué medida Paseo por una guerra antigua (1948-1949), la práctica de segundo curso del Instituto de Investigaciones y Experiencias Cinematográficas (IIEC) en la que Juan Antonio Bardem rueda a un joven mutilado caminando por las ruinas de la Ciudad Universitaria de Madrid, constituye un intento pionero de desmontar los relatos oficiales de la Guerra Civil Española y rescatar la memoria de los vencidos. Filmar las ruinas del campus madrileño en aquellos años era un acto sub­versivo, puesto que el Régimen había emprendido su reconstrucción para borrar las huellas del Madrid republicano y de la Guerra Civil, resignificando por completo el recinto universitario. Por tanto, en Paseo por una guerra antigua, Bardem intenta reapropiarse de un espacio que en la época iba imponiéndose como uno de los “lugares de memoria” del franquismo. Esta película se vale de la función documental del cine para inmortalizar unas ruinas que simbolizan la República y la guerra, para preservarlas de la muerte simbólica que representa su reconstrucción. Mostrar esas ruinas en 1948-1949 equivale a “materializar” el pasado, a traerlo al presente de la posguerra, en un proceso que recuerda a los planteamientos sobre la Historia de Walter Benjamin, para proponer una visión alternativa de la contienda. Se trata de una visión teñida de una memoria íntima, ya que la película es un paseo no solo por las ruinas sino también por los recuerdos de este joven mutilado. En suma, Bardem propone una contramemoria de la Guerra Civil.

Rethinking Care Through Social Reproduction: Articulating Circuits of Migration

Care has come to dominate much feminist research on globalized migrations and the transfer of labor from the South to the North, while the older concept of reproduction had been pushed into the background but is now becoming the subject of debates on the commodification of care in the household and changes in welfare state policies. This article argues that we could achieve a better understanding of the different modalities and trajectories of care in the reproduction of individuals, families, and communities, both of migrant and nonmigrant populations by articulating the diverse circuits of migration, in particular that of labor and the family. In doing this, I go back to the earlier North American writing on racialized minorities and migrants and stratified social reproduction. I also explore insights from current Asian studies of gendered circuits of migration connecting labor and marriage migrations as well as the notion of global householding that highlights the gender politics of social reproduction operating within and beyond households in institutional and welfare architectures. In contrast to Asia, there has relatively been little exploration in European studies of the articulation of labor and family migrations through the lens of social reproduction. However, connecting the different types of migration enables us to achieve a more complex understanding of care trajectories and their contribution to social reproduction.

Las expectativas de los estudiantes y la calidad del servicio ofertado por la universidad de Sevilla

En este artículo se presenta un análisis diferencial de las expectativas de los estudiantes de la Universidad de Sevilla (España), en función de las ramas del conocimiento, agrupadas en las dimensiones personal, universidad, curricular y docencia. Las aportaciones han sido recogidas en un cuestionario aplicado a 1082 estudiantes de las áreas de humanidades, bio-sanitaria, económica-jurídica y científico-técnica, a través de un análisis de la varianza para la comparación de medias (asumiendo varianzas iguales y pruebas de Scheffé y Tukey). Se han contrastado los valores medios de cada rama, con el fin de determinar si las diferencias observadas resultan estadísticamente significativas. Los resultados obtenidos ponen de manifiesto que la dimensión personal y la de universidad son valoradas de forma similar en las cuatro ramas del conocimiento; en cambio en la dimensión curricular, las expectativas son más favorables para la rama bio-sanitaria y, en la docencia para la rama de humanidades. En definitiva, los resultados presentan las fortalezas y las debilidades en las dimensiones consideradas y permiten extraer conclusiones de las que derivan indicadores de interés para la mejora de la comunidad universitaria.