The Neecham Confusion Scale and the Delirium Observation Screening Scale: Capacity to discriminate and ease of use in clinical practice

BACKGROUND: Delirium is a frequent form of psychopathology in elderly hospitalized patients; it is a symptom of acute somatic illness. The consequences of delirium include high morbidity and mortality, lengthened hospital stay, and nursing home placement. Early recognition of delirium symptoms enables the underlying cause to be diagnosed and treated and can prevent negative outcomes. The aim of this study was to determine which of the two delirium observation screening scales, the NEECHAM Confusion Scale or the Delirium Observation Screening (DOS) scale, has the best discriminative capacity for diagnosing delirium and which is more practical for daily use by nurses. METHODS: The project was conducted on four wards of a university hospital; 87 patients were included. During 3 shifts, these patients were observed for symptoms of delirium, which were rated on both scales. A DSM-IV diagnosis of delirium was made or rejected by a geriatrician. Nurses were asked to rate the practical value of both scales using a structured questionnaire. RESULTS: The sensitivity (0.89 – 1.00) and specificity (0.86 – 0.88) of the DOS and the NEECHAM were high for both scales. Nurses rated the practical use of the DOS scale as significantly easier than the NEECHAM. CONCLUSION: Successful implementation of standardized observation depends largely on the consent of professionals and their acceptance of a scale. In our hospital, we therefore chose to involve nurses in the choice between two instruments. During the study they were able to experience both scales and give their opinion on ease of use. In the final decision on the instrument we found that both scales were very acceptable in terms of sensitivity and specificity, so the opinion of the nurses was decisive. They were positive about both instruments; however, they rated the DOS scale as significantly easier to use and relevant to their practice. Our findings were obtained from a single site study with a small sample, so a large comparative trial to study the value of both scales further is recommended. On the basis of our experience during this study and findings from the literature with regard to the implementation of delirium guidelines, we will monitor the further implementation of the DOS Scale in our hospital with intensive consultation

The BeppoSAX WFC X-ray source catalogue

We present the catalogue of X-ray sources detected by the two Wide Field Cameras (WFCs) in complete observations on board BeppoSAX during its 6 years of operational lifetime, between April 1996 and April 2002. The BeppoSAX WFCs were coded mask instruments sensitive in the 2-28 keV energy band with a 40x40 square degree fields of view, pointing in opposite directions and perpendicularly to the BeppoSAX Narrow Field Instruments (NFI). The WFCs were usually operated simultaneously to NFI observations, each lasting up to several days. WFCs observed thus the entire sky several times with a typical sensitivity of 2 to 10 mCrab. A systematic analysis of all WFC observations in the BeppoSAX archive has been carried out using the latest post-mission release of the WFC analysis software and calibrations. The catalogue includes 253 distinct sources, obtained from a total sample of 8253 WFC detections. We describe the basic statistical properties of the sample and present a six-year history of two celestial calibration X-ray sources.Comment: 15 pages, 11 figures, Catalogue, Accepted for publication on A&

Disorder-induced soliton transmission in nonlinear photonic lattices

We address soliton transmission and reflection in nonlinear photonic lattices embedded into uniform Kerr nonlinear media. We show that by introducing disorder into the guiding lattice channels, one may achieve soliton transmission even under conditions where regular lattices reflect the input beam completely. In contrast, in the parameter range where the lattice is almost transparent for incoming solitons, disorder may induce a significant reflection.Comment: 5 pages, 4 figures, to appear in Optics Letter

Theoretical study of dark resonances in micro-metric thin cells

We investigate theoretically dark resonance spectroscopy for a dilute atomic vapor confined in a thin (micro-metric) cell. We identify the physical parameters characterizing the spectra and study their influence. We focus on a Hanle-type situation, with an optical irradiation under normal incidence and resonant with the atomic transition. The dark resonance spectrum is predicted to combine broad wings with a sharp maximum at line-center, that can be singled out when detecting a derivative of the dark resonance spectrum. This narrow signal derivative, shown to broaden only sub-linearly with the cell length, is a signature of the contribution of atoms slow enough to fly between the cell windows in a time as long as the characteristic ground state optical pumping time. We suggest that this dark resonance spectroscopy in micro-metric thin cells could be a suitable tool for probing the effective velocity distribution in the thin cell arising from the atomic desorption processes, and notably to identify the limiting factors affecting desorption under a grazing incidence.Comment: 12 pages, 11 figures theoretical articl

Game-based meditation therapy to improve posttraumatic stress and neurobiological stress systems in traumatized adolescents:Protocol for a randomized controlled trial

Background: Many adolescents in residential care have been exposed to prolonged traumatic experiences such as violence, neglect, or abuse. Consequently, they suffer from posttraumatic stress. This not only negatively affects psychological and behavioral outcomes (eg, increased anxiety, depression, and aggression) but also has adverse effects on physiological outcomes, in particular on their neurobiological stress systems. Although current evidence-based treatment options are effective, they have their limitations. An alternative to traditional trauma treatment is meditation-based treatment that focuses on stress regulation and relaxation. Muse is a game-based meditation intervention that makes use of adolescents’ intrinsic motivation. The neurofeedback element reinforces relaxation abilities. Objective: This paper describes the protocol for a randomized controlled trial in which the goal is to examine the effectiveness of Muse (InteraXon Inc) in reducing posttraumatic stress and normalizing neurobiological stress systems in a sample of traumatized adolescents in residential care. Methods: This will be a multicenter, multi-informant, and multimethod randomized controlled trial. Participants will be adolescents (N=80), aged 10 to 18 years, with clinical levels of posttraumatic symptoms, who are randomized to receive either the Muse therapy sessions and treatment as usual (intervention) or treatment as usual alone (control). Data will be collected at 3 measurement instances: pretest (T1), posttest (T2), and at 2-month follow-up. Primary outcomes will be posttraumatic symptoms (self-report and mentor report) and stress (self-report) at posttest. Secondary outcomes will be neurobiological stress parameters under both resting and acute stress conditions, and anxiety, depression, and aggression at posttest. Secondary outcomes also include all measures at 2-month follow-up: posttraumatic symptoms, stress, anxiety, depression aggression, and neurobiological resting parameters. Results: The medical-ethical committee Arnhem-Nijmegen (NL58674.091.16) approved the trial on November 15, 2017. The study was registered on December 2, 2017. Participant enrollment started in January 2018, and the results of the study are expected to be published in spring or summer 2021. Conclusions: Study results will demonstrate whether game-based meditation therapy improves posttraumatic stress and neurobiological stress systems, and whether it is more effective than treatment as usual alone for traumatized adolescents

An Animal-Assisted Intervention Study in the Nursing Home: Lessons Learned

AAI studies in the nursing home pose a specific set of challenges. In this article the practical and ethical issues encountered during a Dutch psychogeriatric nursing home AAI study are addressed with the aim of sharing our experiences for future researchers as well as AAI practitioners in general. In our study we compared three groups of clients with dementia who participated in group sessions of either visiting dog teams, visiting FurReal Friend robot animals, or visiting students (control group) and monitored the effect on social interaction and neuropsychiatric symptoms through video analysis and questionnaires. We encountered the following four categories of challenges during our study. Participant-related challenges include the legal implications of working with vulnerable patients, the practical implications of a progressive neurodegenerative disease with accompanying memory loss and behavioral problems, and the ethical implications of the use of robot animals for people with diminished cognitive functions. A very important challenge involves the selection of the participating dogs and ensuring animal welfare during the study. We partnered with a local university of applied sciences to help us successfully address these issues. The nursing home setting poses several practical challenges due to its inherent organizational structure, the high workload of nursing home staff, and an often suboptimal environment for a controlled randomized trial, especially when comparing nonpharmacological interventions. Balancing the desire for scientifically sound procedures with the practical limitations of a nursing home setting is often difficult and requires specific considerations

Experimental observation of second-harmonic generation and diffusion inside random media

We have experimentally measured the distribution of the second-harmonic intensity that is generated inside a highly-scattering slab of porous gallium phosphide. Two complementary techniques for determining the distribution are used. First, the spatial distribution of second-harmonic light intensity at the side of a cleaved slab has been recorded. Second, the total second-harmonic radiation at each side of the slab has been measured for several samples at various wavelengths. By combining these measurements with a diffusion model for second-harmonic generation that incorporates extrapolated boundary conditions, we present a consistent picture of the distribution of the second-harmonic intensity inside the slab. We find that the ratio $\ell_{2\omega}/L_c$ of the mean free path at the second-harmonic frequency to the coherence length, which was suggested by some earlier calculations, cannot describe the second-harmonic yield in our samples. For describing the total second-harmonic yield, our experiments show that the scattering parameter at the fundamental frequency \k_{1\omega}\ell_{1\omega} is the most relevant parameter in our type of samples.Comment: 10 pages, 7 figure

Validity of the Empatica E4 wristband to measure heart rate variability (HRV) parameters:A comparison to electrocardiography (ECG)

Wearable monitoring devices are an innovative way to measure heart rate (HR) and heart rate variability (HRV), however, there is still debate about the validity of these wearables. This study aimed to validate the accuracy and predictive value of the Empatica E4 wristband against the VU University Ambulatory Monitoring System (VU-AMS) in a clinical population of traumatized adolescents in residential care. A sample of 345 recordings of both the Empatica E4 wristband and the VU-AMS was derived from a feasibility study that included fifteen participants. They wore both devices during two experimental testing and twelve intervention sessions. We used correlations, cross-correlations, Mann-Whitney tests, difference factors, Bland-Altman plots, and Limits of Agreement to evaluate differences in outcomes between devices. Significant correlations were found between Empatica E4 and VU-AMS recordings for HR, SDNN, RMSSD, and HF recordings. There was a significant difference between the devices for all parameters but HR, although effect sizes were small for SDNN, LF, and HF. For all parameters but RMSSD, testing outcomes of the two devices led to the same conclusions regarding significance. The Empatica E4 wristband provides a new opportunity to measure HRV in an unobtrusive way. Results of this study indicate the potential of the Empatica E4 as a practical and valid tool for research on HR and HRV under non-movement conditions. While more research needs to be conducted, this study could be considered as a first step to support the use of HRV recordings provided by wearables