The Occurrence of Acute Postoperative Confusion in Patients after Cardiac Surgery

This study quantified the occurrence of acute confusion in cardiac surgery patients at three German hospitals. A total of 867 patients, 22-91 years old, were examined each nursing shift postoperatively for 5 days for the presence of acute confusion using a modified version of the Glasgow Coma Scale and Confusion Rating Scale. The night shifts and the third postoperative day showed the most frequent periods of occurrence. Confusional state was noted in patients ranging from 10.5% for patients aged <70, to 40.7% for patients >80 years of age. Those found at increased risk were patients of increasing age and coexisting disease. Targeted nursing interventions for patients at increased risk of acute confusion may decrease this complication

Perspectives on ethnic and racial disparities in Alzheimer\u27s disease and related dementias: Update and areas of immediate need

Alzheimer\u27s disease and related dementias (ADRDs) are a global crisis facing the aging population and society as a whole. With the numbers of people with ADRDs predicted to rise dramatically across the world, the scientific community can no longer neglect the need for research focusing on ADRDs among underrepresented ethnoracial diverse groups. The Alzheimer\u27s Association International Society to Advance Alzheimer\u27s Research and Treatment (ISTAART; alz.org/ISTAART) comprises a number of professional interest areas (PIAs), each focusing on a major scientific area associated with ADRDs. We leverage the expertise of the existing international cadre of ISTAART scientists and experts to synthesize a cross-PIA white paper that provides both a concise “state-of-the-science” report of ethnoracial factors across PIA foci and updated recommendations to address immediate needs to advance ADRD science across ethnoracial populations. © 2018 The Author

New insights into the genetic etiology of Alzheimer's disease and related dementias

Characterization of the genetic landscape of Alzheimer's disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/'proxy' AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

Multiancestry analysis of the HLA locus in Alzheimer’s and Parkinson’s diseases uncovers a shared adaptive immune response mediated by HLA-DRB1*04 subtypes

Across multiancestry groups, we analyzed Human Leukocyte Antigen (HLA) associations in over 176,000 individuals with Parkinson’s disease (PD) and Alzheimer’s disease (AD) versus controls. We demonstrate that the two diseases share the same protective association at the HLA locus. HLA-specific fine-mapping showed that hierarchical protective effects of HLA-DRB1*04 subtypes best accounted for the association, strongest with HLA-DRB1*04:04 and HLA-DRB1*04:07, and intermediary with HLA-DRB1*04:01 and HLA-DRB1*04:03. The same signal was associated with decreased neurofibrillary tangles in postmortem brains and was associated with reduced tau levels in cerebrospinal fluid and to a lower extent with increased Aβ42. Protective HLA-DRB1*04 subtypes strongly bound the aggregation-prone tau PHF6 sequence, however only when acetylated at a lysine (K311), a common posttranslational modification central to tau aggregation. An HLA-DRB1*04-mediated adaptive immune response decreases PD and AD risks, potentially by acting against tau, offering the possibility of therapeutic avenues

Aerodynamic Results from the Star Hover Test: An Examination of Active Twist Actuation

Active rotor control concepts, such as active twist actuation, have the potential to effectively reduce the noise and vibrations of helicopter rotors. Within the STAR (Smart Twisting Active Rotor) hover test, an active twist rotor was tested in the rotor preparation hall at DLR Braunschweig. The rotor blades were actuated with frequencies of 1/rev – 5/rev and peak torsion amplitudes of up to 2°. This paper describes aerodynamic results from the hover test based on time-resolved stereoscopic PIV measurements at the forward blade tip position. Continuous time series of flow fields behind the blade tips were evaluated to investigate the young blade tip vortices between 3.56° and 45.74° of vortex age. For the unactuated baseline case, the vortex trajectory, blade tip scattering, and temporal development of the peak axial and swirl velocity are discussed. The effects of the active twist actuation on the blade tip vortices are examined for the 1/rev and 3/rev actuation frequencies. The variation of the vortex trajectories is dominated by the blade tip deflection for the 1/rev actuation, and by the torsion of the blade tip for the 3/rev actuation. The 3/rev actuation reduces the initial peak swirl velocity by up to 35% compared to the baseline case. The actuation with the control phase angles 225° – 315° achieves a strong variation of the vortex trajectories with a vertical deviation of up to 2.6%R below the rotor tip path plane. The present aerodynamic investigation reveals a high control authority of the actuators – especially for the 3/rev actuation frequency – on the vortex trajectories and the vortex strength, thus demonstrating the usefulness of the active twist concept

The Occurrence of Acute Postoperative Confusion in Patients after Cardiac Surgery

This study quantified the occurrence of acute confusion in cardiac surgery patients at three German hospitals. A total of 867 patients, 22–91 years old, were examined each nursing shift postoperatively for 5 days for the presence of acute confusion using a modified version of the Glasgow Coma Scale and Confusion Rating Scale. The night shifts and the third postoperative day showed the most frequent periods of occurrence. Confusional state was noted in patients ranging from 10.5% for patients aged 80 years of age. Those found at increased risk were patients of increasing age and coexisting disease. Targeted nursing interventions for patients at increased risk of acute confusion may decrease this complication

BOS Flight Tests for 3D Helicopter Rotor Wake Characterization

Interactions between blade tip vortices and the structural components of a helicopter play an important role in the generation of noise and structural vibrations. The detection of the exact vortex trajectories is highly desirable, therefore, especially for the case of full-scale helicopters under realistic flight conditions. The Background Oriented Schlieren (BOS) method has proven to be a reliable and scalable tool for the visualization of these vortices. To date, however, it has not been successfully applied for the reconstruction of an entire three-dimensional helicopter vortex system. In the current study, we present results from a flight test with a full-scale BO 105 in an open pit mine. A BOS measurement system consisting of 10 cameras applied to natural backgrounds was used to visualize the vortices of the helicopter under maneuver flight. Vortex filaments could be visualized up to a vortex age of 360°. From the evaluated images, a three-dimensional reconstruction of the vortex system was calculated using epipolar geometry with iterative photogrammetry. The final paper will include information about the measurement setup, the suitability of the natural backgrounds for the BOS method, the calibration process, different approaches for the reconstruction of a three-dimensional vortex system of a full-scale helicopter, as well as the aerodynamic interpretation of the results obtained

Three-dimensional reconstruction of helicopter blade-tip vortices using a multi-camera BOS system

Noise and structural vibrations in rotorcraft are strongly influenced by interactions between blade-tip vortices and the structural components of a helicopter. As a result, the three-dimensional localization of vortices is highly desirable, especially for the case of full-scale helicopters under realistic flight conditions. In the current study, we present results from a flight test with a full-scale BO 105 in an open pit mine. A background-oriented schlieren measurement system consisting of ten cameras with a natural background was used to visualize the vortices of the helicopter during maneuvering flight. Vortex filaments could be visualized and extracted up to a vortex age of 360°. Vortex instability effects were found for several flight conditions. For the camera calibration, an iterative approach based on points on the helicopter fuselage was applied. Point correspondence between vortex curves in the evaluated images was established by means of epipolar geometry. A three-dimensional reconstruction of the main part of the vortex system was carried out for the first time using stereo-photogrammetry. A quantitative evaluation of the 3D vortex system was carried out, demonstrating the potential of the multi-camera background-oriented Schlieren measurement technique for the analysis of blade-vortex interaction effects in rotorcraft

The Influence of Human Factors Training in Air Rescue Service on Patient Safety in Hospitals: Results of an Online Survey

Background: Air rescue crew members work equally in aviation and medicine, and thus occupy an important interface between the two work environments of aviation and medicine. The aim of this study was to obtain responses from participants to a validated online-based questionnaire regarding whether hospitals may benefit from the commitment of a medical hospital staff which is also professionally involved in the aviation system as emergency physicians and Helicopter Emergency Medical Services Technical Crew Members (HEMS TC). Furthermore, it focused on the question of whether the skills acquired through Crew Resource Management (CRM) training in the air rescue service might also be used in the ground-based rescue service and, if so, whether they may have a positive effect. Methods: Medical air rescue staff of 37 German air rescue stations was included. Between 27 November 2020 and 03 March 2021, 253 out of 621 employees (response rate: 40.7%) participated voluntarily in a validated anonymized online survey. A quantitative test procedure was performed using the modified questionnaire on teamwork and patient safety (German version). Results: The examination and interpretation of the internal consistency (Cronbach’s alpha) resulted in the following reliabilities: Factor I (Cooperation): α = 0.707 (good); Factor II (Human factors): α = 0.853 (very good); Factor III (Communication): α = 0.657 (acceptable); and Factor IV (Safety): α = 0.620 (acceptable). Factor analysis explained 53.1% of the variance. Conclusions: The medical clinicians participating in this online survey believed that the skills they learned in human factors training such as CRM are helpful in their daily routine work in hospitals or other medical facilities, as well as in their ground-based rescue service activities. These findings may result in the recommendation to make CRM available on a regular to the medical staff in all medical facilities and also to ground-based rescue service staff aiming to increase patient safety and employee satisfaction