Trajectories and patterns of delirium and vulnerability in older cancer patients in the hospital and at home near the end of life

Patients with advanced cancer often develop delirium (acute confusion), the prevalence rising to 90% in the final weeks of life. Age, illness severity, comorbidity, and preexisting cognitive impairment increase the risk of delirium, but despite its prevalence, little is known about delirium in older cancer patients. This three-phase study addresses the empirical gap in knowledge about delirium in older cancer patients. The first phase, a secondary analysis of data from studies of acute confusion in hospitalized elders, examined delirium and its etiology in 76 hospitalized older cancer patients, 10 of whom were near the end of life. The second phase comprised a pilot study of a home-based protocol to evaluate delirium in older adults with advanced cancer. The third phase was a descriptive, longitudinal, multiple case study of delirium and delirium vulnerability in seven older adults with advanced cancer near the end of life. The findings clarify the role of delirium in older cancer patients. Delirium occurred in all seven with advanced cancer (the three patients who died had reversible and terminal episodes of delirium; the four who lived each had one reversible episode). Delirium also was common in the hospitalized older cancer patients: 43 of 76 (56%) were delirious at some point during hospitalization; 8 of 10 (80%) who were near the end of life became delirious. Delirium resolved in 13 of the 43 (30%) hospitalized patients, but in 30 (70%) delirium symptoms persisted at discharge. These older cancer patients were at risk for multiple etiologies of delirium: 90%, (including all near the end of life) had metabolic-nutritional risks, and hypoxic, orthostatic-dehydration, and metabolic-toxic risks were common. Five of the hospitalized patients and one of the seven with advanced cancer had chronic cognitive impairment (all became delirious). Physical, behavioral, and physiological functioning in the older adults with advanced cancer declined before they became delirious. This decline in functioning may indicate diminishing reserve capacity, and suggests that early interventions aimed at specific etiologic risk factors may sustain reserve capacity and minimize delirium, thereby enhancing the quality of living and dying of older cancer patients, and minimizing distress for their caregivers

The Evolution of Gero-Oncology Nursing

This article summarizes the evolution of gero-oncology nursing and highlights key educational initiatives, clinical practice issues, and research areas to enhance care of older adults with cancer

Evaluation of a peer mentoring program for early career gerontological nursing faculty and its potential for application to other fields in nursing and health sciences

As the retirement rate of senior nursing faculty increases, the need to implement new models for providing mentorship to early career academics will become key to developing and maintaining an experienced faculty

Damping of Tensor Modes in Cosmology

An analytic formula is given for the traceless transverse part of the anisotropic stress tensor due to free streaming neutrinos, and used to derive an integro-differential equation for the propagation of cosmological gravitational waves. The solution shows that anisotropic stress reduces the squared amplitude by 35.6 % for wavelengths that enter the horizon during the radiation-dominated phase, independent of any cosmological parameters. This decreases the tensor temperature and polarization correlation functions for these wavelengths by the same amount. The effect is less for wavelengths that enter the horizon at later times. At the longest wavelengths the decrease in the tensor correlation functions due to neutrino free streaming ranges from 10.7% for $\Omega_Mh^2=0.1$ to 9.0% for $\Omega_Mh^2=0.15$. An Appendix gives a general proof that tensor as well as scalar modes satisfy a conservation law for perturbations outside the horizon, even when the anisotropic stress tensor is not negligible.Comment: 14 pages. The original version of this paper has been expanded to deal with perturbations of any wavelength. While for wavelengths short enough to enter the horizon during radiation dominance, temperature and polarization correlations are damped by 35.6%, at the longest wavelengths the damping is from 9.0% to 11%. An added Appendix gives a general proof that tensor as well as scalar modes satisfy a conservation law outside the horizon, even during neutrino decoupling. Some references are also adde

Modular Cosmology

An exploratory study of the cosmology of moduli in string theory. Moduli are argued to be natural inflaton fields and lead to a robust inflationary cosmology in which inflation takes place at the top of domain walls. The amplitude of microwave background fluctuations constrains the dynamics responsible for inflation to take place at a higher scale than supersymmetry breaking. Models explaining this difference in scales and also preventing the dilaton from running to infinity are proposed. The problem of dilaton domination of the energy density of the universe is not resolved.Comment: harvmac, 37 pages, 3 figures as a separate uuencoded tar fil

New zebrafish models of neurodegeneration

In modern biomedicine, the increasing need to develop experimental models to further our understanding of disease conditions and delineate innovative treatments has found in the zebrafish (Danio rerio) an experimental model, and indeed a valuable asset, to close the gap between in vitro and in vivo assays. Translation of ideas at a faster pace is vital in the field of neurodegeneration, with the attempt to slow or prevent the dramatic impact on the society's welfare being an essential priority. Our research group has pioneered the use of zebrafish to contribute to the quest for faster and improved understanding and treatment of neurodegeneration in concert with, and inspired by, many others who have primed the study of the zebrafish to understand and search for a cure for disorders of the nervous system. Aware of the many advantages this vertebrate model holds, here, we present an update on the recent zebrafish models available to study neurodegeneration with the goal of stimulating further interest and increasing the number of diseases and applications for which they can be exploited. We shall do so by citing and commenting on recent breakthroughs made possible via zebrafish, highlighting their benefits for the testing of therapeutics and dissecting of disease mechanisms

The conceptual and practical ethical dilemmas of using health discussion board posts as research data.

Increasing numbers of people living with a long-term health condition are putting personal health information online, including on discussion boards. Many discussion boards contain material of potential use to researchers; however, it is unclear how this information can and should be used by researchers. To date there has been no evaluation of the views of those individuals sharing health information online regarding the use of their shared information for research purposes

Complete constraints on a nonminimally coupled chaotic inflationary scenario from the cosmic microwave background

We present complete constraints imposed from observations of the cosmic microwave background radiation (CMBR) on the chaotic inflationary scenario with a nonminimally coupled inflaton field proposed by Fakir and Unruh (FU). Our constraints are complete in the sense that we investigate both the scalar density perturbation and the tensor gravitational wave in the Jordan frame, as well as in the Einstein frame. This makes the constraints extremely strong without any ambiguities due to the choice of frames. We find that the FU scenario generates tiny tensor contributions to the CMBR relative to chaotic models in minimal coupling theory, in spite of its spectral index of scalar perturbation being slightly tilted. This means that the FU scenario will be excluded if any tensor contributions to CMBR are detected by the forthcoming satellite missions. Conversely, if no tensor nature is detected despite the tilted spectrum, a minimal chaotic scenario will be hard to explain and the FU scenario will be supported.Comment: 7 pages, no figure, RevTeX, to appear in Phys.Rev. D59 (Mar. 15, 1999