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The hep-ex data base was decided not to be an appropriate place to make DELPHI notes public. Sorry for the inconvenience.Comment: the paper should not have been made publi

Higher Physiotherapy Frequency Is Associated with Shorter Length of Stay and Greater Functional Recovery in Hospitalized Frail Older Adults: A Retrospective Observational Study.

Extra physiotherapy has been associated with better outcomes in hospitalized patients, but this remains an under-researched area in geriatric medicine wards. We retrospectively studied the association between average physiotherapy frequency and outcomes in hospitalized geriatric patients. High frequency physiotherapy (HFP) was defined as ≥0.5 contacts/day. Of 358 eligible patients, 131 (36.6%) received low, and 227 (63.4%) HFP. Functional improvement (discharge versus admission) in the modified Rankin scale was greater in the HFP group (1.1 versus 0.7 points, P<0.001). The mean length of stay (LOS) of the HFP group was 6 days shorter (7 versus 13 days, P<0.001). After adjusting for age, gender, comorbidity (Charlson index), frailty (Clinical Frailty Scale), dementia and acute illness severity, HFP was an independent predictor of functional improvement, shorter LOS and likelihood of being discharged without a formal care package. Prospective research is needed to examine the effect of physiotherapy frequency and intensity in geriatric wards.Funding was not required for this study

Platinum(0)-mediated C–O bond activation of ethers via an SN2 mechanism

A computational study of the C(methyl)–O bond activation of fluorinated aryl methyl ethers by a platinum(0) complex Pt(PCyp3)2 (Cyp = cyclopentyl) (N. A. Jasim, R. N. Perutz, B. Procacci and A. C. Whitwood, Chem. Commun., 2014, 50, 3914) demonstrates that the reaction proceeds via an SN2 mechanism. Nucleophilic attack of Pt(0) generates an ion pair consisting of a T-shaped platinum cation with an agostic interaction with a cyclopentyl group and a fluoroaryloxy anion. This ion-pair is converted to a 4-coordinate Pt(II) product trans-[PtMe(OArF)(PCyp3)2]. Structure-reactivity correlations are fully consistent with this mechanism. The Gibbs energy of activation is calculated to be substantially higher for aryl methyl ethers without fluorine substituents and higher still for alkyl methyl ethers. These conclusions are in accord with the experimental results. Further support was obtained in an experimental study of the reaction of Pt(PCy3)2 with 2,3,5,6-tetrafluoro-4-allyloxypyridine yielding the salt of the Pt(η3-allyl) cation and the tetrafluoropyridinolate anion [Pt(PCy3)2(η3-allyl)][OC5NF4]. The calculated activation energy for this reaction is significantly lower than that for fluorinated aryl methyl ethers

Sart and individual trial mistake thresholds: Predictive model for mobility decline

The Sustained Attention to Response Task (SART) has been used to measure neurocognitive functions in older adults. However, simplified average features of this complex dataset may result in loss of primary information and fail to express associations between test performance and clinically meaningful outcomes. Here, we describe a new method to visualise individual trial (raw) information obtained from the SART test, vis-a-vis age, and groups based on mobility status in a large population-based study of ageing in Ireland. A thresholding method, based on the individual trial number of mistakes, was employed to better visualise poorer SART performances, and was statistically validated with binary logistic regression models to predict mobility and cognitive decline after 4 years. Raw SART data were available for 4864 participants aged 50 years and over at baseline. The novel visualisation-derived feature bad performance, indicating the number of SART trials with at least 4 mistakes, was the most significant predictor of mobility decline expressed by the transition from Timed Up-and-Go (TUG) &lt; 12 to TUG &gt;= 12 s (OR = 1.29; 95% CI 1.14-1.46; p &lt; 0.001), and the only significant predictor of new falls (OR = 1.11; 95% CI 1.03-1.21; p = 0.011), in models adjusted for multiple covariates. However, no SART-related variables resulted significant for the risk of cognitive decline, expressed by a decrease of &gt;= 2 points in the Mini-Mental State Examination (MMSE) score. This novel multimodal visualisation could help clinicians easily develop clinical hypotheses. A threshold approach to the evaluation of SART performance in older adults may better identify subjects at higher risk of future mobility decline

Longitudinal Study on Sustained Attention to Response Task (SART): Clustering Approach for Mobility and Cognitive Decline

The Sustained Attention to Response Task (SART) is a computer-based go/no-go task to measure neurocognitive function in older adults. However, simplified average features of this complex dataset lead to loss of primary information and fail to express associations between test performance and clinically meaningful outcomes. Here, we combine a novel method to visualise individual trial (raw) information obtained from the SART test in a large population-based study of ageing in Ireland and an automatic clustering technique. We employed a thresholding method, based on the individual trial number of mistakes, to identify poorer SART performances and a fuzzy clusters algorithm to partition the dataset into 3 subgroups, based on the evolution of SART performance after 4 years. Raw SART data were available for 3468 participants aged 50 years and over at baseline. The previously reported SART visualisation-derived feature 'bad performance', indicating the number of SART trials with at least 4 mistakes, and its evolution over time, combined with the fuzzy c-mean (FCM) algorithm, individuated 3 clusters corresponding to 3 degrees of physiological dysregulation. The biggest cluster (94% of the cohort) was constituted by healthy participants, a smaller cluster (5% of the cohort) by participants who showed improvement in cognitive and psychological status, and the smallest cluster (1% of the cohort) by participants whose mobility and cognitive functions dramatically declined after 4 years. We were able to identify in a cohort of relatively high-functioning community-dwelling adults a very small group of participants who showed clinically significant decline. The selected smallest subset manifested not only mobility deterioration, but also cognitive decline, the latter being usually hard to detect in population-based studies. The employed techniques could identify at-risk participants with more specificity than current methods, and help clinicians better identify and manage the small proportion of community-dwelling older adults who are at significant risk of functional decline and loss of independence

Development and Validation of an Electronic Postoperative Morbidity Score.

BACKGROUND: Electronic health records are being adopted due to numerous potential benefits. This requires the development of objective metrics to characterize morbidity, comparable to studies performed in centers without an electronic health record. We outline the development of an electronic version of the postoperative morbidity score for integration into our electronic health record. METHODS: Twohundred and three frail patients who underwent elective surgery were reviewed. We retrospectively defined postoperative morbidity score on postoperative day 3. We also recorded potential electronic surrogates for morbidities that could not be easily extracted in an objective format. We compared discriminative capability (area under the receiver operator curve) for patients having prolonged length of stay or complex discharge requirements. RESULTS: One hundred thirty-nine patients (68%) had morbidity in ≥1 postoperative morbidity score domain. Initial electronic surrogates were overly sensitive, identifying 173 patients (84%) as having morbidity. We refined our definitions using backward logistic regression against "gold-standard" postoperative morbidity score. The final electronic postoperative morbidity score differed from the initial version in its definition of cardiac and neurological morbidity. There was no significant difference in the discriminative capability between electronic postoperative morbidity score and postoperative morbidity score for either outcome (area under the receiver operator curve: 0.66 vs 0.66 for complex discharge requirement, area under the receiver operator curve: 0.66 vs 0.67 for a prolonged length of stay; P> .05 for both). Patients with postoperative morbidity score or electronic postoperative morbidity score-defined morbidity on day 3 had increased risk of prolonged length of stay (P < .001 for both). CONCLUSIONS: We present a variant of postoperative morbidity score based on objective electronic metrics. Discriminative performance appeared comparable to gold-standard definitions for discharge outcomes. Electronic postoperative morbidity score may allow characterization of morbidity within our electronic health record, but further study is required to assess external validity

Statistical properties of two-particle transmission at Anderson transition

The ensemble of $L \times L$ power-law random banded matrices, where the random hopping $H_{i,j}$ decays as a power-law $(b/| i-j |)^a$, is known to present an Anderson localization transition at $a=1$, where one-particle eigenfunctions are multifractal. Here we study numerically, at this critical point, the statistical properties of the transmission $T_2$ for two distinguishable particles, two bosons or two fermions. We find that the statistics of $T_2$ is multifractal, i.e. the probability to have $T_2(L) \sim 1/L^{\kappa}$ behaves as $L^{\Phi_2(\kappa)}$, where the multifractal spectrum $\Phi_2(\kappa)$ for fermions is different from the common multifractal spectrum concerning distinguishable particles and bosons. However in the three cases, the typical transmission $T_2^{typ}(L)$ is governed by the same exponent $\kappa_2^{typ}$, which is much smaller than the naive expectation $2\kappa_1^{typ}$, where $\kappa_1^{typ}$ is the typical exponent of the one-particle transmission $T_1(L)$.Comment: 9 pages, 4 figure

Anticholinergic medications in patients admitted with cognitive impairment or falls (AMiCI). The impact of hospital admission on anticholinergic cognitive medication burden. Results of a multicentre observational study

What is known and objectiveDrugs with anticholinergic properties increase the risk of falls, delirium, chronic cognitive impairment, and mortality and counteract procholinergic medications used in the treatment of dementia. Medication review and optimisation to reduce anticholinergic burden in patients at risk is recommended by specialist bodies. Little is known how effective this review is in patients who present acutely and how often drugs with anticholinergic properties are used temporarily during an admission. The aim of the study was to describe the changes in the anticholinergic cognitive burden (ACB) in patients admitted to hospital with a diagnosis of delirium, chronic cognitive impairment or falls and to look at the temporary use of anticholinergic medications during hospital stay. MethodsThis is a multi-centre observational study that was conducted in seven different hospitals in the UK, Finland, The Netherlands and Italy. Results and discussion21.1% of patients had their ACB score reduced by a mean of 1.7%, 19.7% had their ACB increased by a mean of 1.6%, 22.8% of DAP naive patients were discharged on anticholinergic medications. There was no change in the ACB scores in 59.2% of patients. 54.1% of patients on procholinergics were taking anticholinergics. Out of the 98 medications on the ACB scale, only 56 were seen. Medications with a low individual burden were accounting for 64.9% of the total burden. Anticholinergic drugs were used temporarily during the admission in 21.9% of all patients. A higher number of DAPs used temporarily during admission was associated with a higher risk of ACB score increase on discharge (OR=1.82, 95% CI for OR: 1.36-2.45, P What is new and conclusionThere was no reduction in anticholinergic cognitive burden during the acute admissions. This was the same for all diagnostic subgroups. The anticholinergic load was predominantly caused by medications with a low individual burden. More than 1 in 5 patients not taking anticholinergics on admission were discharged on them and similar numbers saw temporary use of these medications during their admission. More than half of patients on cholinesterase-inhibitors were taking anticholinergics at the same time on admission, potentially directly counteracting their effects.Peer reviewe

Quantum and classical localisation, the spin quantum Hall effect and generalisations

We consider network models for localisation problems belonging to symmetry class C. This symmetry class arises in a description of the dynamics of quasiparticles for disordered spin-singlet superconductors which have a Bogoliubov - de Gennes Hamiltonian that is invariant under spin rotations but not under time-reversal. Our models include but also generalise the one studied previously in the context of the spin quantum Hall effect. For these systems we express the disorder-averaged conductance and density of states in terms of sums over certain classical random walks, which are self-avoiding and have attractive interactions. A transition between localised and extended phases of the quantum system maps in this way to a similar transition for the classical walks. In the case of the spin quantum Hall effect, the classical walks are the hulls of percolation clusters, and our approach provides an alternative derivation of a mapping first established by Gruzberg, Read and Ludwig, Phys. Rev. Lett. 82, 4254 (1999).Comment: 11 pages, 5 figure