"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 \ub1 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

Le pinete a Pinus sylvestris L. delle Prealpi Lombarde orientali (Italia settentrionale) : sintassonomia e significato fitogeografico

Phytogeography and syntaxonomy of Scotch Pine woods in the eastern Lombardy Pre-Alps. In the present paper the distribution, ecology and syntaxonomy of pinewoods were studied. The pinewoods of Pinus sylvestris are located in the area between Garda Lake and Iseo Lake, along the eastern Pre-Alps (Benacensi and Bresciane Pre-Alps). In this area the Pinewoods have Pinus sylvestris as the most important tree. Some deciduous trees, as Ostrya carpinifolia and Fraxinus ornus, are often present in the canopy and they are very frequent in the underbrush. The herb cover is high, formed by basiphilous scrubs and herbs. Erica carnea, Sesleria varia and Chamaecytisus purpureus are dominant. The pinewoods are present on calcareous substrata, strictly connected to dolomite limestone outcrop (Dolomia Principale formation). The pinewoods with Pinus sylvestris and Ostrya carpinifolia can be included into the Chamaecytiso purpurei-Pinetum sylvestris Minghetti, Pedrotti et Poldini 2003, a prealpine association described for Trentino, with which it is in phytogeographical continuity. This association is collocated between the Erico-Pinion pinewoods of central Alps and the Erico-Fraxinion orni pinewoods of E-southern Pre-Alps (Fraxino orni-Pinetum nigrae pinetosum sylvestris), with which they share a similar floristic composition. Along the eastern Lombardy Pre-Alps this association is characterized by mesophilous elements, described as Chamaecytiso purpurei-Pinetum sylvestris caricetosum albae subass. nova. This syntaxon and in general all the pinewoods on basic substrata become rarer towards the western part of Lombardy

Investigation of the ISPP dynamics and of the programming efficiency of charge-trap memories

Abstract—This paper presents a detailed investigation of the ISPP dynamics of charge-trap memory capacitors, considering not only the flat-band voltage but also the bottom oxide electric field and tunneling current evolution during programming. Differently from the floating-gate case, results on nitride-based memories show that the flat-band increase per step does not equal the step amplitude of the gate staircase, decreasing, moreover, as programming proceeds. As a consequence, the electric field and tunneling current through the bottom oxide are shown to largely increase. Using results at different temperatures and on samples with different stack compositions, this dynamics is explained in terms of a drop of the programming efficiency as more and more charge is stored in the nitride layer, due to the reduction of the number of free traps available for capturing the injected electrons