Occurrence rate of delirium in acute stroke settings

Background and Purpose— Delirium is associated with increased mortality, length of stay, and poor functional outcome following critical illness. The epidemiology of delirium in stroke is poorly described. We sought to collate evidence around occurrence (incidence or prevalence) of delirium in acute stroke. Methods— We searched multiple cross-disciplinary electronic databases using a prespecified search strategy, complemented by hand searching. Eligible studies described delirium in acute (first 6 weeks) stroke. We compared delirium occurrence using random-effects models to describe summary estimates. We assessed risk of bias using the Newcastle-Ottawa tool, incorporating this in sensitivity analyses. We performed subgroup analyses for delirium diagnostic method (confusion assessment method scoring, clinical diagnosis, other), duration and timing of delirium assessment (>1 or <1 week), and performed meta-regression based on the year of publication. Results— Of 8822 titles, we included 32 papers (6718 participants) in the quantitative analysis. Summary estimate for occurrence of delirium was 25% (95% CI, 20%–30%; moderate quality evidence). Limiting to studies at low risk of bias (22 studies, 4422 participants), the occurrence rate was 23% (95% CI, 17%–28%). Subgroup summary estimates suggest that delirium occurrence may vary with assessment method: confusion assessment method, 21% (95% CI, 16%–27%); clinical diagnosis, 27% (95% CI, 19%–38%); other, 32% (95% CI, 22%–43%) but not with duration and timing of assessment. Meta-regression suggested decline in occurrence of delirium comparing historical to more recent studies (slope, 0.03 [SE, 0.004]; P<0.0001). Conclusions— Delirium is common, affecting 1 in 4 acute stroke patients. Reported rates of delirium may be dependent on assessment method. Our estimate of delirium occurrence could be used for audit, to plan intervention studies, and inform clinical practice. Clinical Trial Registration— URL: http://www.crd.york.ac.uk/PROSPERO/. Unique identifier: CRD42015029251

Exploring how age influences sensory perception, thirst and hunger during the consumption of oral nutritional supplements using the check-all-that-apply methodology

The Check-all-that-apply (CATA) method has been widely used for the sensory characterisation of many different foods and beverages. However, this methodology has been rarely used with older adults. The aim of this study was to measure the effectiveness of the CATA methodology to investigate the differences in sensory perception of Oral Nutritional Supplements (ONS) between younger and community dwelling older adults over successive sips of a full volume of two ONS. The study also sought to measure the effects of ONS on thirst, hunger and fullness. 160 participants (eighty aged over 65 and eighty aged 18-35) evaluated two ONS over two different days. They consumed five 40 ml aliquots of ONS amounting to one serving. After each 40 ml they completed a CATA questionnaire, which recorded liking using a 9-point hedonic scale and hunger, fullness, desire, and thirst using 100 mm visual analogue scales. The results indicated significantly lower levels in hunger (p ≤ 0.01) and thirst (p ≤ 0.01) in the older cohort than the younger cohort. Significant differences in texture perception with age were also observed with the younger cohort selecting ‘Watery’ significantly more (p ≤ 0.05) than the older cohort for ONS 1 and ‘Thick’ and ‘Viscous’ significantly more (p ≤ 0.05) for ONS 2. The study showed that the CATA methodology is appropriate for use with older adults. The findings enhanced our understanding of how an older population experience ONS and drivers of ‘liking’. This information has the potential to enhance ONS adherence and ultimately improve the nutritional status of older people

Student employability enhancement through fieldwork: purposefully integrated or a beneficial side effect?

Fieldwork provides opportunities for students to develop employability-enhancing transferable skills as well as technical, discipline-specific skills and disciplinary knowledge. However, the extent to which staff purposely plan transferable skills outcomes of field courses, and, therefore, whether they are communicated to students is unknown. We investigated whether staff intentionally plan transferable skills development opportunities into fieldwork by interviewing academic staff responsible for planning and leading residential field courses at a UK university. We also conducted a thematic analysis of associated module specifications and teaching materials to understand whether transferable skills were signposted to colleagues and students. Our findings show that although most staff recognise that their field courses help students to develop transferable skills, staff awareness of skills and professional development outcomes is narrowly focused on technical skills and discipline-related careers. Furthermore, those transferable skills outcomes that staff are aware of are not fully translated into module specifications and infrequently signposted to students via teaching materials. These findings suggest that transferable skills form a hidden curriculum of fieldwork. To maximise the employability benefits of fieldwork, we recommend that all skills should be signposted to students both during field course teaching and also via the associated teaching materials

Demography and ecology of southern right whales Eubalaena australis wintering at sub-Antarctic Campbell Island, New Zealand

Since the decimation of the southern right whale Eubalaena australis population in New Zealand by whaling, research on its recovery has focused on the wintering ground at the Auckland Islands, neglecting potentially important wintering habitat at Campbell Island. For the first time in 20 years we conducted an expedition to sub-Antarctic Campbell Island to document and describe E. australis occupying this wintering habitat. We used a variety of methods including photo-identification, genetic and stable isotope analyses of tissue samples, and visual surveys of abundance and distribution, to provide details on the demography, population connectivity and ecology of E. australis wintering at Campbell Island. Our primary findings include (1) a lack of calves observed at Campbell Island, (2) an age-class bias toward sub-adults encountered at Campbell Island, (3) nine photo-identification matches between individuals observed at Campbell Island and previously documented elsewhere in New Zealand, (4) no genetic differentiation between E. australis at Campbell Island and the broader New Zealand population, (5) increased abundance estimates of E. australis at Campbell Island over the last 20 years, and (6) indications that E. australis forage within the sub-Antarctic region based on stable isotope analyses. Our results confirm that the Auckland Islands are currently the only significant calving area for E. australis in New Zealand, and therefore previous abundance estimates based on demographic data from the Auckland Islands are applicable to the entire New Zealand population of E. australis. However, future periodic surveys to Campbell Island are recommended to monitor population recovery and expansion.PostprintPeer reviewe

Study protocol for a randomised controlled trial of invasive versus conservative management of primary spontaneous pneumothorax

INTRODUCTION: Current management of primary spontaneous pneumothorax (PSP) is variable, with little evidence from randomised controlled trials to guide treatment. Guidelines emphasise intervention in many patients, which involves chest drain insertion, hospital admission and occasionally surgery. However, there is evidence that conservative management may be effective and safe, and it may also reduce the risk of recurrence. Significant questions remain regarding the optimal initial approach to the management of PSP

Identification of single-site gold catalysis in acetylene hydrochlorination

There remains considerable debate over the active form of gold under operating conditions of a recently validated gold catalyst for acetylene hydrochlorination. We have performed an in situ x-ray absorption fine structure study of gold/carbon (Au/C) catalysts under acetylene hydrochlorination reaction conditions and show that highly active catalysts comprise single-site cationic Au entities whose activity correlates with the ratio of Au(I):Au(III) present. We demonstrate that these Au/C catalysts are supported analogs of single-site homogeneous Au catalysts and propose a mechanism, supported by computational modeling, based on a redox couple of Au(I)-Au(III) species. View Full Tex

Contrasting Responses of Rhizosphere Bacterial, Fungal, Protist and Nematode Communities to Nitrogen Fertilisation and Crop Genotype in Field Grown Oilseed Rape (Brassica napus)

© 2021 Picot, Hale, Hilton, Teakle, Schäfer, Huang, Perryman, West and Bending. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). https://creativecommons.org/licenses/by/4.0/The rhizosphere microbiome is considered to play a key role in determining crop health. However, current understanding of the factors which shape assembly and composition of the microbiome is heavily biased toward bacterial communities, and the relevance for other microbial groups is unclear. Furthermore, community assembly is determined by a variety of factors, including host genotype, environment and agricultural management practices, and their relative importance and interactions remain to be elucidated. We investigated the impact of nitrogen fertilization on rhizosphere bacterial, fungal, nematode and protist communities of 10 contrasting oilseed rape genotypes in a field experiment. We found significant differences in the composition of bacteria, fungi, protist and nematode communities between the rhizosphere and bulk soil. Nitrogen application had a significant but weak effect on fungal, bacterial, and protist community composition, and this was associated with increased relative abundance of a complex of fungal pathogens in the rhizosphere and soil, including Mycosphaerella sp. and Leptosphaeria sp. Network analysis showed that nitrogen application had different effects on microbial community connectivity in the soil and rhizosphere. Crop genotype significantly affected fungal community composition, with evidence for a degree of genotype specificity for a number of pathogens, including L. maculans, Alternaria sp., Pyrenopeziza brassicae, Olpidium brassicae, and L. biglobosa, and also potentially beneficial Heliotales root endophytes. Crop genotype had no significant effect on assembly of bacteria, protist or nematode communities. There was no relationship between genetic distance of crop genotypes and the extent of dissimilarity of rhizosphere microbial communities. Field disease assessment confirmed infection of crops by Leptosphaeria sp., P. brassicae, and Alternaria sp., indicating that rhizosphere microbiome sequencing was an effective indicator of plant health. We conclude that under field conditions soil and rhizosphere nutrient stoichiometry and crop genotype are key factors determining crop health by influencing the infection of roots by pathogenic and mutualistic fungal communities, and the connectivity and stability of rhizosphere microbiome interaction networks.Peer reviewedFinal Published versio