"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

Machine Learning for Text-Independent Speaker Verification : How to Teach a Machine to RecognizeHuman Voices

The aim of speaker recognition and veri cation is to identify people's identity from the characteristics of their voices (voice biometrics). Traditionally this technology has been employed mostly for security or authentication purposes, identi cation of employees/customers and criminal investigations. During the last decade the increasing popularity of hands-free and voice-controlled systems and the massive growth of media content generated on the internet has increased the need for techniques to automatically and accurately analyse speech signals. Speaker recognition is thus becoming a fundamental block for the smart analysis of speech in video and audio content, along with other technologies like speech recognition and diarization. Examples of useful applications of these technologies are query-by-voice, automatic subtitling and automatic metadata generation for movies and television. In this thesis we evaluate di erent state-of-the-art techniques for text-independent speaker veri cation on a large database of read English speech (LibriSpeech ASR corpus). The di erent techniques are compared in terms of classi cation accuracy, scalability and robustness to noise. A classi cation approach based on discriminatively trained Arti cial Neural Networks (ANNs) is presented, showing superior classi cation performance to traditional generative models like Gaussian Mixture Models (GMMs) and Ivectors. The core contribution of the thesis is a novel hybrid generative/discriminative method, using ANNs and a GMM-Universal Background Model (UBM) to obtain state-of-the-art speaker recognition results. The advantage of the new system is the possibility of using ANNs while maintaining complete scalability: an arbitrary number of new speakers can be added to the system without the need of retraining the speaker models. At the same time the system achieves very good performance, with only 0.23% Equal Error Rate (EER) in veri cation mode and 99.6% classi cation accuracy on a dataset of 2483 speakers, both male and female.Syftet med talarigenkänning och verifiering är att identifiera människors identitet utifrån de egenskaper som karakteriserar deras röster (röstbiometri). Traditionellt har denna teknologi främst använts inom säkerhets och autentiseringsområdet för att identifiera anställda/kunder eller personer i brottsutredningar. Under det senaste decenniet har den successivt ökande populariteten för handsfree och röststyrda system och den massiva ökningen av medieinnehåll som genereras på Internet ökat behovet av tekniker för att automatiskt och noggrant analysera talsignaler. Talarigenkänning är därmed på väg att bli en grundläggande teknologi för smart analys av tal i video och ljud, tillsammans med andra teknologier som taligenkänning och diarieföring. Exempel på användbara tillämpningar av dessa teknologier är röstbaserade användarinterface, automatisk textning och automatisk generering av metadata för film och TV. I detta examensarbete utvärderar vi olika state-of-the-art tekniker för text oberoende talarverifiering på en stor databas av engelska ljudböcker (LibriSpeech ASR corpus). De olika teknikerna jämförs i termer av klassificeringsnoggrannhet, skalbarhet och robusthet för buller. En klassificeringsmetod baserad på diskriminativt tränade Artificiella Neu-rala N¨atverk (ANN) presenteras. Metoden visar överlägsen klassificeringsprestanda över traditionella generativt tränade modeller som Gaussiska mixtur-modeller (GMMer) och i-vektorer. Huvudbidraget i examensarbetet är en ny hybrid generativ/diskriminativ metod som använder en kombination av en ANN och en GMM-Universal bakgrundsmodell (UBM) för att uppnå state-of-the-art talarigenkänningsresultat. Fördelen med det nya systemet är möjligheten att använda ANN med bibehållen skalbarhet: ett godtyckligt antal nya talare kan adderas till systemet utan behov av omträning av talarmodellerna. Samtidigt uppnår systemet mycket bra prestanda, endast 0,23% Equal Error Rate (EER) i verifieringsläget och 99,6% klassificeringsnoggrannhet på ett dataset med 2483 talare, både män och kvinnor

Taste loss in hospitalized multimorbid elderly subjects

Background: Loss of the sense of taste is common among older people. Morbidities and polypharmacy may contribute to the age-related decline in gustatory function. The aims of the present study were to investigate taste perception in elderly hospitalized patients by comparing their taste recognition thresholds with those of healthy, free-living elderly individuals and to identify potential determinants of taste loss. Methods: The participants in this observational study were 55 elderly patients hospitalized in the acute geriatric section of the Department of Medical and Surgical Sciences at Padova University and 41 free-living individuals aged older than 65 years, randomly recruited from elderly people attending mild fitness programs at public gymnasiums in Padova. Data were collected on nutrition, health, cognitive, and functional status for all participants. Gustatory capabilities were assessed using aqueous solutions of sucrose, sodium chloride, citric acid, and quinine hydrochloride (representing sweet, salty, sour, and bitter stimuli, respectively), and taste recognition thresholds were measured in both groups. Results: In comparison with the free-living elderly subjects, those in hospital were significantly less able to recognize the taste of citric acid (P , 0.05). Low citric acid sensitivity was independently associated with advanced age ($75 years; odds ratio [OR] 3.01, 95$ 4; OR 2.74, 95% CI 1.01–7.72), and poor nutritional status (as assessed by Mini Nutritional Assessment score , 23.5; OR 5.08, 95% CI 1.76–14.6). Conclusion: Because gustatory impairment may reduce a person’s appetite and lead to inadequate dietary intake, compensatory nutritional measures, such as the use of flavor-enhanced foods, should be strongly encouraged, particularly in the hospital setting

Taste loss in hospitalized multimorbid elderly subjects

Loss of the sense of taste is common among older people. Morbidities and polypharmacy may contribute to the age-related decline in gustatory function. The aims of the present study were to investigate taste perception in elderly hospitalized patients by comparing their taste recognition thresholds with those of healthy, free-living elderly individuals and to identify potential determinants of taste loss. The participants in this observational study were 55 elderly patients hospitalized in the acute geriatric section of the Department of Medical and Surgical Sciences at Padova University and 41 free-living individuals aged older than 65 years, randomly recruited from elderly people attending mild fitness programs at public gymnasiums in Padova. Data were collected on nutrition, health, cognitive, and functional status for all participants. Gustatory capabilities were assessed using aqueous solutions of sucrose, sodium chloride, citric acid, and quinine hydrochloride (representing sweet, salty, sour, and bitter stimuli, respectively), and taste recognition thresholds were measured in both groups. In comparison with the free-living elderly subjects, those in hospital were significantly less able to recognize the taste of citric acid (P = 75 years; odds ratio [OR] 3.01, 95% confidence interval [CI] 1.01-9.82), polypharmacy (number of prescribed drugs >= 4; OR 2.74, 95% CI 1.01-7.72), and poor nutritional status (as assessed by Mini Nutritional Assessment score < 23.5; OR 5.08, 95% CI 1.76-14.6). Because gustatory impairment may reduce a person's appetite and lead to inadequate dietary intake, compensatory nutritional measures, such as the use of flavor-enhanced foods, should be strongly encouraged, particularly in the hospital settin

Malnutrition is associated with increased risk of hospital admission and death in the first 18 months of institutionalization

Objectives: This study aimed to investigate the association between different nutritional and anthropometric parameters with the risk of hospitalizations and death within 18 months from nursing home admission. Our hypothesis was that measures of malnutrition could be more strongly associated with worse clinical outcomes than measures of overweight/obesity. Methods: This prospective study involved 144 older adults newly admitted in nursing home and followed up over 18 months. A multidimensional assessment focusing on clinical, functional and cognitive status was performed at baseline. Assessment also included body mass index (BMI), waist circumference, calf circumference, MNA Short-Form (MNA-SF), and serum albumin and lymphocytes levels. Anthropometric measurements were repeated at 6 months. Data on hospitalizations and mortality over the study period, with their respective causes, were obtained from administrative data. The associations between baseline nutritional parameters and the risk of hospitalizations or death were analyzed through multinomial logistic regressions and Cox regressions, respectively. Results: During the follow-up, 64 individuals (44.4%) were hospitalized, and 52 (36.1%) died. Residents who reported low MNA-SF and calf circumference at nursing home admission had more than threefold-increased odds of hospitalizations compared with their healthier counterparts. Adults with low calf circumference also had the highest mortality (HR = 3.39, 95%CI:1.80\u20136.39), while more attenuated results were observed for low serum albumin, MNA-SF, and BMI (either when considering cut-offs of excess weight or malnutrition). When assessing the associations between 0 and 6 month changes in calf circumference and mortality in the following 12 months, we found that each 1 cm decrease in calf circumference increased the one-year mortality by 29% (95%CI 1.04\u20131.60). Conclusions: Malnutrition, but not overweight/obesity, seems associated with a higher risk of hospitalization and mortality after nursing home admission. Monitoring calf circumference, in particular, may help in the early detection of individuals who are potentially vulnerable to adverse health-related outcomes after institutionalization