What you need to know about: delirium in older adults in hospital

Delirium is a clinical syndrome characterised by a disturbance of perception, consciousness and/or cognitive function, with an acute onset, fluctuating course and a severe deterioration arising over hours or days. Delirium is usually triggered by a combination of influences including acute illness, surgery, drugs and environmental factors. It is commonly seen in older people presenting to hospital, but can also develop during hospitalisation. There are three types of delirium: hypoactive, hyperactive and mixed. All patients over 65 years old presenting to hospital should be screened for delirium using the ‘4AT’ tool. An alternate method for diagnosing hospital-acquired delirium is described. This article outlines a 10-stage method for diagnosing, managing and preventing delirium, with emphasis on which areas of the history and examination should be prioritised, what the salient investigations are and both non-pharmacological and pharmacological approaches to preventing and treating delirium. Finally, this article explores which patients require specialist referrals or investigations and how to best follow up patients with delirium

The Use of a Satellite Communications System for Command and Control of the National Aeronautics and Space Administration Surrogate Unmanned Aerial System Research Aircraft

The NASA Langley Research Center has transformed a Cirrus Design SR22 general aviation (GA) aircraft into an Unmanned Aerial Systems (UAS) Surrogate research aircraft which has served for several years as a platform for unmanned systems research and development. The aircraft is manned with a Safety Pilot and a Research Systems Operator (RSO) that allows for flight operations almost any-where in the national airspace system (NAS) without the need for a Federal Aviation Administration (FAA) Certificate of Authorization (COA). The UAS Surrogate can be remotely controlled from a modular, transportable ground control station (GCS) like a true UAS. Ground control of the aircraft is accomplished by the use of data links that allow the two-way passage of the required data to control the aircraft and provide the GCS with situational awareness. The original UAS Surrogate data-link system was composed of redundant very high frequency (VHF) data radio modems with a maximum range of approximately 40 nautical miles. A new requirement was developed to extend this range beyond visual range (BVR). This new requirement led to the development of a satellite communications system that provided the means to command and control the UAS Surrogate at ranges beyond the limits of the VHF data links. The system makes use of the Globalstar low earth orbit (LEO) satellite communications system. This paper will provide details of the development, implementation, and flight testing of the satellite data communications system on the UAS Surrogate research aircraft

The NASA Langley Research Center's Unmanned Aerial System Surrogate Research Aircraft

Research is needed to determine what procedures, aircraft sensors and other systems will be required to allow Unmanned Aerial Systems (UAS) to safely operate with manned aircraft in the National Airspace System (NAS). The NASA Langley Research Center has transformed a Cirrus Design SR22 general aviation (GA) aircraft into a UAS Surrogate research aircraft to serve as a platform for UAS systems research, development, flight testing and evaluation. The aircraft is manned with a Safety Pilot and systems operator that allows for flight operations almost anywhere in the NAS without the need for a Federal Aviation Administration (FAA) Certificate of Authorization (COA). The UAS Surrogate can be controlled from a modular, transportable ground station like a true UAS. The UAS Surrogate is able to file and fly in the NAS with normal traffic and is a better platform for real world UAS research and development than existing vehicles flying in restricted ranges or other sterilized airspace. The Cirrus Design SR22 aircraft is a small, singleengine, four-place, composite-construction aircraft that NASA Langley acquired to support NASA flight-research programs like the Small Aircraft Transportation System (SATS) Project. Systems were installed to support flight test research and data gathering. These systems include: separate research power; multi-function flat-panel displays; research computers; research air data and inertial state sensors; video recording; data acquisition; data-link; S-band video and data telemetry; Common Airborne Instrumentation System (CAIS); Automatic Dependent Surveillance-Broadcast (ADS-B); instrumented surfaces and controls; and a systems operator work station. The transformation of the SR22 to a UAS Surrogate was accomplished in phases. The first phase was to modify the existing autopilot to accept external commands from a research computer that was connected by redundant data-link radios to a ground control station. An electro-mechanical auto-throttle was added in the next phase to provide ground station control of airspeed. Additional phases are in progress to add waypoint navigation and long range satellite voice and data communications. Potential areas for UAS Surrogate research include the development, flight test and evaluation of sensors to aid in the process of air traffic detect-sense-and-avoid. These sensors could be evaluated in real-time and compared with onboard human evaluation pilots. This paper describes the systems and design considerations that were incorporated in the development of the UAS Surrogate along with details of development problems encountered and the corresponding solutions

Brown dwarfs and very low mass stars in the Praesepe open cluster: a dynamically unevolved mass function?

[Abridged] In this paper, we present the results of a photometric survey to identify low mass and brown dwarf members of the old open cluster Praesepe (age of 590[+150][-120]Myr and distance of 190[+6.0][-5.8]pc) and use this to infer its mass function which we compare with that of other clusters. We have performed an optical (Ic-band) and near-infrared (J and Ks-band) photometric survey of Praesepe with a spatial coverage of 3.1deg^2. With 5sigma detection limits of Ic=23.4 and J=20.0, our survey is sensitive to objects with masses from about 0.6 to 0.05Msol. The mass function of Praesepe rises from 0.6Msol down to 0.1Msol and then turns-over at ~0.1Msol. The rise observed is in agreement with the mass function derived by previous studies, including a survey based on proper motion and photometry. Comparing our mass function with that for another open cluster with a similar age, the Hyades (age ~ 600Myr), we see a significant difference. Possible reasons are that dynamical evaporation has not influenced the Hyades and Praesepe in the same way, or that the clusters did not have the same initial mass function, or that dynamical interactions have modified the evolution of one or both clusters. Although a difference in the binary fractions of the clusters could cause the observed (i.e. system) mass functions to differ, measurements in the literature give no evidence for a significant difference in the binary fractions of the two clusters. Of our cluster candidates, six have masses predicted to be equal to or below the stellar/substellar boundary at 0.072Msol.Comment: 11 pages, 11 figures, accepted for publication in A&A. Higher resolution of Figures 2-3-4-5 in A&A published version. Revised version corrected for Englis

Acetyl-CoA synthetase 2 promotes acetate utilization and maintains cancer cell growth under metabolic stress

A functional genomics study revealed that the activity of acetyl-CoA synthetase 2 (ACSS2) contributes to cancer cell growth under low-oxygen and lipid-depleted conditions. Comparative metabolomics and lipidomics demonstrated that acetate is used as a nutritional source by cancer cells in an ACSS2-dependent manner, and supplied a significant fraction of the carbon within the fatty acid and phospholipid pools. ACSS2 expression is upregulated under metabolically stressed conditions and ACSS2 silencing reduced the growth of tumor xenografts. ACSS2 exhibits copy-number gain in human breast tumors, and ACSS2 expression correlates with disease progression. These results signify a critical role for acetate consumption in the production of lipid biomass within the harsh tumor microenvironment

Treatment of Peri‐Implant Defects With Combination Growth Factor Cement

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141685/1/jper0008.pd

Developing a model for decision-making around antibiotic prescribing for patients with COVID-19 pneumonia in acute NHS hospitals during the first wave of the COVID-19 pandemic: Qualitative results from the Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients (PEACH Study)

\ua9 Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Objective To explore and model factors affecting antibiotic prescribing decision-making early in the pandemic. Design Semistructured qualitative interview study. Setting National Health Service (NHS) trusts/health boards in England and Wales. Participants Clinicians from NHS trusts/health boards in England and Wales. Method Individual semistructured interviews were conducted with clinicians in six NHS trusts/health boards in England and Wales as part of the Procalcitonin Evaluation of Antibiotic use in COVID-19 Hospitalised patients study, a wider study that included statistical analysis of procalcitonin (PCT) use in hospitals during the first wave of the pandemic. Thematic analysis was used to identify key factors influencing antibiotic prescribing decisions for patients with COVID-19 pneumonia during the first wave of the pandemic (March to May 2020), including how much influence PCT test results had on these decisions. Results During the first wave of the pandemic, recommendations to prescribe antibiotics for patients with COVID-19 pneumonia were based on concerns about secondary bacterial infections. However, as clinicians gained more experience with COVID-19, they reported increasing confidence in their ability to distinguish between symptoms and signs caused by SARS-CoV-2 viral infection alone, and secondary bacterial infections. Antibiotic prescribing decisions were influenced by factors such as clinician experience, confidence, senior support, situational factors and organisational influences. A decision-making model was developed. Conclusion This study provides insight into the decision-making process around antibiotic prescribing for patients with COVID-19 pneumonia during the first wave of the pandemic. The importance of clinician experience and of senior review of decisions as factors in optimising antibiotic stewardship is highlighted. In addition, situational and organisational factors were identified that could be optimised. The model presented in the study can be used as a tool to aid understanding of the complexity of the decision-making process around antibiotic prescribing and planning antimicrobial stewardship support in the context of a pandemic. Trial registration number ISRCTN66682918