Informant single screening questions for delirium and dementia in acute care – a cross-sectional test accuracy pilot study

Background Cognitive impairment often goes undetected in older people in hospital. Efficient screening tools are required to improve detection.<p></p> To determine diagnostic properties of two separate informant-based single screening questions for cognitive impairment (dementia and delirium) in hospitalised older people.<p></p> Methods Patients over 65 years non-electively admitted to medical or geriatric wards within a teaching hospital. Our index tests were single screening questions (SSQ), one for dementia (“How has your relative/friend’s memory changed over the past 5 years (up to just before their current illness)?”) and one for delirium (“How has your relative/friend’s memory changed with his/her current illness?”), which were assessed with informant response given on a five point Likert scale.<p></p> Any deterioration on our index tests of SSQ-dementia and SSQ-delirium was accepted as a positive screen for cognitive impairment. Scores were compared to the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) >3.38 accepted as dementia, and Confusion Assessment Method (CAM) diagnosis of delirium. We also collected direct cognitive screening data using Mini Mental Status Examination (MMSE).<p></p> Results Informant responses were obtained in 70/161 (43.5%) patients, median age 80.8 (range:67–97) years; mean MMSE score 18.5 (SD: 8.1). The SSQ-dementia when compared to the IQCODE had a sensitivity of 83.3% and specificity of 93.1%. The SSQ-delirium when compared to CAM diagnosis had sensitivity of 76.9% and a specificity of 56.1%.<p></p> Conclusions These findings show promise for use of an informant single screening question tool as the first step in detection of dementia in older people in acute hospital care, although this approach appears to be less accurate in screening for delirium.<p></p&gt

Sexy streamers? The role of natural and sexual selection in the evolution of hirundine tail streamers

In this comment we review some experiments, which address the initial selection pressures promoting the development of tail streamers in some hirundine species. The results of recent experiments have been interpreted as providing evidence for the hypothesis that tail streamers evolved as a handicap, through sexual selection. We offer an alternative explanation with evidence from our studies which suggest that tail streamers may have evolved initially through natural selection for increased manoeuvrability, and would not therefore originally act as a handicap

Assessing the aerodynamic effects of tail elongations in the house martin (Delichon urbica): Implications for the initial selection pressures in hirundines

Of the three species of Hirundine that breed sympatrically across the U.K., one, the barn swallow, has outer tail feathers elongated into streamers, whereas the other two species, the house martin and the sand martin, do not. The tail streamer of the barn swallow is regarded as a classic example of a sexually selected trait. Recent evidence, however, has suggested that streamers may have evolved largely through natural selection for enhanced flight performance and increased maneuverability. We tested the hypotheses that small streamers 1) increase performance in turning flight, but 2) decrease performance in flight variables related to velocity. We manipulated the lengths of house martin outer tail feathers and measured changes in their free-flight performance, using stereo-video to reconstruct the birds’ 3D flight paths. Five flight variables were found to best describe individual variation in flight performance. Of these five, the three variables determining maneuverability predicted that flight performance would be optimized by a 6 to 10mm increase in the length of the outer tail feathers. In contrast, for mean velocity and mean acceleration, extension of the outer tail feathers appears to have a detrimental effect on flight performance. We suggest that the initial selection pressure for streamers in ancestral short-tailed ‘barn swallows’ was via natural selection for increased maneuverability. In addition, we propose that the benefits of increased maneuverability has differed between hirundines in the past, such that the cost of increasing the length of the outer tail feather has, to date, outweighed the benefits of doing so in streamer-less hirundines

The influence of exposure approaches to in vitro lung epithelial barrier models to assess engineered nanomaterial hazard

Exposure to engineered nanomaterials (ENM) poses a potential health risk to humans through long-term, repetitive low-dose exposures. Currently, this is not commonplace within in vitro lung cell cultures. Therefore, the purpose of this study was to consider the optimal exposure approach toward determining the stability, sensitivity and validity of using in vitro lung cell mono- and co-cultures to determine ENM hazard. A range of exposure scenarios were conducted with DQ12 (previously established as a positive particle control) (historic and re-activated), TiO2 (JRC NM–105) and BaSO4 (JRC NM–220) on both monocultures of A549 cells as well as co-cultures of A549 cells and differentiated T HP-1 cells. Cell cultures were exposed to either a single, or a repeated exposure over 24, 48- or 72-hours at in vivo extrapolated concentrations of 0–5.2 μg/cm2, 0-6 μg/cm2 and 0-1μg/cm2. The focus of this study was the pro-inflammatory, cytotoxic and genotoxic response elicited by these ENMs. Exposure to DQ12 caused pro-inflammatory responses after 48 hours repeat exposures, as well as increases in micronucleus frequency. Neither TiO2 nor BaSO4 elicited a pro-inflammatory response at this time point. However, there was induction of IL-6 after 24 hours TiO2 exposure. In conclusion, it is important to consider the appropriateness of the positive control implemented, the cell culture model, the time of exposure as well as the type of exposure (bolus or fractionated) before establishing if an in vitro model is appropriate to determine the level of response to the specific ENM of interest

Primary school teachers' experiences of well-being. How can well-being be supported by schools and educational psychologists?

With the additional responsibilities that come from the new SEND Code of practice and a government focus on supporting the mental health of children, the well-being of teachers was deemed a relevant and useful focus of research. This study aimed to elicit teachers’ experiences of well-being and the factors that support well-being, considering the role for the school and the Educational Psychologist. Data was collected from five Key Stage Two teachers in the same local authority using semi-structured interviews and analysed using Interpretative Phenomenological Analysis (Smith, Flowers and Larkin, 2009). The concept of well-being, professional identity, interpersonal relationships and interpersonal approaches, managing the demands of the role and personal resources were developed as superordinate themes. Conclusions and suggestions have been provided for schools and Educational Psychologists to discuss, which focus on a whole school approach to supporting well-being

Evaluation of delirium screening tools in geriatric medical inpatients: a diagnostic test accuracy study

Introduction: screening all unscheduled older adults for delirium is recommended in national guidelines, but there is no consensus on how to perform initial assessment. Aim: to evaluate the test accuracy of five brief cognitive assessment tools for delirium diagnosis in routine clinical practice. Methods: a consecutive cohort of non-elective, elderly care (older than 65 years) hospital inpatients admitted to a geriatric medical assessment unit of an urban teaching hospital. Reference assessments were clinical diagnosis of delirium performed by elderly care physicians. Routine screening tests were: Abbreviated Mental Test (AMT-10, AMT-4), 4 A's Test (4AT), brief Confusion Assessment Method (bCAM), months of the year backwards (MOTYB) and informant Single Question in Delirium (SQiD). Results: we assessed 500 patients, mean age 83 years (range = 66−101). Clinical diagnoses were: 93 of 500 (18.6%) definite delirium, 104 of 500 (20.8%) possible delirium and 277 of 500 (55.4%) no delirium; 266 of 500 (53.2%) were identified as definite or possible dementia. For diagnosis of definite delirium, AMT-4 (cut-point < 3/4) had a sensitivity of 92.7% (95% confidence interval (CI): 84.8–97.3), with a specificity of 53.7% (95% CI: 48.1–59.2); AMT-10 (<4/10), MOTYB (<4/12) and SQiD showed similar performance. bCAM had a sensitivity of 70.3% (95% CI: 58.5–80.3) with a specificity of 91.4% (95% CI: 87.7–94.3). 4AT (>4/12) had a sensitivity of 86.7% (95% CI: 77.5–93.2) and specificity of 69.5% (95% CI: 64.4–74.3). Conclusions: short screening tools such as AMT-4 or MOTYB have good sensitivity for definite delirium, but poor specificity; these tools may be reasonable as a first stage in assessment for delirium. The 4AT is feasible and appears to perform well with good sensitivity and reasonable specificity

Four weeks of augmented eccentric loading using a novel leg press device improved leg strength in well-trained athletes and professional sprint track cyclists

This study assessed the efficacy of strength training using augmented eccentric loading to provoke increases in leg strength in well-trained athletes, and sprint track cyclists, using a novel leg press device. Twelve well-trained athletes were randomly allocated traditional resistance training (TRAD, n = 6), or resistance training using augmented eccentric loading (AEL, n = 6). A further 5 full-time, professional sprint track cyclists from a senior national squad programme also trained with augmented eccentric loading (AEL-ATH) alongside their usual sport-specific training. Participants completed four weeks of twice-weekly resistance training using the leg press exercise. In TRAD the lowering phase of the lift was set relative to concentric strength. In AEL and AEL-ATH the lowering phase was individualised to eccentric strength. Concentric, eccentric, isometric and coupled eccentric-concentric leg press strength, and back squat 1 repetition maximum (1RM), were assessed pre- and post-training. The AEL and AEL-ATH groups performed the eccentric phase with an average 26 ± 4% greater load across the programme. All groups experienced increases in concentric (5%, 7% and 3% for TRAD, AEL & AEL-ATH respectively), eccentric (7%, 11% and 6% for TRAD, AEL & AEL-ATH respectively), and squat 1RM (all p < 0.05), where the AEL-ATH group experienced relatively greater increases (13% vs. 5% in TRAD and AEL, p < 0.01). The TRAD and AEL groups also increased isometric strength (p < 0.05). A four-week period of augmented eccentric loading increased leg strength in well-trained athletes and track cyclists. The eccentric leg press stimulus was well-tolerated, supporting the inclusion of such training in the preparation programmes of athletes

Mitochondrial Respiration Is Decreased in Rat Kidney Following Fetal Exposure to a MaternalLow-ProteinDiet

Maternal protein restriction in rat pregnancy is associated with impaired renal development and age-related loss of renal function in the resulting offspring. Pregnant rats were fed either control or low-protein (LP) diets, and kidneys from their male offspring were collected at 4, 13, or 16 weeks of age. Mitochondrial state 3 and state 4 respiratory rates were decreased by a third in the LP exposed adults. The reduction in mitochondrial function was not explained by complex IV deficiency or altered expression of the complex I subunits that are typically associated with mitochondrial dysfunction. Similarly, there was no evidence that LP-exposure resulted in greater oxidative damage to the kidney, differential expression of ATP synthetase β-subunit, and ATP-ADP translocase 1. mRNA expression of uncoupling protein 2 was increased in adult rats exposed to LP in utero, but there was no evidence of differential expression at the protein level. Exposure to maternal undernutrition is associated with a decrease in mitochondrial respiration in kidneys of adult rats. In the absence of gross disturbances in respiratory chain protein expression, programming of coupling efficiency may explain the long-term impact of the maternal diet

Variability of phenylalanine ammonia-lyase and peroxidase activities in leaves of subterranean clover is determined by their susceptibility to Kabatiella caulivora

Kabatiella caulivora is the causal organism of northern anthracnose or clover (Trifolium spp.) scorch disease. The activities of phenylalanine ammonia-lyase (PAL) and soluble peroxidase were determined in seedling leaves of two cultivars of subterranean clover (T. subterraneum) inoculated with race 1 or race 2 of K. caulivora. A small increase in activity of PAL was recorded in both cultivars 2–4 h post inoculation with either race. A second, large increase in PAL activity was observed only in the incompatible interaction (cv. Daliak inoculated with race 1), increasing 18-fold between 8 and 48 h post inoculation. Peroxidase activity in cv. Daliak increased rapidly within 2 h post inoculation with either race but was significantly higher in the incompatible interaction. Peroxidase activity in cv. Woogenellup increased by 4 h post inoculation with either race, but was significantly lower than that in cv. Daliak. Subsequent increases in peroxidase activity were recorded in both cultivars, however the levels remained constant in cv. Daliak infected with race 1, while activities in the other race-cultivar combinations decreased to control levels. It is hypothesised that the peak of activity of PAL at 48 h, and the rapid increase in peroxidase at 2 h are related to the race-specific resistance response of cv. Daliak to race 1 of K. caulivora, and that minor peaks of activity in the compatible interactions are general defence responses

The Characteristics and Biological Relevance of Inorganic Amorphous Calcium Carbonate (ACC) Precipitated from Seawater

The importance of amorphous calcium carbonate (ACC) as a precursor phase in the biomineralization of marine calcifiers is increasingly being reported, particularly as the presence of ACC has been observed or inferred in several major groups. Here, we investigate the structure of ACC and the conditions required for its precipitation from seawater-based solutions, with an emphasis on the coinfluence of the carbonate system (pH, dissolved inorganic carbon (DIC) concentration), seawater Mg/Ca ratio, and presence of amino acids. We find that Mg2+ and the presence of aspartic acid, glutamic acid, and glycine strongly inhibit ACC precipitation. Moreover, we were unable to precipitate ACC from seawater with a carbonate chemistry within the range of that thought to characterize the calcification site of certain marine calcifiers (i.e., DIC < 6 mM, pH < 9.3), although substantial modification of the seawater Mg/Ca ratio (Mg/Casw) allowed precipitation at a reduced DIC with the implication that this could be an important component of utilizing an ACC pathway. In addition, the degree to which Mg/Casw and the presence of amino acids influences the structure of ACC and the necessary seawater [CO3 2-] for precipitation is strongly pH dependent. At lower, more biologically relevant pH than that typical of much inorganic work, decreasing Mg/Casw can result in greater long-range order and less water of crystallization but facilitates precipitation at a considerably lower [CO3 2-] than at higher pH