Tools to Detect Delirium Superimposed on Dementia:A Systematic Review

BACKGROUND: Delirium commonly occurs in patients with dementia. Though several tools for detecting delirium exist, it is unclear which are valid in patients with delirium superimposed on dementia. OBJECTIVES: Identify valid tools to diagnose delirium superimposed on dementia DESIGN: We performed a systematic review of studies of delirium tools, which explicitly included patients with dementia. SETTING: In-hospital patients PARTICIPANTS: Studies were included if delirium assessment tools were validated against standard criteria, and the presence of dementia was assessed according to standard criteria that used validated instruments. MEASUREMENTS: PubMed, Embase, and Web of Science databases were searched for articles in English published between January 1960 and January 2012. RESULTS: Nine studies fulfilled the selection criteria. Of the total of 1569 patients, 401 had dementia, and 50 had delirium superimposed on dementia. Six delirium tools were evaluated. One studyusing the Confusion Assessment Method (CAM) with 85% patients with dementia showed a high specificity (96–100%) and moderate sensitivity (77%).Two intensive care unit studies that used the CAM for the Intensive Care Unit (CAM-ICU) ICU reported 100% sensitivity and specificity for delirium among 23 dementia patients. One study using electroencephalography reported a sensitivity of 67% and a specificity of 91% among a population with 100% prevalence of dementia. No studies examined potential effects of dementia severity or subtype upon diagnostic accuracy. CONCLUSIONS: The evidence base on tools for detection of delirium superimposed on dementia is limited, although some existing tools show promise. Further studies of existing or refined tools with larger samples and more detailed characterization of dementia are now required to address the identification of delirium superimposed on dementia

Data for wetlandscapes and their changes around the world

Geography and associated hydrological, hydroclimate and land-use conditions and their changes determine the states and dynamics of wetlands and their ecosystem services. The influences of these controls are not limited to just the local scale of each individual wetland but extend over larger landscape areas that integrate multiple wetlands and their total hydrological catchment – the wetlandscape. However, the data and knowledge of conditions and changes over entire wetlandscapes are still scarce, limiting the capacity to accurately understand and manage critical wetland ecosystems and their services under global change. We present a new Wetlandscape Change Information Database (WetCID), consisting of geographic, hydrological, hydroclimate and land-use information and data for 27 wetlandscapes around the world. This combines survey-based local information with geographic shapefiles and gridded datasets of large-scale hydroclimate and land-use conditions and their changes over whole wetlandscapes. Temporally, WetCID contains 30-year time series of data for mean monthly precipitation and temperature and annual land-use conditions. The survey-based site information includes local knowledge on the wetlands, hydrology, hydroclimate and land uses within each wetlandscape and on the availability and accessibility of associated local data. This novel database (available through PANGAEA https://doi.org/10.1594/PANGAEA.907398; Ghajarnia et al., 2019) can support site assessments; cross-regional comparisons; and scenario analyses of the roles and impacts of land use, hydroclimatic and wetland conditions, and changes in whole-wetlandscape functions and ecosystem services

Muscarinic modulation of the sodium-calcium exchanger in heart failure.

BACKGROUND: The Na-Ca exchanger (NCX) is a critical calcium efflux pathway in excitable cells, but little is known regarding its autonomic regulation. METHODS AND RESULTS: We investigated beta-adrenergic receptor and muscarinic receptor regulation of the cardiac NCX in control and heart failure (HF) conditions in atrially paced pigs. NCX current in myocytes from control swine hearts was significantly increased by isoproterenol, and this response was reversed by concurrent muscarinic receptor stimulation with the addition of carbachol, demonstrating accentuated antagonism. Okadaic acid eliminated the inhibitory effect of carbachol on isoproterenol-stimulated NCX current, indicating that muscarinic receptor regulation operates via protein phosphatase-induced dephosphorylation. However, in myocytes from atrially paced tachycardia-induced HF pigs, the NCX current was significantly larger at baseline but less responsive to isoproterenol compared with controls, whereas carbachol failed to inhibit isoproterenol-stimulated NCX current, and 8-Br-cGMP did not restore muscarinic responsiveness. Protein phosphatase type 1 dialysis significantly reduced NCX current in failing but not control cells, consistent with NCX hyperphosphorylation in HF. Protein phosphatase type 1 levels associated with NCX were significantly depressed in HF pigs compared with control, and total phosphatase activity associated with NCX was significantly decreased. CONCLUSIONS: We conclude that the NCX is autonomically modulated, but HF reduces the level and activity of associated phosphatases; defective dephosphorylation then locks the exchanger in a highly active state

Abstract 42: Association of Optimism with Cardiovascular Health: Results From the Hispanic Community Health Study/Study (HCHS/SOL) of Latinos Sociocultural Ancillary Study

Introduction: There is mounting evidence linking positive psychological functioning to restorative health processes and favorable medical outcomes. However, very little is known about the relationship between optimism--an indicator of psychological functioning--and the American Heart Association ( AHA ) defined concept of cardiovascular health ( CVH ), particularly in Hispanics/Latinos of diverse backgrounds. Hypothesis: Persons with greater optimism will have more favorable CVH profiles. Methods: We analyzed data from adults ages 18-75 that participated in the Hispanic Community Health Study/Study of Latinos ( HCHS/SOL ) Sociocultural Ancillary Study in 2010-11. Optimism was assessed using the Life-Orientation Test-Revised, with scores ranging from 6-24 and higher scores indicative of greater levels of optimism. AHA classification standards were used to derive a composite CVH score with subsequent grouping into categorizes of poor (0-7 points), intermediate (8-11 points), and ideal (12-14 points). Metrics considered when calculating the overall CVH score included diet, body mass index, physical activity, cholesterol, blood pressure, fasting glucose, and smoking status. Multinomial logistic regression was used to examine associations of optimism with ideal and intermediate CVH (poor CVH—ref. group), after adjusting for socio-demographic factors and depressive symptoms. Results: Among 4,960 participants with complete data, 9.2% were categorized as having ideal CVH. In multivariable-adjusted models, participants with moderate levels of optimism were more likely to have intermediate [OR = 1.37: 95%CI = 1.08, 1.74] and ideal [OR = 1.61: 95%CI = 1.04, 2.48] CVH when compared to the least optimistic group ( Table 1 ). Conclusions: The current study offers preliminary evidence for an association between optimism and CVH in a large heterogeneous group of Hispanic/Latino adults. Future studies should explore the concept of optimistic bias and whether exaggerated levels of optimism are detrimental to health

Léon Сlédat. Manuel de Phonétique et de Morphologie romanes. Paris, Ed. Champion, 1926

Anglade Joseph. Léon Сlédat. Manuel de Phonétique et de Morphologie romanes. Paris, Ed. Champion, 1926. In: Annales du Midi : revue archéologique, historique et philologique de la France méridionale, Tome 41, N°163-164, 1929. pp. 183-185

Uniform Partition of Heirs Property Act

The Uniform Partition of Heirs Property Act is an act of limited scope which addresses a widespread, well-documented problem faced by many low to middle-income families across the country who have been dispossessed of their real property and much of their real property-related wealth over the past several decades as a result of court-ordered partition sales of tenancy-in-common properties. The highly unstable ownership these families experience stands in sharp contrast to the secure property rights wealthier families typically enjoy. Further, the loss of real property-related wealth these low to middle-income families have experienced has been particularly devastating to these families given the fact that real property constitutes by far the single greatest asset that these property owners typically own, unlike the much more diversified asset portfolios that wealthier families normally possess. In addition, the Act may be very helpful to a surprising number of wealthier families who own tenancy-in-common property under the default rules and who also experience great problems with this ownership form