Delirium and delirium severity predict the trajectory of the Hierarchical Assessment of Balance and Mobility (HABAM) in hospitalised older people: findings from the DECIDE Study

BACKGROUND: Delirium is common, distressing and associated with poor outcomes. Despite this, delirium remains poorly recognised, resulting in worse outcomes. There is an urgent need for methods to objectively assess for delirium. Physical function has been proposed as a potential surrogate marker, but few studies have monitored physical function in the context of delirium. We examined if trajectories of physical function are affected by the presence and severity of delirium in a representative sample of hospitalised participants over 65 years. METHODS: During hospital admissions in 2016, we assessed participants from the DECIDE study daily for delirium and physical function, using the Hierarchical Assessment of Balance and Mobility (HABAM). We used linear mixed models to assess the effect of delirium and delirium severity during admission on HABAM trajectory. RESULTS: Of 178 participants, 58 experienced delirium during admission. Median HABAM scores in those with delirium were significantly higher (indicating worse mobility) than those without delirium. Modelling HABAM trajectories, HABAM scores at first assessment were worse in those with delirium than those without, by 0.76 (95% CI: 0.49-1.04) points. Participants with severe delirium experienced a much greater perturbance in their physical function, with an even lower value at first assessment and slower subsequent improvement. CONCLUSIONS: Physical function was worse in those with delirium compared to without. This supports the assertion that motor disturbances are a core feature of delirium and monitoring physical function, using a tool such as the HABAM, may have clinical utility as a surrogate marker for delirium and its resolution

AEGIS-X: The Chandra Deep Survey of the Extended Groth Strip

We present the AEGIS-X survey, a series of deep Chandra ACIS-I observations of the Extended Groth Strip. The survey comprises pointings at 8 separate positions, each with nominal exposure 200ks, covering a total area of approximately 0.67 deg2 in a strip of length 2 degrees. We describe in detail an updated version of our data reduction and point source detection algorithms used to analyze these data. A total of 1325 band-merged sources have been found to a Poisson probability limit of 4e-6, with limiting fluxes of 5.3e-17 erg/cm2/s in the soft (0.5-2 keV) band and 3.8e-16 erg/cm2/s in the hard (2-10 keV) band. We present simulations verifying the validity of our source detection procedure and showing a very small, <1.5%, contamination rate from spurious sources. Optical/NIR counterparts have been identified from the DEEP2, CFHTLS, and Spitzer/IRAC surveys of the same region. Using a likelihood ratio method, we find optical counterparts for 76% of our sources, complete to R(AB)=24.1, and, of the 66% of the sources that have IRAC coverage, 94% have a counterpart to a limit of 0.9 microJy at 3.6 microns (m(AB)=23.8). After accounting for (small) positional offsets in the 8 Chandra fields, the astrometric accuracy of the Chandra positions is found to be 0.8 arcsec RMS, however this number depends both on the off-axis angle and the number of detected counts for a given source. All the data products described in this paper are made available via a public website.Comment: 17 pages, 9 figures. Accepted for publication in ApJS. Data products are available at http://astro.imperial.ac.uk/research/aegis

High-resolution x-ray telescopes

High-energy astrophysics is a relatively young scientific field, made possible by space-borne telescopes. During the half-century history of x-ray astronomy, the sensitivity of focusing x-ray telescopes-through finer angular resolution and increased effective area-has improved by a factor of a 100 million. This technological advance has enabled numerous exciting discoveries and increasingly detailed study of the high-energy universe-including accreting (stellar-mass and super-massive) black holes, accreting and isolated neutron stars, pulsar-wind nebulae, shocked plasma in supernova remnants, and hot thermal plasma in clusters of galaxies. As the largest structures in the universe, galaxy clusters constitute a unique laboratory for measuring the gravitational effects of dark matter and of dark energy. Here, we review the history of high-resolution x-ray telescopes and highlight some of the scientific results enabled by these telescopes. Next, we describe the planned next-generation x-ray-astronomy facility-the International X-ray Observatory (IXO). We conclude with an overview of a concept for the next next-generation facility-Generation X. The scientific objectives of such a mission will require very large areas (about 10000 m2) of highly-nested lightweight grazing-incidence mirrors with exceptional (about 0.1-arcsecond) angular resolution. Achieving this angular resolution with lightweight mirrors will likely require on-orbit adjustment of alignment and figure.Comment: 19 pages, 11 figures, SPIE Conference 7803 "Adaptive X-ray Optics", part of SPIE Optics+Photonics 2010, San Diego CA, 2010 August 2-

Constraints on planet X/Nemesis from Solar System's inner dynamics

We put full 3D constraints on a putative planet X by using the dynamics of the inner planets of the solar system. In particular, we compute the mimium distance of X as a function of its heliocentric latitude and longitude for different values of its mass.Comment: LaTex, MNRAS macros. 12 pages, 4 figures, 3 tables. To appear in Monthly Notices of the Royal Astronomical Society (MNRAS). Some typos fixe

Effects of alteplase for acute stroke on the distribution of functional outcomes: a pooled analysis of 9 trials

Background—Thrombolytic therapy with intravenous alteplase within 4.5 hours of ischemic stroke onset increases the overall likelihood of an excellent outcome (no, or nondisabling, symptoms). Any improvement in functional outcome distribution has value, and herein we provide an assessment of the effect of alteplase on the distribution of the functional level by treatment delay, age, and stroke severity. Methods—Prespecified pooled analysis of 6756 patients from 9 randomized trials comparing alteplase versus placebo/open control. Ordinal logistic regression models assessed treatment differences after adjustment for treatment delay, age, stroke severity, and relevant interaction term(s). Results—Treatment with alteplase was beneficial for a delay in treatment extending to 4.5 hours after stroke onset, with a greater benefit with earlier treatment. Neither age nor stroke severity significantly influenced the slope of the relationship between benefit and time to treatment initiation. For the observed case mix of patients treated within 4.5 hours of stroke onset (mean 3 hours and 20 minutes), the net absolute benefit from alteplase (ie, the difference between those who would do better if given alteplase and those who would do worse) was 55 patients per 1000 treated (95% confidence interval, 13–91; P=0.004). Conclusions—Treatment with intravenous alteplase initiated within 4.5 hours of stroke onset increases the chance of achieving an improved level of function for all patients across the age spectrum, including the over 80s and across all severities of stroke studied (top versus bottom fifth means: 22 versus 4); the earlier that treatment is initiated, the greater the benefit

Magnet Laboratory Research

Contains reports on five research projects.United States Atomic Energy Commission (Contract AT(30-1)-1283