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The hep-ex data base was decided not to be an appropriate place to make DELPHI notes public. Sorry for the inconvenience.Comment: the paper should not have been made publi

Care home residents admitted to hospital through the emergency pathway: characteristics and associations with inpatient mortality.

BACKGROUND: Routinely collected hospital information could help to understand the characteristics and outcomes of care home residents admitted to hospital as an emergency. METHODS: This retrospective 2-year service evaluation included first emergency admissions of any older adult (≥75 years) presenting to Cambridge University Hospital. Routinely collected patient variables were captured by an electronic patient record system. Care home status was established using an official register of care homes. RESULTS: 7.7% of 14,777 admissions were care home residents. They were older, frailer, more likely to be women and have cognitive impairment than those admitted from their own homes. Additionally, 42% presented with an Emergency Department Modified Early Warning Score above the threshold triggering urgent review, compared to 26% of older adults from their own homes. Admission from a care home was associated with higher 30-day inpatient mortality (11.1 vs 5.7%), which persisted after multivariable adjustment (hazard ratio: 1.42; 95% confidence interval: 1.09-1.83; p = 0.008). CONCLUSION: Care home residents admitted to hospital as an emergency have high illness acuity and inpatient mortality

Cyclophospholipids Increase Protocellular Stability to Metal Ions

Model protocells have long been constructed with fatty acids, because these lipids are prebiotically plausible and can, at least theoretically, support a protocell life cycle. However, fatty acid protocells are stable only within a narrow range of pH and metal ion concentration. This instability is particularly problematic as the early Earth would have had a range of conditions, and life as we know it is completely reliant on metal ions for catalysis and the folding and activity of biological polymers. Here we show that prebiotically plausible monoacyl cyclophospholipids form robust vesicles that survive a broad range of pH and high concentrations of Mg2+, Ca2+, and Na+. Importantly, stability to Mg2+ and Ca2+ is improved by the presence of environmental concentrations of Na+. These results suggest that cyclophospholipids, or lipids with similar characteristics, may have played a central role during the emergence of Darwinian evolution.</p

New horizons in frailty: the contingent, the existential and the clinical

In the past decade, frailty research has focused on refinement of biomedical tools and operationalisations, potentially introducing a reductionist approach. This article suggests that a new horizon in frailty lies in a more holistic approach to health and illness in old age. This would build on approaches that view healthy ageing in terms of functionality, in the sense of intrinsic capacity in interplay with social environment, whilst also emphasising positive attributes. Within this framework, frailty is conceptualised as originating as much in the social as in the biological domain; as co-existing with positive attributes and resilience, and as situated on a continuum with health and illness. Relatedly, social science-based studies involving interviews with, and observations of, frail, older people indicate that the social and biographical context in which frailty arises might be more impactful on the subsequent frailty trajectory than the health crisis which precipitates it. For these reasons, the article suggests that interpretive methodologies, derived from the social sciences and humanities, will be of particular use to the geriatrician in understanding health, illness and frailty from the perspective of the older person. These may be included in a toolkit with the purpose of identifying how biological and social factors jointly underpin the fluctuations of frailty and in designing interventions accordingly. Such an approach will bring clinical approaches closer to the views and experiences of older people who live with frailty, as well as to the holistic traditions of geriatric medicine itself

Sart and individual trial mistake thresholds: Predictive model for mobility decline

The Sustained Attention to Response Task (SART) has been used to measure neurocognitive functions in older adults. However, simplified average features of this complex dataset may result in loss of primary information and fail to express associations between test performance and clinically meaningful outcomes. Here, we describe a new method to visualise individual trial (raw) information obtained from the SART test, vis-a-vis age, and groups based on mobility status in a large population-based study of ageing in Ireland. A thresholding method, based on the individual trial number of mistakes, was employed to better visualise poorer SART performances, and was statistically validated with binary logistic regression models to predict mobility and cognitive decline after 4 years. Raw SART data were available for 4864 participants aged 50 years and over at baseline. The novel visualisation-derived feature bad performance, indicating the number of SART trials with at least 4 mistakes, was the most significant predictor of mobility decline expressed by the transition from Timed Up-and-Go (TUG) &lt; 12 to TUG &gt;= 12 s (OR = 1.29; 95% CI 1.14-1.46; p &lt; 0.001), and the only significant predictor of new falls (OR = 1.11; 95% CI 1.03-1.21; p = 0.011), in models adjusted for multiple covariates. However, no SART-related variables resulted significant for the risk of cognitive decline, expressed by a decrease of &gt;= 2 points in the Mini-Mental State Examination (MMSE) score. This novel multimodal visualisation could help clinicians easily develop clinical hypotheses. A threshold approach to the evaluation of SART performance in older adults may better identify subjects at higher risk of future mobility decline

Disordered hyperuniformity in superconducting vortex lattices

The current carrying capability of type II superconductors under magnetic fields is determined to a large extent by the interaction of superconducting vortices with pinning centers. Vortices are arranged in lattices with varying degrees of disorder depending on the balance between the intervortex interactions and the pinning strength. We analyze here vortex arrangements in disordered vortex lattices of different superconducting systems, single crystals (Co-doped NbSe2, LiFeAs, and CaKFe4As4), and amorphous W- based thin films (with critical temperatures T-c from 4 K to 35 K and critical fields from 3.4 T to more than 90 T). We calculate for each case the structure factor and number variance and compare to calculations on an interacting set of partially pinned particles. We find that random density fluctuations appear when pinning overcomes interactions and show that the suppression of density fluctuations is correlated to the presence of interactions. We discuss the results within the framework of hyperuniform distributions and find that all studied lattices follow a similar increase of the number variance with the defect density

Care home residents admitted to hospital through the emergency pathway: characteristics and associations with inpatient mortality

Background Routinely collected hospital information could help to understand the characteristics and outcomes of care home residents admitted to hospital as an emergency. Methods This retrospective 2-year service evaluation included first emergency admissions of any older adult (≥75 years) presenting to Cambridge University Hospital. Routinely collected patient variables were captured by an electronic patient record system. Care home status was established using an official register of care homes. Results 7.7% of 14,777 admissions were care home residents. They were older, frailer, more likely to be women and have cognitive impairment than those admitted from their own homes. Additionally, 42% presented with an Emergency Department Modified Early Warning Score above the threshold triggering urgent review, compared to 26% of older adults from their own homes. Admission from a care home was associated with higher 30-day inpatient mortality (11.1 vs 5.7%), which persisted after multivariable adjustment (hazard ratio: 1.42; 95% confidence interval: 1.09–1.83; p = 0.008). Conclusion Care home residents admitted to hospital as an emergency have high illness acuity and inpatient mortality

Statistical properties of two-particle transmission at Anderson transition

The ensemble of $L \times L$ power-law random banded matrices, where the random hopping $H_{i,j}$ decays as a power-law $(b/| i-j |)^a$, is known to present an Anderson localization transition at $a=1$, where one-particle eigenfunctions are multifractal. Here we study numerically, at this critical point, the statistical properties of the transmission $T_2$ for two distinguishable particles, two bosons or two fermions. We find that the statistics of $T_2$ is multifractal, i.e. the probability to have $T_2(L) \sim 1/L^{\kappa}$ behaves as $L^{\Phi_2(\kappa)}$, where the multifractal spectrum $\Phi_2(\kappa)$ for fermions is different from the common multifractal spectrum concerning distinguishable particles and bosons. However in the three cases, the typical transmission $T_2^{typ}(L)$ is governed by the same exponent $\kappa_2^{typ}$, which is much smaller than the naive expectation $2\kappa_1^{typ}$, where $\kappa_1^{typ}$ is the typical exponent of the one-particle transmission $T_1(L)$.Comment: 9 pages, 4 figure

Anticholinergic medications in patients admitted with cognitive impairment or falls (AMiCI). The impact of hospital admission on anticholinergic cognitive medication burden. Results of a multicentre observational study

What is known and objectiveDrugs with anticholinergic properties increase the risk of falls, delirium, chronic cognitive impairment, and mortality and counteract procholinergic medications used in the treatment of dementia. Medication review and optimisation to reduce anticholinergic burden in patients at risk is recommended by specialist bodies. Little is known how effective this review is in patients who present acutely and how often drugs with anticholinergic properties are used temporarily during an admission. The aim of the study was to describe the changes in the anticholinergic cognitive burden (ACB) in patients admitted to hospital with a diagnosis of delirium, chronic cognitive impairment or falls and to look at the temporary use of anticholinergic medications during hospital stay. MethodsThis is a multi-centre observational study that was conducted in seven different hospitals in the UK, Finland, The Netherlands and Italy. Results and discussion21.1% of patients had their ACB score reduced by a mean of 1.7%, 19.7% had their ACB increased by a mean of 1.6%, 22.8% of DAP naive patients were discharged on anticholinergic medications. There was no change in the ACB scores in 59.2% of patients. 54.1% of patients on procholinergics were taking anticholinergics. Out of the 98 medications on the ACB scale, only 56 were seen. Medications with a low individual burden were accounting for 64.9% of the total burden. Anticholinergic drugs were used temporarily during the admission in 21.9% of all patients. A higher number of DAPs used temporarily during admission was associated with a higher risk of ACB score increase on discharge (OR=1.82, 95% CI for OR: 1.36-2.45, P What is new and conclusionThere was no reduction in anticholinergic cognitive burden during the acute admissions. This was the same for all diagnostic subgroups. The anticholinergic load was predominantly caused by medications with a low individual burden. More than 1 in 5 patients not taking anticholinergics on admission were discharged on them and similar numbers saw temporary use of these medications during their admission. More than half of patients on cholinesterase-inhibitors were taking anticholinergics at the same time on admission, potentially directly counteracting their effects.Peer reviewe