"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 \ub1 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

New insights into the mechanism of activation of atom transfer radical polymerization by Cu(I) complexes

The kinetics of activation of RX by a Cu(I) complex has been investigated in MeCN both in the absence and presence of halide ions. The system Cu(I)/L/X (L = Me6TREN) is mainly composed of Cu(I)L+, XCu(I)L and Cu(I)X2-, but only Cu(I)L+ is found to be an active catalyst reacting with RX

Kinetic investigation of the activation of alkyl halides of relevance to controlled radical polymerization by copper(I)-amine complexes

Atom transfer radical polymerization (ATRP) is one of the most widely used methods of controlled radical polymerization for the synthesis of a vast range of polymeric materials with controlled molecular weights and well-defined architectures. The process is catalyzed by transition metal complexes, mainly copper complexes with polydentate amine ligands. One of the most important parameters in ATRP is the rate constant (kact) of the activation reaction between the metal catalyst and the initiator or dormant species, PnX. Often activated alkyl halides are used as initiators and mimics of the dormant species. The kinetics of the activation reaction of a wide range of alkyl halides by several copper(I) complexes has been studied by techniques such as NMR, UV-Vis, HPLC and gas chromatography. Since these techniques are suitable for slow reactions, only processes with very low rate constants have been examined. In addition, in most studies the rate constants were determined in the presence of halide ions, X-, without examining the role of such ions in the process. In this study we used electrochemical methods for the determination of kact of the reaction between [CuIMe6TREN]+ (Me6TREN = tris(2-dimethylaminoethyl)amine with some alkyl halides both in the absence and presence of halide ions in acetonitrile. The reactions were investigated in a wide range of temperatures, which allowed determination of the activation parameters of the process. The kinetics of the reactions has been analyzed by voltammery with rotating disc electrode by monitoring the decrease of the limiting current for the oxidation of Cu(I), either under pseudo-first-order conditions or under second-order conditions, depending on the value of kact. A remarkable dependence of kact on the concentration of X- was found for each alkyl halide. This finding, together with the activation parameters and copper speciation data obtained in a separate study by our research group, has shed light on the mechanism of RX activation by copper(I) complexes

Kinetics of Activation of Alkyl Halides by Copper(I) Complexes used as Catalysts in Atom Transfer Radical Polymerization

Atom transfer radical polymerization (ATRP) is a powerful polymerization technique for the synthesis of a vast range of polymeric materials with controlled molecular weights and well-defined architectures. In copper-catalyzed ATRP, a Cu(I)X/L complex (X = Br, Cl; L = polydentate amine ligand) is employed to activate a dormant species (PnX) to produce the propagating radical (Pn\u2022) and a deactivator (XCuIIL). One of the most important parameters in ATRP is the activation rate constant (kact). Using simple alkyl halides as mimics of PnX, the kinetics of the activation reaction with several copper complexes has been studied by techniques such as NMR, UV-Vis, HPLC and gas chromatography. Most of these techniques, however, are suitable for the study of slow reactions and indeed the vast majority of the reported rate constants are smaller than 1.0 Lmol-1s-1. In this study we propose electrochemical methods for the determination of kact boh for slow and fast reactions. The kinetics of slow to moderately fast reactions can be easily analyzed by monitoring the decrease of the limiting current for the oxidation of Cu(I), either under pseudo-first-order conditions or under second-order conditions, depending on the value of kact. The rate constants of very fast reactions can be obtained by using cyclic voltammetry with digital simulation of voltammetric responses. These methods have been applied to a series of alkyl halides and some of the most widely employed Cu complexes. Careful analysis of the effect of the metal complex structure, especially factors that affect speciation of Cu(I), on the reaction rate has given valuable insights into the reaction mechanism, particularly the identity of the activating species

Mechanism and kinetics of activation of alkyl halides by Cu(I) complexes used as catalysts in atom transfer radical polymerization

Atom transfer radical polymerization (ATRP) is one of the most used methods of controlled/living radical polymerization for the synthesis of a vast range of well-defined, low-polydispersity polymeric materials. The process is initiated by a reversible reaction between a transition metal complex (mainly Cu(I) with an amine ligand, CuIL+) and an activated alkyl halide to produce the propagating radical. The initiation reaction is considered to involve a transfer of a halogen atom from the alkyl halide to the metal center. A fundamental question which, however, has not been adequately addressed is on the nature of the active Cu(I) species, since the metal ion exists under ATRP conditions as a multiplicity of species. A second important issue on the activation reaction regards determination of the activation rate constants. Several methods, mainly limited to the study of slow reactions, have previously been proposed to measure kact. Herein, we first examine the mechanism of the activation reaction with the aim of unambiguously identifying the active Cu(I) species. We investigated the kinetics of activation of RX by CuIL+ (L = Me6TREN) in CH3CN both in the absence and presence of X-. It is found that although the system CuI/L/X- is mainly composed of CuIL+, XCuIL and CuIX2-, only CuIL+ is an active catalyst reacting with RX. Next, we describe electrochemical methods for the determination of kact both for slow and fast reactions and apply them for the measurement of kact for a variety of activated alkyl halides and Cu(I) complexes

Electrochemical Procedures To Determine Thermodynamic and Kinetic Parameters of Atom Transfer Radical Polymerization

Electrochemical investigation provides information about the stability, activity and halidophilicity of catalysts for Atom Transfer Radical Polymerization (ATRP). Moreover, several electrochemical tools were developed to measure thermodynamic and kinetic parameters of ATRP. These techniques enabled to determine activation rate constants spanning over 12 orders of magnitude. ATRP equilibrium constant and relevant side reactions concerning the catalyst were also examined by electrochemical methods. As such, electrochemistry enables to build a database of kinetic and thermodynamic constants of ATRP and related reactions of copper complexes

Controlled Radical Polymerization of Acrylates Regulated by Visible Light

The controlled radical polymerization of a variety of acrylate monomers is reported using an Ir-catalyzed visible light mediated process leading to well-defined homo-, random, and block copolymers. The polymerizations could be efficiently activated and deactivated using light while maintaining a linear increase in molecular weight with conversion and first order kinetics. The robust nature of the fac-[Ir(ppy)3] catalyst allows carboxylic acids to be directly introduced at the chain ends through functional initiators or along the backbone of random copolymers (controlled process up to 50 mol % acrylic acid incorporation). In contrast to traditional ATRP procedures, low polydispersity block copolymers, poly(acrylate)-b-(acrylate), poly(methacrylate)-b-(acrylate), and poly(acrylate)-b-(methacrylate), could be prepared with no monomer sequence requirements. These results illustrate the increasing generality and utility of light mediated Ir-catalyzed polymerization as a platform for polymer synthesis