Postoperative delirium in the elderly: diagnosis and management

Delirium is a common but often undiagnosed complication in the elderly following a major operation. Recognizing the presentation of delirium and the criteria to establish the diagnosis of delirium will improve a clinician’s ability to detect this complication. Treating delirium with environmental, supportive, and pharmacologic interventions reduces the incidence and side effects of postoperative delirium. The purpose of this review is to describe the diagnosis and treatment of postoperative delirium

Non-alcoholic fatty liver disease: relationship with cardiovascular risk markers and clinical endpoints

Non-alcoholic fatty liver disease (NAFLD) is a common diagnosis and is increasing in prevalence worldwide. NAFLD is usually asymptomatic at presentation; progression of the disease is unpredictable, leading to the development of a variety of techniques for screening, diagnosis and risk stratification. Clinical methods in current use include serum biomarker panels, hepatic ultrasound, magnetic resonance imaging, and liver biopsy. NAFLD is strongly associated with the metabolic syndrome, and the most common cause of death for people with the condition is cardiovascular disease. Whether NAFLD is an independent cardiovascular risk factor needs exploration. NAFLD has been associated with surrogate markers of cardiovascular disease such as carotid intima-media thickness, the presence of carotid plaque, brachial artery vasodilatory responsiveness and CT coronary artery calcification score. There is no effective medical treatment for NAFLD and evidence is lacking regarding the efficacy of interventions in mitigating cardiovascular risk. Health care professionals managing patients with NAFLD should tackle the issue with early identification of risk factors and aggressive modification. Current management strategies therefore comprise lifestyle change,with close attention to known cardiovascular risk factors

Effect of a mobile app intervention on vegetable consumption in overweight adults: a randomized controlled trial.

BACKGROUND: Mobile applications (apps) have been heralded as transformative tools to deliver behavioral health interventions at scale, but few have been tested in rigorous randomized controlled trials. We tested the effect of a mobile app to increase vegetable consumption among overweight adults attempting weight loss maintenance. METHODS: Overweight adults (n=135) aged 18-50 years with BMI=28-40 kg/m2 near Stanford, CA were recruited from an ongoing 12-month weight loss trial (parent trial) and randomly assigned to either the stand-alone, theory-based Vegethon mobile app (enabling goal setting, self-monitoring, and feedback and using "process motivators" including fun, surprise, choice, control, social comparison, and competition) or a wait-listed control condition. The primary outcome was daily vegetables servings, measured by an adapted Harvard food frequency questionnaire (FFQ) 8 weeks post-randomization. Daily vegetable servings from 24-hour dietary recalls, administered by trained, certified, and blinded interviewers 5 weeks post-randomization, was included as a secondary outcome. All analyses were conducted according to principles of intention-to-treat. RESULTS: Daily vegetable consumption was significantly greater in the intervention versus control condition for both measures (adjusted mean difference: 2.0 servings; 95% CI: 0.1, 3.8, p=0.04 for FFQ; and 1.0 servings; 95% CI: 0.2, 1.9; p=0.02 for 24-hour recalls). Baseline vegetable consumption was a significant moderator of intervention effects (p=0.002) in which effects increased as baseline consumption increased. CONCLUSIONS: These results demonstrate the efficacy of a mobile app to increase vegetable consumption among overweight adults. Theory-based mobile interventions may present a low-cost, scalable, and effective approach to improving dietary behaviors and preventing associated chronic diseases. TRIAL REGISTRATION: ClinicalTrials.gov NCT01826591. Registered 27 March 2013

Human EEG recordings for 1,854 concepts presented in rapid serial visual presentation streams

The neural basis of object recognition and semantic knowledge has been extensively studied but the high dimensionality of object space makes it challenging to develop overarching theories on how the brain organises object knowledge. To help understand how the brain allows us to recognise, categorise, and represent objects and object categories, there is a growing interest in using large-scale image databases for neuroimaging experiments. In the current paper, we present THINGS-EEG, a dataset containing human electroencephalography responses from 50 subjects to 1,854 object concepts and 22,248 images in the THINGS stimulus set, a manually curated and high-quality image database that was specifically designed for studying human vision. The THINGS-EEG dataset provides neuroimaging recordings to a systematic collection of objects and concepts and can therefore support a wide array of research to understand visual object processing in the human brain

Instructional strategies to promote incremental beliefs in youth sport

Implicit beliefs about the nature of human abilities have significant motivational, behavioral, and affective consequences. The purpose of this article was to review the application of implicit beliefs to the youth sport context and to provide theoretically derived and evidence-based instructional strategies to promote adaptive implicit beliefs about human abilities within this context. A narrative overview of theory and a review of research pertaining to implicit beliefs in education, sport, and physical activity are undertaken. Theoretically derived and evidence-based instructional strategies are outlined, and specific coaching behaviors are suggested. Six instructional strategies to promote adaptive implicit beliefs in these contexts are suggested: focusing on effort and persistence, facilitating challenge, promoting the value of failure, defining success as effort, the promotion of learning, and providing high expectations. It is concluded that instructional strategies may be used to facilitate positive motivational, behavioral, and affective outcomes for young people within a sport context

Screenomics : a new approach for observing and studying individuals' digital lives

This study describes when and how adolescents engage with their fast-moving and dynamic digital environment as they go about their daily lives. We illustrate a new approach—screenomics—for capturing, visualizing, and analyzing screenomes, the record of individuals’ day-to-day digital experiences. Sample includes over 500,000 smartphone screenshots provided by four Latino/Hispanic youth, age 14 to 15 years, from low-income, racial/ethnic minority neighborhoods. Screenomes collected from smartphones for 1 to 3 months, as sequences of smartphone screenshots obtained every 5 seconds that the device is activated, are analyzed using computational machinery for processing images and text, machine learning algorithms, human labeling, and qualitative inquiry. Adolescents’ digital lives differ substantially across persons, days, hours, and minutes. Screenomes highlight the extent of switching among multiple applications, and how each adolescent is exposed to different content at different times for different durations—with apps, food-related content, and sentiment as illustrative examples. We propose that the screenome provides the fine granularity of data needed to study individuals’ digital lives, for testing existing theories about media use, and for generation of new theory about the interplay between digital media and development

Statistical methodologies to pool across multiple intervention studies

Combining and analyzing data from heterogeneous randomized controlled trials of complex multiple-component intervention studies, or discussing them in a systematic review, is not straightforward. The present article describes certain issues to be considered when combining data across studies, based on discussions in an NIH-sponsored workshop on pooling issues across studies in consortia (see Belle et al. in Psychol Aging, 18(3):396-405, 2003). Several statistical methodologies are described and their advantages and limitations are explored. Whether weighting the different studies data differently, or via employing random effects, one must recognize that different pooling methodologies may yield different results. Pooling can be used for comprehensive exploratory analyses of data from RCTs and should not be viewed as replacing the standard analysis plan for each study. Pooling may help to identify intervention components that may be more effective especially for subsets of participants with certain behavioral characteristics. Pooling, when supported by statistical tests, can allow exploratory investigation of potential hypotheses and for the design of future interventions

Optical Spectroscopy of the Surface Population of the rho Ophiuchi Molecular Cloud: The First Wave of Star Formation

We present the results of optical spectroscopy of 139 stars obtained with the Hydra multi-object spectrograph. The objects extend over a 1.3 square degree area surrounding the main cloud of the rho Oph complex. The objects were selected from narrowband images to have H alpha in emission. Using the presence of strong H alpha emission, lithium absorption, location in the Hertzsprung-Russell diagram, or previously reported x-ray emission, we were able to identify 88 objects as young stars associated with the cloud. Strong H alpha emission was confirmed in 39 objects with line widths consistent with their origin in magnetospheric accretion columns. Two of the strongest emission-line objects are young, x-ray emitting brown dwarf candidates with M8 spectral types. Comparisons of the bolometric luminosities and effective temperatures with theoretical models suggest a medianage for this population of 2.1 Myr which is signifcantly older than the ages derived for objects in the cloud core. It appears that these stars formed contemporaneously with low mass stars in the Upper Scorpius subgroup, likely triggered by massive stars in the Upper-Centaurus subgroup.Comment: 35 pages of postscript which includes seven figures (some of which are multi-panel) and four postscript tables. Astronomical Journal (in press

Clinical utility of PKD2 mutation testing in a polycystic kidney disease cohort attending a specialist nephrology out-patient clinic.

BACKGROUND: ADPKD affects approximately 1:1000 of the worldwide population. It is caused by mutations in two genes, PKD1 and PKD2. Although allelic variation has some influence on disease severity, genic effects are strong, with PKD2 mutations predicting later onset of ESRF by up to 20 years. We therefore screened a cohort of ADPKD patients attending a nephrology out-patient clinic for PKD2 mutations, to identify factors that can be used to offer targeted gene testing and to provide patients with improved prognostic information. METHODS: 142 consecutive individuals presenting to a hospital nephrology out-patient service with a diagnosis of ADPKD and CKD stage 4 or less were screened for mutations in PKD2, following clinical evaluation and provision of a detailed family history (FH). RESULTS: PKD2 mutations were identified in one fifth of cases. 12% of non-PKD2 patients progressed to ESRF during this study whilst none with a PKD2 mutation did (median 38.5 months of follow-up, range 16-88 months, p < 0.03). A significant difference was found in age at ESRF of affected family members (non-PKD2 vs. PKD2, 54 yrs vs. 65 yrs; p < 0.0001). No PKD2 mutations were identified in patients with a FH of ESRF occurring before age 50 yrs, whereas a PKD2 mutation was predicted by a positive FH without ESRF. CONCLUSIONS: PKD2 testing has a clinically significant detection rate in the pre-ESRF population. It did not accurately distinguish those individuals with milder renal disease defined by stage of CKD but did identify a group less likely to progress to ESRF. When used with detailed FH, it offers useful prognostic information for individuals and their families. It can therefore be offered to all but those whose relatives have developed ESRF before age 50

Clenbuterol in the horse: Confirmation and quantitation of serum clenbuterol by LC-MS-MS after oral and intratracheal administration

Clenbuterol is a β2 agonist/antagonist bronchodilator, and its identification in post-race samples may lead to sanctions. The objective of this study was to develop a specific and highly sensitive serum quantitation method for clenbuterol that would allow effective regulatory control of this agent in horses. Therefore, clenbuterol-d9 was synthesized for use as an internal standard, an automated solid-phase extraction method was developed, and both were used in conjunction with a multiple reaction monitoring liquid chromatography-tandem mass spectrometry (LC-MS-MS) method to allow unequivocal identification and quantitation of clenbuterol in 2 mL of serum at concentrations as low as 10 pg/mL. Five horses were dosed with oral clenbuterol (0.8 μg/kg, BID) for 10 days, and serum was collected for 14 days thereafter. Serum clenbuterol showed mean trough concentrations of ∼150 pg/mL. After the last dose on day 10, serum clenbuterol reached a peak of ∼500 pg/mL and then declined with a half-life of ∼7 h. Serum clenbuterol declined to 30 and 10 pg/mL at 48 and 72 h after dosing, respectively. By 96 h after dosing, the concentration was below 4 pg/mL, the limit of detection for this method. Compared with previous results obtained in parallel urinary experiments, the serum-based approach was more reliable and satisfactory for regulation of the use of clenbuterol. Clenbuterol (90 μg) was also administered intratracheally to five horses. Peak serum concentrations of ∼230 pg/mL were detected 10 min after administration, dropping to ∼50 pg/mL within 30 min and declining much more slowly thereafter. These observations suggest that intratracheal administration of clenbuterol shortly before race time can be detected with this serum test. Traditionally, equine drug testing has been dependent on urine testing because of the small volume of serum samples and the low concentrations of drugs found therein. Using LC-MS-MS testing, it is now possible to unequivocally identify and quantitate low concentrations (10 pg/mL) of drugs in serum. Based on the utility of this approach, the speed with which new tests can be developed, and the confidence with which the findings can be applied in the forensic situation, this approach, offers considerable scientific and regulatory advantages over more traditional urine testing approaches