Delirium markers in older fallers: a case-control study

Background: When a hospitalized older patient falls or develops delirium, there are significant consequences for the patient and the health care system. Assessments of inattention and altered consciousness, markers for delirium, were analyzed to determine if they were also associated with falls. Methods: This retrospective case-control study from a regional tertiary Veterans Affairs referral center identified falls and delirium risk factors from quality databases from 2010 to 2012. Older fallers with complete delirium risk assessments prior to falling were identified. As a control, non-fallers were matched at a 3:1 ratio. Admission risk factors that were compared in fallers and non-fallers included altered consciousness, cognitive performance, attention, sensory deficits, and dehydration. Odds ratio (OR) was reported (95% confidence interval [CI]). Results: After identifying 67 fallers, the control population (n=201) was matched on age (74.4±9.8 years) and ward (83.6% medical; 16.4% intensive care unit). Inattention as assessed by the Months of the Year Backward test was more common in fallers (67.2% versus 50.8%, OR=2.0; 95% CI: 1.1–3.7). Fallers tended to have altered consciousness prior to falling (28.4% versus 12.4%, OR=2.8; 95% CI: 1.3–5.8). Conclusion: In this case-control study, alterations in consciousness and inattention, assessed prior to falling, were more common in patients who fell. Brief assessments of consciousness and attention should be considered for inclusion in fall prediction

Self-Directed IEP: Bridging Values of Diverse Cultures and Secondary Education

This article describes the relationships among the Self-Directed IEP, cultural values, self-determination, and transition. Educators must move toward understanding collectivist values to provide appropriate opportunities to succeed within an individualistic school culture for culturally and linguistically diverse students with Individualized Education Programs and their families. The Self-Directed IEP process is a tool for culture sharing, which has been identified as a best practice for meeting the needs, preferences, and interests of culturally and linguistically diverse students and their families. School districts may use the Self-Directed IEP process to bridge the chasm between the individualistic values of schools and collectivist values of culturally and linguistically diverse students and their families to facilitate culturally appropriate transitions to adulthood.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

Influence of dynamic river stage on the vulnerability of water wells and structure foundations in cold regions

This research was undertaken thanks, in part, with support from the Global Water Futures Program funded by the Canada First Research Excellence Fund (CFREF)Groundwater is important for people in Northern Canada, yet the groundwater protection protocols and water well vulnerability assessments designed for other warmer regions of Canada may not be applicable to communities in Northern Canada due to the unique hydrogeological characteristics there. The seasonal melt of snow and ice leads to intense river stage fluctuations and might cause flood issues to the adjacent floodplain; however, their influences on the vulnerability of drinking water wells and nearby infrastructure are not fully understood. This research considers a case study at Carmacks, central Yukon, where an integrated surface-subsurface numerical modelling code was used to examine these processes. The model results indicate that the annual variation in the river stage temporarily reverses the direction of the hydraulic gradient between the surface water body and the adjacent aquifer. Stream reaches that gain groundwater under lower river stages can become losing streams during the high stage periods, which facilitates the transport of solute from the river to the adjacent aquifer. Additionally, the model shows that the annual river stage variation can temporarily alter the size and orientation of the region that contributes water to pumping wells, which means new environmental threats could become important. In terms of travel time, the model results suggest that annual river stage variation accelerates the transport of river-origin solutes to the adjacent aquifer, and higher river peaks facilitate more rapid solute migration. Thus, the natural protection of the soil travel path against microbial pathogens may become inefficient and water wells may become more vulnerable. The model results also demonstrate that higher peak river stages are more likely to cause basement inundation at buildings on the riverbank than an average peaks, and that the duration of basement inundation varies at different locations.Engineering Research Council of Canada (NSERC) || Government of Yukon || Global Water Futures (Canada First Research Excellence Fund

Simulating chemistry efficiently on fault-tolerant quantum computers

Quantum computers can in principle simulate quantum physics exponentially faster than their classical counterparts, but some technical hurdles remain. Here we consider methods to make proposed chemical simulation algorithms computationally fast on fault-tolerant quantum computers in the circuit model. Fault tolerance constrains the choice of available gates, so that arbitrary gates required for a simulation algorithm must be constructed from sequences of fundamental operations. We examine techniques for constructing arbitrary gates which perform substantially faster than circuits based on the conventional Solovay-Kitaev algorithm [C.M. Dawson and M.A. Nielsen, \emph{Quantum Inf. Comput.}, \textbf{6}:81, 2006]. For a given approximation error $\epsilon$, arbitrary single-qubit gates can be produced fault-tolerantly and using a limited set of gates in time which is $O(\log \epsilon)$ or $O(\log \log \epsilon)$; with sufficient parallel preparation of ancillas, constant average depth is possible using a method we call programmable ancilla rotations. Moreover, we construct and analyze efficient implementations of first- and second-quantized simulation algorithms using the fault-tolerant arbitrary gates and other techniques, such as implementing various subroutines in constant time. A specific example we analyze is the ground-state energy calculation for Lithium hydride.Comment: 33 pages, 18 figure

Delirium is associated with early postoperative cognitive dysfunction

The purpose of this analysis was to determine if postoperative delirium was associated with early postoperative cognitive dysfunction (at 7 days) and long-term postoperative cognitive dysfunction (at 3 months). The International Study of Postoperative Cognitive Dysfunction recruited 1218 subjects ≥ 60 years old undergoing elective, non-cardiac surgery. Postoperatively, subjects were evaluated for delirium using the criteria of the Diagnostic and Statistical Manual. Subjects underwent neuropsychological testing pre-operatively and postoperatively at 7 days (n = 1018) and 3 months (n = 946). Postoperative cognitive dysfunction was defined as a composite Z-score > 2 across tests or at least two individual test Z-scores > 2. Subjects with delirium were significantly less likely to participate in postoperative testing. Delirium was associated with an increased incidence of early postoperative cognitive dysfunction (adjusted risk ratio 1.6, 95% CI 1.1–2.1), but not long-term postoperative cognitive dysfunction (adjusted risk ratio 1.3, 95% CI 0.6–2.4). Delirium was associated with early postoperative cognitive dysfunction, but the relationship of delirium to long-term postoperative cognitive dysfunction remains unclear

The Herschel Virgo Cluster Survey. IX. Dust-to-gas mass ratio and metallicity gradients in four Virgo spiral galaxies

Using Herschel data from the Open Time Key Project the Herschel Virgo Cluster Survey (HeViCS), we investigated the relationship between the metallicity gradients expressed by metal abundances in the gas phase as traced by the chemical composition of HII regions, and in the solid phase, as traced by the dust-to-gas mass ratio. We derived the radial gradient of the dust-to-gas mass ratio for all galaxies observed by HeViCS whose metallicity gradients are available in the literature. They are all late type Sbc galaxies, namely NGC4254, NGC4303, NGC4321, and NGC4501. We examined different dependencies on metallicity of the CO-to-H$_2$ conversion factor (\xco), used to transform the $^{12}$CO observations into the amount of molecular hydrogen. We found that in these galaxies the dust-to-gas mass ratio radial profile is extremely sensitive to choice of the \xco\ value, since the molecular gas is the dominant component in the inner parts. We found that for three galaxies of our sample, namely NGC4254, NGC4321, and NGC4501, the slopes of the oxygen and of the dust-to-gas radial gradients agree up to $\sim$0.6-0.7R$_{25}$ using \xco\ values in the range 1/3-1/2 Galactic \xco. For NGC4303 a lower value of \xco$\sim0.1\times$ 10$^{20}$ is necessary. We suggest that such low \xco\ values might be due to a metallicity dependence of \xco (from close to linear for NGC4254, NGC4321, and NGC4501 to superlinear for NGC4303), especially in the radial regions R$_G<$0.6-0.7R$_{25}$ where the molecular gas dominates. On the other hand, the outer regions, where the atomic gas component is dominant, are less affected by the choice of \xco, and thus we cannot put constraints on its value.Comment: 13 pages, 8 figures, A&A accepte

Deweyan tools for inquiry and the epistemological context of critical pedagogy

This article develops the notion of resistance as articulated in the literature of critical pedagogy as being both culturally sponsored and cognitively manifested. To do so, the authors draw upon John Dewey\u27s conception of tools for inquiry. Dewey provides a way to conceptualize student resistance not as a form of willful disputation, but instead as a function of socialization into cultural models of thought that actively truncate inquiry. In other words, resistance can be construed as the cognitive and emotive dimensions of the ongoing failure of institutions to provide ideas that help individuals both recognize social problems and imagine possible solutions. Focusing on Dewey\u27s epistemological framework, specifically tools for inquiry, provides a way to grasp this problem. It also affords some innovative solutions; for instance, it helps conceive of possible links between the regular curriculum and the study of specific social justice issues, a relationship that is often under-examined. The aims of critical pedagogy depend upon students developing dexterity with the conceptual tools they use to make meaning of the evidence they confront; these are background skills that the regular curriculum can be made to serve even outside social justice-focused curricula. Furthermore, the article concludes that because such inquiry involves the exploration and potential revision of students\u27 world-ordering beliefs, developing flexibility in how one thinks may be better achieved within academic subjects and topics that are not so intimately connected to students\u27 current social lives, especially where students may be directly implicated