Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Pancreaticobiliary metastasis presenting as primary mucinous ovarian neoplasm: A systematic literature review

True primary mucinous ovarian carcinomas are rarer than originally thought and their clinical behavior and treatment response are different than more common epithelial ovarian carcinomas. Secondary ovarian neoplasms often mimic the clinical and histological features of mucinous ovarian cancer making their diagnosis, and therefore treatment, more difficult. Misdiagnosis can have a significant impact on both treatment and prognosis. The majority of these secondary ovarian neoplasms arise from the gastrointestinal tract, with mucinous histology often of pancreaticobiliary origin. Our study objective was to review current evidence distinguishing pancreaticobiliary ovarian metastasis from primary mucinous ovarian carcinoma. We utilized a PubMed search using MeSH terms and selected articles were reviewed, synthesized and summarized. Thirty-nine articles were included in the review. The clinical, gross, histological and immunohistochemical features distinguishing primary mucinous ovarian carcinomas from pancreaticobiliary ovarian metastasis were identified. Compared to primary mucinous ovarian carcinoma, metastatic pancreaticobiliary tumors are more often bilateral, <10 cm, have irregular external surface and surface implants, display an infiltrative pattern of invasion and stain for MUC1 and CK17. Primary ovarian mucinous tumors rarely (<3%) have signet ring cells or involvement of the hilum. Metastatic mucinous tumors mimic their primary mucinous ovarian counterparts and their clinical and histopathological features overlap in many ways. However, these metastatic tumors have features that can help differentiate them from primary mucinous carcinoma. With a high index of suspicion and knowledge of the reviewed features, distinguishing these tumors will continue to become easier. Keywords: Metastatic pancreaticobiliary tumors, Ovarian mucinous tumors, Immunohistochemistr

Cultivating trust in technology-mediated sustainable agricultural research

We formed the Precision Sustainable Agriculture (PSA) team to conduct interdisciplinary research and technology development to improve adoption and practice of knowledge-intensive sustainable agricultural practices such as cover cropping. In this paper, we share our approach to cultivating trust among diverse stakeholders (researchers, farmers, extensionists, agricultural and information specialists, private and public entities) vested in agricultural data collection, management, and use. Our trust framework describes how we aim to be trusted with data (through preserving privacy and increasing stakeholder agency) and trusted in the process (through practicing transparency and accountability). It is operationalized through a series of social and technical infrastructures. Our project governance, stakeholder engagement tools and activities, and technology development methods aim to promote transparency and accountability in our process. We use a maturity model to govern data acquisition to ensure that only robust, privacy-preserving technologies are deployed on our partner farms and describe evolving mechanisms for handling data with varying sensitivity. Finally, we share preliminary work aimed at anticipating data use, and identify challenges on the horizon for cultivating trust in agricultural technologies and data-driven agriculture.This article is published as Raturi, Ankita, Jennifer J. Thompson, Victoria Ackroyd, Carlene A. Chase, Brian W. Davis, Robert Myers, Aurelie Poncet et al. "Cultivating trust in technology‐mediated sustainable agricultural research." Agronomy Journal (2021). doi:10.1002/agj2.20974. Works produced by employees of the U.S. Government as part of their official duties are not copyrighted within the U.S. The content of this document is not copyrighted

Traces of Wilde: Fact and Fiction in Dorian: An Imitation

The life and art of Oscar Wilde are of enduring interest to contemporary readers and audiences who remain fascinated not only by his work, but also by his biography. The dramatic nature of the three trials that took place in 1895, and Wilde's spectacular fall from grace following imprisonment and exile, speak to our own period in which questions of gender and sexuality are topics of continuing tension and concern. This essay examines two examples of contemporary writing that are informed by Wilde's biography and oeuvre: Will Self's novel, Dorian: An Imitation (2002), and Craig Wilmann's drama, The Picture of John Gray (2014), and offers the first academic analysis of Wilmann's play. Exploring these works through the lens of neo-Victorianism, it considers the balance between history and fiction in each text. Drawing on Ricoeur's treatise The Reality of the Historical Past (1984), it proposes that Ricoeur's concept of the Analogue, which encompasses both the imaginative reconstruction of the past through the documentary trace and the adoption of the critical distance required to understand it, provides a new way in which neo-Victorian literature might be understood

Knee range of motion after total knee arthroplasty: How important is this as an outcome measure?

We investigated the relationship of knee range of motion (ROM) and function in a prospective, observational study of primary total knee arthroplasty (TKA). Preoperative and 12-month data were collected on 684 patients, including knee ROM, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function questionnaire scores, patient satisfaction, and perceived improvement in quality of life (QOL). Only modest correlations were found between knee ROM and WOMAC function (r3.5; P<.0001), but knee flexion was not. For assessment of these outcomes, WOMAC function appears to be more important than knee flexion.</p