Informant single screening questions for delirium and dementia in acute care – a cross-sectional test accuracy pilot study

Background Cognitive impairment often goes undetected in older people in hospital. Efficient screening tools are required to improve detection.<p></p> To determine diagnostic properties of two separate informant-based single screening questions for cognitive impairment (dementia and delirium) in hospitalised older people.<p></p> Methods Patients over 65 years non-electively admitted to medical or geriatric wards within a teaching hospital. Our index tests were single screening questions (SSQ), one for dementia (“How has your relative/friend’s memory changed over the past 5 years (up to just before their current illness)?”) and one for delirium (“How has your relative/friend’s memory changed with his/her current illness?”), which were assessed with informant response given on a five point Likert scale.<p></p> Any deterioration on our index tests of SSQ-dementia and SSQ-delirium was accepted as a positive screen for cognitive impairment. Scores were compared to the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) >3.38 accepted as dementia, and Confusion Assessment Method (CAM) diagnosis of delirium. We also collected direct cognitive screening data using Mini Mental Status Examination (MMSE).<p></p> Results Informant responses were obtained in 70/161 (43.5%) patients, median age 80.8 (range:67–97) years; mean MMSE score 18.5 (SD: 8.1). The SSQ-dementia when compared to the IQCODE had a sensitivity of 83.3% and specificity of 93.1%. The SSQ-delirium when compared to CAM diagnosis had sensitivity of 76.9% and a specificity of 56.1%.<p></p> Conclusions These findings show promise for use of an informant single screening question tool as the first step in detection of dementia in older people in acute hospital care, although this approach appears to be less accurate in screening for delirium.<p></p&gt

Twist modulated phases in chiral smectic liquid crystals

By considering short period helical planar modulations about the layer normal, we construct a model free energy for the ferriclinic phases observed in chiral smectic liquid crystals. We then use this free energy to construct the phase diagram for our model. The resulting phases are compared with the experimentally observed smectic-C* subphases (ferroclinic, antiferroclinic, and heliclinic). A strong coupling is found between the ferroclinic q=2π/a and the heliclinic q=2π/3a modes. This coupling was not considered in previous models. The resulting additional stability of this “locked in” phase is discussed

Microscopic origins of heliclinic phases in smectic liquid crystals

In a previous article [Phys. Rev. E 60, 1799 (1999)], the authors considered a model Landau free energy that explained the ferriclinic phases of chiral smectic liquid crystals as a series of short period helical modulations. In this paper we begin with a physically more realistic, more microscopic interlayer free energy and show how our previous work can be derived using only simple short-ranged interactions. We then discuss what additional information this provides about the Landau coefficients used previously to construct the phase diagram for the heliclinic phases of chiral smectic liquid crystals. Finally, we investigate a means for explicitly including chirality in our model

Evaluation of delirium screening tools in geriatric medical inpatients: a diagnostic test accuracy study

Introduction: screening all unscheduled older adults for delirium is recommended in national guidelines, but there is no consensus on how to perform initial assessment. Aim: to evaluate the test accuracy of five brief cognitive assessment tools for delirium diagnosis in routine clinical practice. Methods: a consecutive cohort of non-elective, elderly care (older than 65 years) hospital inpatients admitted to a geriatric medical assessment unit of an urban teaching hospital. Reference assessments were clinical diagnosis of delirium performed by elderly care physicians. Routine screening tests were: Abbreviated Mental Test (AMT-10, AMT-4), 4 A's Test (4AT), brief Confusion Assessment Method (bCAM), months of the year backwards (MOTYB) and informant Single Question in Delirium (SQiD). Results: we assessed 500 patients, mean age 83 years (range = 66−101). Clinical diagnoses were: 93 of 500 (18.6%) definite delirium, 104 of 500 (20.8%) possible delirium and 277 of 500 (55.4%) no delirium; 266 of 500 (53.2%) were identified as definite or possible dementia. For diagnosis of definite delirium, AMT-4 (cut-point < 3/4) had a sensitivity of 92.7% (95% confidence interval (CI): 84.8–97.3), with a specificity of 53.7% (95% CI: 48.1–59.2); AMT-10 (<4/10), MOTYB (<4/12) and SQiD showed similar performance. bCAM had a sensitivity of 70.3% (95% CI: 58.5–80.3) with a specificity of 91.4% (95% CI: 87.7–94.3). 4AT (>4/12) had a sensitivity of 86.7% (95% CI: 77.5–93.2) and specificity of 69.5% (95% CI: 64.4–74.3). Conclusions: short screening tools such as AMT-4 or MOTYB have good sensitivity for definite delirium, but poor specificity; these tools may be reasonable as a first stage in assessment for delirium. The 4AT is feasible and appears to perform well with good sensitivity and reasonable specificity

Routes to self-assembling stable photonic band-gap phases in emulsions of chiral nematics with isotropic fluids

Blue phases are stable phases with crystalline packing of interwoven topological defects in chiral nematic liquid crystals. We argue that chiral nematics with appropriate surfactants are likely to form blue phases for a wide range of parameters. We derive the transition curve for stable emulsified blue phases and find that the required low surface tension is within the accessible range of surfactants. These emulsified blue phases provide possible routes to photonic band-gap materials

Identity, legitimacy and cooperation with police: comparing general-population and street-population samples from London

Social identity is a core aspect of procedural justice theory, which predicts that fair treatment at the hands of power holders such as police expresses, communicates, and generates feelings of inclusion, status, and belonging within salient social categories. In turn, a sense of shared group membership with power holders, with police officers as powerful symbolic representatives of “law-abiding society,” engenders trust, legitimacy, and cooperation. Yet, this aspect of the theory is rarely explicitly considered in empirical research. Moreover, the theory rests on the underexamined assumption that the police represent one fixed and stable superordinate group, including the often-marginalized people with whom they interact, and that it is only superordinate identification that is important to legitimacy and cooperation. In this article, we present results from two U.K.-based studies that explore the identity dynamics of procedural justice theory. We reason that the police not only represent the “law-abiding, national citizen” superordinate group but also are a symbol of order/conflict and a range of connected social categories that can generate relational identification. First, we used a general-population sample and found that relational identification with police and identification as a law-abiding citizen mediated some of the association between procedural justice and legitimacy and were both stronger predictors of cooperation than legitimacy. Second, a sample of people living on the streets of London was used to explore these same relationships among a highly marginalized group for whom the police might represent a salient outgroup. We found that relational and superordinate identification were both strong positive predictors of cooperation, whereas legitimacy was not. These results have important implications for our understanding of both police legitimacy and public cooperation, as well as the extent to which police activity can serve to include—or exclude—members of the public

Prevalence of pre-stroke depression and its association with post-stroke depression: a systematic review and meta-analysis

Background: Depression is a common post-stroke complication. Pre-stroke depression may be an important contributor, however the epidemiology of pre-stroke depression is poorly understood. Using systematic review and meta-analysis, we described the prevalence of pre-stroke depression and its association with post-stroke depression. Methods: We searched multiple cross-disciplinary databases from inception to July 2017 and extracted data on the prevalence of pre-stroke depression and its association with post-stroke depression. We assessed the risk of bias (RoB) using validated tools. We described summary estimates of prevalence and summary odds ratio (OR) for association with post-stroke depression, using random-effects models. We performed subgroup analysis describing the effect of depression assessment method. We used a funnel plot to describe potential publication bias. The strength of evidence presented in this review was summarised via ‘GRADE’. Results: Of 11 884 studies identified, 29 were included (total participants n = 164 993). Pre-stroke depression pooled prevalence was 11.6% [95% confidence interval (CI) 9.2–14.7]; range: 0.4–24% (I2 95.8). Prevalence of pre-stroke depression varied by assessment method (p = 0.02) with clinical interview suggesting greater pre-stroke depression prevalence (~17%) than case-note review (9%) or self-report (11%). Pre-stroke depression was associated with increased odds of post-stroke depression; summary OR 3.0 (95% CI 2.3–4.0). All studies were judged to be at RoB: 59% of included studies had an uncertain RoB in stroke assessment; 83% had high or uncertain RoB for pre-stroke depression assessment. Funnel plot indicated no risk of publication bias. The strength of evidence based on GRADE was ‘very low’. Conclusions: One in six stroke patients have had pre-stroke depression. Reported rates may be routinely underestimated due to limitations around assessment. Pre-stroke depression significantly increases odds of post-stroke depression. Protocol identifier: PROSPERO identifier: CRD42017065544