Association between components of the delirium syndrome and outcomes in hospitalised adults: a systematic review and meta-analysis.

BACKGROUND: Delirium is a heterogeneous syndrome with inattention as the core feature. There is considerable variation in the presence and degree of other symptom domains such as altered arousal, psychotic features and global cognitive dysfunction. Delirium is independently associated with increased mortality, but it is unclear whether individual symptom domains of delirium have prognostic importance. We conducted a systematic review and meta-analysis of studies in hospitalised adults in general settings to identify the relationship between symptom domains of delirium and outcomes. (PROSPERO: CRD42018093935). METHODS: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, clinicaltrials.gov and the Cochrane Central Register of Controlled Trials from inception to November 2019. We included studies of hospitalised adults that reported associations between symptom domains of delirium and 30-day mortality (primary outcome), and other outcomes including mortality at other time points, length of stay, and dementia. Reviewer pairs independently screened articles, extracted data, and assessed risk of bias (Risk of Bias Assessment tool for Non-randomized Studies) and quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation framework. We performed random-effects meta-analyses stratified by delirium domain where possible. RESULTS: From 7092 citations we included 6 studies (6002 patients, 1112 with delirium). Higher mortality (ranging from in-hospital to follow-up beyond 12 months) was associated with altered arousal (pooled Odds Ratio (OR) 2.80, 95% Confidence Interval (CI) 2.33-3.37; moderate-quality evidence), inattention (pooled OR 2.57, 95% CI 1.74-3.80; low-quality evidence), and in single studies with disorientation, memory deficits and disorganised thoughts. Risk of bias varied across studies but was moderate-to-high overall, mainly due to selection bias, lack of blinding of assessments and unclear risk of selective outcome reporting. We found no studies on the association between psychotic features, visuospatial deficits or affective disturbances in delirium and outcomes, or studies reporting non-mortality outcomes. CONCLUSIONS: Few studies have related symptom domains of delirium to outcomes, but the available evidence suggests that altered arousal and inattention in delirium are associated with higher mortality than normal arousal and attention in people with or without delirium. Measurable symptom domains of delirium may have value in predicting survival and stratifying patients for treatment. We recommend that future delirium studies report outcomes by symptom domain

New perspectives on the ecology of tree structure and tree communities through terrestrial laser scanning

Terrestrial laser scanning (TLS) opens up the possibility of describing the three-dimensional structures of trees in natural environments with unprecedented detail and accuracy. It is already being extensively applied to describe how ecosystem biomass and structure vary between sites, but can also facilitate major advances in developing and testing mechanistic theories of tree form and forest structure, thereby enabling us to understand why trees and forests have the biomass and three-dimensional structure they do. Here we focus on the ecological challenges and benefits of understanding tree form, and highlight some advances related to capturing and describing tree shape that are becoming possible with the advent of TLS. We present examples of ongoing work that applies, or could potentially apply, new TLS measurements to better understand the constraints on optimization of tree form. Theories of resource distribution networks, such as metabolic scaling theory, can be tested and further refined. TLS can also provide new approaches to the scaling of woody surface area and crown area, and thereby better quantify the metabolism of trees. Finally, we demonstrate how we can develop a more mechanistic understanding of the effects of avoidance of wind risk on tree form and maximum size. Over the next few years, TLS promises to deliver both major empirical and conceptual advances in the quantitative understanding of trees and tree-dominated ecosystems, leading to advances in understanding the ecology of why trees and ecosystems look and grow the way they do

Delirium is under-reported in discharge summaries and in hospital administrative systems: a systematic review

Background Accurate recording of delirium in discharge summaries (DS) and hospital administrative systems (HAS) is critical for patient care. Objective To systematically review studies reporting the frequency of delirium documentation and coding in DS and HAS, respectively. Method We searched Medline, Embase, PsycINFO and Web of Science databases from inception to 23 June 2021. Eligibility criteria included requiring the term delirium in DS or HAS. Screening and full-text reviews were performed independently by two reviewers. Risk of bias (RoB) was assessed using the Effective Public Health Practice Project tool. Results The search yielded 7,910 results; 24 studies were included. The studies were heterogeneous in design and size (N=25 to 809,512). Mean age ranged from 57 to 84 years. Four studies reported only overall DS documentation and HAS coding in whole hospital or healthcare databases. Twenty studies used additional delirium ascertainment methods (e.g. chart review) in smaller patient subsets. Studies reported either DS figures only (N=8), HAS figures only (N=11), or both (N=5). Documentation rates in DS ranged from 0.1% to 64%. Coding rates in HAS ranged from 1.5% to 49%. Some studies explored the impact of race, and nurse versus physician practice. No significant differences were reported for race; one study reported that nurses showed higher documentation rates in DS relative to physicians. Most studies (N=22) had medium to high RoB. Conclusion Delirium is a common and serious medical emergency, yet studies show considerable under-documentation and under-coding in healthcare systems. This has important implications for patient care and service planning. Healthcare systems need to take action to reach satisfactory delirium documentation and coding rates

The Impact of the COVID-19 Pandemic on the Psychological Well-Being of Caregivers of People with Dementia or Mild Cognitive Impairment: A Systematic Review and Meta-Analysis

The aim of this systematic review was to investigate the effects of the COVID-19 lockdown on the psychological well-being of caregivers of people with dementia or mild cognitive impairment (PwD/MCI). Electronic databases were searched from inception to August 2022 for observational studies investigating the COVID-19 lockdown and psychological well-being of caregivers of PwD/MCI. Summary estimates of standardized mean differences (SMD) in psychological well-being scores pre- versus during COVID-19 were calculated using a random-effects model. Fifteen studies including 1702 caregivers (65.7% female, mean age 60.40 ± 12.9 years) with PwD/MCI were evaluated. Five studies found no change in psychological well-being parameters, including depression, anxiety, distress, caregiver burden, and quality of life. Ten studies found a worsening in at least one parameter: depression (six studies, n = 1368; SMD = 0.40; 95%CI: 0.09–0.71; p = 0.01, I2 = 86.8%), anxiety (seven studies, n = 1569; SMD = 1.35; 95%CI: 0.05–2.65; I2 = 99.2%), caregiver distress (six studies, n = 1320, SMD = 3.190; 95%CI: 1.42–4.95; p < 0.0001; I2 = 99.4%), and caregiver burden (four studies, n = 852, SMD = 0.34; 95%CI: 0.13–0.56; p = 0.001; I2 = 54.1%) (p < 0.05). There was an increase in depression, anxiety, caregiver burden, and distress in caregivers of PwD/MCI during the lockdown in the COVID pandemic. This could have longer term consequences, and it is essential that caregivers’ psychological well-being is assessed and supported, to benefit both themselves and those for whom they care

Delirium is under-reported in discharge summaries and in hospital administrative systems: a systematic review

Background Accurate recording of delirium in discharge summaries (DS) and hospital administrative systems (HAS) is critical for patient care. Objective To systematically review studies reporting the frequency of delirium documentation and coding in DS and HAS, respectively. Method We searched Medline, Embase, PsycINFO and Web of Science databases from inception to 23 June 2021. Eligibility criteria included requiring the term delirium in DS or HAS. Screening and full-text reviews were performed independently by two reviewers. Risk of bias (RoB) was assessed using the Effective Public Health Practice Project tool. Results The search yielded 7,910 results; 24 studies were included. The studies were heterogeneous in design and size (N=25 to 809,512). Mean age ranged from 57 to 84 years. Four studies reported only overall DS documentation and HAS coding in whole hospital or healthcare databases. Twenty studies used additional delirium ascertainment methods (e.g. chart review) in smaller patient subsets. Studies reported either DS figures only (N=8), HAS figures only (N=11), or both (N=5). Documentation rates in DS ranged from 0.1% to 64%. Coding rates in HAS ranged from 1.5% to 49%. Some studies explored the impact of race, and nurse versus physician practice. No significant differences were reported for race; one study reported that nurses showed higher documentation rates in DS relative to physicians. Most studies (N=22) had medium to high RoB. Conclusion Delirium is a common and serious medical emergency, yet studies show considerable under-documentation and under-coding in healthcare systems. This has important implications for patient care and service planning. Healthcare systems need to take action to reach satisfactory delirium documentation and coding rates

Validity of recalled versus recorded birth weight: a systematic review and meta-analysis

Low birth weight is associated with adverse health outcomes. If birth weight records are not available, studies may use recalled birth weight. It is unclear whether this is reliable. We performed a systematic review and meta-analysis of studies comparing recalled with recorded birth weights. We followed the Meta-Analyses of Observational Studies in Epidemiology (MOOSE) statement and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched MEDLINE, EMBASE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) to May 2015. We included studies that reported recalled birth weight and recorded birth weight. We excluded studies investigating a clinical population. Two reviewers independently reviewed citations, extracted data, assessed risk of bias. Data were pooled in a random effects meta-analysis for correlation and mean difference. In total, 40 studies were eligible for qualitative synthesis (n=78,997 births from 78,196 parents). Agreement between recalled and recorded birth weight was high: pooled estimate of correlation in 23 samples from 19 studies (n=7406) was 0.90 [95% confidence interval (CI) 0.87–0.93]. The difference between recalled and recorded birth weight in 29 samples from 26 studies (n=29,293) was small [range −86–129 g; random effects estimate 1.4 g (95% CI −4.0–6.9 g)]. Studies were heterogeneous, with no evidence for an effect of time since birth, person reporting, recall bias, or birth order. In post-hoc subgroup analysis, recall was higher than recorded birth weight by 80 g (95% CI 57–103 g) in low and middle income countries. In conclusion, there is high agreement between recalled and recorded birth weight. If birth weight is recalled, it is suitable for use in epidemiological studies, at least in high income countries

Finite element analysis of trees in the wind based on terrestrial laser scanning data

Wind damage is an important driver of forest structure and dynamics, but it is poorly understood in natural broadleaf forests. This paper presents a new approach in the study of wind damage: combining terrestrial laser scanning (TLS) data and finite element analysis. Recent advances in tree reconstruction from TLS data allowed us to accurately represent the 3D geometry of a tree in a mechanical simulation, without the need for arduous manual mapping or simplifying assumptions about tree shape. We used this simulation to predict the mechanical strains produced on the trunks of 21 trees in Wytham Woods, UK, and validated it using strain data measured on these same trees. For a subset of five trees near the anemometer, the model predicted a five-minute time-series of strain with a mean cross-correlation coefficient of 0.71, when forced by the locally measured wind speed data. Additionally, the maximum strain associated with a 5 ms−1 or 15 ms-1 wind speed was well predicted by the model (N = 17, R2 = 0.81 and R2 = 0.79, respectively). We also predicted the critical wind speed at which the trees will break from both the field data and models and find a good overall agreement (N = 17, R2 = 0.40). Finally, the model predicted the correct trend in the fundamental frequencies of the trees (N = 20, R2 = 0.38) although there was a systematic underprediction, possibly due to the simplified treatment of material properties in the model. The current approach relies on local wind data, so must be combined with wind flow modelling to be applicable at the landscape-scale or over complex terrain. This approach is applicable at the plot level and could also be applied to open-grown trees, such as in cities or parks

Early Life Socioeconomic Circumstance and Late Life Brain Hyperintensities : A Population Based Cohort Study

Funding: Image acquisition and image analysis for this study was funded by the Alzheimer's Research Trust (now Alzheimer's Research UK). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Acknowledgments The authors would like to thank the participants of the Aberdeen 1936 Birth Cohort (ABC36), without whom this research would not have been possible.Peer reviewedPublisher PD

The World's Tallest Tropical Tree in Three Dimensions

We would like to thank NERC for funding the airborne remote sensing campaign (HMTF grant NE/K016377/1 to the BALI consortium, YM, DC and DB) + direct access grant to MC, DSB, GM and DB), analyses (grants NE/P004806/1 to MC, DSB, GF, DB, GH, and NE/I528477/1 to GH, DSB, GF), and ground-based work (grant NE/P012337/1 to YM, MD and LPB); an ERC Advanced Investigator Award (321131) to YM for funding the UAV work; LAStools’ LASmoons program for a free academic license; and an Anne McLaren Research fellowship by the University of Nottingham to GH for funding the tree climbing. YM is supported by the Jackson Foundation. Data availability statement Generated Statement: The datasets generated for this study are available on request to the corresponding author.Peer reviewedPublisher PD