Delirium in older hospitalized patients—A prospective analysis of the detailed course of delirium in geriatric inpatients

Background: Delirium in older hospitalized patients (> 65) is a common clinical syndrome, which is frequently unrecognized. Aims: We aimed to describe the detailed clinical course of delirium and related cognitive functioning in geriatric patients in a mainly non-postoperative setting in association with demographic and clinical parameters and additionally to identify risk factors for delirium in this common setting. Methods: Inpatients of a geriatric ward were screened for delirium and in the case of presence of delirium included into the study. Patients received three assessments including Mini-Mental-Status-Examination (MMSE) and the Delirium Rating Scale Revised 98 (DRS-R-98). We conducted correlation and linear mixed-effects model analyses to detect associations. Results: Overall 31 patients (82 years (mean)) met the criteria for delirium and were included in the prospective observational study. Within one week of treatment, mean delirium symptom severity fell below the predefined cut-off. While overall cognitive functioning improved over time, short- and long-term memory deficits remained. Neuroradiological conspicuities were associated with cognitive deficits, but not with delirium severity. Discussion: The temporal stability of some delirium symptoms (short-/long-term memory, language) on the one hand and on the other hand decrease in others (hallucinations, orientation) shown in our study visualizes the heterogeneity of symptoms attributed to delirium and their different courses, which complicates the differentiation between delirium and a preexisting cognitive decline. The recovery from delirium seems to be independent of preclinical cognitive status. Conclusion: Treatment of the acute medical condition is associated with a fast decrease in delirium severity. Given the high incidence and prevalence of delirium in hospitalized older patients and its detrimental impact on cognition, abilities and personal independence further research needs to be done

Amino-acid site variability among natural and designed proteins

Computational protein design attempts to create protein sequences that fold stably into pre-specified structures. Here we compare alignments of designed proteins to alignments of natural proteins and assess how closely designed sequences recapitulate patterns of sequence variation found in natural protein sequences. We design proteins using RosettaDesign, and we evaluate both fixed-backbone designs and variable-backbone designs with different amounts of backbone flexibility. We find that proteins designed with a fixed backbone tend to underestimate the amount of site variability observed in natural proteins while proteins designed with an intermediate amount of backbone flexibility result in more realistic site variability. Further, the correlation between solvent exposure and site variability in designed proteins is lower than that in natural proteins. This finding suggests that site variability is too uniform across different solvent exposure states (i.e., buried residues are too variable or exposed residues too conserved). When comparing the amino acid frequencies in the designed proteins with those in natural proteins we find that in the designed proteins hydrophobic residues are underrepresented in the core. From these results we conclude that intermediate backbone flexibility during design results in more accurate protein design and that either scoring functions or backbone sampling methods require further improvement to accurately replicate structural constraints on site variability

Repositories for Taxonomic Data: Where We Are and What is Missing

AbstractNatural history collections are leading successful large-scale projects of specimen digitization (images, metadata, DNA barcodes), thereby transforming taxonomy into a big data science. Yet, little effort has been directed towards safeguarding and subsequently mobilizing the considerable amount of original data generated during the process of naming 15,000–20,000 species every year. From the perspective of alpha-taxonomists, we provide a review of the properties and diversity of taxonomic data, assess their volume and use, and establish criteria for optimizing data repositories. We surveyed 4113 alpha-taxonomic studies in representative journals for 2002, 2010, and 2018, and found an increasing yet comparatively limited use of molecular data in species diagnosis and description. In 2018, of the 2661 papers published in specialized taxonomic journals, molecular data were widely used in mycology (94%), regularly in vertebrates (53%), but rarely in botany (15%) and entomology (10%). Images play an important role in taxonomic research on all taxa, with photographs used in &amp;gt;80% and drawings in 58% of the surveyed papers. The use of omics (high-throughput) approaches or 3D documentation is still rare. Improved archiving strategies for metabarcoding consensus reads, genome and transcriptome assemblies, and chemical and metabolomic data could help to mobilize the wealth of high-throughput data for alpha-taxonomy. Because long-term—ideally perpetual—data storage is of particular importance for taxonomy, energy footprint reduction via less storage-demanding formats is a priority if their information content suffices for the purpose of taxonomic studies. Whereas taxonomic assignments are quasifacts for most biological disciplines, they remain hypotheses pertaining to evolutionary relatedness of individuals for alpha-taxonomy. For this reason, an improved reuse of taxonomic data, including machine-learning-based species identification and delimitation pipelines, requires a cyberspecimen approach—linking data via unique specimen identifiers, and thereby making them findable, accessible, interoperable, and reusable for taxonomic research. This poses both qualitative challenges to adapt the existing infrastructure of data centers to a specimen-centered concept and quantitative challenges to host and connect an estimated $\le$2 million images produced per year by alpha-taxonomic studies, plus many millions of images from digitization campaigns. Of the 30,000–40,000 taxonomists globally, many are thought to be nonprofessionals, and capturing the data for online storage and reuse therefore requires low-complexity submission workflows and cost-free repository use. Expert taxonomists are the main stakeholders able to identify and formalize the needs of the discipline; their expertise is needed to implement the envisioned virtual collections of cyberspecimens. [Big data; cyberspecimen; new species; omics; repositories; specimen identifier; taxonomy; taxonomic data.]</jats:p

Phylogenetic Approach Reveals That Virus Genotype Largely Determines HIV Set-Point Viral Load

HIV virulence, i.e. the time of progression to AIDS, varies greatly among patients. As for other rapidly evolving pathogens of humans, it is difficult to know if this variance is controlled by the genotype of the host or that of the virus because the transmission chain is usually unknown. We apply the phylogenetic comparative approach (PCA) to estimate the heritability of a trait from one infection to the next, which indicates the control of the virus genotype over this trait. The idea is to use viral RNA sequences obtained from patients infected by HIV-1 subtype B to build a phylogeny, which approximately reflects the transmission chain. Heritability is measured statistically as the propensity for patients close in the phylogeny to exhibit similar infection trait values. The approach reveals that up to half of the variance in set-point viral load, a trait associated with virulence, can be heritable. Our estimate is significant and robust to noise in the phylogeny. We also check for the consistency of our approach by showing that a trait related to drug resistance is almost entirely heritable. Finally, we show the importance of taking into account the transmission chain when estimating correlations between infection traits. The fact that HIV virulence is, at least partially, heritable from one infection to the next has clinical and epidemiological implications. The difference between earlier studies and ours comes from the quality of our dataset and from the power of the PCA, which can be applied to large datasets and accounts for within-host evolution. The PCA opens new perspectives for approaches linking clinical data and evolutionary biology because it can be extended to study other traits or other infectious diseases

A weighted taxonomic matrix key for species of the rotifer genus Synchaeta (Rotifera, Monogononta, Synchaetidae)

Volume: 871Start Page: 1End Page: 4

Rechtsmedizinische Modelle der Versorgung von gewaltbetroffenen Personen in Deutschland

&lt;jats:title&gt;Zusammenfassung&lt;/jats:title&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Hintergrund&lt;/jats:title&gt; &lt;jats:p&gt;In Deutschland bestehen keine einheitlichen Strukturen für die Versorgung von Gewaltbetroffenen. Aktuellen politischen Bestrebungen zufolge soll eine Beweissicherung auch ohne Strafanzeige flächendeckend in Deutschland ermöglicht werden. Die Rechtsmedizin verfügt über die notwendige Expertise, um eine gerichtsverwertbare Befunderhebung niederschwellig durchzuführen und den Aufbau eines solchen Angebotes zu begleiten.&lt;/jats:p&gt; &lt;/jats:sec&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Material und Methoden&lt;/jats:title&gt; &lt;jats:p&gt;Durch die Arbeitsgemeinschaft Klinische Rechtsmedizin der Deutschen Gesellschaft für Rechtsmedizin erfolgte eine Umfrage an rechtsmedizinischen Instituten in Deutschland zu aktuellen Modellen der Versorgung von Gewaltbetroffenen. Ausgewertet wurden Angaben zur Projektstruktur, zum Leistungsangebot und zum Versorgungsgebiet, zur Finanzierung sowie zu Vor- und Nachteilen der Projekte.&lt;/jats:p&gt; &lt;/jats:sec&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Ergebnisse&lt;/jats:title&gt; &lt;jats:p&gt;Es wurden 16 Projekte aus 14 Bundesländern rückgemeldet, die körperliche Untersuchungen an eigenen und peripheren Standorten, Beratungen, Lagerungen von Asservaten sowie Fortbildungen beinhalten. In etwa der Hälfte der Projekte haben die rechtsmedizinischen Institute zusätzlich koordinierende Funktion, wobei Kooperationspartner die Untersuchungen durchführen. Der Großteil der Projekte wird über öffentliche Mittel finanziert; in 7 Projekten müssen zusätzlich eigene oder sonstige Mittel aufgebracht werden. Elf Projekte sind befristet oder Modellprojekte.&lt;/jats:p&gt; &lt;/jats:sec&gt;&lt;jats:sec&gt; &lt;jats:title&gt;Diskussion&lt;/jats:title&gt; &lt;jats:p&gt;Rechtsmedizinische Institute verfügen über die notwendige Expertise und bieten ein umfassendes niederschwelliges Angebot für Gewaltbetroffene. Die Finanzierungsmodelle sind heterogen, häufig befristet und nicht auskömmlich. Um die politisch geforderte, flächendeckende Versorgung zu etablieren, sind eine bundesweite Einbeziehung der Rechtsmedizin und auskömmliche Finanzierung dringend notwendig.&lt;/jats:p&gt; &lt;/jats:sec&gt

Wie funktioniert Sicherheit ohne (viel) Staat? Befunde aus Nordostafghanistan und Pakistan

Wilke B, Jan K. Wie funktioniert Sicherheit ohne (viel) Staat? Befunde aus Nordostafghanistan und Pakistan. In: Beisheim M, Börzel TA, Genschel P, Zangl B, eds. Wozu Staat? Governance in Räumen konsolidierter und begrenzter Staatlichkeit. Baden-Baden: Nomos; 2011: 55-86

Amino-acid site variability among natural and designed proteins.

Computational protein design attempts to create protein sequences that fold stably into pre-specified structures. Here we compare alignments of designed proteins to alignments of natural proteins and assess how closely designed sequences recapitulate patterns of sequence variation found in natural protein sequences. We design proteins using RosettaDesign, and we evaluate both fixed-backbone designs and variable-backbone designs with different amounts of backbone flexibility. We find that proteins designed with a fixed backbone tend to underestimate the amount of site variability observed in natural proteins while proteins designed with an intermediate amount of backbone flexibility result in more realistic site variability. Further, the correlation between solvent exposure and site variability in designed proteins is lower than that in natural proteins. This finding suggests that site variability is too uniform across different solvent exposure states (i.e., buried residues are too variable or exposed residues too conserved). When comparing the amino acid frequencies in the designed proteins with those in natural proteins we find that in the designed proteins hydrophobic residues are underrepresented in the core. From these results we conclude that intermediate backbone flexibility during design results in more accurate protein design and that either scoring functions or backbone sampling methods require further improvement to accurately replicate structural constraints on site variability