Occurrence rate of delirium in acute stroke settings

Background and Purpose— Delirium is associated with increased mortality, length of stay, and poor functional outcome following critical illness. The epidemiology of delirium in stroke is poorly described. We sought to collate evidence around occurrence (incidence or prevalence) of delirium in acute stroke. Methods— We searched multiple cross-disciplinary electronic databases using a prespecified search strategy, complemented by hand searching. Eligible studies described delirium in acute (first 6 weeks) stroke. We compared delirium occurrence using random-effects models to describe summary estimates. We assessed risk of bias using the Newcastle-Ottawa tool, incorporating this in sensitivity analyses. We performed subgroup analyses for delirium diagnostic method (confusion assessment method scoring, clinical diagnosis, other), duration and timing of delirium assessment (>1 or <1 week), and performed meta-regression based on the year of publication. Results— Of 8822 titles, we included 32 papers (6718 participants) in the quantitative analysis. Summary estimate for occurrence of delirium was 25% (95% CI, 20%–30%; moderate quality evidence). Limiting to studies at low risk of bias (22 studies, 4422 participants), the occurrence rate was 23% (95% CI, 17%–28%). Subgroup summary estimates suggest that delirium occurrence may vary with assessment method: confusion assessment method, 21% (95% CI, 16%–27%); clinical diagnosis, 27% (95% CI, 19%–38%); other, 32% (95% CI, 22%–43%) but not with duration and timing of assessment. Meta-regression suggested decline in occurrence of delirium comparing historical to more recent studies (slope, 0.03 [SE, 0.004]; P<0.0001). Conclusions— Delirium is common, affecting 1 in 4 acute stroke patients. Reported rates of delirium may be dependent on assessment method. Our estimate of delirium occurrence could be used for audit, to plan intervention studies, and inform clinical practice. Clinical Trial Registration— URL: http://www.crd.york.ac.uk/PROSPERO/. Unique identifier: CRD42015029251

Antibiotic Elution and Mechanical Strength of PMMA Bone Cement Loaded With Borate Bioactive Glass

A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author's publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.Introduction: Local delivery of antibiotics using bone cement as the delivery vehicle is an established method of managing implant-associated orthopedic infections. Various fillers have been added to cement to increase antibiotic elution, but they often do so at the expense of strength. This study evaluated the effect of adding a borate bioactive glass, previously shown to promote bone formation, on vancomycin elution from PMMA bone cement. Methods: Five cement composites were made: three loaded with borate bioactive glass along with 0, 1, and 5 grams of vancomycin and two without any glass but with 1 and 5 grams vancomycin to serve as controls. The specimens were soaked in PBS. Eluate of vancomycin was collected every 24 hours and analyzed by HPLC. Orthopedic-relevant mechanical properties of each composite were tested over time. Results: The addition of borate bioactive glass provided an increase in vancomycin release at Day 1 and an increase in sustained vancomycin release throughout the treatment period. An 87.6% and 21.1% increase in cumulative vancomycin release was seen for both 1g and 5g loading groups, respectively. Compressive strength of all composites remained above the weight-bearing threshold of 70 MPa throughout the duration of the study with the glass-containing composites showing comparable strength to their respective controls. Conclusion: The incorporation of borate bioactive glass into commercial PMMA bone cement can significantly increase the elution of vancomycin. The mechanical strength of the cement-glass composites remained above 70 MPa even after soaking for 8 weeks, suggesting their suitability for orthopedic weight-bearing applications.Marc A. and Elinor J. Asher Orthopedic Research Endowmen

Evaluating the Environmental Performance of the U.S. Next Generation Air Transportation System

The environmental impacts of several possible U.S. Next Generation Air Transportation scenarios have been quantitatively evaluated for noise, air-quality, fuel-efficiency, and CO2 impacts. Three principal findings have emerged. (1) 2025 traffic levels about 30% higher than 2006 are obtained by increasing traffic according to FAA projections while also limiting traffic at each airport using reasonable ratios of demand to capacity. NextGen operational capabilities alone enable attainment of an additional 10-15% more flights beyond that 2025 baseline level with negligible additional noise, air-quality, and fuel-efficiency impacts. (2) The addition of advanced engine and airframe technologies provides substantial additional reductions in noise and air-quality impacts, and further improves fuel efficiency. 2025 environmental goals based on projected system-wide improvement rates of about 1% per year for noise and fuel-efficiency (an air-quality goal is not yet formulated) are achieved using this new vehicle technology. (3) Overall air-transport "product", as measured by total flown distance or total payload distance, increases by about 50% relative to 2006, but total fuel consumption and CO2 production increase by only about 40% using NextGen operational capabilities. With the addition of advanced engine/airframe technologies, the increase in total fuel consumption and CO2 production can be reduced to about 30%

The effects of intramuscular tenotomy on the lengthening characteristics of tibialis posterior: high versus low intramuscular tenotomy

BACKGROUND: Lengthening of soft-tissue contractures is frequently required in children with a wide variety of congenital and acquired deformities. However, little is known about the biomechanics of surgical procedures which are commonly used in contracture surgery, or if variations in technique may have a bearing on surgical outcomes. We investigated the hypothesis that the site of intramuscular tenotomy (IMT) within the muscle-tendon-unit (MTU) of the tibialis posterior (TP) would affect the lengthening characteristics. METHODS: We performed a randomized trial on paired cadaver tibialis posterior muscle-tendon-units (TP-MTUs). By random allocation, one of each pair of formalin-preserved TP-MTUs received a high IMT, and the other a low IMT. These were individually tensile-tested with an Instron(®) machine under controlled conditions. A graph of load (Newtons) versus displacement (millimetres) was generated for each pair of tests. The differences in lengthening and load at failure for each pair of TP-MTUs were noted and compared using paired t tests. RESULTS: We found 48% greater lengthening for low IMT compared to high IMT for a given load (P = 0.004, two tailed t test). Load at failure was also significantly lower for the low IMT. These findings confirm our hypothesis that the site of the tenotomy affects the amount of lengthening achieved. This may contribute to the reported variability in clinical outcome. CONCLUSIONS: Understanding the relationship between tenotomy site and lengthening may allow surgeons to vary the site of the tenotomy in order to achieve pre-determined surgical goals. It may be possible to control the surgical "dose" by altering the position of the intramuscular tenotomy within the muscle-tendon-unit

De novo assembly of red clover transcriptome based on RNA-Seq data provides insight into drought response, gene discovery and marker identification

Background Red clover (Trifolium pratense L.) is a versatile forage crop legume, which can tolerate a variety of soils and is suitable for silage production for winter feed and for grazing. It is one of the most important forage legumes in temperate livestock agriculture. Its beneficial attributes include ability to fix nitrogen, improve soil and provide protein rich animal feed. It is however, a short-lived perennial providing good biomass yield for two or three years. Improved persistency is thus a major breeding target. Better water-stress tolerance is one of the key factors influencing persistency, but little is known about how red clover tolerates water stress. Results Plants from a full sib mapping family were used in a drought experiment, in which the growth rate and relative water content (RWC) identified two pools of ten plants contrasting in their tolerance to drought. Key metabolites were measured and RNA-Seq analysis was carried out on four bulked samples: the two pools sampled before and after drought. Massively parallel sequencing was used to analyse the bulked RNA samples. A de novo transcriptome reconstruction based on the RNA-Seq data was made, resulting in 45181 contigs, representing ‘transcript tags’. These transcript tags were annotated with gene ontology (GO) terms. One of the most striking results from the expression analysis was that the drought sensitive plants were characterised by having approximately twice the number of differentially expressed transcript tags than the tolerant plants after drought. This difference was evident in most of the major GO terms. Before onset of drought the sensitive plants overexpressed a number of genes annotated as senescence-related. Furthermore, the concentration of three metabolites, particularly pinitol, but also proline and malate increased in leaves after drought stress. Conclusions This de novo assembly of a red clover transcriptome from leaf material of droughted and non-droughted plants provides a rich source for gene identification, single nucleotide polymorphisms (SNP) and short sequence repeats (SSR). Comparison of gene expression levels between pools and treatments identified candidate genes for further analysis of the genetic basis of drought tolerance in red clover

Understanding stakeholder views regarding the design of an intervention trial to reduce anticholinergic burden : a qualitative study

Funding statement This research was supported by the Chief Scientist Office under their Catalytic Research Grants Scheme, CSO reference number: CGA/18/47. Acknowledgments We gratefully acknowledge the support from the Alliance, the Glasgow Stroke Group and NKS in recruiting focus group participants and conducting the focus groups and Scottish Primary Care Research Network for recruiting patients from primary care. Special thanks to Irene Oldfather from Alliance and Naseem Suleman from NKS for their help in setting up interviews and focus groups. We gratefully acknowledge the research participants who provided their views and insights.Peer reviewedPublisher PD

A self-consistent, multi-variate method for the determination of gas phase rate coefficients, applied to reactions of atmospheric VOCs and the hydroxyl radical

Gas-phase rate coefficients are fundamental to understanding atmospheric chemistry, yet experimental data are not available for the oxidation reactions of many of the thousands of volatile organic compounds (VOCs) observed in the troposphere. Here a new experimental method is reported for the simultaneous study of reactions between multiple different VOCs and OH, the most important daytime atmospheric radical oxidant. This technique is based upon established relative rate concepts but has the advantage of a much higher throughput of target VOCs. By evaluating multiple VOCs in each experiment, and through measurement of the depletion in each VOC after reaction with OH, the OH + VOC reaction rate coefficients can be derived. Results from experiments conducted under controlled laboratory conditions were in good agreement with the available literature for the reaction of nineteen VOCs, prepared in synthetic gas mixtures, with OH. This approach was used to determine a rate coefficient for the reaction of OH with 2,3-dimethylpent-1-ene for the first time; k = 5.7 (±0.3) × 10–11–cm3 molecule−1 s−1. In addition, a further seven VOCs had only two, or fewer, individual OH rate coefficient measurements available in the literature. The results from this work were in good agreement with those measurements. A similar dataset, at an elevated temperature of 323 (±10) K, was used to determine new OH rate coefficients for twelve aromatic, five alkane, five alkene and three monoterpene VOC + OH reactions. In OH relative reactivity experiments that used ambient air at the University of York, a large number of different VOCs were observed, of which 23 were positively identified. 19 OH rate coefficients were derived from these ambient air samples, including ten reactions for which data was previously unavailable at the elevated reaction temperature of T = 323 (±10) K

The variation in acute and community service provision of care of the elderly services across the Scotland: Findings from the Scottish Care of Older People (SCoOP) National Audit initial scoping survey

We gratefully acknowledge the support of the British Geriatrics Society (BGS) in raising awareness of this work and the BGS Scotland Council for dissemination of the scoping survey. We also would like to thank Mr Tiberiu Pana, Mr Jesus Perdomo, Dr Maryam Barma and Dr Adrian Wood for their assistance with the project. We would also like to thank the SCoOP Steering Committee Members and Dr Claire Copeland (NHS Forth Valley) for their contribution. The SCoOP Steering Group includes: Dr Louise Beveridge (NHS Tayside), Professor Corri Black (University of Aberdeen), Ms Penny Bond (Healthcare Improvement Scotland), Dr Jennifer Burns (NHS Greater Glasgow and Clyde), Dr Tony Byrne (NHS Forth Valley), Dr Andrew Coull (NHS Lothian), Dr Alison Donaldson (University of Aberdeen), Dr Alice Einarsson (NHS Grampian), Professor Graham Ellis (NHS Lanarkshire, Glasgow Caledonian University and Co-Chair), Ms Karen Goudie(Healthcare Improvement Scotland) , Dr Graeme Hoyle (NHS Grampian), Dr Allan MacDonald (NHS Highland), Dr Christine McAlpine (NHS Greater Glasgow and Clyde), Dr Morven McElroy (NHS Greater Glasgow and Clyde), Professor Phyo Kyaw Myint (University of Aberdeen, Co-Chair), Dr Terence J Quinn (University of Glasgow), Professor Sir Lewis Ritchie (University of Aberdeen), Dr Susan Shenkin (University of Edinburgh), Dr Ralph Thomas (NHS Fife) and Dr Andrew Watt (NHS Ayrshire and Arran).Peer reviewedPublisher PD