Prednisolone improves the response to primary endocrine treatment for advanced breast cancer.

Two hundred and twenty patients with progressive advanced breast cancer were given primary endocrine treatment (PET) according to menstrual status. Pre-menopausal patients received ovarian irradiation (O) and post-menopausal tamoxifen 10 mg bd (T). Patients were randomised to receive either no additional treatment or prednisolone 5 mg bd (P). Similar results were observed in each menstrual subgroup. In 194 evaluable patients, the response to PET + P was 49% and to PET alone 30% (P less than 0.01). P increased the median duration of response from 9 to 14 months (P less than 0.002) and the median time to disease progression from 5 to 9 months (P less than 0.001). Response to P after O or T alone occurred in only 2/62 (3%). Median survival in patients randomised to receive P at the outset of PET was prolonged by 4 months (P less than 0.05). The addition of P significantly improves the response to O or T in the treatment of advanced breast cancer

Worldviews about change: their structure and their implications for understanding responses to sustainability, technology, and political change

People hold different perspectives about how they think the world is changing or should change. We examined five of these “worldviews” about change: Progress, Golden Age, Endless Cycle, Maintenance, and Balance. In Studies 1–4 (total N = 2733) we established reliable measures of each change worldview, and showed how these help explain when people will support or oppose social change in contexts spanning sustainability, technological innovations, and political elections. In mapping out these relationships we identify how the importance of different change worldviews varies across contexts, with Balance most critical for understanding support for sustainability, Progress/Golden Age important for understanding responses to innovations, and Golden Age uniquely important for preferring Trump/Republicans in the 2016 US election. These relationships were independent of prominent individual differences (e.g., values, political orientation for elections) or context-specific factors (e.g., self-reported innovativeness for responses to innovations). Study 5 (N = 2140) examined generalizability in 10 countries/regions spanning five continents, establishing that these worldviews exhibited metric invariance, but with country/region differences in how change worldviews were related to support for sustainability. These findings show that change worldviews can act as a general “lens” people use to help determine whether to support or oppose social change

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

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

Influence of selenitetriglyceride supplementation on selenium blood status and selected hematological and biochemical parameters in camels (Camelus dromedarius)

This study examined the impact of oral supplementation with a new organic selenium preparation (selenitetriglycerides) on the health of camels (Camelus dromedarius). The experiment was conducted on 7 female camels, which were given 240 mg per animal per day of selenitetriglycerides with an oesophageal probe and subsequently monitored for 28 days. Blood samples for tests were collected 10 times (on day 1, 2, 3, 4, 5, 6, 7, 8, 14 and 28) and the following parameters were determined: the level of selenium, vitamin E, the activity of aspartate transaminase (AST), gamma-glutamyl transpeptidase (GGTP), lactate dehydrogenase (LDH), creatine kinase (CK) and the concentration of total protein, glucose, urea and creatinine. The following hematological parameters were determined in whole blood: white blood cell count (WBC), red blood cell count (RBC), hemoglobin level (HGB), platelet count (PLT) and packed cell volume (PCV). Selenium serum level increased significantly on the second day (from 40.18 µg l-1 to 198.79 µg l-1), peaked on day 7 (514.76 µg l-1) and remained at a statistically significant level relative to the baseline to the end of the experiment. Clinical observations and analysis of the hematological parameters, liver and kidney function parameters did not show any negative effect of selenitetriglycerides on camel health. The results indicate that selenitetriglycerides can be a safe and effective method of selenium supplementation in camels