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

Preservice Generalist Teachers Enlightened Approach to Teaching Physical Education through Teacher Biography.

This paper describes a new learning experience, which was introduced following an examination of the literature regarding preservice primary school teachers’ (PPST) notions of their past experience in Physical Education (PE) (Elliott 2013). PPSTs were given the opportunity to recognise, reflect, interrogate and reframe a critical incident from their schooling in PE or Sport. This exercise was designed to enlighten students about their own schooling and the potential impact this event may have on pre-conceived ideas and opinions about teaching PE. Students (N=214) enrolled in off and on campus mode, of a preservice teacher education program in a university located in regional NSW, were asked to provide information about, and to analyse, an incident, either positive or negative that occurred in PE or Sport during their primary or secondary school years. In addition, students were encouraged to reframe the incident and to seek out alternative actions that could have influenced the outcome. The aim was to encourage reflection about how preconceived notions pertaining to PE might be dealt within their present position as a preservice teacher. The PPSTs scripts were analysed using the Leximancer text mining software (Smith, 2000). Findings from the analysis provided themes and concepts, which suggest a similarity for both, off and on campus, males and females. However, there are some subtle differences between the cohorts that may be due to an age or experience

Inflammasome assembly in the chorioamniotic membranes during spontaneous labor at term

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137494/1/aji12648.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137494/2/aji12648_am.pd

Tidal Stripping of Globular Clusters in the Virgo Cluster

With the aim of finding evidence of tidal stripping of globular clusters (GCs) we analysed a sample of 13 elliptical galaxies taken from the ACS Virgo Cluster Survey (VCS). These galaxies belong to the main concentration of the Virgo cluster (VC) and present absolute magnitudes $-18.5<M_z<-22.5$. We used the public GC catalog of Jord\'an et al. (2008) and separated the GC population into metal poor (blue) and metal rich (red) according to their integrated colors. The galaxy properties were taken from \citet{Peng:2008}. We found that: 1) The specific frequencies ($S_N$) of total and blue GC populations increase as a function of the projected galaxy distances $r_p$ to M87. A similar result is observed when 3-dimensional distances $r_{3D}$ are used. The same behaviours are found if the analysis are made using the number of GCs per 10^9\Msun ($T$). The correlations with the clustocentric distance of the host galaxy are interpreted as evidence of GCs stripping due to tidal forces. 2) No correlation is found between the slope of GC density profiles of host galaxies and the galaxy distance to M87 (Virgo central galaxy). 3) We also computed the local density of GCs ($\rho_{out}$) located further than 6.2 \kpc from the galaxy center for nine galaxies of our sample. We find that the GC population around most of these galaxies is mainly composed of blue GCs. Our results suggest that the number and the fraction of blue and red GCs observed in elliptical galaxies located near the centers of massive clusters, could be significantly different from the underlying GC population. These differences could be explained by tidal stripping effects that occur as galaxies approach the centers of clusters.Comment: Accepted to the Astrophysical Journa

Multicenter observational study on factors and outcomes associated with various methicillin-resistant Staphylococcus aureus types in children with cystic fibrosis

Rationale: Methicillin-resistant Staphylococcus aureus (MRSA) prevalence continues to increase in patients with cystic fibrosis (CF) in the United States, reaching 26.5% in 2012. Approximately 30% of strains are SCCmec (staphylococcal cassette chromosome mec) IV type, frequently USA300, which in the general population have different genotypic and phenotypic features than SCCmec II type. Objectives: We hypothesized that risk factors for acquisition and outcomes in patients with CF differed for "health care-associated" (SCCmec II) versus "community-associated" (SCCmec IV)MRSAstrains. Methods: To determine the role of SCCmec type and Panton-Valentine leukocidin (PVL), MRSA isolates from patients not more than 18 years old at seven CF centers were typed and the association of potential risk factors and subsequent clinical course was assessed, using data provided by the CF Patient Registry. Measurements and Main Results: Participants with chronic MRSA (295) had typeable isolates and clinical data; 205 (69.5%) had SCCmec II PVL(-), 39 (13.2%) had SCCmec IV PVL(-), and 51 (17.3%) had SCCmec IVPVL(1) strains.SCCmec IV, comparedwith SCCmec II, increased during the study period, 1996-2010 (P = 0.03). SCCmec II was associated with Pseudomonas aeruginosa-positive cultures and three or more clinic visits in the 6 months preceding the first positive MRSA culture (adjusted odds ratio, 2.05; 95% confidence interval, 1.13-3.74; P = 0.019). Lung function and anthropometrics remained unchanged in the 6 months after initial MRSA detection compared with the 6 months prior. Although CF care increased for participants in both groups in the 6 months after MRSA detection, inhaled antibiotics were prescribed more frequently in those with SCCmec II strains and increased hospitalizations occurred in those with SCCmec IV PVL(-) strains compared with those with PVL(1) strains (adjusted difference, 34.10%; 95% confidence interval, 7.58-60.61; P = 0.012). Participants in both groups had an increase in CF care in the 2 years after MRSA detection compared with the 2 years prior. Conclusions: Increased exposure to CF clinics and P. aeruginosa may constitute risk factors for acquisition of SCCmec II MRSA strains. Clinical interventions increased 6 months and 2 years after initial MRSA detection regardless of SCCmec type

Innate Lymphoid Cells in the Maternal and Fetal Compartments

Pregnancy success is orchestrated by the complex balance between the maternal and fetal immune systems. Herein, we summarize the potential role of innate lymphoid cells (ILCs) in the maternal and fetal compartments. We reviewed published literature describing different ILC subsets [ILC1s, ILC2s, ILC3s, and lymphoid tissue inducer (LTi) cells] in the uterus, decidua, fetal tissues [liver, secondary lymphoid organs (SLO), intestine, and lung] and amniotic cavity. ILC1s, ILC2s, and ILC3s are present in the murine uterus prior to and during pregnancy but have only been detected in the non-pregnant endometrium in humans. Specifically, ILC2s reside in the murine uterus from mid-pregnancy to term, ILC1s increase throughout gestation, and ILC3s remain constant. Yet, LTi cells have only been detected in the non-pregnant murine uterus. In the human decidua, ILC1s, ILC3s, and LTi-like cells are more abundant during early gestation, whereas ILC2s increase at the end of pregnancy. Decidual ILC1s were also detected during mid-gestation in mice. Interestingly, functional decidual ILC2s and ILC3s increased in women who underwent spontaneous preterm labor, indicating the involvement of such cells in this pregnancy complication. Fetal ILCs exist in the liver, SLO, intestine, lung, and amniotic cavity. The fetal liver is thought to be the source of ILC progenitors since the differentiation of these cells from hematopoietic stem cells occurs at this site, and mature ILC subsets can be found in this compartment as well. The interaction between LTi cells and specialized stromal cells is important during the formation of SLO. Mature ILCs are found at the mucosal surfaces of the lung and intestine, from where they can extravasate into the amniotic cavity. Amniotic fluid ILCs express high levels of RORγt, CD161, and CD103, hallmarks of ILC3s. Such cells are more abundant in the second trimester than later in gestation. Although amniotic fluid ILC3s produce IL-17A and TNFα, indicating their functionality, their numbers in patients with intra-amniotic infection/inflammation remain unchanged compared to those without this pregnancy complication. Collectively, these findings suggest that maternal (uterine and decidual) ILCs play central roles in both the initiation and maintenance of pregnancy, and fetal ILCs participate in the development of immunity