Delirium is common and serious acute syndrome among older people precipitated by multiple external factors such as acute illnesses, trauma, surgery, and drugs. The aim of this study was to find ...possible stressors and causative triggers for acute delirium and compare patients with or without dementia in this respect.
193 delirious patients from two separate delirium studies including settings of nursing homes and geriatric wards were thoroughly assessed for precipitating factors of delirium. Patients with and without dementia were compared for their clinical status, symptoms and signs, prognosis, and the profile of precipitating factors of delirium.
The patients with dementia (n=98) and without dementia (n=95) did not differ in their demographic factors, mean number of drugs, or their psychiatric symptoms. The patients with dementia had higher number of comorbidities, poorer cognition, and they were more often restrained than those without dementia. The mean number of precipitators for delirium was 2.6 among those without dementia and 2.0 among those with dementia (p=0.0019). Infections, metabolic conditions, trauma, and surgery were more common precipitating factors for delirium in those without than those with dementia. There was no difference in mortality between the groups.
Most patients had multiple precipitating factors for delirium irrespective of prior dementia. Those with dementia and decreased cognitive reserves needed lower number of etiologies to develop delirium. The profile of causative agents differed among patients with and without dementia.
•Delirium has very often multiple etiological factors.•Patients without prior dementia require more stress triggers than those with dementia.•The etiologies differ among patients with and without dementia.•Both groups had very poor prognosis and there was no difference between the groups in mortality.
Model–data comparisons of plant physiological processes provide an understanding of mechanisms underlying vegetation responses to climate. We simulated the physiology of a piñon pine–juniper woodland ...(Pinus edulis–Juniperus monosperma) that experienced mortality during a 5 yr precipitation-reduction experiment, allowing a framework with which to examine our knowledge of drought-induced tree mortality. We used six models designed for scales ranging from individual plants to a global level, all containing state-of-the-art representations of the internal hydraulic and carbohydrate dynamics of woody plants. Despite the large range of model structures, tuning, and parameterization employed, all simulations predicted hydraulic failure and carbon starvation processes co-occurring in dying trees of both species, with the time spent with severe hydraulic failure and carbon starvation, rather than absolute thresholds per se, being a better predictor of impending mortality. Model and empirical data suggest that limited carbon and water exchanges at stomatal, phloem, and below-ground interfaces were associated with mortality of both species. The model–data comparison suggests that the introduction of a mechanistic process into physiology-based models provides equal or improved predictive power over traditional process-model or empirical thresholds. Both biophysical and empirical modeling approaches are useful in understanding processes, particularly when the models fail, because they reveal mechanisms that are likely to underlie mortality. We suggest that for some ecosystems, integration of mechanistic pathogen models into current vegetation models, and evaluation against observations, could result in a breakthrough capability to simulate vegetation dynamics.
During the past decades, extreme events have become more prevalent and last longer, and as a result drought-induced plant mortality has increased globally. Timely information on plant water dynamics ...is essential for understanding and anticipating drought-induced plant mortality. Leaf water potential (ΨL), which is usually measured destructively, is the most common metric that has been used for decades for measuring water stress. Remote sensing methods have been developed to obtain information on water dynamics from trees and forested landscapes. However, the spatial and temporal resolutions of the existing methods have limited our understanding of the water dynamics and diurnal variation of ΨL within single trees. Thus, we investigated the capability of terrestrial laser scanning (TLS) intensity in observing diurnal variation in ΨL during a 50-h monitoring period. We aimed to improve the understanding on how large a part of the diurnal variation in ΨL can be captured using TLS intensity observations. We found that TLS intensity at the 905 nm wavelength measured from a static position was able to explain 77% of the variation in ΨL for three trees of two tree species with a root mean square error of 0.141 MPa. Based on our experiment with three trees, a time series of TLS intensity measurements can be used in detecting changes in ΨL, and thus it is worthwhile to expand the investigations to cover a wider range of tree species and forests and further increase our understanding of plant water dynamics at wider spatial and temporal scales.
•Laser intensity metrics explained 56–77% of the variation in leaf water potential.•The 905 nm wavelength showed better performance compared to the 1550 nm wavelength.•Best-performing intensity metrics differed between species.
Abstract Background The prevalence and overlap of psychotic symptoms among patients with dementia compared to those with delirium superimposed to dementia have received little attention. The aim of ...our study was to investigate the overlapping and distinguishing capability of psychotic symptoms among patients with dementia or with delirium superimposed to dementia, and to clarify their prognostic value. Methods We assessed 255 residents with dementia in nursing homes and acute geriatric wards for psychotic symptoms and delirium. The residents were divided into three groups: those with delirium (Group 1; n = 66), those with psychotic symptoms without delirium (Group 2; n = 74), and without psychotic symptoms or delirium (Group 3; n = 115). Results Of the participants, 30.9% suffered from delusions, 22.1% from visual hallucinations and 14.2% from auditory hallucinations. Delusions occurred more often in Group 2 than in Group 1. Of the subjects in Group 3, 6.5% suffered from misidentifications, whereas the respective figures in Groups 1 and 2 were 17.5% and 20.8%, respectively. Of those suffering from psychotic symptoms ( n = 109), one in three ( n = 35) suffered delirium, and two in three ( n = 74), psychotic symptoms without delirium. In the adjusted Cox proportional hazard model with Group 2 as the referent, we found no difference between the groups in mortality rates (Group 1: HR 0.98, 95% CI: 0.64–1.52 and Group 3: HR 1.49, 95% CI: 0.92–2.42). Conclusions Psychotic symptoms cannot be used to distinguish patients with dementia from those with delirium superimposed to dementia.
The association of apathy with Alzheimer disease and other dementias and caregiver burden has been examined in a number of studies; however, less is known about its relationship with delirium and ...mortality. We aimed to investigate the prevalence, relationship with delirium and dementia, and prognostic value of apathy in an elderly and frail inpatient population.
The cohort included 425 patients in acute geriatric wards and in 7 nursing homes in Helsinki (1999-2000). Demographic factors, physical functioning, diagnoses, and drugs were assessed with special reference for dementia, delirium, and apathy. Mortality was registered from central registers.
Of the patients, 98 (23.1%) suffered from apathy, and it was more frequent among men (32% versus 21% women, P = .037 ). There was no difference in mean age, number of comorbidities, or in the mean number of medications between those with and without apathy; however, those with apathy had lower mean MMSE points (9.2 versus 14.0 without apathy, P < .001), more often severe dementia according to Clinical Dementia Rating, and higher dependence in activities of daily living (P = .001). Furthermore, patients with apathy were more often suffering from delirium (37.8% versus 21.1%, P ≤ .001). Mortality during the 1-year follow-up was 34.7% (n = 34) and 22.0% (n = 72) among individuals with and without apathy, respectively (P = .011). In the Cox proportional hazard model with age, gender, activities of daily living, and delirium as covariates, apathy significantly predicted mortality (HR 1.89, 95% CI 1.24 to 2.89; P = .003).
Apathy is a common and serious neuropsychiatric symptom associated with cognitive decline, delirium, and disability, and it also independently predicts mortality.
Background & Aim
To assess consonant proficiency and velopharyngeal function in 10‐year‐old children born with unilateral cleft lip and palate (UCLP) within the Scandcleft project.
Methods & ...Procedures
Three parallel group, randomized, clinical trials were undertaken as an international multicentre study by nine cleft teams in five countries. Three different surgical protocols for primary palate repair (Arm B–Lip and soft palate closure at 3–4 months, hard palate closure at 36 months, Arm C–Lip closure at 3–4 months, hard and soft palate closure at 12 months, and Arm D–Lip closure at 3–4 months combined with a single‐layer closure of the hard palate using a vomer flap, soft palate closure at 12 months) were tested against a common procedure (Arm A–Lip and soft palate closure at 3–4 months followed by hard palate closure at 12 months) in the total cohort of 431 children born with a non‐syndromic UCLP. Speech audio and video recordings of 399 children were available and perceptually analysed. Percentage of consonants correct (PCC) from a naming test, an overall rating of velopharyngeal competence (VPC) (VPC‐Rate), and a composite measure (VPC‐Sum) were reported.
Outcomes & Results
The mean levels of consonant proficiency (PCC score) in the trial arms were 86–92% and between 58% and 83% of the children had VPC (VPC‐Sum). Only 50–73% of the participants had a consonant proficiency level with their peers. Girls performed better throughout. Long delay of the hard palate repair (Arm B) indicated lower PCC and simultaneous hard and soft palate closure higher (Arm C). However, the proportion of participants with primary VPC (not including velopharyngeal surgeries) was highest in Arm B (68%) and lowest in Arm C (47%).
Conclusions & Implications
The speech outcome in terms of PCC and VPC was low across the trials. The different protocols had their pros and cons and there is no obvious evidence to recommend any of the protocols as superior. Aspects other than primary surgical method, such as time after velopharyngeal surgery, surgical experience, hearing level, language difficulties and speech therapy, need to be thoroughly reviewed for a better understanding of what has affected speech outcome at 10 years.
WHAT THIS PAPER ADDS
What is already known on the subject
Speech outcomes at 10 years of age in children treated for UCLP are sparse and contradictory. Previous studies have examined speech outcomes and the relationship with surgical intervention in 5‐year‐olds.
What this study adds to the existing knowledge
Speech outcomes based on standardized assessment in a large group of 10‐year‐old children born with UCLP and surgically treated according to different protocols are presented. While speech therapy had been provided, a large proportion of the children across treatment protocols still needed further speech therapy.
What are the potential or actual clinical implications of this work?
Aspects other than surgery and speech function might add to the understanding of what affects speech outcome. Effective speech therapy should be available for children in addition to primary surgical repair of the cleft and secondary surgeries if needed.
The enzyme ornithine decarboxylase is the key regulator of the synthesis of polyamines which are essential for cell proliferation. Expression of this enzyme is transiently increased upon stimulation ...by growth factors, but becomes constitutively activated during cell transformation induced by carcinogens, viruses or oncogenes. To test whether ornithine decarboxylase could be a common mediator of transformation and oncogenic itself, we transfected NIH3T3 cells with expression vectors carrying the complementary DNA encoding human ornithine decarboxylase in sense and antisense orientations. The increased expression of the enzyme (50-100-times endogenous levels) induced not only cell transformation, but also anchorage-independent growth in soft agar and increased tyrosine phosphorylation of a protein of M(r) 130K. Expression of ornithine decarboxylase antisense RNA was associated with an epithelioid morphology and reduced cell proliferation. Moreover, blocking the endogenous enzyme using specific inhibitor or synthesizing antisense RNA prevented transformation of rat fibroblasts by temperature-sensitive v-src oncogene. Our results imply that the gene encoding ornithine decarboxylase is a proto-oncogene central for regulation of cell growth and transformation.
Coniferous tree stems contain large amounts of oleoresin under positive pressure in the resin ducts. Studies in North‐American pines indicated that the stem oleoresin exudation pressure (OEP) ...correlates negatively with transpiration rate and soil water content. However, it is not known how the OEP changes affect the emissions of volatile vapours from the trees. We measured the OEP, xylem diameter changes indicating changes in xylem water potential and monoterpene emissions under field conditions in mature Scots pine (Pinus sylvestris L.) trees in southern Finland. Contrary to earlier reports, the diurnal OEP changes were positively correlated with temperature and transpiration rate. OEP was lowest at the top part of the stem, where water potentials were also more negative, and often closely linked to ambient temperature and stem monoterpene emissions. However, occasionally OEP was affected by sudden changes in vapour pressure deficit (VPD), indicating the importance of xylem water potential on OEP as well. We conclude that the oleoresin storage pools in tree stems are in a dynamic relationship with ambient temperature and xylem water potential, and that the canopy monoterpene emission rates may therefore be also regulated by whole tree processes and not only by the conditions prevailing in the upper canopy.
The Finnish Centre of Excellence (FCoE) in "Physics, Chemistry, Biology and Meteorology of Atmospheric Composition and Climate Change" (2008–2013) completed its research activity at the end of 2013. ...The FCoE research was originally focused on enhanced process-level understanding of various couplings between atmospheric CO2 concentrations, photosynthesis, biogenic volatile organic compounds (BVOC), aerosol particles and clouds. During the FCoE period, the scientific scope moved gradually towards the so-called all-scale concept. In this paper we summarize its main scientific achievements, and give an outlook for future scientific activities and focus.
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