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  1. Delirium

    MedlinePlus

    ... occur together. Delirium starts suddenly and can cause hallucinations. The symptoms may get better or worse, and ... hand, dementia develops slowly and does not cause hallucinations. The symptoms are stable, and may last for ...

  2. Delirium

    MedlinePlus

    ... Behavior modification to control unacceptable or dangerous behaviors Reality orientation to reduce disorientation ... treatment of metabolic disorders and infections, and using reality orientation programs will reduce the risk of delirium ...

  3. Delirium

    MedlinePlus

    ... at night. People may have bizarre, frightening visual hallucinations, seeing things or people that are not there. ... function. If delirium is accompanied by agitation and hallucinations, delusions, or paranoia, it must be distinguished from ...

  4. Delirium

    PubMed Central

    Burns, A; Gallagley, A; Byrne, J

    2004-01-01

    Delirium is a common cause of mortality and morbidity in older people in hospital, and indicates severe illness in younger patients. Identification of risk factors, education of professional carers, and a systematic approach to management can improve the outcome of the syndrome. Physicians should be aware that delirium sufferers often have an awareness of their experience, which may be belied by their varying grasp of reality. PMID:14966146

  5. Delirium (PDQ)

    MedlinePlus

    ... being hypoactive and hyperactive. Delirium may come and go during the day. The symptoms of delirium usually ... within hours or days and may come and go. Delirium is often temporary and can be treated. ...

  6. What to Ask: Delirium

    MedlinePlus

    ... Join our e-newsletter! Resources What to Ask: Delirium Tools and Tips Under recognition of delirium is a major problem. It is important to ... questions you can ask your healthcare professional about delirium. What is delirium? What are its symptoms? How ...

  7. Delirium Tremens.

    PubMed

    Mehta, S R; Prabhu, Hra; Swamy, A J; Dhaliwal, Harinder; Prasad, Dinesh

    2004-01-01

    The varied clinical manifestations and management of 14 male patients with delirium tremens (DT) have been studied. Eight patients were initially hospitalised for diseases unrelated to ethanol abuse i.e. 2 each for gun shot wound, myocardial infarction and stroke, and one each for pneumonia and gastroenteritis. One patient was going through withdrawal because of prodrome of viral hepatitis before he was hospitalised for uncontrolled agitation and delirium. Two known cases of mild essential hypertension on dietary therapy reported for agitation, abnormal behaviour, a single episode of tonic clonic seizure and hypertensive encephalopathy as they could not/did not get alcohol for 3 days. Three patients presented denovo with DT without concomitant illness. The other features besides delirium and hallucinations were tremulousness in 10, tachycardia in 12, fever in 3, diaphoresis in 2 and tonic clonic seizures in 4 patients. The symptoms fluctuated markedly at short intervals and 2 patients did not have any features of sympathetic overactivity. Altered hepatic biochemical parameters and ketonuria with normal blood sugar were noted in 4 and one patients respectively. Other biochemical parameters including serum electrolytes were normal. CT scan brain done for 5 patients revealed subdural haematoma in one. Cerebro spinal fluid (CSF) and EEG findings were noncontributory. All made good recovery with heavy doses of intravenous vitamin B complex, glucose and oral benzodiazepine. Short course of haloperidol was used in 2 patients. Two patients developed pancreatitis during follow up. All patients made complete recovery, and 8 patients have been followed for 8 to 12 months without relapse. The reason for hospitalisation in such cases is often unrelated to alcohol abuse; hence a detailed history of alcoholism is mandatory to identify those at risk as well as for prompt treatment and decreasing the mortality.

  8. Delirium Superimposed on Dementia

    PubMed Central

    Steis, Melinda R.; Fick, Donna M.

    2012-01-01

    Delirium is an acute, fluctuating confusional state that results in poor outcomes for older adults. Dementia causes a more convoluted course when coexisting with delirium. This study examined 128 days of documentation to describe what nurses document when caring for patients with dementia who experience delirium. Nurses did not document that they recognized delirium. Common descriptive terms included words and phrases indicating fluctuating mental status, lethargy, confusion, negative behavior, delusions, and restlessness. Delirium is a medical emergency. Nurses are in need of education coupled with clinical and decisional support to facilitate recognition and treatment of underlying causes of delirium in individuals with dementia. PMID:21761816

  9. Delirium and its treatment.

    PubMed

    Attard, Azizah; Ranjith, Gopinath; Taylor, David

    2008-01-01

    Delirium occurs at rates ranging from 10% to 30% of all hospital admissions. It is a negative prognostic indicator, often leading to longer hospital stays and higher mortality. The aetiology of delirium is multifactorial and many causes have been suggested. The stress-diathesis model, which posits an interaction between the underlying vulnerability and the nature of the precipitating factor, is useful in understanding delirium. Preventing delirium is the most effective strategy for reducing its frequency and complications. Environmental strategies are valuable but are often underutilized, while remedial treatment is usually aimed at specific symptoms of delirium. Antipsychotics are the mainstay of pharmacological treatment and have been shown to be effective in treating symptoms of both hyperactive and hypoactive delirium, as well as generally improving cognition. Haloperidol is considered to be first-line treatment as it can be administered via many routes, has fewer active metabolites, limited anticholinergic effects and has a lower propensity for sedative or hypotensive effects compared with many other antipsychotics. Potential benefits of atypical compared with typical antipsychotics include the lower propensity to cause over-sedation and movement disorder. Of the second-generation antipsychotics investigated in delirium, most data support the use of risperidone and olanzapine. Other drugs (e.g. aripiprazole, quetiapine, donepezil and flumazenil) have been evaluated but data are limited. Benzodiazepines are the drugs of choice (in addition to antipsychotics) for delirium that is not controlled with an antipsychotic (and can be used alone for the treatment of alcohol and sedative hypnotic withdrawal-related delirium). Lorazepam is the benzodiazepine of choice as it has a rapid onset and shorter duration of action, a low risk of accumulation, no major active metabolites and its bioavailability is more predictable when it is administered both orally and

  10. Zolpidem withdrawal delirium

    PubMed Central

    Mattoo, Surendra K.; Gaur, Navendu; Das, Partha P.

    2011-01-01

    The Z-category hypnotics are promoted for their relative safety. However, this view is challenged by the emerging clinical evidence in the form of zolpidem related intoxication delirium and seizures, and dependence and complicated withdrawal. We report the case of a zolpidem-naive alcohol-dependent inpatient that, while undergoing alcohol de-addiction, was prescribed zolpidem for insomnia and developed delirium during taper-off. He was successfully detoxified for alcohol, treated for delirium and put on disulfiram prophylaxis. The case highlights the need for being cautious while using zolpidem for insomnia in alcohol dependent subjects. PMID:22144786

  11. [Delirium and dementia].

    PubMed

    Marín Carmona, José Manuel

    2008-01-01

    Delirium and dementia are highly prevalent neurocognitive syndromes in the elderly. These syndromes are defined by level of consciousness, clinical onset, and potential reversibility, etc. Frequently, both syndromes coincide in the elderly patient and share many epidemiologic, pathogenic and clinical features, which are reviewed in this article. There is no solid scientific evidence that explains the association between delirium and dementia. The present article proposes a change of paradigm in the diagnostic, preventive and therapeutic approach to delirium in the elderly that recognizes the inherent complexity of this geriatric syndrome and, unlike dichotomic models, explores the complex interrelations between both geriatric syndromes. Delirium is viewed as an important model to investigate cognitive disorders and dementia.

  12. Impact of Delirium

    MedlinePlus

    ... the morning, less at night) Hallucinations and delusions Variable levels of consciousness or awareness Disrupted sleep patterns, ... Institute on Aging is currently conducting clinical-trial research into delirium. You can learn more about that ...

  13. Delirium Research: Where Am I?

    MedlinePlus

    ... of this page please turn JavaScript on. Feature: Delirium Research Where Am I? Past Issues / Fall 2015 Table of Contents The overlooked danger of delirium in hospitals In his mid-80s, Jerry (not ...

  14. [Delirium in patients with cancer].

    PubMed

    Staniszewska, Agnieszka; Kłoszewska, Iwona

    2007-01-01

    Delirium is a frequent complication of cancer. It is the cause of patients' suffering and due to worsening of communication, the impediment to clinical assessment. It lowers the quality of life of family caregivers as well. Instant diagnosis and therapy of delirium are essential in clinical practice. In this review etiology, prevalence, clinical features and management of delirium in cancer patients are described.

  15. Thiamine Deficiency and Delirium

    PubMed Central

    Ali, Shahid; Freeman, C.; Barker, Narviar C.; Jabeen, Shagufta; Maitra, Sarbani; Olagbemiro, Yetunde; Richie, William; Bailey, Rahn K.

    2013-01-01

    Thiamine is an essential vitamin that plays an important role in cellular production of energy from ingested food and enhances normal neuronal actives. Deficiency of this vitamin leads to a very serious clinical condition known as delirium. Studies performed in the United States and other parts of the world have established the link between thiamine deficiency and delirium. This literature review examines the physiology, pathophysiology, predisposing factors, clinical manifestations (e.g., Wernicke’s encephalopathy, Wernicke-Korsakoff syndrome, structural and functional brain injuries) and diagnosis of thiamine deficiency and delirium. Current treatment practices are also discussed that may improve patient outcome, which ultimately may result in a reduction in healthcare costs. PMID:23696956

  16. Delirium in critically ill patients.

    PubMed

    Slooter, A J C; Van De Leur, R R; Zaal, I J

    2017-01-01

    Delirium is common in critically ill patients and associated with increased length of stay in the intensive care unit (ICU) and long-term cognitive impairment. The pathophysiology of delirium has been explained by neuroinflammation, an aberrant stress response, neurotransmitter imbalances, and neuronal network alterations. Delirium develops mostly in vulnerable patients (e.g., elderly and cognitively impaired) in the throes of a critical illness. Delirium is by definition due to an underlying condition and can be identified at ICU admission using prediction models. Treatment of delirium can be improved with frequent monitoring, as early detection and subsequent treatment of the underlying condition can improve outcome. Cautious use or avoidance of benzodiazepines may reduce the likelihood of developing delirium. Nonpharmacologic strategies with early mobilization, reducing causes for sleep deprivation, and reorientation measures may be effective in the prevention of delirium. Antipsychotics are effective in treating hallucinations and agitation, but do not reduce the duration of delirium. Combined pain, agitation, and delirium protocols seem to improve the outcome of critically ill patients and may reduce delirium incidence.

  17. Delirium from the gliocentric perspective

    PubMed Central

    Sfera, Adonis; Osorio, Carolina; Price, Amy I.; Gradini, Roberto; Cummings, Michael

    2015-01-01

    Delirium is an acute state marked by disturbances in cognition, attention, memory, perception, and sleep-wake cycle which is common in elderly. Others have shown an association between delirium and increased mortality, length of hospitalization, cost, and discharge to extended stay facilities. Until recently it was not known that after an episode of delirium in elderly, there is a 63% probability of developing dementia at 48 months compared to 8% in patients without delirium. Currently there are no preventive therapies for delirium, thus elucidation of cellular and molecular underpinnings of this condition may lead to the development of early interventions and thus prevent permanent cognitive damage. In this article we make the case for the role of glia in the pathophysiology of delirium and describe an astrocyte-dependent central and peripheral cholinergic anti-inflammatory shield which may be disabled by astrocytic pathology, leading to neuroinflammation and delirium. We also touch on the role of glia in information processing and neuroimaging. PMID:26029046

  18. Delirium in the intensive care unit

    PubMed Central

    2013-01-01

    Delirium is a serious complication that commonly occurs in critically ill patients in the intensive care unit (ICU). Delirium is frequently unrecognized or missed despite its high incidence and prevalence, and leads to poor clinical outcomes and an increased cost by increasing morbidity, mortality, and hospital and ICU length of stay. Although its pathophysiology is poorly understood, numerous risk factors for delirium have been suggested. To improve clinical outcomes, it is crucial to perform preventive measures against delirium, to detect delirium early using valid and reliable screening tools, and to treat the underlying causes or hazard symptoms of delirium in a timely manner. PMID:24101952

  19. Delirium: a disorder of consciousness?

    PubMed

    Eeles, E M; Pandy, S; Ray, J L

    2013-04-01

    Delirium is recognised as a disorder of consciousness, however, no evidence has been previously generated to specifically address this premise. In order to evaluate this established notion, we have attempted to review consciousness, the components of consciousness and the emerging evidence for neuroanatomical correlates and then relate this to the recognized features of delirium. We have established that the level of awareness is modulated by alertness and arousal, focused by attention and has the ability to switch between the personal resonances of the experience to the precision of cognition. We have discussed consciousness's relationship with delirium and how the degree of integration of CNS function is mandatory for realisation of higher order function and this has implications for the conceptualisation and management of delirium. We have explored the understanding of downstream, components of consciousness as not giving rise to the full condition of delirium but as a subsyndromal state. We have argued that there is a need for future diagnostic criteria, such as DSM-V, to operationalize disturbance of consciousness together with non-cognitive manifestations of delirium. Intervention studies in delirium have focussed on drugs that improve memory (cholinesterase inhibitors). If memory is only one element of consciousness then we reason instead on evaluating the determinants of consciousness that may be modifiable, such as awareness. Reinforcement of environmental awareness by managing a patient within a low stimulus or familiar surrounding may therefore offer a therapeutic intervention. Overall there seemed support for, or no evidence against, the belief that delirium is a disorder of consciousness. From Descartes 'I think therefore I am' we can say 'I am aware not therefore delirious I am'.

  20. Delirium and sedation in the ICU.

    PubMed

    Frontera, Jennifer A

    2011-06-01

    Delirium is defined by a fluctuating level of attentiveness and has been associated with increased ICU mortality and poor cognitive outcomes in both general ICU and neurocritical care populations. Sedation use in the ICU can contribute to delirium. Limiting ICU sedation allows for the diagnosis of underlying acute neurological insults associated with delirium and leads to shorter mechanical ventilation time, shorter length of stay, and improved 1 year mortality rates. Identifying the underlying etiology of delirium is critical to developing treatment paradigms.

  1. Opium Withdrawal Delirium: Two Case Reports

    PubMed Central

    Sharma, Ravi C.; Kumar, Ramesh; Sharma, Dinesh Dutt; Kanwar, Pankaj

    2017-01-01

    Two patients with opium dependence developed delirium during abstinence. The delirium resolved completely within 48–58 hours of appropriate treatment. Caution needs to be exercised during opioid detoxification in timely detecting and treating potentially life-threatening condition like delirium. PMID:28138205

  2. Diagnosis and Treatment of Delirium

    PubMed Central

    Henry, W. Desmond; Mann, Alan M.

    1965-01-01

    Delirium is not a clinical entity but a symptom-complex of manifold etiology. Its presence signifies acute cerebral insufficiency and often represents a medical and/or psychiatric emergency. Though some forms of delirium have distinctive features, the fundamental phenomena are common to all, with clouding of consciousness the sine qua non. The condition has two major components: (1) the basic “acute brain syndrome” and (2) associated release phenomena. Clinicians must first make the vital differentiation between delirium and “functional” mental disorder, then proceed with the elucidation of the underlying diagnosis and the concurrent organization of symptomatic and etiologic treatment. Proper treatment combines management of the acute brain syndrome with general and specific procedures for control of the underlying condition. Dealing with the symptom-complex itself involves the principles and practice of sedation, hydration, and nutrition, nursing care and supportive measures. Provided the basic organic condition is treatable, the prognosis today is usually good. PMID:5844423

  3. Where next for delirium research?

    PubMed

    Harwood, Rowan H; Teale, Elizabeth

    2017-03-08

    Clinicians who manage delirium must do so without key information required for evidence-based practice, not least lack of any clearly effective treatment for established delirium. Both the nature of delirium and the methods used to research it contribute to difficulties. Delirium is heterogeneous, with respect to motor subtype, aetiology, setting and the co-existence of dementia, and may be almost inevitable towards the end of life. Elements of assessment are subjective, so diagnosis can be uncertain or unreliable. Defining objectives of care and outcomes is sometimes unclear. Better identification and case definition, including seeking biomarkers, stratification by type, or aetiology, and application of more complex models of causation may help. This will likely require further observational epidemiology, imaging and laboratory-based research before further rounds of large-scale randomised controlled trials. Application of trial methodologies designed for drug treatments of better-defined conditions may have failed to take account of the complexities both of diagnosis and complex intervention in delirium. Both drug and complex intervention trials need sufficient preliminary work to ensure that the right dose, duration or intensity of treatment is delivered and a range of 'intermediate' and 'distal' outcome measures assessed. Re-purposing of established drugs may provide a source of investigational products. Greater use of alternative research methodologies (qualitative and realist), or adjuvants to trials (process evaluation), will help answer questions about focus, generalisability and why interventions succeed or fail. Delirium research will have to embrace both a 'back to basics' approach with increased breadth of methodologies to make progress. Copyright © 2017 John Wiley & Sons, Ltd.

  4. Delirium and hospitalized older adults: a review of nonpharmacologic treatment.

    PubMed

    Aguirre, Eric

    2010-04-01

    Delirium is a common and debilitating disorder that affects primarily the elderly in acute care settings. This column reviews the assessment, etiology, complications, and nonpharmacologic treatment of delirium.

  5. Using Standardized Case Vignettes to Evaluate Nursing Home Staff Recognition of Delirium and Delirium Superimposed on Dementia

    PubMed Central

    Fick, Donna M.; Kolanowski, Ann M.; Hill, Nikki L.; Yevchak, Andrea; DiMeglio, Brittney; Mulhall, Paula M.

    2014-01-01

    The purpose of this study is to describe nursing home staff knowledge regarding delirium detection and the most common causes of delirium. Specific aims that guided this study include identifying the rate of nurse recognition of delirium and delirium superimposed on dementia (DSD), including different motoric subtypes of delirium, using standardized case vignettes, and exploring what nursing home staff describe as the potential causes of delirium. The study showed overall poor recognition of delirium and DSD, which did not improve over time. Interventions have the potential to increase the early detection of delirium and DSD by the staff and warrant development. PMID:25400513

  6. Diagnosing and managing delirium in the elderly.

    PubMed Central

    Conn, D. K.; Lieff, S.

    2001-01-01

    OBJECTIVE: To outline current approaches to diagnosing and managing delirium in the elderly. QUALITY OF EVIDENCE: A literature review was based on a MEDLINE search (1966 to 1998). Selected articles were reviewed and used as the basis for discussion of diagnosis and etiology. We planned to include all published randomized controlled trials regarding management but found only two. Consequently, we also used review articles and recent practice guidelines for delirium published by the American Psychiatric Association. MAIN FINDINGS: Clinical diagnosis of delirium can be aided by using DSM-IV criteria, the Delirium Symptom Interview, or the confusion assessment method. Management must include investigation and treatment of underlying causes and general supportive measures. Providing optimal levels of stimulation, reorienting patients, education, and supporting families are important. Pharmacologic management of delirium should be considered only for specific symptoms or behaviours, e.g., aggression, severe agitation, or psychosis. Only one randomized controlled trial of tranquilizer use for delirium in medically ill people has been published. Findings support the current belief that neuroleptics are superior to benzodiazepines in most cases of delirium. Most authorities still consider haloperidol the neuroleptic of choice. Controlled trials of the new atypical neuroleptics for treating delirium are not yet available. Benzodiazepines with relatively short half-lives, such as lorazepam, are the drugs of choice for withdrawal symptoms. CONCLUSION: Delirium is frequently underdiagnosed in clinical practice. It should be suspected with acute changes in behaviour. Careful investigation of the underlying cause permits appropriate management. PMID:11212421

  7. PREDICTORS FOR POST- STROKE DELIRIUM OUTCOME

    PubMed Central

    Dostovic, Zikrija; Dostovic, Ernestina; Smajlovic, Dzevdet; Ibrahimagic, Omer C.; Avdic, Leila; Becirovic, Elvir

    2016-01-01

    Background: There have been only a small number of studies that have evaluated the outcome of post-stroke delirium. Objectives: To evaluate the effects of gender, age, stroke localization, delirium severity, previous illnesses, associated medical complications on delirium outcome as well as, to determine effects of delirium on cognitive functioning one year after stroke. Patients and Methods: Comprehensive neuropsychological assessments were performed within the first week of stroke onset, at hospital discharge, and followed-up for 3, 6 and 12 months after stroke. We used diagnostic tools such as Glazgow Coma Scale, Delirium Rating Scale, National Institutes of Health Stroke Scale and Mini-Mental State. Results: Patients who developed post-stroke delirium had significantly more complications (p = 0.0005). Direct logistic regression was performed to assess the impact of several factors on the likelihood that patients will die. The strongest predictor of outcome was age, mean age ≥ 65 years with a odds ratio (OR) 4.9. Cox’s regression survival was conducted to assess the impact of multiple factors on survival. The accompanying medical complications were the strongest predictor of respondents poore outcome with Hazard-risk 3.3. Cognitive assessments including Mini Mental State score have showen that post-stroke delirium patients had significant cognitive impairment, three (p = 0.0005), six months (p = 0.0005) and one year (p = 0.0005) after stroke, compared to patients without delirium. Conclusion: Patient gender, age, localization of stroke, severity of delirium, chronic diseases and emerging complications significantly affect the outcome of post- stroke delirium. Delirium significantly reduced cognitive functioning of after stroke patients. PMID:27999490

  8. Delirium in the Intensive Care Unit

    PubMed Central

    Arumugam, Suresh; El-Menyar, Ayman; Al-Hassani, Ammar; Strandvik, Gustav; Asim, Mohammad; Mekkodithal, Ahammed; Mudali, Insolvisagan; Al-Thani, Hassan

    2017-01-01

    Delirium is characterized by impaired cognition with nonspecific manifestations. In critically ill patients, it may develop secondary to multiple precipitating or predisposing causes. Although it can be a transient and reversible syndrome, its occurrence in Intensive Care Unit (ICU) patients may be associated with long-term cognitive dysfunction. This condition is often under-recognized by treating physicians, leading to inappropriate management. For appropriate management of delirium, early identification and risk factor assessment are key factors. Multidisciplinary collaboration and standardized care can enhance the recognition of delirium. Interdisciplinary team working, together with updated guideline implementation, demonstrates proven success in minimizing delirium in the ICU. Moreover, should the use of physical restraint be necessary to prevent harm among mechanically ventilated patients, ethical clinical practice methodology must be employed. This traditional narrative review aims to address the presentation, risk factors, management, and ethical considerations in the management of delirium in ICU settings. PMID:28243012

  9. Delirium and older people: repositioning nursing care.

    PubMed

    Neville, Stephen

    2006-06-01

    Aims.  To critically examine the nursing care offered to older people who have been delirious. Background.  Delirium occurs as a result of physiological imbalances resulting in an alteration in consciousness and cognitive impairment. Delirium is a prevalent and serious cognitive disorder experienced by older people. While there is a vast number of studies published utilizing quantitative methods, there remains a dearth of research relating to delirium in older people from a qualitative perspective. Design.  A qualitative research design that utilized a critical gerontological framework underpinned this study. This framework drew on aspects of postmodernism and Foucault's understanding of discourse. Methods.  Data sources included published documents on delirium, semi-structured taped interviews with people over the age of 65 years who had been delirious (as well as their clinical notes), family members, Registered Nurses and a hospital doctor. A postmodern discourse analytic approach was used to interrogate the 20 sets of data collected. Findings.  Textual analysis revealed the presence of two major discourses impacting on being an older person with delirium. These were identified as a nursing discourse of delirium and a personal discourse of delirium. A nursing discourse of delirium was largely focussed on the biomedical processes that resulted in a delirious episode. Conversely, a personal discourse of delirium highlights that there are other ways of 'knowing' about delirium through considering the narratives of older adults, and their families, when offering a nursing service to this group of people. Relevance to clinical practice.  Nursing needs to critically examine all aspects of nursing care as it applies to older people who have delirium to ensure the rhetorical claims of the profession become the reality for consumers of health services. The use of critical gerontology provides nurses with the tools to challenge the status quo and uncover the

  10. Preoperative Sleep Disruption and Postoperative Delirium

    PubMed Central

    Leung, Jacqueline M.; Sands, Laura P.; Newman, Stacey; Meckler, Gabriela; Xie, Yimeng; Gay, Caryl; Lee, Kathryn

    2015-01-01

    Study Objectives: To describe preoperative and postoperative sleep disruption and its relationship to postoperative delirium. Design: Prospective cohort study with 6 time points (3 nights pre-hospitalization and 3 nights post-surgery). Setting: University medical center. Patients: The sample consisted of 50 English-speaking patients ≥ 40 years of age scheduled for major non-cardiac surgery, with an anticipated hospital stay ≥ 3 days. Interventions: None. Measurements and results: Sleep was measured before and after surgery for a total of 6 days using a wrist actigraph to quantify movement in a continuous fashion. Postoperative delirium was measured by a structured interview using the Confusion Assessment Method. Sleep variables for patients with (n = 7) and without (n = 43) postoperative delirium were compared using the unpaired Student t-tests or χ2 tests. Repeated measures analysis of variance for the 6 days was used to examine within-subject changes over time and between group differences. The mean age of the patients was 66 ± 11 years (range 43–91 years), and it was not associated with sleep variables or postoperative delirium. The incidence of postoperative delirium observed during any of the 3 postoperative days was 14%. For the 7 patients who subsequently developed postoperative delirium, wake after sleep onset (WASO) as a percentage of total sleep time was significantly higher (44% ± 22%) during the night before surgery compared to the patients who did not subsequently developed delirium (21% ± 20%, p = 0.012). This sleep disruption continued postoperatively, and to a greater extent, for the first 2 nights after surgery. Patients with WASO < 10% did not experience postoperative delirium. Self-reported sleep disturbance did not differ between patients with vs. without postoperative delirium. Conclusions: In this pilot study of adults over 40 years of age, sleep disruption was more severe before surgery in the patients who experienced postoperative

  11. [Psychopharmalogical treatment of delirium in the elderly].

    PubMed

    Drach, Lutz M

    2014-04-01

    Delirium is frequent in hospitalized elderly. Treatment of the medical problems causing delirium is paramount. Mostly antipsychotics are used for treatment of psychological and behavioral symptoms in delirium. Increased mortality of elderly and demented patients receiving antipsychotics suggests caution in prescribing antipsychotics for delirium. Standard treatment is low-dose haloperidol. If more sedation is needed, melperone or pipamperone can be used. In delirious Parkinsonian patients or if dementia with Lewy-bodies is suspected quetiapine is better tolerated. Other sedating antipsychotics like prothipendyl, promethazine or levomepromazin are considered inappropriate medication in the elderly due to their anticholinergic and orthostatic side effects. Cholinesterase inhibitors are not effective in delirium, except physostigmine for treatment of anticholinergic intoxication confined to intensive care. Benzodiazepines are effective in alcohol- und benzodiazepine-withdrawal, but may induce delirium (paradox reaction). Clomethiazole is contraindicated in frequent pulmonal conditions in the elderly like COPD. Chloral hydrate is considered inappropriate medication in the elderly due to QTc-prolongation. On intensive care units clonidine and recently dexmedetomidine are useful. At the moment there are no data indicating melatonin being effective for treatment of delirium.

  12. [Delirium, depression, dementia: solving the 3D's].

    PubMed

    Schuerch, M; Farag, L; Deom, S

    2012-01-01

    As there is no consensus in the specialized literature, it is often difficult to recognize the ties existing between dementia, delirium and depression. Depression preceding dementia is well-documented. Depressive symptoms during the process of dementia are less well-known. So are the close relationships between dementia and delirium as well as between delirium and depression. The commonality of symptoms between the three often causes diagnostic dilemmas. Unfortunately, elderly patients can often present two, or even three, of the "3 D's" simultaneously. Untangling the 3 D's has been the subject of several articles. We propose a synthesis as well as our thoughts on the subject from a clinical psychogeriatric standpoint.

  13. Delirium: a guide for the general physician.

    PubMed

    Todd, Oliver M; Teale, Elizabeth A

    2016-12-01

    Delirium describes a sudden onset change in mental status of fluctuating course. This is a state of altered consciousness characterised chiefly by inattention or lack of arousal, but can also include new impairment of language, perception and behaviour. Certain predisposing factors can make an individual more susceptible to delirium in the face of a stressor. Stressors include direct insults to the brain, insults peripheral to the brain or external changes in the environment of an individual. Delirium is varied in its presentation, and can be categorised by the psychomotor profile as: hyperactive type (overly vigilant, agitated, often wandersome), hypoactive type (sedate or withdrawn) or mixed types.

  14. Intensive Care Unit Nurses' Beliefs About Delirium Assessment and Management.

    PubMed

    Oosterhouse, Kimberly J; Vincent, Catherine; Foreman, Marquis D; Gruss, Valerie A; Corte, Colleen; Berger, Barbara

    2016-10-01

    Delirium, the most frequent complication of hospitalized older adults, particularly in intensive care units (ICUs), can result in increased mortality rates and length of stay. Nurses are neither consistently identifying nor managing delirium in these patients. The purpose of this study was to explore ICU nurses' identification of delirium, actions they would take for patients with signs or symptoms of delirium, and beliefs about delirium assessment and management. In this cross-sectional study using qualitative descriptive methods guided by the theory of planned behavior, 30 ICU nurses' responses to patient vignettes depicting different delirium subtypes were explored. Descriptive and content analyses revealed that nurses did not consistently identify delirium; their actions varied in different vignettes. Nurses believed that they needed adequate staffing, balanced workload, interprofessional collaboration, and established policy and protocols to identify and manage delirium successfully. Research is needed to determine if implementing these changes increases recognition and decreases consequences of delirium.

  15. A rare cause of hypoactive delirium

    PubMed Central

    Kosari, S A; Amiruddin, A; Shorakae, S; Kane, R

    2014-01-01

    A 90-year-old man was transferred to a geriatric evaluation and management (GEM) unit for management of hypoactive delirium following a pneumonia and acute myocardial infarction complicated by septic shock. He was found to have central hypothyroidism and hypoadrenalism leading to the diagnosis of hypopituitarism. Cerebral imaging confirmed this was secondary to a pituitary haemorrhage. This case illustrates the complexity of assessment of delirium and its aetiologies. Hypoactive forms of delirium in particular can be difficult to detect and therefore remain undiagnosed. While this patient's delirium was likely multifactorial, his hypopituitary state explained much of his hypoactivity. His drowsiness, bradycardia, hypotension and electrolyte imbalance provided clinical clues to the diagnosis. PMID:25331146

  16. Postoperative Delirium in the Geriatric Patient

    PubMed Central

    Schenning, Katie J.; Deiner, Stacie G.

    2015-01-01

    SYNOPSIS Postoperative delirium, a common complication in older surgical patients, is independently associated with increased morbidity and mortality. Patients over the age of 65 years receive greater than 1/3 of the over 40 million anesthetics delivered yearly in the United States. This number is expected to increase with the aging of the population. Thus, it is increasingly important that perioperative clinicians who care for geriatric patients have an understanding of the complex syndrome of postoperative delirium. PMID:26315635

  17. Hospital-Related Delirium May Help Worsen Dementia

    MedlinePlus

    ... medlineplus.gov/news/fullstory_163123.html Hospital-Related Delirium May Help Worsen Dementia But disorienting condition can ... WEDNESDAY, Jan. 18, 2017 (HealthDay News) -- Hospitalization-related delirium may speed mental decline in patients with dementia, ...

  18. [Non-withdrawal-related delirium : Evidence on prevention and therapy].

    PubMed

    Haussmann, R; Bauer, M; Donix, M

    2016-05-01

    Delirium is a severe and common yet under-diagnosed disorder in the clinical routine. Multiple factors may contribute to the development of delirium, which is associated with increased mortality and high healthcare costs. Treatment of delirium is often provided with delay and limited to pharmacological interventions. This article summarizes the key symptoms for delirium as well as risk factors and highlights the pharmacological and non-pharmacological options for treatment and prevention.

  19. Postoperative delirium. part 2: detection, prevention and treatment.

    PubMed

    Steiner, Luzius A

    2011-10-01

    To target pharmacological prevention, instruments giving an approximation of an individual patient's risk of developing postoperative delirium are available. In view of the variable clinical presentation, identifying patients in whom prophylaxis has failed (that is, who develop delirium) remains a challenge. Several bedside instruments are available for the routine ward and ICU setting. Several have been shown to have a high specificity and sensitivity when compared with the standard definitions according to DSM-IV-TR and ICD-10. The Confusion Assessment Method (CAM) and a version specifically developed for the intensive care setting (CAM-ICU) have emerged as a standard. However, alternatives allowing grading of the severity of delirium are also available. In many units, the approach to delirium follows a three-step strategy. Initially, non-pharmacological multicomponent strategies are used for primary prevention. As a second step, pharmacological prophylaxis may be added. Perioperative administration of haloperidol has been shown to reduce the severity, but not the incidence, of delirium. Perioperative administration of atypical antipsychotics has been shown to reduce the incidence of delirium in specific groups of patients. In patients with delirium, both symptomatic and causal treatment of delirium need to be considered. So far symptomatic treatment of delirium is primarily based on antipsychotics. Currently, cholinesterase inhibitors cannot be recommended and the data on dexmedetomidine are inconclusive. With the exception of alcohol-withdrawal delirium, there is no role for benzodiazepines in the treatment of delirium. It is unclear whether treating delirium prevents long-term sequelae.

  20. Screening and Management of Delirium in Critically Ill Patients

    PubMed Central

    Farina, Nicholas; Smithburger, Pamela

    2015-01-01

    Delirium is highly prevalent in the critically ill population and has been associated with numerous negative outcomes including increased mortality. The presentation of a delirious patient in the intensive care unit (ICU) is characterized by a fluctuating cognitive status and inattention that varies dramatically among patients. Delirium can present in 3 different motoric subtypes: hyperactive, hypoactive, and mixed. Two tools, the Intensive Care Delirium Screening Checklist and Confusion Assessment ICU, are validated and recommended for the detection of delirium in critically ill patients. The identification of delirium in a critically ill patient should be facilitated using one of these tools. An intermediate form of delirium known as subsyndromal delirium also exists, although the significance of this syndrome is largely unknown. Another phenomenon known as sedation-related delirium has been recently described, although more research is needed to understand its significance. Patients in the ICU are exposed to many risk factors for developing delirium; controlling these risk factors is essential for preventing delirium development in critically ill patients. Nonpharmacologic interventions have been shown to prevent patients from developing delirium. Prevention is crucial because once delirium develops pharmacologic therapy is limited. PMID:26715799

  1. Review of delirium in patients with Parkinson's disease.

    PubMed

    Vardy, Emma R L C; Teodorczuk, Andrew; Yarnall, Alison J

    2015-11-01

    Parkinson's disease (PD) is common and has a number of associated neuropsychiatric disturbances. Of these, delirium has historically been under-recognised. Delirium is an acute disturbance of attention and awareness that fluctuates, and is accompanied by an additional disturbance of cognition. As delirium is known to carry a particularly poor prognosis in terms of morbidity and mortality, and the relationship between delirium and dementia is becoming better defined, we completed a literature review of delirium in the context of PD. A literature search was completed using the databases PubMed, Embase and Ovid Medline. PubMed (1945-2014) was searched in September 2014; Embase (1974-2014); and Ovid Medline (1946-2014) in October 2014. The search terms 'delirium' and 'Parkinsons' in combination were used. Large studies using a robust definition of delirium were lacking in PD. There is the suggestion that PD is a risk factor for delirium and that delirium negatively impacts upon the motor symptom trajectory. Deficits in the neurotransmitters dopamine and acetylcholine are implicated in the pathophysiology of delirium in PD. Systemic inflammation also appears to have a role. Treatment of delirium in PD should include medication review and cautious use of atypical antipsychotics where pharmacological treatment is indicated. Of the atypical antipsychotics studied, quetiapine has the least extrapyramidal side effects. Evidence suggests a specific link between delirium and PD but well-designed clinical studies to evaluate the prevalence, impact and treatment of delirium in PD are required. Given the potential to improve outcomes through delirium prevention we conclude that delirium in PD is an area worthy of further study.

  2. Delirium: a diagnostic dilemma. Part 1.

    PubMed

    Hardy, Kersten; Brown, Michelle

    Effective symptom management for a patient with a palliative diagnosis can be challenging. There are some symptoms that may be more difficult to control and understand than others. Delirium, as a symptom, may well prove to be a significant challenge for all involved, leaving family and health professionals perplexed and exhausted. Understanding the predisposing factors and the manifestations may aid the health professional in the assessment and identification of this distressing symptom, facilitating more effective management and care of those who are approaching the end of life. This article attempts to address some of the challenges and offer a number of suggestions that may aid in identifying delirium in patients at the end of life, but also examines some of the dilemmas when attempting to treat delirium.

  3. Paraneoplastic neuropsychiatric syndrome presenting as delirium.

    PubMed

    Roldan Urgoiti, Gloria; Sinnarajah, Aynharan; Hussain, Seema; Hao, Desiree

    2016-07-28

    Delirium in patients with cancer is associated with poor outcomes, but reversible causes need to be ruled out. We report the case of a 59-year-old woman who was presented with behavioural and cognitive changes over 2 weeks. She was non-verbal and combative, requiring involuntary admission and declaration of incompetence to make healthcare treatment decisions. Infectious and metabolic investigations and initial brain imaging were unremarkable. She was diagnosed with limited-stage small cell lung cancer and a paraneoplastic neuropsychiatric syndrome. Owing to the patient's delirium, chemotherapy delivery required pharmacological and physical restraints. After 2 cycles of chemotherapy, she could participate in the decision process and was discharged home. She completed radical chemo-radiotherapy and has remained free of disease progression for 18 months. Paraneoplastic neuropsychiatric syndromes, although rare, are potentially treatable and need to be excluded as a cause of delirium.

  4. Bedside coaching to improve nurses' recognition of delirium.

    PubMed

    Gordon, Susan Jean; Melillo, Karen Devereaux; Nannini, Angela; Lakatos, Barbara E

    2013-10-01

    Delirium is a widespread complication of hospitalization and is frequently unrecognized by nurses and other healthcare professionals. Patients with neuroscience diagnoses are at increased risk for delirium as compared with other patients. The aims of this quality improvement project were to (1) increase neuroscience nurses' knowledge of delirium, (2) integrate coaching into evidence-based practice, and (3) evaluate the effectiveness of this combined approach to improve nurses' recognition of delirium on a neuroscience unit. Institutional review board approval was obtained. A retrospective chart review of randomly selected patients admitted before the intervention was completed. The (modified) Nurse's Knowledge of Delirium Tool was electronically administered to nursing staff (n = 47), followed within 2 weeks by a didactic presentation on delirium. Bedside coaching was performed over a period of 4 weeks. The (modified) Nurses Knowledge of Delirium Tool was electronically readministered to nurses 4 weeks later to determine the change in aggregate knowledge. A postintervention chart review was conducted. SPSS software was used to analyze descriptive statistics with regard to chart reviews, documentation, and change in questionnaire scores. Findings reveal that neuroscience nurses recognize the absence of delirium 94.4% of the time and the presence of delirium 100% of the time after a didactic session and coaching. The postintervention chart review showed a statistically significant increase (p = .000) in the documentation of delirium screening results. Expert coaching at the bedside may be a reliable method for teaching nurses to use evidence-based screening tools to detect delirium in patients with neuroscience diagnoses.

  5. An approach to drug induced delirium in the elderly

    PubMed Central

    Alagiakrishnan, K; Wiens, C

    2004-01-01

    Drugs have been associated with the development of delirium in the elderly. Successful treatment of delirium depends on identifying the reversible contributing factors, and drugs are the most common reversible cause of delirium. Anticholinergic medications, benzodiazepines, and narcotics in high doses are common causes of drug induced delirium. This article provides an approach for clinicians to prevent, recognise, and manage drug induced delirium. It also reviews the mechanisms for this condition, especially the neurotransmitter imbalances involving acetylcholine, dopamine, and gamma aminobutyric acid and discusses the age related changes that may contribute to altered pharmacological effects which have a role in delirium. Specific interventions for high risk elderly with the goal of preventing drug induced delirium are discussed. PMID:15254302

  6. Multicomponent delirium prevention: not as effective as NICE suggest?

    PubMed

    Teale, Elizabeth; Young, John

    2015-11-01

    Multicomponent delirium prevention strategies have been shown in intervention studies consistently to reduce the occurrence of delirium. Based on this convincing evidence base, the National Institute for Health and Care Excellence has advocated the widespread adoption of multicomponent delirium prevention interventions into the routine inpatient care of older people. However, despite successful reductions in incident delirium of about a third, anticipated reductions in mortality or admissions to long-term care--both clinically important endpoints statistically correlated with the occurrence of delirium--have not been conclusively observed. We hypothesise that the reasons for this disconnection are partly methodological, due to difficulties in delirium detection and blinding of study personnel to the intervention, but predominantly due to the underlying relationship between delirium and the abnormal health state of frailty; the interaction between these two geriatric syndromes is currently poorly understood.

  7. Delirium in elderly vascular surgery patients.

    PubMed

    Cudennec, Tristan; Goëau-Brissonnière, Olivier; Coscas, Raphaël; Capdevila, Clément; Moulias, Sophi; Coggia, Marc; Teillet, Laurent

    2014-04-01

    The elderly represent a large percentage of patients seen in departments of vascular surgery. Delirium is a frequent perioperative complication in this population and contributes to increased morbidity and mortality. Prevention of problems associated with mental confusion rests in identifying comorbidities, their severity, and the risk factors associated with delirium syndrome. The aging of our population implies management of increasing numbers of older patients who often have concomitant pathologies and, consequently, polypharmacy. Optimization of their management rests on collaboration between surgeons, anesthetists, and geriatrists.

  8. Digging Into the Mysteries of Delirium | NIH MedlinePlus the Magazine

    MedlinePlus

    ... turn JavaScript on. Feature: Delirium Research Digging Into the Mysteries of Delirium Past Issues / Fall 2015 Table ... by delirium experience its effects for weeks after the first occurrence. Why is this? That's part of ...

  9. Postoperative delirium. Part 1: pathophysiology and risk factors.

    PubMed

    Steiner, Luzius A

    2011-09-01

    Delirium presents clinically with differing subtypes ranging from hyperactive to hypoactive. The clinical presentation is not clearly linked to specific pathophysiological mechanisms. Nevertheless, there seem to be different mechanisms that lead to delirium; for example the mechanisms leading to alcohol-withdrawal delirium are different from those responsible for postoperative delirium. In many forms of delirium, the brain's reaction to a peripheral inflammatory process is considered to be a pathophysiological key element and the aged brain seems to react more markedly to a peripheral inflammatory stimulus than a younger brain. The effects of inflammatory mediators on the brain include changes in neurotransmission and apoptosis. On a neurotransmitter level, impaired cholinergic transmission and disturbances of the intricate interactions between dopamine, serotonin and acetylcholine seem to play an important role in the development of delirium. The risk factors for delirium are categorised as predisposing or precipitating factors. In the presence of many predisposing factors, even trivial precipitating factors may trigger delirium, whereas in patients without or with only a few predisposing factors, a major precipitating insult is necessary to trigger delirium. Well documented predisposing factors are age, medical comorbidities, cognitive, functional, visual and hearing impairment and institutional residence. Important precipitating factors apart from surgery are admission to an ICU, anticholinergic drugs, alcohol or drug withdrawal, infections, iatrogenic complications, metabolic derangements and pain. Scores to predict the risk of delirium based on four or five risk factors have been validated in surgical patients.

  10. Levetiracetam: an unusual cause of delirium.

    PubMed

    Hwang, Eileen S; Siemianowski, Laura A; Sen, Sanchita; Patel, Ritesh

    2014-01-01

    Levetiracetam is a second-generation anticonvulsant that was approved by the Federal Drug Administration in 1999 for the treatment of epilepsy. Recently, levetiracetam has become more popular for the prevention of posttraumatic seizures. Some of the well-known adverse effects of levetiracetam are somnolence, behavioral abnormalities, and less commonly, psychosis. Delirium is not a well-known adverse effect of levetiracetam. Here, we present the case of a 77-year-old Caucasian male who developed disorientation, agitation, and lethargy after initiation of levetiracetam to prevent posttraumatic seizures. Imaging on admission demonstrated a subacute subdural hematoma in the left frontal lobe without mass effect, and the patient was started on levetiracetam 500 mg intravenously twice daily. Less than 24 hours later, the patient began to display a fluctuating level of consciousness, disorientation, an inability to follow commands, and garbled speech. His symptoms continued for 12 days unabated despite episodic treatment with sedatives and antipsychotics. At one point, the patient progressed to aggressive behavior and required restraints. Laboratory tests during this period did not demonstrate signs of infection or metabolic abnormalities. Delirium from levetiracetam was suspected and the drug was discontinued. The patient's mental status improved dramatically within 24 hours after administration of the last dose of levetiracetam and he was discharged home. Based on the Naranjo scale, the episode of delirium was probably related to levetiracetam. Although the other neuropsychiatric effects of levetiracetam are well known, we highlight the first case of delirium without psychotic features associated with levetiracetam.

  11. Dementia and delirium, the outcomes in elderly hip fracture patients

    PubMed Central

    Mosk, Christina A; Mus, Marnix; Vroemen, Jos PAM; van der Ploeg, Tjeerd; Vos, Dagmar I; Elmans, Leon HGJ; van der Laan, Lijckle

    2017-01-01

    Background Delirium in hip fractured patients is a frequent complication. Dementia is an important risk factor for delirium and is common in frail elderly. This study aimed to extend the previous knowledge on risk factors for delirium and the consequences. Special attention was given to patients with dementia and delirium. Methods This is a retrospective cohort study performed in the Amphia Hospital, Breda, the Netherlands. A full electronic patient file system (Hyperspace Version IU4: Epic, Inc., Verona, WI, USA) was used to assess data between January 2014 and September 2015. All patients presented were aged ≥70 years with a hip fracture, who underwent surgery with osteosynthesis or arthroplasty. Patients were excluded in case of a pathological or a periprosthetic hip fracture, multiple traumatic injuries, and high-energy trauma. Patient and surgical characteristics were documented. Postoperative outcomes were noted. Delirium was screened using Delirium Observation Screening Scale and dementia was assessed from medical notes. Results Of a total of 566 included patients, 75% were females. The median age was 84 years (interquartile range: 9). Delirium was observed in 35%. Significant risk factors for delirium were a high American Society of Anesthesiology score, delirium in medical history, functional dependency, preoperative institutionalization, low hemoglobin level, and high amount of blood transfusion. Delirium was correlated with a longer hospital stay (P=0.001), increased association with complications (P<0.001), institutionalization (P<0.001), and 6-month mortality (P<0.001). Patients with dementia (N=168) had a higher delirium rate (57.7%, P<0.001) but a shorter hospital stay (P<0.001). There was no significant difference in the 6-month mortality between delirious patients with (34.0%) and without dementia (26.3%). Conclusion Elderly patients with a hip fracture are vulnerable for delirium, especially when the patient has dementia. Patients who underwent

  12. Delirium screening anchored in child development: The Cornell Assessment for Pediatric Delirium

    PubMed Central

    SILVER, GABRIELLE; KEARNEY, JULIA; TRAUBE, CHANI; HERTZIG, MARGARET

    2016-01-01

    Objective The recently validated Cornell Assessment for Pediatric Delirium (CAPD) is a new rapid bedside nursing screen for delirium in hospitalized children of all ages. The present manuscript provides a “developmental anchor points” reference chart, which helps ground clinicians’ assessment of CAPD symptom domains in a developmental understanding of the presentation of delirium. Method During the development of this CAPD screening tool, it became clear that clinicians need specific guidance and training to help them draw on their expertise in child development and pediatrics to improve the interpretative reliability of the tool and its accuracy in diagnosing delirium. The developmental anchor points chart was formulated and reviewed by a multidisciplinary panel of experts to evaluate content validity and include consideration of sick behaviors within a hospital setting. Results The CAPD developmental anchor points for the key ages of newborn, 4 weeks, 6 weeks, 8 weeks, 28 weeks, 1 year, and 2 years served as the basis for training bedside nurses in scoring the CAPD for the validation trial and as a multifaceted bedside reference chart to be implemented within a clinical setting. In the current paper, we discuss the lessons learned during implementation, with particular emphasis on the importance of collaboration with the bedside nurse, the challenges of establishing a developmental baseline, and further questions about delirium diagnosis in children. Significance of Results The CAPD with developmental anchor points provides a validated, structured, and developmentally informed approach to screening and assessment of delirium in children. With minimal training on the use of the tool, bedside nurses and other pediatric practitioners can reliably identify children at risk for delirium. PMID:25127028

  13. Identifying and managing patients with delirium in acute care settings.

    PubMed

    Bond, Penny; Goudie, Karen

    2015-11-01

    Delirium is an acute medical emergency affecting about one in eight acute hospital inpatients. It is associated with poor outcomes, is more prevalent in older people and it is estimated that half of all patients receiving intensive care or surgery for a hip fracture will be affected. Despite its prevalence and impact, delirium is not reliably identified or well managed. Improving the identification and management of patients with delirium has been a focus for the national improving older people's acute care work programme in NHS Scotland. A delirium toolkit has been developed, which includes the 4AT rapid assessment test, information for patients and carers and a care bundle for managing delirium based on existing guidance. This toolkit has been tested and implemented by teams from a range of acute care settings to support improvements in the identification and immediate management of delirium.

  14. Delirium: assessment and treatment of patients with cancer. PART 2.

    PubMed

    Brown, Michelle; Hardy, Kersten

    Delirium at the end of life may present significant ethical dilemmas in clinical practice: whether to simply treat it in order to maximise symptom relief, with the resulting side effect being palliative sedation, or to attempt to reverse delirium and risk prolonging suffering. Determining whether the delirium can be reversed involves comprehensive assessment using established tools, which may or may not provide the answer to the question posed. This article examines the evidence surrounding several assessment tools that have been suggested as effective in identifying delirium, and the consequences of various approaches to the management of delirium in a patient with a cancer diagnosis. It also considers the impact delirium may have on the health professional and those close to the patient.

  15. Delirium in elderly patients hospitalized in internal medicine wards.

    PubMed

    Fortini, Alberto; Morettini, Alessandro; Tavernese, Giuseppe; Facchini, Sofia; Tofani, Lorenzo; Pazzi, Maddalena

    2014-06-01

    A prospective observational study was conducted to evaluate the impact of delirium on geriatric inpatients in internal medical wards and to identify predisposing factors for the development of delirium. The study included all patients aged 65 years and older, who were consecutively admitted to the internal medicine wards of two public hospitals in Florence, Italy. On admission, 29 baseline risk factors were examined, cognitive impairment was evaluated by Short Portable Mental Status Questionnaire, and prevalent delirium cases were diagnosed by Confusion Assessment Method (CAM). Enrolled patients were evaluated daily with CAM to detect incident delirium cases. Among the 560 included patients, 19 (3 %) had delirium on admission (prevalent) and 44 (8 %) developed delirium during hospitalization (incident). Prevalent delirium cases were excluded from the statistical analysis. Incident delirium was associated with increased length of hospital stay (p < 0.01) and institutionalization (p < 0.01, OR 3.026). Multivariate analysis found that cognitive impairment on admission (p < 0.0002), diabetes (p < 0.05, OR 1.936), chronic kidney failure (p < 0.05, OR 2.078) and male gender (p < 0.05, OR 2.178) was significantly associated with the development of delirium during hospitalization. Results show that delirium impact is relevant to older patients hospitalized in internal medicine wards. The present study confirms cognitive impairment as a risk factor for incident delirium. The cognitive evaluation proved to be an important instrument to improve identification of patients at high risk for delirium. In this context, our study may contribute to improve application of preventive strategies.

  16. Pharmacological interventions for preventing delirium in the elderly.

    PubMed

    Ford, Andrew H; Almeida, Osvaldo P

    2015-06-01

    Delirium is a common occurrence in older hospitalised patients, particularly in the setting of surgical intervention and acute illness. Delirium is associated with a number of adverse clinical and social outcomes with higher financial cost and risk of developing dementia, as well as increased likelihood of need for residential care. Current interventions for the prevention of delirium typically involve recognition and amelioration of modifiable risk factors and treatment of underlying conditions that predispose the individual to delirium. A number of pharmacological strategies for delirium prevention have been tested. Antipsychotic medications are used for treatment of agitation in the setting of delirium when other measures have failed, but their efficacy in prevention is limited by study heterogeneity and concerns about tolerability. Acetylcholinesterase inhibitors are effective in the symptomatic treatment of Alzheimer's disease but do not appear to be effective in preventing delirium. Melatonin and melatonin agonists have a rather benign side effect profile and show promise for prevention of delirium in medically unwell individuals. The alpha-2 agonist, dexmedetomidine may be helpful in the intensive care unit setting but intravenous route of administration and need for close clinical supervision limits its use in the wider hospital environment. Other agents such as benzodiazepines, corticosteroids, statins and gabapentin have been suggested but lack evidence to support their role in delirium prevention. To date, there is inconsistent and conflicting data regarding the efficacy of any particular pharmacological agent although some interventions do show promise. Larger, well-designed, placebo-controlled clinical trials are needed.

  17. Detecting delirium in older adults living at home.

    PubMed

    Malenfant, Priscilla; Voyer, Philippe

    2012-01-01

    The aim of this study was to determine whether in-home care nurses had the necessary knowledge to detect delirium in older adults. To this end, 87 home care nurses from 2 sites in the greater Quebec City region in Canada answered a questionnaire. The results showed nurses had limited level of knowledge about the diagnostic criteria for delirium, the main signs and symptoms of delirium, and the tools for its detection. Moreover, 54.4% of the in-home care nurses were able to recognize delirium, from structured clinical vignettes.

  18. Frequency of delirium in a neurological emergency room.

    PubMed

    Ramirez-Bermudez, Jesus; Lopez-Gómez, Mario; Sosa Ana, Luisa; Aceves, Sergio; Nader-Kawachi, Juan; Nicolini, Humberto

    2006-01-01

    The authors present a cross-sectional survey designed to evaluate the presence of delirium in patients with neurological emergencies. Two hundred and two patients were included in the study: 14.9% of subjects had delirium; 62.4% had no arousal disturbances; and 22.7% presented a coma or stupor state. Findings revealed that the presence of a cerebral infection, the presence of multiple etiologies, and the location of lesions in the frontal and temporal lobes were all associated with delirium. Results substantiate that delirium is a frequent occurrence in neurological patients and that the presence of multiple etiologies must be investigated in each patient.

  19. Delirium detection and improved delirium management in older patients hospitalized for hip fracture.

    PubMed

    Todd, Kristine S; Barry, Jean; Hoppough, Susan; McConnell, Eleanor

    2015-11-01

    Delirium is a common and potentially devastating problem for older patients following hip fracture. Although early detection is recommended, description and evaluation of standardized approaches are scarce. The aims of this quality improvement project were to: (1) implement a clinical algorithm for improving delirium detection and management and (2) assess the impact of the clinical algorithm on length of stay, discharge disposition and patient satisfaction. The pilot study was implemented on an orthopedic unit to evaluate the effectiveness of a clinical protocol for delirium detection and management to improve outcomes. Outcomes of 33 elderly post-operative hip fracture patients were compared to historical controls from the same unit. Delirium was detected in 18% of patients. Length of stay was reduced by 22% (P < .001), discharge disposition showed a 13% improvement (P = .17) and patient satisfaction scores showed a 15% (P = .15) improvement post-intervention. Implementation of a clinical algorithm to promote early detection and treatment of delirium in post-operative hip fracture patients is feasible and associated with improved outcomes.

  20. Delirium, Caused by Suspending Treatment of Hypothyroidism

    PubMed Central

    Hernández-Sandí, Alejandro; Quirós-Baltodano, David; Oconitrillo-Chaves, Michelle

    2016-01-01

    Delirium, or acute confusional syndrome, is a set of symptoms whose care involves not only psychiatry, but also many other medical specialties. Being as how the syndrome is caused by multiple factors, it is important to recognize each risk factor affecting the patient in order to anticipate and prevent it. In case of diagnosis, identifying and treating the root cause that triggered is important, given that it has a high rate of comorbidity and an elevated cost of medical care. We describe a case where a patient with hypothyroidism began suffering from delirium due to an abrupt discontinuation of levothyroxine treatment. Previously, the patient was seemingly healthy. After the medical treatment was interrupted, sensory processing and behavior were altered, and symptoms fluctuated, for a short period of time, showing disorientation and memory and language impairment. PMID:27994835

  1. Does Apolipoprotein E Genotype Increase Risk of Postoperative Delirium?

    PubMed Central

    Vasunilashorn, Sarinnapha; Ngo, Long; Kosar, Cyrus M.; Fong, Tamara G.; Jones, Richard N.

    2015-01-01

    Objectives To determine whether Apolipoprotein E (ApoE) is associated with postoperative delirium incidence, severity, and duration in older patients free of dementia at baseline. Design, Setting, Participants We examined 557 non-demented patients age ≥70 undergoing major non-cardiac surgery enrolled in the Successful Aging after Elective Surgery (SAGES) Study. Measurements We considered three ApoE measures: ε2, ε4 carriers vs. non-carriers, and a three-category ApoE measure. Delirium was determined using the Confusion Assessment Method (CAM) and chart review. We used generalized linear models to estimate the association between ApoE and delirium incidence, severity (peak CAM Severity [CAM-S] score), and days. Results ApoE ε2 and ε4 was present in 15% and 19% respectively, and postoperative delirium occurred in 24%. Among patients with delirium, the mean peak CAM-S score was 8.0 (standard deviation 4), with most patients experiencing one or two delirium days (51% or 28%, respectively). After adjusting for age, sex, surgical procedure, and preoperative cognitive function, ApoE ε4 and ε2 carrier status were not associated with postoperative delirium: RR for ε4=1.0, 95% confidence interval (CI) 0.7-1.5 and RR for ε2=0.9, 95% CI 0.6-1.4. No association between ApoE and delirium severity or number of delirium days was observed. Conclusions In older surgery patients free of dementia, our findings do not support the hypothesis that the ApoE genotype does not confer either risk or protection in postoperative delirium incidence, severity, or duration. Thus, an important genetic risk factor for Alzheimer's Disease does not affect risk of delirium. PMID:26238230

  2. Delirium in intensive care: an under-diagnosed reality

    PubMed Central

    Faria, Rita da Silva Baptista; Moreno, Rui Paulo

    2013-01-01

    Delirium occurs in up to 80% of patients admitted to intensive care units. Although under-diagnosed, delirium is associated with a significant increase in morbidity and mortality in critical patients. Here, we review the main risk factors, clinical manifestations and preventative and therapeutic approaches (pharmacological and non-pharmacological) for this illness. PMID:23917979

  3. Mental Status Change in the Elderly: Recognizing and Treating Delirium.

    ERIC Educational Resources Information Center

    Morency, Catherine Reilly

    1990-01-01

    Discusses delirium and how it differs from other types of mental status changes seen in the elderly and what interventions are most appropriate in affected individuals. Presents data from a study regarding nursing assessment of patients with delirium and outlines an educational model. (JOW)

  4. Commentary: The Diagnosis of Delirium in Pediatric Patients

    ERIC Educational Resources Information Center

    Martini, D. Richard

    2005-01-01

    Pediatric patients seem to be especially vulnerable to toxic, metabolic, or traumatic CNS insults and are at greater risk of delirium with fever regardless of the etiology. Developmental limitations, in the areas of communication and cognition, prevent a thorough evaluation of the young patient for delirium. Only the most severe cases are…

  5. Melatonin and melatonin agonist for delirium in the elderly patients.

    PubMed

    Chakraborti, Dwaipayan; Tampi, Deena J; Tampi, Rajesh R

    2015-03-01

    The objective of this review is to summarize the available data on the use of melatonin and melatonin agonist for the prevention and management of delirium in the elderly patients from randomized controlled trials (RCTs). A systematic search of 5 major databases PubMed, MEDLINE, PsychINFO, Embase, and Cochrane Library was conducted. This search yielded a total of 2 RCTs for melatonin. One study compared melatonin to midazolam, clonidine, and control groups for the prevention and management of delirium in individuals who were pre- and posthip post-hip arthroplasty. The other study compared melatonin to placebo for the prevention of delirium in older adults admitted to an inpatient internal medicine service. Data from these 2 studies indicate that melatonin may have some benefit in the prevention and management of delirium in older adults. However, there is no evidence that melatonin reduces the severity of delirium or has any effect on behaviors or functions in these individuals. Melatonin was well tolerated in these 2 studies. The search for a melatonin agonist for delirium in the elderly patients yielded 1 study of ramelteon. In this study, ramelteon was found to be beneficial in preventing delirium in medically ill individuals when compared to placebo. Ramelteon was well tolerated in this study.

  6. Educational interventions to improve recognition of delirium: a systematic review.

    PubMed

    Yanamadala, Mamata; Wieland, Darryl; Heflin, Mitchell T

    2013-11-01

    Delirium is a common and serious condition that is underrecognized in older adults in a variety of healthcare settings. It is poorly recognized because of deficiencies in provider knowledge and its atypical presentation. Early recognition of delirium is warranted to better manage the disease and prevent the adverse outcomes associated with it. The purpose of this article is to review the literature concerning educational interventions focusing on recognition of delirium. The Medline and Cumulative Index to Nursing and Allied Health Literature (CINHAL) databases were searched for studies with specific educational focus in the recognition of delirium, and 26 studies with various designs were identified. The types of interventions used were classified according to the Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model, and outcomes were sorted according to Kirkpatrick's hierarchy. Educational strategies combining predisposing, enabling, and reinforcing factors achieved better results than strategies that included one or two of these components. Studies using predisposing, enabling, and reinforcing strategies together were more often effective in producing changes in staff behavior and participant outcomes. Based on this review, improvements in knowledge and skill alone seem insufficient to favorably influence recognition of delirium. Educational interventions to recognize delirium are most effective when formal teaching is interactive and is combined with strategies including engaging leadership and using clinical pathways and assessment tools. The goal of the current study was to systematically review the published literature to determine the effect of educational interventions on recognition of delirium.

  7. Knowns and Unknowns About Delirium in Stroke: A Review.

    PubMed

    Klimiec, Elzbieta; Dziedzic, Tomasz; Kowalska, Katarzyna; Slowik, Agnieszka; Klimkowicz-Mrowiec, Aleksandra

    2016-12-01

    Delirium is a transient condition characterized by sudden and fluctuating disturbances in cognitive function. The condition can be considered a sign of the brain's vulnerability and diminished resilience to insult. Among the many clinical manifestations are cognitive, psychomotor, and sleep disturbances. Delirium is associated with longer hospital stays, worse functional outcomes, and higher mortality. Although up to 48% of patients who have had a stroke develop delirium, the condition has been studied much less in these patients than in general medicine, surgical, and intensive care patients. Coexisting neurologic deficits in patients with stroke limit the use of screening tools that are widely accepted in other populations. The variability of reported assessment methods highlights the need for delirium screening guidelines in stroke. Further, risk factors that are specific to stroke may play an important role in the etiology of delirium, along with such well-known factors as older age and infections. The delirium literature lacks data on differences in clinical manifestations and course in the various types of stroke. Here we review predisposing factors, diagnostic methods, and biomarkers of delirium in stroke and discuss aspects that need further research.

  8. Evidence-Based Treatment of Delirium in Patients With Cancer

    PubMed Central

    Breitbart, William; Alici, Yesne

    2012-01-01

    Delirium is the most common neuropsychiatric complication seen in patients with cancer, and it is associated with significant morbidity and mortality. Increased health care costs, prolonged hospital stays, and long-term cognitive decline are other well-recognized adverse outcomes of delirium. Improved recognition of delirium and early treatment are important in diminishing such morbidity. There has been an increasing number of studies published in the literature over the last 10 years regarding delirium treatment as well as prevention. Antipsychotics, cholinesterase inhibitors, and alpha-2 agonists are the three groups of medications that have been studied in randomized controlled trials in different patient populations. In patients with cancer, the evidence is most clearly supportive of short-term, low-dose use of antipsychotics for controlling the symptoms of delirium, with close monitoring for possible adverse effects, especially in older patients with multiple medical comorbidities. Nonpharmacologic interventions also appear to have a beneficial role in the treatment of patients with cancer who have or are at risk for delirium. This article presents evidence-based recommendations based on the results of pharmacologic and nonpharmacologic studies of the treatment and prevention of delirium. PMID:22412123

  9. Gabapentin-induced delirium and dependence.

    PubMed

    Kruszewski, Stefan P; Paczynski, Richard P; Kahn, David A

    2009-07-01

    Gabapentin (Neurontin) is approved by the US Food and Drug Administration for treatment of epilepsy and post-herpetic neuralgia. Despite lack of strong evidence, gabapentin is also often prescribed off-label for psychiatric conditions. The case described here involved a 38-year-old male physician with substance intoxication delirium and psychoactive substance dependence due to high self-administered doses of gabapentin, which had been prescribed at lower doses in combination with buspirone and bupropion for depression and anxiety. This unusual case of gabapentin dependence and abuse involved toxic delirium, intense cravings, and a prolonged post-withdrawal confusional state reminiscent of benzodiazepine withdrawal. Gabapentin is a central nervous system inhibitory agent with likely gamma-aminobutyric acid (GABA)-ergic and non-GABAergic mechanisms of action. The similarity between benzodiazepine withdrawal and what this patient experienced with gabapentin suggests a common role for GABA-related effects. The case reported here suggests the need for heightened concern regarding the off-label prescription of this drug to vulnerable individuals with psychiatric conditions.

  10. [Delirium prevention and treatment in elderly hip fracture].

    PubMed

    Robles, María José; Formiga, Francesc; Vidán, M Teresa

    2014-04-22

    The fracture of the proximal femur or hip fracture in the elderly usually happens after a fall and carries a high morbidity and mortality. One of the most common complications during hospitalization for hip fracture is the onset of delirium or acute confusional state that in elderly patients has a negative impact on the hospital stay, and prognosis, worsening functional ability, cognitive status and mortality. Also the development of delirium during hospitalization increases health care costs. Strategies to prevent and treat delirium during hospitalization for hip fracture have been less studied. In this context, this paper aims to conduct a review of the literature on strategies that exist in the prevention and treatment of delirium in elderly patients with hip fracture.

  11. Delirium in Parkinson’s Disease: A Cocktail Diagnosis

    PubMed Central

    2016-01-01

    Mental disturbances have been described in patients with Parkinson’s Disease (PD). Of these, the common conditions are delirium and psychosis. Delirium has been attributed to change of environment, especially hospital stay and infections; while psychosis is due to drugs like dopamine agonists. This is a case of a 75-year-old male, on levodopa therapy for PD, who presented with delirium and ended up with a cocktail diagnosis: Cryptococcal meningitis, Hashimoto’s Encephalopathy (HE), Urinary tract infection with acute renal failure, Uremic encephalopathy and Levodopa induced psychosis. This case report, therefore, highlights the need to look for other causes of delirium in a patient with PD who is on levodopa therapy. PMID:28208916

  12. Delirium after a traumatic brain injury: predictors and symptom patterns

    PubMed Central

    Maneewong, Jutaporn; Maneeton, Benchalak; Maneeton, Narong; Vaniyapong, Tanat; Traisathit, Patrinee; Sricharoen, Natthanidnan; Srisurapanont, Manit

    2017-01-01

    Background Delirium in traumatic brain injury (TBI) is common, may be predictable, and has a multifaceted symptom complex. This study aimed to examine: 1) the sum score of Glasgow Coma Scale (GCS) and if its component scores could predict delirium in TBI patients, and 2) the prominent symptoms and their courses over the first days after TBI. Methods TBI patients were recruited from neurosurgical ward inpatients. All participants were hospitalized within 24 hours after their TBI. Apart from the sum score of GCS, which was obtained at the emergency department (ED), the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria for delirium were applied daily. The severity of delirium symptoms was assessed daily using the Delirium Rating Scale – Revised-98 (DRS-R-98). Results The participants were 54 TBI patients with a mean GCS score of 12.7 (standard deviation [SD] =2.9). A total of 25 patients (46.3%) met the diagnosis of delirium and had a mean age of 36.7 years (SD =14.8). Compared with 29 non-delirious patients, 25 delirious patients had a significantly lower mean GCS score (P=0.04), especially a significantly lower verbal component score (P=0.03). Among 18 delirious patients, four symptoms of the DRS-R-98 cognitive domain (orientation, attention, long-term memory, and visuospatial ability) were moderate symptoms (score ≥2) at the first day of admission. After follow-up, three cognitive (orientation, attention, and visuospatial ability) and two noncognitive symptoms (lability of affect and motor agitation) rapidly resolved. Conclusion Almost half of patients with mild to moderate head injuries may develop delirium in the first 4 days after TBI. Those having a low GCS score, especially the verbal component score, at the ED were likely to have delirium in this period. Most cognitive domains of delirium described in the DRS-R-98 were prominent within the first 4 days of TBI with delirium. Three cognitive and two noncognitive

  13. Delirium in acute promyelocytic leukemia patients: two case reports

    PubMed Central

    2013-01-01

    Background Delirium is a frequently misdiagnosed and inadequately treated neuropsychiatric complication most commonly observed in terminally ill cancer patients. To our knowledge this is the first report describing delirium in two patients aged less than 60 years and enrolled in an intensive chemotherapeutic protocol for acute promyelocytic leukemia. Case presentation Two female Caucasian acute promyelocytic leukemia patients aged 46 and 56 years developed delirium during their induction treatment with all-trans retinoic acid and idarubicin. In both cases symptoms were initially attributed to all-trans retinoic acid that was therefore immediately suspended. In these two patients several situations may have contribute to the delirium: in patient 1 a previous psychiatric disorder, concomitant treatments with steroids and benzodiazepines, a severe infection and central nervous system bleeding while in patient 2 steroid treatment and isolation. In patient 1 delirium was treated with short-term low-doses of haloperidol while in patient 2 non-pharmacologic interventions had a beneficial role. When the diagnosis of delirium was clear, induction treatment was resumed and both patients completed their therapeutic program without any relapse of the psychiatric symptoms. Both patients are alive and in complete remission as far as their leukemia is concerned. Conclusions We suggest that patients with acute promyelocytic leukemia eligible to intensive chemotherapy should be carefully evaluated by a multisciplinary team including psychiatrists in order to early recognize symptoms of delirium and avoid inadequate treatments. In case of delirium, both pharmacologic and non-pharmacologic interventions may be considered. PMID:24237998

  14. Emergency Department Stay Associated Delirium in Older Patients*

    PubMed Central

    Émond, Marcel; Grenier, David; Morin, Jacques; Eagles, Debra; Boucher, Valérie; Le Sage, Natalie; Mercier, Éric; Voyer, Philippe; Lee, Jacques S.

    2017-01-01

    Background Caring for older patients can be challenging in the Emergency Department (ED). A > 12 hr ED stay could lead to incident episodes of delirium in those patients. The aim of this study was to assess the incidence and impacts of ED-stay associated delirium. Methods A historical cohort of patients who presented to a Canadian ED in 2009 and 2011 was randomly constituted. Included patients were aged ≥ 65 years old, admitted to any hospital ward, non-delirious upon arrival and had at least a 12-hour ED stay. Delirium was detected using a modified chart-based Confusion Assessment Method (CAM) tool. Hospital length of stay (LOS) was log-transformed and linear regression assessed differences between groups. Adjustments were made for age and comorbidity profile. Results 200 records were reviewed, 55.5% were female, median age was 78.9 yrs (SD:7.3). 36(18%) patients experienced ED-stay associated delirium. Nearly 50% of episodes started in the ED and within 36 hours of arrival. Comorbidity profile was similar between the positive CAM group and the negative CAM group. Mean adjusted hospital LOS were 20.5 days and 11.9 days respectively (p<.03). Conclusions 1 older adult out of 5 became delirious after a 12 hr ED stay. Since delirium increases hospital LOS by more than a week, better screening and implementation of preventing measures for delirium could reduce LOS and overcrowding in the ED.

  15. Ethical Challenges and Solutions Regarding Delirium Studies in Palliative Care

    PubMed Central

    Sweet, Lisa; Adamis, Dimitrios; Meagher, David; Davis, Daniel; Currow, David; Bush, Shirley H.; Barnes, Christopher; Hartwick, Michael; Agar, Meera; Simon, Jessica; Breitbart, William; MacDonald, Neil; Lawlor, Peter G.

    2014-01-01

    Context Delirium occurs commonly in settings of palliative care (PC), in which patient vulnerability in the unique context of end-of-life care and delirium-associated impairment of decision-making capacity may together present many ethical challenges. Objectives Based on deliberations at the Studies to Understand Delirium in Palliative Care Settings (SUNDIPS) meeting and an associated literature review, this article discusses ethical issues central to the conduct of research on delirious PC patients. Methods Together with an analysis of the ethical deliberations at the SUNDIPS meeting, we conducted a narrative literature review by key words searching of relevant databases and a subsequent hand search of initially identified articles. We also reviewed statements of relevance to delirium research in major national and international ethics guidelines. Results Key issues identified include the inclusion of PC patients in delirium research, capacity determination, and the mandate to respect patient autonomy and ensure maintenance of patient dignity. Proposed solutions include designing informed consent statements that are clear, concise, and free of complex phraseology; use of concise, yet accurate, capacity assessment instruments with a minimally burdensome schedule; and use of PC friendly consent models, such as facilitated, deferred, experienced, advance, and proxy models. Conclusion Delirium research in PC patients must meet the common standards for such research in any setting. Certain features unique to PC establish a need for extra diligence in meeting these standards and the employment of assessments, consent procedures, and patient-family interactions that are clearly grounded on the tenets of PC. PMID:24388124

  16. Delirium epidemiology in critical care (DECCA): an international study

    PubMed Central

    2010-01-01

    Introduction Delirium is a frequent source of morbidity in intensive care units (ICUs). Most data on its epidemiology is from single-center studies. Our aim was to conduct a multicenter study to evaluate the epidemiology of delirium in the ICU. Methods A 1-day point-prevalence study was undertaken in 104 ICUs from 11 countries in South and North America and Spain. Results In total, 975 patients were screened, and 497 fulfilled inclusion criteria and were enrolled (median age, 62 years; 52.5% men; 16.7% and 19.9% for ICU and hospital mortality); 64% were admitted to the ICU because of medical causes, and sepsis was the main diagnosis (n = 76; 15.3%). In total, 265 patients were sedated with the Richmond agitation and sedation scale (RASS) deeper than -3, and only 232 (46.6%) patients could be evaluated with the confusion-assessment method for the ICU. The prevalence of delirium was 32.3%. Compared with patients without delirium, those with the diagnosis of delirium had a greater severity of illness at admission, demonstrated by higher sequential organ-failure assessment (SOFA (P = 0.004)) and simplified acute physiology score 3 (SAPS3) scores (P < 0.0001). Delirium was associated with increased ICU (20% versus 5.7%; P = 0.002) and hospital mortality (24 versus 8.3%; P = 0.0017), and longer ICU (P < 0.0001) and hospital length of stay (LOS) (22 (11 to 40) versus 7 (4 to 18) days; P < 0.0001). Previous use of midazolam (P = 0.009) was more frequent in patients with delirium. On multivariate analysis, delirium was independently associated with increased ICU mortality (OR = 3.14 (1.26 to 7.86); CI, 95%) and hospital mortality (OR = 2.5 (1.1 to 5.7); CI, 95%). Conclusions In this 1-day international study, delirium was frequent and associated with increased mortality and ICU LOS. The main modifiable risk factors associated with the diagnosis of delirium were the use of invasive devices and sedatives (midazolam). PMID:21092264

  17. The Diagnosis of Delirium Superimposed on Dementia: An Emerging Challenge.

    PubMed

    Morandi, Alessandro; Davis, Daniel; Bellelli, Giuseppe; Arora, Rakesh C; Caplan, Gideon A; Kamholz, Barbara; Kolanowski, Ann; Fick, Donna Marie; Kreisel, Stefan; MacLullich, Alasdair; Meagher, David; Neufeld, Karen; Pandharipande, Pratik P; Richardson, Sarah; Slooter, Arjen J C; Taylor, John P; Thomas, Christine; Tieges, Zoë; Teodorczuk, Andrew; Voyer, Philippe; Rudolph, James L

    2017-01-01

    Delirium occurring in patients with dementia is referred to as delirium superimposed on dementia (DSD). People who are older with dementia and who are institutionalized are at increased risk of developing delirium when hospitalized. In addition, their prior cognitive impairment makes detecting their delirium a challenge. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision are considered the standard reference for the diagnosis of delirium and include criteria of impairments in cognitive processes such as attention, additional cognitive disturbances, or altered level of arousal. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision does not provide guidance regarding specific tests for assessment of the cognitive process impaired in delirium. Importantly, the assessment or inclusion of preexisting cognitive impairment is also not addressed by these standards. The challenge of DSD gets more complex as types of dementia, particularly dementia with Lewy bodies, which has features of both delirium and dementia, are considered. The objective of this article is to critically review key elements for the diagnosis of DSD, including the challenge of neuropsychological assessment in patients with dementia and the influence of particular tests used to diagnose DSD. To address the challenges of DSD diagnosis, we present a framework for guiding the focus of future research efforts to develop a reliable reference standard to diagnose DSD. A key feature of a reliable reference standard will improve the ability to clinically diagnose DSD in facility-based patients and research studies.

  18. The Diagnosis of Delirium Superimposed on Dementia: An Emerging Challenge

    PubMed Central

    Morandi, Alessandro; Davis, Daniel; Bellelli, Giuseppe; Arora, Rakesh C.; Caplan, Gideon A.; Kamholz, Barbara; Kolanowski, Ann; Fick, Donna Marie; Kreisel, Stefan; MacLullich, Alasdair; (UK), MRCP; Meagher, David; Neufeld, Karen; Pandharipande, Pratik P.; Richardson, Sarah; Slooter, Arjen J.C.; Taylor, John P.; Thomas, Christine; Tieges, Zoë; Teodorczuk, Andrew; Voyer, Philippe; Rudolph, James L.

    2017-01-01

    Delirium occurring in patients with dementia is referred to as delirium superimposed on dementia (DSD). People who are older with dementia and who are institutionalized are at increased risk of developing delirium when hospitalized. In addition, their prior cognitive impairment makes detecting their delirium a challenge. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision are considered the standard reference for the diagnosis of delirium and include criteria of impairments in cognitive processes such as attention, additional cognitive disturbances, or altered level of arousal. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision does not provide guidance regarding specific tests for assessment of the cognitive process impaired in delirium. Importantly, the assessment or inclusion of preexisting cognitive impairment is also not addressed by these standards. The challenge of DSD gets more complex as types of dementia, particularly dementia with Lewy bodies, which has features of both delirium and dementia, are considered. The objective of this article is to critically review key elements for the diagnosis of DSD, including the challenge of neuropsychological assessment in patients with dementia and the influence of particular tests used to diagnose DSD. To address the challenges of DSD diagnosis, we present a framework for guiding the focus of future research efforts to develop a reliable reference standard to diagnose DSD. A key feature of a reliable reference standard will improve the ability to clinically diagnose DSD in facility-based patients and research studies. PMID:27650668

  19. Role of CRP, TNF-a, and IGF-1 in Delirium Pathophysiology

    PubMed Central

    ÇINAR, Mehmet Alper; BALIKÇI, Adem; SERTOĞLU, Erdim; Mehmet, AK; SERDAR, Muhittin A.; ÖZMENLER, Kamil Nahit

    2014-01-01

    Introduction Delirium is a common and life-threatening neuropsychiatric syndrome. Diagnosing delirium can be challenging, which increases mortality and mortality rates and health care costs. The biologic model of delirium is not definite yet, but evidence supports a cholinergic deficiency model. Delirium may be the result of processes and drugs that trespass a compromised blood-brain barrier. We aimed to evaluate the possible diagnostic utilization and the role of certain biomarkers, such as C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), and insulin like growth factor-1 (IGF-1), in delirium etiology. Methods A total of 93 inpatients that planned to undergo cardiovascular surgery were informed; 35 of them completed the study. Medical history and current cognitive status were evaluated pre-operatively. Participants were followed using Delirium Rating Scale-Revised-98 Turkish (DRS-R98-T) for delirium symptoms, and blood samples were collected post-operatively. Results Delirium was developed more in participants who had worse pre-operative cognitive status. Also, low pre-operative IGF-1 levels were detected in the delirium group. Pre-operative CRP and TNF-α levels were not different between groups. Conclusion Low IGF-1 levels can be used to predict delirium after surgery. However, the complex nature of cytokines and delirium itself make it difficult to utilize cytokines to predict delirium instead of psychometric tools.

  20. Quality of clinical practice guidelines in delirium: a systematic appraisal

    PubMed Central

    Marchington, Katie L; Agar, Meera; Davis, Daniel H J; Sikora, Lindsey; Tsang, Tammy W Y

    2017-01-01

    Objective To determine the accessibility and currency of delirium guidelines, guideline summary papers and evaluation studies, and critically appraise guideline quality. Design Systematic literature search for formal guidelines (in English or French) with focus on delirium assessment and/or management in adults (≥18 years), guideline summary papers and evaluation studies. Full appraisal of delirium guidelines published between 2008 and 2013 and obtaining a ‘Rigour of Development’ domain screening score cut-off of >40% using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Data sources Multiple bibliographic databases, guideline organisation databases, complemented by a grey literature search. Results 3327 database citations and 83 grey literature links were identified. A total of 118 retrieved delirium guidelines and related documents underwent full-text screening. A final 21 delirium guidelines (with 10 being >5 years old), 12 guideline summary papers and 3 evaluation studies were included. For 11 delirium guidelines published between 2008 and 2013, the screening AGREE II ‘Rigour’ scores ranged from 3% to 91%, with seven meeting the cut-off score of >40%. Overall, the highest rating AGREE II domains were ‘Scope and Purpose’ (mean 80.1%, range 64–100%) and ‘Clarity and Presentation’ (mean 76.7%, range 38–97%). The lowest rating domains were ‘Applicability’ (mean 48.7%, range 8–81%) and ‘Editorial Independence’ (mean 53%, range 2–90%). The three highest rating guidelines in the ‘Applicability’ domain incorporated monitoring criteria or audit and costing templates, and/or implementation strategies. Conclusions Delirium guidelines are best sourced by a systematic grey literature search. Delirium guideline quality varied across all six AGREE II domains, demonstrating the importance of using a formal appraisal tool prior to guideline adaptation and implementation into clinical settings. Adding more

  1. Delirium in the elderly: Current problems with increasing geriatric age.

    PubMed

    Kukreja, Deepti; Günther, Ulf; Popp, Julius

    2015-12-01

    Delirium is an acute disorder of attention and cognition seen relatively commonly in people aged 65 yr or older. The prevalence is estimated to be between 11 and 42 per cent for elderly patients on medical wards. The prevalence is also high in nursing homes and long term care (LTC) facilities. The consequences of delirium could be significant such as an increase in mortality in the hospital, long-term cognitive decline, loss of autonomy and increased risk to be institutionalized. Despite being a common condition, it remains under-recognised, poorly understood and not adequately managed. Advanced age and dementia are the most important risk factors. Pain, dehydration, infections, stroke and metabolic disturbances, and surgery are the most common triggering factors. Delirium is preventable in a large proportion of cases and therefore, it is also important from a public health perspective for interventions to reduce further complications and the substantial costs associated with these. Since the aetiology is, in most cases, multifactorial, it is important to consider a multi-component approach to management, both pharmacological and non-pharmacological. Detection and treatment of triggering causes must have high priority in case of delirium. The aim of this review is to highlight the importance of delirium in the elderly population, given the increasing numbers of ageing people as well as increasing geriatric age.

  2. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors.

    PubMed

    Kain, Zeev N; Caldwell-Andrews, Alison A; Maranets, Inna; McClain, Brenda; Gaal, Dorothy; Mayes, Linda C; Feng, Rui; Zhang, Heping

    2004-12-01

    Based on previous studies, we hypothesized that the clinical phenomena of preoperative anxiety, emergence delirium, and postoperative maladaptive behavioral changes were closely related. We examined this issue using data obtained by our laboratory over the past 6 years. Only children who underwent surgery and general anesthesia using sevoflurane/O(2)/N(2)O and who did not receive midazolam were recruited. Children's anxiety was assessed preoperatively with the modified Yale Preoperative Anxiety Scale (mYPAS), emergence delirium was assessed in the postanesthesia care unit, and behavioral changes were assessed with the Post Hospital Behavior Questionnaire (PHBQ) on postoperative days 1, 2, 3, 7, and 14. Regression analysis showed that the odds of having marked symptoms of emergence delirium increased by 10% for each increment of 10 points in the child's state anxiety score (mYPAS). The odds ratio of having new-onset postoperative maladaptive behavior changes was 1.43 for children with marked emergence status as compared with children with no symptoms of emergence delirium. A 10-point increase in state anxiety scores led to a 12.5% increase in the odds that the child would have a new-onset maladaptive behavioral change after the surgery. This finding is highly significant to practicing clinicians, who can now predict the development of adverse postoperative phenomena, such as emergence delirium and postoperative behavioral changes, based on levels of preoperative anxiety.

  3. Delirium in Prolonged Hospitalized Patients in the Intensive Care Unit

    PubMed Central

    Vahedian Azimi, Amir; Ebadi, Abbas; Ahmadi, Fazlollah; Saadat, Soheil

    2015-01-01

    Background: Prolonged hospitalization in the intensive care unit (ICU) can impose long-term psychological effects on patients. One of the most significant psychological effects from prolonged hospitalization is delirium. Objectives: The aim of this study was to assess the effect of prolonged hospitalization of patients and subsequent delirium in the intensive care unit. Patients and Methods: This conventional content analysis study was conducted in the General Intensive Care Unit of the Shariati Hospital of Tehran University of Medical Sciences, from the beginning of 2013 to 2014. All prolonged hospitalized patients and their families were eligible participants. From the 34 eligible patients and 63 family members, the final numbers of actual patients and family members were 9 and 16, respectively. Several semi-structured interviews were conducted face-to-face with patients and their families in a private room and data were gathered. Results: Two main themes from two different perspectives emerged, 'patients' perspectives' (experiences during ICU hospitalization) and 'family members' perspectives' (supportive-communicational experiences). The main results of this study focused on delirium, Patients' findings were described as pleasant and unpleasant, factual and delusional experiences. Conclusions: Family members are valuable components in the therapeutic process of delirium. Effective use of family members in the delirium caring process can be considered to be one of the key non-medical nursing components in the therapeutic process. PMID:26290854

  4. Risk Factors and Outcomes for Postoperative Delirium after Major Surgery in Elderly Patients

    PubMed Central

    Raats, Jelle W.; van Eijsden, Wilbert A.; Crolla, Rogier M. P. H.; Steyerberg, Ewout W.; van der Laan, Lijckle

    2015-01-01

    Background Early identification of patients at risk for delirium is important, since adequate well timed interventions could prevent occurrence of delirium and related detrimental outcomes. The aim of this study is to evaluate prognostic factors for delirium, including factors describing frailty, in elderly patients undergoing major surgery. Methods We included patients of 65 years and older, who underwent elective surgery from March 2013 to November 2014. Patients had surgery for Abdominal Aortic Aneurysm (AAA) or colorectal cancer. Delirium was scored prospectively using the Delirium Observation Screening Scale. Pre- and peri-operative predictors of delirium were analyzed using regression analysis. Outcomes after delirium included adverse events, length of hospital stay, discharge destination and mortality. Results We included 232 patients. 51 (22%) underwent surgery for AAA and 181 (78%) for colorectal cancer. Postoperative delirium occurred in 35 patients (15%). Predictors of postoperative delirium included: delirium in medical history (Odds Ratio 12 [95% Confidence Interval 2.7–50]), advancing age (Odds Ratio 2.0 [95% Confidence Interval 1.1–3.8]) per 10 years, and ASA-score ≥3 (Odds Ratio 2.6 [95% Confidence Interval 1.1–5.9]). Occurrence of delirium was related to an increase in adverse events, length of hospital stay and mortality. Conclusion Postoperative delirium is a frequent complication after major surgery in elderly patients and is related to an increase in adverse events, length of hospital stay, and mortality. A delirium in the medical history, advanced age, and ASA-score may assist in defining patients at increased risk for delirium. Further attention to prevention of delirium is essential in elderly patients undergoing major surgery. PMID:26291459

  5. [Pain, agitation and delirium in acute respiratory failure].

    PubMed

    Funk, G-C

    2016-02-01

    Avoiding pain, agitation and delirium as well as avoiding unnecessary deep sedation is a powerful yet challenging strategy in critical care medicine. A number of interactions between cerebral function and respiratory function should be regarded in patients with respiratory failure and mechanical ventilation. A cooperative sedation strategy (i.e. patient is awake and free of pain and delirium) is feasible in many patients requiring invasive mechanical ventilation. Especially patients with mild acute respiratory distress syndrome (ARDS) seem to benefit from preserved spontaneous breathing. While completely disabling spontaneous ventilation with or without neuromuscular blockade is not a standard strategy in ARDS, it might be temporarily required in patients with severe ARDS, who have substantial dyssynchrony or persistent hypoxaemia. Since pain, agitation and delirium compromise respiratory function they should also be regarded during noninvasive ventilation and during ventilator weaning. Pharmacological sedation can have favourable effects in these situations, but should not be given routinely or uncritically.

  6. The Neuropsychological Course of Acute Delirium in Adult Hematopoietic Stem Cell Transplantation Patients

    PubMed Central

    Beglinger, Leigh J.; Mills, James A.; Vik, Stacie M.; Duff, Kevin; Denburg, Natalie L.; Weckmann, Michelle T.; Paulsen, Jane S.; Gingrich, Roger

    2011-01-01

    Although delirium is a common medical comorbidity with altered cognition as its defining feature, few publications have addressed the neuropsychological prodrome, profile, and recovery of patients tested during delirium. We characterize neuropsychological performance in 54 hemapoietic stem cell/bone marrow transplantation (BMT) patients shortly before, during, and after delirium and in BMT patients without delirium and 10 healthy adults. Patients were assessed prospectively before and after transplantation using a brief battery. BMT patients with delirium performed more poorly than comparisons and those without delirium on cross-sectional and trend analyses. Deficits were in expected areas of attention and memory, but also in psychomotor speed and learning. The patients with delirium did not return to normative “average” on any test during observation. Most tests showed a mild decline in the visit before delirium, a sharp decline with delirium onset, and variable performance in the following days. This study adds to the few investigations of neuropsychological performance surrounding delirium and provides targets for monitoring and early detection; Trails A and B, RBANS Coding, and List Recall may be useful for delirium assessment. PMID:21183605

  7. Agitation and delirium at the end of life: "We couldn't manage him".

    PubMed

    Breitbart, William; Alici, Yesne

    2008-12-24

    Delirium is the most common neuropsychiatric complication experienced by patients with advanced illness, occurring in up to 85% of patients in the last weeks of life. Using the case of Mr L, a 59-year-old man with metastatic lung cancer who developed an agitated delirium in the last week of life, we review the evaluation and management of delirium near the end of life. Although some studies have identified agitation as a central feature of delirium in 13% to 46% of patients, other studies have found up to 80% of patients near the end of life develop a hypoactive, nonagitated delirium. Both the agitated (hyperactive) and nonagitated (hypoactive) forms of delirium are harbingers of impending death and are associated with increased morbidity in patients who are terminally ill, causing distress for patients, family members, and staff. Delirium is a sign of significant physiological disturbance, usually involving multiple causes, including infection, organ failure, and medication adverse effects. Often these causes of delirium are not reversible in the dying patient, and this influences the outcomes of its management. Delirium can also significantly interfere with the recognition and control of other physical and psychological symptoms, such as pain. Unfortunately, delirium is often misdiagnosed or unrecognized and thus inappropriately treated or untreated in terminally ill patients. To manage delirium in terminally ill patients, clinicians must be able to diagnose it accurately, undertake appropriate assessment of underlying causes, and understand the benefits and risks of the available pharmacological and nonpharmacological interventions.

  8. Implementing Delirium Screening in the Intensive Care Unit: Secrets to Success

    PubMed Central

    Brummel, Nathan E.; Vasilevskis, Eduard E.; Han, Jin Ho; Boehm, Leanne; Pun, Brenda T.; Ely, E. Wesley

    2013-01-01

    Objective To review delirium screening tools available for use in the adult and pediatric ICU, review evidence-based delirium screening implementation and to discuss common pitfalls encountered during delirium screening in the ICU. Data Sources Review of delirium screening literature and expert opinion. Results Over the past decade, tools specifically designed for use in critically ill adults and children have been developed and validated. Delirium screening has been effectively implemented across many ICUs settings. Keys to effective implementation include addressing barriers to routine screening, multi-faceted training such as lectures, case-based scenarios, one-on-one teaching and real-time feedback of delirium screening and interdisciplinary communication through discussion of a patient’s delirium status during bedside rounds and through documentation systems. If delirium is present clinicians should search for reversible or treatable causes since it is often multifactorial. Conclusion Implementation of effective delirium screening is feasible but requires attention to implementation methods, including a change in the current ICU culture that believes delirium is inevitable or a normal part of a critical illness, to a future culture that views delirium as a dangerous syndrome which portends poor clinical outcomes and which is potentially modifiable depending on the individual patients circumstances. PMID:23896832

  9. American Geriatrics Society abstracted clinical practice guideline for postoperative delirium in older adults.

    PubMed

    2015-01-01

    The abstracted set of recommendations presented here provides essential guidance both on the prevention of postoperative delirium in older patients at risk of delirium and on the treatment of older surgical patients with delirium, and is based on the 2014 American Geriatrics Society (AGS) Guideline. The full version of the guideline, American Geriatrics Society Clinical Practice Guideline for Postoperative Delirium in Older Adults is available at the website of the AGS. The overall aims of the study were twofold: first, to present nonpharmacologic and pharmacologic interventions that should be implemented perioperatively for the prevention of postoperative delirium in older adults; and second, to present nonpharmacologic and pharmacologic interventions that should be implemented perioperatively for the treatment of postoperative delirium in older adults. Prevention recommendations focused on primary prevention (i.e., preventing delirium before it occurs) in patients who are at risk for postoperative delirium (e.g., those identified as moderate-to-high risk based on previous risk stratification models such as the National Institute for Health and Care Excellence (NICE) guidelines, Delirium: Diagnosis, Prevention and Management. Clinical Guideline 103; London (UK): 2010 July 29). For management of delirium, the goals of this guideline are to decrease delirium severity and duration, ensure patient safety and improve outcomes.

  10. [Effect of anaesthesia on incidence of postoperative delirium after major abdominal surgery in elderly patients].

    PubMed

    Zabolotskikh, I B; Trembach, N V

    2013-01-01

    Delirium can be caused by haemodynamics abnormalities during anaesthesia. The main role in delirium appearance is given to decreasing of cerebral perfusion pressure. Especially it can happen in patients with underlying intracranial hypertension. Anaesthetics effects on intracranial pressure are different therefore cerebral hypoperfusion can happens in these patients even without systemic hypotension. Purpose of the study was to define an effect of cerebral perfusion pressure decreasing during different technics of anaesthesia on frequency of delirium in elderly patients after major abdominal surgery. The article deals with results of study of 182 patients (medium age 69 y.o.) underwent elective major abdominal surgery. Delirium frequency was 11%, continuing of delirium was 3 days. The frequency of delirium was higher in patients who had got anaesthesia based on sevoflurane. Additionally these patients had higher frequency of cerebral perfusion pressure decreasing. Conclusions; Anaesthesia based on sevoflurane is characterized by higher frequency of postoperative delirium in elderly patients after major abdominal surgery.

  11. Delirium associated with concomitant use of duloxetine and bupropion in an elderly patient.

    PubMed

    Ma, Szu-Pin; Tsai, Chia-Jui; Chang, Cheng-Chen; Hsu, Wen-Yu

    2017-03-01

    Delirium is common in daily practice. Drug-induced delirium constitutes approximately one-third of all cases of delirium. In cases characterized by the limited efficacy of a single antidepressant, a combination of two antidepressants is required, which may induce a complex drug-drug interaction. We reviewed a case of duloxetine- and bupropion-related delirium in an elderly male patient in our clinical practice. The patient was diagnosed with major depressive disorder and was treated with duloxetine. However, he developed delirium 10 days after bupropion was added to his treatment regimen. Three days after the cessation of bupropion, his delirious condition gradually improved. Duloxetine and bupropion are both cytochrome P450 2D6 inhibitors that may result in a higher level of hydroxybupropion. An increased level of hydroxybupropion may cause the elevation of dopamine and a risk of subsequent delirium. We should be aware of the risk of delirium induced by drug-drug interactions.

  12. Use of aripiprazole for delirium in the elderly: a short review.

    PubMed

    Kirino, Eiji

    2015-03-01

    The effects and tolerability of antipsychotics in delirium treatment remain controversial. Compared to other antipsychotics, aripiprazole differs in pharmacological activity because it exerts its effect as a dopamine D2 partial agonist. The guidelines of the American Psychiatric Association rank aripiprazole highly among antipsychotics with regard to safety, and this drug is likely to be useful for delirium treatment. Here, we reviewed the efficacy and safety of aripiprazole for delirium. The results of our literature review on the efficacy and safety of delirium treatments suggest that aripiprazole is an effective treatment option for delirium in the elderly. Aripiprazole is as effective as other antipsychotics in improving delirium symptoms, and it is safer because it is less likely to cause extrapyramidal symptoms, excessive sedation, and weight gain. However, these findings are based on only a few clinical studies of elderly patients with delirium. Therefore, further investigations are necessary.

  13. [Preventive program for postoperative delirium in the elderly].

    PubMed

    Ocádiz-Carrasco, Jesús; Gutiérrez-Padilla, Ruth Alicia; Páramo-Rivas, Frida; Serrano, Alejandro Tovar; Hernández-Ortega, José Luis

    2013-01-01

    Antecedentes: el delirium es un padecimiento poco reconocido en los pacientes quirúrgicos que frecuentemente se confunde con deterioro cognitivo o demencia. Es de vital importancia conocer las medidas que pueden disminuir su incidencia y reconocerlo de manera temprana para iniciar el tratamiento específico. Objetivo: implementar un programa educativo en delirium para el equipo de salud, con el propósito de disminuir su incidencia. Material y métodos: estudio observacional, longitudinal y analítico basado en medidas no farmacológicas y con apoyo de los familiares con quienes se tuvieron sesiones educativas, material didáctico, cuestionarios y estrategias específicas para todos los pacientes mayores de 65 años. Se realizaron dos evaluaciones al personal médico y de enfermería antes y después de implementar el programa.Resultados: se observó mejoría en la capacidad para dentificar el delirium (22% inicial vs 93%; p= 0.000). Se incluyeron 200 pacientes en el grupo de ensayo a un año y se encontró un solo caso de delirium que mostró reducción importante respecto a la incidencia previa en el hospital (10 vs 0.5% p= 0.000), mientras que en el subgrupo de 98 pacientes quirúrgicos no hubo ningún caso de delirium (4.8% inicial vs 0% p= 0.01, NNT= 21). Conclusiones: la implementación de un programa preventivo para el delirium es factible. Los resultados fueron satisfactorios, por lo que puede considerarse una estrategia efectiva para reducir la incidencia de esta afección que puede causar gran morbilidad y mortalidad postoperatoria.

  14. Suspected Delirium Predicts the Thoroughness of Catatonia Evaluation.

    PubMed

    Llesuy, Joan Roig; Coffey, M Justin; Jacobson, Kristen C; Cooper, Joseph J

    2016-11-30

    Although commonly linked to psychiatric disorders, catatonia is frequently identified secondary to neurological and general medical conditions (GMCs). The present study aimed to characterize the diagnostic workup of cases of catatonia in a general hospital setting. The authors performed a retrospective chart review of 54 cases of catatonia, over 3 years. Clinical suspicion of comorbid delirium was the strongest predictor of a more thorough general medical workup. Attribution of catatonia to a psychiatric etiology was associated with significantly less diagnostic workup. Prospective studies should help clarify the relationship between catatonia and delirium and standardize the diagnostic approach to patients presenting with catatonia.

  15. Pain Assessment in Hospitalized Older Adults With Dementia and Delirium

    PubMed Central

    Paulson, Christina May; Monroe, Todd; Mion, Lorraine C.

    2015-01-01

    Pain can have negative effects leading to prolonged hospital stays. Determining the presence of uncontrolled and untreated pain in patients with cognitive impairments such as delirium, dementia, and delirium superimposed on dementia (DSD) is challenging. One tool commonly suggested for use in assessment of pain in older adults with cognitive impairment is the Pain Assessment In Advanced Dementia (PAINAD) scale. Proper use of the PAINAD scale as part of a comprehensive pain management plan can help reduce the likelihood of a patient experiencing unrecognized and untreated pain. Using an individual example, this article illustrates best practices in pain assessment and management for a woman experiencing DSD during an acute hospitalization. PMID:24800815

  16. Randomized Trial of a Delirium Abatement Program for Post-acute Skilled Nursing Facilities

    PubMed Central

    Marcantonio, Edward R.; Bergmann, Margaret A.; Kiely, Dan K.; Orav, E John; Jones, Richard N.

    2010-01-01

    Objectives To determine whether a Delirium Abatement Program (DAP) can shorten the duration of delirium among new admissions to post-acute care (PAC). Design Cluster randomized controlled trial. Setting Eight skilled nursing facilities specializing in PAC within a single metropolitan region. Participants Four hundred fifty-seven participants with delirium at PAC admission. Intervention The DAP consisted of four steps: 1) assessment for delirium within 5 days of PAC admission, 2) assessment and correction of common reversible causes of delirium, 3) prevention of complications of delirium, and 4) restoration of function. Measurements Eligible patients were screened by trained researchers. Those with Confusion Assessment Method defined delirium were eligible for participation via proxy consent. Two weeks and one month after enrollment, regardless of location, participants were re-assessed for delirium by researchers blind to intervention status. Results Nurses at DAP sites detected delirium in 41% of participants vs. 12% in usual care (UC) sites (p<.001) and completed DAP documentation in most delirium-detected participants. However, the DAP intervention had no impact on delirium persistence based on two measurements at 2 weeks (DAP 68% vs. UC 66%) and 1 month (DAP 60% vs. UC 51%), adjusted p values ≥ 0.20. Adjusting for baseline differences between DAP and UC participants and restricting analysis to delirium-detected DAP participants did not alter the results. Conclusion Detection of delirium improved at the DAP sites, however, the DAP had no impact on the persistence of delirium. This effectiveness trial demonstrated that a nurse-led DAP intervention was not effective in typical PAC facilities. PMID:20487083

  17. Delirium superimposed on dementia: a quantitative and qualitative evaluation of patient experience

    PubMed Central

    Morandi, Alessandro; Lucchi, Elena; Turco, Renato; Morghen, Sara; Guerini, Fabio; Santi, Rossana; Gentile, Simona; Meagher, David; Voyer, Philippe; Fick, Donna; Schmitt, Eva M.; Inouye, Sharon K.; Trabucchi, Marco; Bellelli, Giuseppe

    2015-01-01

    Objective Delirium superimposed on dementia is common and is associated with adverse outcomes. Yet little is known about the patients’ personal delirium experiences. We used quantitative and qualitative methods to assess the delirium superimposed on dementia experience among older patients. Methods We conducted a prospective cohort study among patients with delirium superimposed on dementia who were admitted to a rehabilitation ward. Delirium was diagnosed using DSM-IV-TR criteria. Delirium severity and symptoms were evaluated with the Delirium-O-Meter (D-O-M). The experience of delirium was assessed after delirium resolution (T0) and one month later (T1) with a standardized questionnaire and a qualitative interview. Level of distress was measured with the Delirium Experience Questionnaire. Results Of the 30 patients included in the study, 50% had mild dementia; 33% and 17% had moderate and severe dementia. Half of the patients had evidence of the full range of D-O-M delirium symptoms. We evaluated 30 patients at T0 and 20 at T1. At T0, half of the patients remembered being confused as part of the delirium episode, and reported an overall moderate level of related distress. Patients reported high distress related to memories of anxiety/fear, delusions, restlessness, hypokinesia, and impaired orientation. Qualitative interviews revealed six main aspects of patients delirium experiences: Emotions; Cognitive Impairment; Psychosis; Memories; Awareness of Change; and Physical Symptoms. Conclusions The study provides novel information on the delirium experience in patients with dementia. These findings are key for health care providers to improve the everyday care of this important group of frail older patients. PMID:26282373

  18. Sepsis associated delirium mimicking postoperative delirium as the initial presenting symptom of urosepsis in a patient who underwent nephrolithotomy.

    PubMed

    Nag, Deb Sanjay; Chatterjee, Abhishek; Samaddar, Devi Prasad; Singh, Harprit

    2016-05-16

    We report a case of 70 years old male who underwent percutaneous nephrolithotomy for renal calculi. After an uneventful recovery from anaesthesia, the patient developed delirium which manifested as restlessness, agitation, irritability and combative behavior. All other clinical parameters including arterial blood gas, chest X-ray and core temperature were normal and the patient remained haemodynamically stable. But 45 min later the patient developed florid manifestations of septic shock. He was aggressively managed in a protocolized manner as per the Surviving Sepsis Guidelines in the Critical Care Unit and recovered completely. There are no case reports showing postoperative delirium as the only initial presentation of severe sepsis, with other clinical parameters remaining normal. Both urosepsis and sepsis associated delirium have very high mortality. High index of suspicion and a protocolized approach in the management of sepsis can save lives.

  19. Delirium as a complication of the surgical intensive care

    PubMed Central

    Horacek, Rostislav; Krnacova, Barbora; Prasko, Jan; Latalova, Klara

    2016-01-01

    Background The aim of this study was to examine the impact of somatic illnesses, electrolyte imbalance, red blood cell count, hypotension, and antipsychotic and opioid treatment on the duration of delirium in Central Intensive Care Unit for Surgery. Patients and methods Patients who were admitted to the Department of Central Intensive Care Unit for Surgery in the University Hospital Olomouc from February 2004 to November 2008 were evaluated using Riker sedation–agitation scale. Their blood pressure, heart rate, respiratory rate, and peripheral blood oxygen saturation were measured continually, and body temperature was monitored once in an hour. The laboratory blood tests including sodium, potassium, chlorides, phosphorus, urea and creatinine, hemoglobin, hematocrit, red and white blood cell count, and C-reactive protein, albumin levels and laboratory markers of renal and liver dysfunction were done every day. All measurements were made at least for ten consecutive days or longer until the delirium resolved. Results The sample consisted of 140 consecutive delirious patients with a mean age of 68.21±12.07 years. Delirium was diagnosed in 140 of 5,642 patients (2.48%) admitted in CICUS in the last 5 years. The median duration of delirium was 48 hours with a range of 12–240 hours. Statistical analysis showed that hyperactive subtype of delirium and treatment with antipsychotics were associated with prolonged delirium duration (hyperactive 76.15±40.53 hours, hypoactive 54.46±28.44 hours, mixed 61.22±37.86 hours; Kruskal–Wallis test: 8.022; P<0.05). The duration of delirium was significantly correlated also with blood potassium levels (Pearson’s r=0.2189, P<0.05), hypotension (hypotension 40.41±30.23 hours versus normotension 70.47±54.98 hours; Mann–Whitney U=1,512; P<0.05), administration of antipsychotics compared to other drugs (antipsychotics 72.83±40.6, benzodiazepines 42.00±20.78, others drugs, mostly piracetam 46.96±18.42 hours; Kruskal

  20. A Family-Focused Delirium Educational Initiative With Practice and Research Implications.

    PubMed

    Paulson, Christina May; Monroe, Todd; McDougall, Graham J; Fick, Donna M

    2016-01-01

    Delirium is burdensome and psychologically distressing for formal and informal caregivers, yet family caregivers often have very little understanding or knowledge about delirium. As part of a large multisite intervention study, the Early Nurse Detection of Delirium Superimposed on Dementia (END-DSD), the authors identified a need for family educational materials. This educational initiative's purpose was to develop a delirium admission brochure for family members to aid in the prevention and earlier identification of delirium during hospitalization. A brochure was developed using an iterative approach with an expert panel. Following three iterations, a final brochure was approved. The authors found that an iterative expert consensus approach can be used to develop a brochure for families. Major content areas were helping families understand the difference between delirium and dementia, signs and symptoms of delirium, causes of delirium, and strategies family members can use to prevent delirium. A caregiver-focused educational brochure is one intervention to use in targeting older adults hospitalized with delirium.

  1. Nursing care for people with delirium superimposed on dementia.

    PubMed

    Pryor, Claire; Clarke, Amanda

    2017-03-31

    Nursing and healthcare is changing in response to an ageing population. There is a renewed need for holistic nursing to provide clinically competent, appropriate and timely care for patients who may present with inextricably linked mental and physical health requirements. This article explores the dichotomy in healthcare provision for 'physical' and 'mental' health, and the unique role nurses have when caring for people with delirium superimposed on dementia (DSD). Delirium is prevalent in older people and recognised as 'acute brain failure'. As an acute change in cognition, it presents a unique challenge when occurring in a person with dementia and poses a significant risk of mortality. In this article, dementia is contrasted with delirium and subtypes of delirium presentation are discussed. Nurses can recognise DSD through history gathering, implementation of appropriate care and effective communication with families and the multidisciplinary team. A simple mnemonic called PINCH ME (Pain, INfection, Constipation, deHydration, Medication, Environment) can help identify potential underlying causes of DSD and considerations for care planning. The mnemonic can easily be adapted to different clinical settings and a fictitious scenario is presented to show its application in practice.

  2. Differential Diagnosis in Older Adults: Dementia, Depression, and Delirium.

    ERIC Educational Resources Information Center

    Gintner, Gary G.

    1995-01-01

    Examines three common disorders, dementia, depression, and delirium, which can be particularly difficult to diagnose in older adults. Presents three aspects that are helpful in making a decision: age-related differences, medical issues that need to be ruled out, and assessment methods particularly useful in the diagnostic process. (JPS)

  3. Standardizing Management of Adults with Delirium Hospitalized on Medical-Surgical Units

    PubMed Central

    Angel, Clay; Brooks, Kristen; Fourie, Julie

    2016-01-01

    Context Delirium is common among inpatients aged 65 years and older and is associated with multiple adverse consequences, including increased length of stay (LOS). However, delirium is frequently unrecognized and poorly understood. At one hospital, baseline management of delirium on medical-surgical units varied greatly, and psychiatric consultations focused exclusively on crisis management. Objective To implement a multidisciplinary program for rapid identification and proactive management of patients with delirium on medical-surgical units. Design A pilot from September 2010 to July 2012 included 920 unique patients, of whom 470 were seen by the delirium management team. A delirium management team included a redesigned role for consulting psychiatrists and a new clinical nurse specialist role; the team provided assistance with diagnosis and recommendations for nonpharmacologic and pharmacologic management of delirium. Multidisciplinary education focused on delirium identification and management and nurses’ use of appropriate assessment tools. Electronic health record functions supported accurate problem list coding, referrals to the team, and standardized documentation. Main Outcome Measure Length of stay. Results During the study period, average LOS in the target population decreased from 8.5 days to 6.5 days (p = 0.001); average LOS for the Medical Center remained stable. Compared with patients whose delirium was diagnosed during the baseline period, patients who received a delirium diagnosis during the pilot period had a higher illness burden and were likelier to have a history of delirium and diagnosed dementia. Conclusion Program implementation was associated with reduced LOS among older inpatients with delirium. The delirium team is an effective model that can be quickly implemented with few additional resources. PMID:27644045

  4. Developing and implementing an integrated delirium prevention system of care: a theory driven, participatory research study

    PubMed Central

    2013-01-01

    Background Delirium is a common complication for older people in hospital. Evidence suggests that delirium incidence in hospital may be reduced by about a third through a multi-component intervention targeted at known modifiable risk factors. We describe the research design and conceptual framework underpinning it that informed the development of a novel delirium prevention system of care for acute hospital wards. Particular focus of the study was on developing an implementation process aimed at embedding practice change within routine care delivery. Methods We adopted a participatory action research approach involving staff, volunteers, and patient and carer representatives in three northern NHS Trusts in England. We employed Normalization Process Theory to explore knowledge and ward practices on delirium and delirium prevention. We established a Development Team in each Trust comprising senior and frontline staff from selected wards, and others with a potential role or interest in delirium prevention. Data collection included facilitated workshops, relevant documents/records, qualitative one-to-one interviews and focus groups with multiple stakeholders and observation of ward practices. We used grounded theory strategies in analysing and synthesising data. Results Awareness of delirium was variable among staff with no attention on delirium prevention at any level; delirium prevention was typically neither understood nor perceived as meaningful. The busy, chaotic and challenging ward life rhythm focused primarily on diagnostics, clinical observations and treatment. Ward practices pertinent to delirium prevention were undertaken inconsistently. Staff welcomed the possibility of volunteers being engaged in delirium prevention work, but existing systems for volunteer support were viewed as a barrier. Our evolving conception of an integrated model of delirium prevention presented major implementation challenges flowing from minimal understanding of delirium prevention

  5. New aspects of delirium in elderly patients with critical limb ischemia

    PubMed Central

    van Eijsden, Willem A; Raats, Jelle W; Mulder, Paul GH; van der Laan, Lijckle

    2015-01-01

    Objective The primary objective was to identify possible risk factors for delirium in patients with critical limb ischemia undergoing surgery. The secondary objective was to study the effect of delirium on complications, the length of hospital stay, health care costs, and mortality. Methods All patients 65 years or older with critical limb ischemia undergoing surgery from February 2013 to July 2014 at Amphia Hospital, were included and followed up until December 31, 2014. Delirium was scored using the Delirium Observation Screening Scale (DOSS). Perioperative risk factors (age, comorbidity, factors of frailty, operation type, hemoglobulin, and transfusion) were collected and analyzed using logistic regression. Secondary outcomes were the number of complications, total hospital stay, extra health care costs per delirium, and mortality within 3 months and 6 months of surgery. Results We included 92 patients with critical limb ischemia undergoing surgery. Twenty-nine (32%) patients developed a delirium during admission, of whom 17 (59%) developed delirium preoperatively. After multivariable analysis, only diabetes mellitus (odds ratio [OR] =6.23; 95% confidence interval [CI]: 1.11–52.2; P=0.035) and Short Nutritional Assessment Questionnaire for Residential Care (SNAQ-RC) ≥3 (OR =5.55; 95% CI: 1.07–42.0; P=0.039) was significantly associated with the onset of delirium. Delirium was associated with longer hospital stay (P=0.001), increased health care costs, and higher mortality after 6 months (P<0.001). Conclusion Delirium is a common adverse event in patients with critical limb ischemia undergoing surgery with devastating outcome in the long term. Most patients developed delirium preoperatively, which indicates the need for early recognition and preventive strategies in the preoperative period. This study identified undernourishment and diabetes mellitus as independent risk factors for delirium. PMID:26451094

  6. Cerebral blood flow during delirium tremens and related clinical states studied with xenon-133 inhalation tomography

    SciTech Connect

    Hemmingsen, R.; Vorstrup, S.; Clemmesen, L.; Holm, S.; Tfelt-Hansen, P.; Sorensen, A.S.; Hansen, C.; Sommer, W.; Bolwig, T.G.

    1988-11-01

    The regional cerebral blood flow of 12 patients with severe alcohol withdrawal reactions (delirium tremens or impending delirium tremens) was measured during the acute state before treatment and after recovery. Greater cerebral blood flow was significantly correlated with visual hallucinations and agitation during the acute withdrawal reaction. The results suggest that delirium tremens and related clinical states represent a type of acute brain syndrome mainly characterized by CNS hyperexcitability.

  7. Post–Liver Transplant Delirium Increases Mortality and Length of Stay

    PubMed Central

    Oliver, Nathan; Bohorquez, Humberto; Anders, Stephanie; Freeman, Andrew; Fine, Kerry; Ahmed, Emily; Bruce, David S.; Carmody, Ian C.; Cohen, Ari J.; Seal, John; Reichman, Trevor W.; Loss, George E.

    2017-01-01

    Background: Incidence of delirium after liver transplantation (LT) has been reported to occur in 10%-47% of patients and is associated with increased hospital and intensive care unit lengths of stay and poor outcomes. Methods: Our primary objective was to evaluate the incidence and predisposing risk factors for developing delirium after LT. Our secondary objectives were to describe how delirium is managed in patients after LT, to examine the utilization of resources associated with delirium after LT, and to analyze the outcomes of patients who were treated for delirium after LT. Results: In a population of 181 consecutive patients who received an LT, 38 (21.0%) developed delirium. In the multivariate analysis, delirium was associated with pretransplant use of antidepressants (odds ratio [OR] 3.34, 95% confidence interval [CI] 1.29-8.70) and pretransplant hospital admission for encephalopathy (OR 4.39, 95% CI 1.77-10.9). Patients with delirium spent more time on mechanical ventilation (2.0 vs 1.3 days, P=0.008) and had longer intensive care unit stays (4.6 vs 2.7 days, P=0.008), longer hospital stays (27.6 vs 11.2 days, P=0.003), and higher 6-month mortality (13.2% vs 1.4%, P=0.003) than patients who did not develop delirium. Conclusion: The presence of delirium is common after LT and is associated with high morbidity and mortality within the first 6 months posttransplant. Pretransplant factors independently associated with developing delirium after LT include prior use of antidepressants and pretransplant hospital admission for encephalopathy. Efforts should be made to identify patients at risk for delirium, as protocol-based management may improve outcomes in a cost-effective manner. PMID:28331444

  8. Diagnosis and Management of Delirium in Critically Ill Infants: Case Report and Review.

    PubMed

    Brahmbhatt, Khyati; Whitgob, Emily

    2016-03-01

    Delirium in children is common but not widely understood by pediatric practitioners, often leading to underdiagnosis and lack of treatment. This presents a significant challenge in the young patients in the PICU who are most at risk for delirium and in whom the core features of delirium are difficult to assess and treat. However, because of the potential increased morbidity and mortality associated with untreated delirium in adults and children, it remains important to address it promptly. The literature for delirium in this age group is limited. Here we present the case of an infant with multiple underlying medical risk factors who exhibited waxing and waning motor restlessness with disrupted sleep-wake cycles contributing significantly to destabilization of vital parameters. Making a diagnosis of delirium was key to guiding further treatment. After appropriate environmental interventions are implemented and underlying medical causes are addressed, antipsychotic medications, although not Food and Drug Administration-approved in infants, are the mainstay of pharmacotherapy for delirium in older age groups. They may lengthen corrected QT interval (QTc) intervals, presenting a challenge in infants who frequently have other coexisting risks for QTc prolongation, as in our case. The risk from QTc prolongation needs to be balanced against that from untreated delirium. Low doses of risperidone were successfully used in this patient and without side effects or worsening of QTc interval. This case illustrates the importance of increased recognition of delirium in children, including infants, and the role for cautious consideration of atypical antipsychotics in the very young.

  9. Preoperative risk factors of postoperative delirium after transurethral prostatectomy for benign prostatic hyperplasia

    PubMed Central

    Tai, Sheng; Xu, Lingfan; Zhang, Li; Fan, Song; Liang, Chaozhao

    2015-01-01

    The aim of this observational study was to investigate the occurrence of post operation delirium in the elderly patients undergoing the transurethral prostatectomy and to identify these factors associated with the delirium. 485 patients, undergoing the transurethral prostatectomy, were selected. Demographics, medical, cognitive and functional data, IPSS and NIH-CPSI score were collected as predictors for delirium. After surgery, the patients were divided on the basis of delirium onset within one week observation period, and the delirium was diagnosed by the Confusion Assessment Method. Totally, 21.23% (103) subjects were identified as the delirium and it lasted 2.9 ± 0.8 days. Patients with post operation delirium were significantly older and single, widowed and divorced, had a previous history of prehospitalization, were with the poor International Prostate Symptom Score (IPSS) and National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score, were more impaired in the instrumental activities of daily living (IADL), and had poor clock drawing test (CDT) and geriatric depression scale (GDS) score. Age, marital status, IPSS and NIH-CPIS score, cognitive and functional status and previous history of hospitalization are the predictors of post operation delirium. Our study has implications in preventing delirium via an early and targeted evaluation. PMID:26064386

  10. Existential Absence: The Lived Experience of Family Members During Their Older Loved One's Delirium.

    PubMed

    Day, Jenny; Higgins, Isabel

    2015-12-01

    When older people develop delirium, their demeanor changes; they often behave in ways that are out of character and seem to inhabit another world. Despite this, little is known about the experiences of family members who are with their older loved one at this time. This article reports a phenomenological study that involved in-depth interviews with 14 women whose older loved one had delirium. Analysis and interpretation of the data depict the women's experiences as "Changing family portraits: Sudden existential absence during delirium," capturing the way family members lose the taken-for-granted presence of their familiar older loved one and confront a stranger during delirium.

  11. Treatment of post-electroconvulsive therapy delirium and agitation with donepezil.

    PubMed

    Logan, Christopher J; Stewart, Jonathan T

    2007-03-01

    Delirium and agitation are commonly encountered after administration of electroconvulsive therapy (ECT). Management is generally fairly straightforward, although some patients may have a severe, prolonged, or refractory course. We recently cared for a 65-year-old man who consistently developed severe and very prolonged post-ECT delirium that did not respond to typical pharmacological agents; the duration of delirium was dramatically shortened by the addition of donepezil. Cholinesterase inhibitors may have a place in mitigating severe and prolonged post-ECT delirium.

  12. Delirium Detection and Impact of Comorbid Health Conditions in a Post-Acute Rehabilitation Hospital Setting

    PubMed Central

    Stelmokas, Julija; Gabel, Nicolette; Flaherty, Jennifer M.; Rayson, Katherine; Tran, Kathileen; Anderson, Jason R.; Bieliauskas, Linas A.

    2016-01-01

    Misdiagnosis and under-detection of delirium may occur in many medical settings. This is important to address as delirium clearly increases risk of morbidity and mortality in such settings. This study assessed whether Veterans who screened positive on a delirium severity measure (Memorial Delirium Assessment Scale; MDAS) differed from those with and without corresponding medical documentation of delirium in terms of cognitive functioning, psychiatric/medical history, and medication use. A medical record review of 266 inpatients at a VA post-acute rehabilitation unit found that 10.9% were identified as delirious according to the MDAS and/or medical records. Of the Veterans who screened positive on the MDAS (N = 19), 68.4% went undetected by medical screening. Undetected cases had a higher number of comorbid medical conditions as measured by the Age-Adjusted Charlson Index (AACI) scores (median = 9, SD = 3.15; U = 5.5, p = .003) than medically documented cases. For Veterans with a score of 7 or greater on the AACI, the general relative risk for delirium was 4.46. Delirium is frequently under-detected in a post-acute rehabilitation unit, particularly for Veterans with high comorbid illness. The relative risk of delirium is up to 4.46 for those with high medical burden, suggesting the need for more comprehensive delirium screening in these patients. PMID:27902744

  13. Identifying Barriers to Delirium Screening and Prevention in the Pediatric ICU: Evaluation of PICU Staff Knowledge.

    PubMed

    Flaigle, Melanie Cooper; Ascenzi, Judy; Kudchadkar, Sapna R

    2016-01-01

    Delirium in the pediatric intensive care unit (PICU) setting is often unrecognized and undertreated. The importance of screening and identification of ICU delirium has been identified in both adult and pediatric literature. Delirium increases ICU morbidity, length of mechanical ventilation and length of stay. The objective of this study was to determine the current knowledge level about delirium and its risk factors among pediatric critical care nurses through a short questionnaire. We hypothesized that before a targeted educational intervention, PICU care providers do not have an adequate knowledge base for accurate screening and diagnosis of delirium in critically ill children. A 17 question online survey was given to all nurses in a tertiary 36-bed PICU to assess current knowledge about delirium in children. The response rate was 73% (105/143). When asked to identify the correct way to diagnose pediatric delirium, 11.4% of nurses surveyed (12/105) incorrectly believed that Glasgow Coma Score is the appropriate screening tool. A large proportion of respondents (40/105) believed that benzodiazepines are helpful in treatment of delirium. The results of the survey identified specific knowledge gaps about risk factors and treatment of pediatric delirium in the critically ill child. There is a critical need for education about pediatric delirium and its risk factors among PICU staff prior to unit-wide implementation of a delirium screening and prevention program, specifically with regards to screening methods and pharmacologic risk factors. These results are likely generalizable to all physicians, nurses and staff who care for critically ill children.

  14. The diurnal profile of melatonin during delirium in elderly patients--preliminary results.

    PubMed

    Piotrowicz, Karolina; Klich-Rączka, Alicja; Pac, Agnieszka; Zdzienicka, Anna; Grodzicki, Tomasz

    2015-12-01

    Delirium is an acute-onset syndrome that exacerbates patients' condition and significantly increases consequential morbidity and mortality. There is no comprehensive, cellular and tissue-level, pathophysiological theory. The melatonin hormone imbalance has been shown to be linked to circadian rhythms, sleep-wake cycle disturbances, and delirium incidence. There has been relatively little research about melatonin in delirium, and there has been no such study done in the group of elderly patients of a general medicine ward yet. The aim of our study was to compare melatonin hormone concentration in relation to the presence of delirium in elderly patients hospitalized in the general medicine ward. Blood samples were collected four times a day for two days (at 12:00, 18:00, 00:00 and 6:00), on the day when delirium was diagnosed and 72 h after the delirium resolution. Delirium was diagnosed with the Confusion Assessment Method and the criteria of the Diagnostic and Statistic Manual of Mental Disorders, 4th Revision. The mean age of 30 patients (73.3% women) was 86.5 ± 5.2 years. Delirium was diagnosed most often on the second and third day of hospitalization. A lot of predisposing and precipitating factors for delirium were identified. There was a significant difference in the melatonin hormone concentration measurement at 12:00 when patients had acute delirium and after its resolution [18.5 (13.8, 27.5) vs 12.9 (9.8, 17.8), p<0.01]. Different patterns of the melatonin hormone concentration were shown in analyses in the subgroups defined according to the patients' diagnosis of dementia. We found that the delirium recovery was, in fact, associated with the alteration of the daily profile of melatonin.

  15. One-Year Health Care Costs Associated with Delirium in the Elderly

    PubMed Central

    Leslie, Douglas L.; Marcantonio, Edward R.; Zhang, Ying; Leo-Summers, Linda; Inouye, Sharon K.

    2015-01-01

    Background While delirium has been increasingly recognized as a serious and potentially preventable source of morbidity and mortality for hospitalized older persons, its long-term implications are not well understood. The objective of this study is to determine the total 1-year health care costs associated with delirium. Methods Hospitalized patients aged 70 years and older who participated in a previous controlled clinical trial of a delirium prevention intervention at an academic medical center between 1995 and 1998 were followed for 1 year after discharge. Total inflation-adjusted healthcare costs were computed using data from Medicare administrative files, hospital billing records, and the Connecticut Long-Term Care Registry. Regression models were used to determine costs associated with delirium after adjusting for patient sociodemographic and clinical characteristics. Results During the index hospitalization, 109 (13%) patients developed delirium while 732 did not. Patients with delirium had significantly higher unadjusted healthcare costs than non-delirious patients and survived fewer days. After adjusting for pertinent demographic and clinical characteristics, average costs per day survived among patients with delirium were over two and a half times the costs among patients without delirium. Total cost estimates attributable to delirium ranged from $16,303 to $64,421 per patient, implying that the national burden of delirium on the health care system ranges from $38 billion to $152 billion each year. Conclusions The economic impact of delirium is substantial, rivaling the health care costs of falls and diabetes. These results highlight the need for increased efforts to mitigate this clinically significant and costly disorder. PMID:18195192

  16. Delirium in Severely Ill Young Children in the Pediatric Intensive Care Unit (PICU)

    ERIC Educational Resources Information Center

    Schieveld, Jan N. M.; Leentjens, Albert F. G.

    2005-01-01

    Delirium is a serious neuropsychiatric disorder frequently seen in severely ill adult and geriatric patients. The clinical picture in adults is well known, as are the negative prognostic implications of delirium on length of hospital stay, morbidity, and mortality (American Psychiatric Association, 1999); however, it is less appreciated that…

  17. Delirium in intensive care unit patients under noninvasive ventilation: a multinational survey

    PubMed Central

    Tanaka, Lilian Maria Sobreira; Salluh, Jorge Ibrain Figueira; Dal-Pizzol, Felipe; Barreto, Bruna Brandão; Zantieff, Ricardo; Tobar, Eduardo; Esquinas, Antonio; Quarantini, Lucas de Castro; Gusmao-Flores, Dimitri

    2015-01-01

    Objective To conduct a multinational survey of intensive care unit professionals to determine the practices on delirium assessment and management, in addition to their perceptions and attitudes toward the evaluation and impact of delirium in patients requiring noninvasive ventilation. Methods An electronic questionnaire was created to evaluate the profiles of the respondents and their related intensive care units, the systematic delirium assessment and management and the respondents' perceptions and attitudes regarding delirium in patients requiring noninvasive ventilation. The questionnaire was distributed to the cooperative network for research of the Associação de Medicina Intensiva Brasileira (AMIB-Net) mailing list and to researchers in different centers in Latin America and Europe. Results Four hundred thirty-six questionnaires were available for analysis; the majority of the questionnaires were from Brazil (61.9%), followed by Turkey (8.7%) and Italy (4.8%). Approximately 61% of the respondents reported no delirium assessment in the intensive care unit, and 31% evaluated delirium in patients under noninvasive ventilation. The Confusion Assessment Method for the intensive care unit was the most reported validated diagnostic tool (66.9%). Concerning the indication of noninvasive ventilation in patients already presenting with delirium, 16.3% of respondents never allow the use of noninvasive ventilation in this clinical context. Conclusion This survey provides data that strongly reemphasizes poor efforts toward delirium assessment and management in the intensive care unit setting, especially regarding patients requiring noninvasive ventilation. PMID:26761474

  18. Beyond Grand Rounds: A Comprehensive and Sequential Intervention to Improve Identification of Delirium

    ERIC Educational Resources Information Center

    Ramaswamy, Ravishankar; Dix, Edward F.; Drew, Janet E.; Diamond, James J.; Inouye, Sharon K.; Roehl, Barbara J. O.

    2011-01-01

    Purpose of the Study: Delirium is a widespread concern for hospitalized seniors, yet is often unrecognized. A comprehensive and sequential intervention (CSI) aiming to effect change in clinician behavior by improving knowledge about delirium was tested. Design and Methods: A 2-day CSI program that consisted of progressive 4-part didactic series,…

  19. [The influence of epileptic predisposition on clinical features of schizophrenia in patients after delirium tremens].

    PubMed

    Dvirskiĭ, A A

    2001-01-01

    153 patients with schizophrenia in combination with alcoholic delirium were examined. Latent epilepsy has been found in 36 patients (23.5%). The basis of the epileptic seizures during alcoholic delirium was hereditary epileptic predisposition. Frequency of the progredient course was high while that of the favourable--recurrent course of schizophrenia was low in these cases.

  20. Case Study: Delirium in an Adolescent Girl with Human Immunodeficiency Virus-Associated Dementia

    ERIC Educational Resources Information Center

    Scharko, Alexander M.; Baker, Eva H.; Kothari, Priti; Khattak, Hina; Lancaster, Duniya

    2006-01-01

    Delirium and human immunodeficiency virus (HIV)-associated dementia are well recognized neuropsychiatric consequences of HIV infection in adults. Almost nothing is known regarding the management of delirium in HIV-infected children and adolescents. HIV-related progressive encephalopathy is thought to represent the pediatric form of HIV-associated…

  1. Short-term cognitive effects after recovery from a delirium in a hospitalized elderly sample.

    PubMed

    Mark, Ruth E; Muselaers, Noortje; Scholten, Hetty; van Boxtel, Anton; Eerenberg, Trudy

    2014-10-01

    The aim of this study was to examine early cognitive performance after a delirium in elderly general hospital patients. Patients were divided into a delirium (n = 47) and a control (n = 25) group. One week before discharge and after delirium had cleared in the first group, all patients completed a neuropsychological test battery (The Cambridge Cognitive Examination-Revised [CAMCOG-R]). Group differences in cognitive performance were analyzed adjusting for differences in baseline sociodemographic and clinical variables. Adjusting for group differences in baseline variables, the delirium group performed significantly worse than the control group on CAMCOG-R; its subdomains language, praxis, and executive functioning; and on Mini Mental State Examination derived from CAMCOG-R. The occurrence of delirium in hospital thus detrimentally affects early cognitive performance.

  2. DELirium Prediction Based on Hospital Information (Delphi) in General Surgery Patients.

    PubMed

    Kim, Min Young; Park, Ui Jun; Kim, Hyoung Tae; Cho, Won Hyun

    2016-03-01

    To develop a simple and accurate delirium prediction score that would allow identification of individuals with a high probability of postoperative delirium on the basis of preoperative and immediate postoperative data.Postoperative delirium, although transient, is associated with adverse outcomes after surgery. However, there has been no appropriate tool to predict postoperative delirium.This was a prospective observational single-center study, which consisted of the development of the DELirium Prediction based on Hospital Information (Delphi) score (n = 561) and its validation (n = 533). We collected potential risk factors for postoperative delirium, which were identified by conducting a comprehensive review of the literatures.Age, low physical activity, hearing impairment, heavy alcoholism, history of prior delirium, intensive care unit (ICU) admission, emergency surgery, open surgery, and increased preoperative C-reactive protein were identified as independent predictors of postoperative delirium. The Delphi score was generated using logistic regression coefficients. The maximum Delphi score was 15 and the optimal cut-off point identified with the Youden index was 6.5. Generated area under the (AUC) of the receiver operating characteristic (ROC) curve was 0.911 (95% CI: 0.88-0.94). In the validation study, the calculated AUC of the ROC curve based on the Delphi score was 0.938 (95% Cl: 0.91-0.97). We divided the validation cohort into the low-risk group (Delphi score 0-6) and high-risk group (7-15). Sensitivity of Delphi score was 80.8% and specificity 92.5%.Our proposed Delphi score could help health-care provider to predict the development of delirium and make possible targeted intervention to prevent delirium in high-risk surgery patients.

  3. Delirium in the geriatric unit: proton-pump inhibitors and other risk factors

    PubMed Central

    Otremba, Iwona; Wilczyński, Krzysztof; Szewieczek, Jan

    2016-01-01

    Background Delirium remains a major nosocomial complication of hospitalized elderly. Predictive models for delirium may be useful for identification of high-risk patients for implementation of preventive strategies. Objective Evaluate specific factors for development of delirium in a geriatric ward setting. Methods Prospective cross-sectional study comprised 675 consecutive patients aged 79.2±7.7 years (66% women and 34% men), admitted to the subacute geriatric ward of a multiprofile university hospital after exclusion of 113 patients treated with antipsychotic medication because of behavioral disorders before admission. Comprehensive geriatric assessments including a structured interview, physical examination, geriatric functional assessment, blood sampling, ECG, abdominal ultrasound, chest X-ray, Confusion Assessment Method for diagnosis of delirium, Delirium-O-Meter to assess delirium severity, Richmond Agitation-Sedation Scale to assess sedation or agitation, visual analog scale and Doloplus-2 scale to assess pain level were performed. Results Multivariate logistic regression analysis revealed five independent factors associated with development of delirium in geriatric inpatients: transfer between hospital wards (odds ratio [OR] =2.78; confidence interval [CI] =1.54–5.01; P=0.001), preexisting dementia (OR =2.29; CI =1.44–3.65; P<0.001), previous delirium incidents (OR =2.23; CI =1.47–3.38; P<0.001), previous fall incidents (OR =1.76; CI =1.17–2.64; P=0.006), and use of proton-pump inhibitors (OR =1.67; CI =1.11–2.53; P=0.014). Conclusion Transfer between hospital wards, preexisting dementia, previous delirium incidents, previous fall incidents, and use of proton-pump inhibitors are predictive of development of delirium in the geriatric inpatient setting. PMID:27103793

  4. Melatonin treatment in the prevention of postoperative delirium in cardiac surgery patients

    PubMed Central

    Artemiou, Panagiotis; Bilecova-Rabajdova, Miroslava; Sabol, Frantisek; Torok, Pavol; Kolarcik, Peter; Kolesar, Adrian

    2015-01-01

    Introduction Post-cardiac surgery delirium is a severe complication. The circadian rhythm of melatonin secretion has been shown to be altered postoperatively. Aim of the study It was hypothesized that restoring normal sleeping patterns with a substance that is capable of resynchronizing circadian rhythm such as exogenous administration of melatonin may possibly reduce the incidence of postoperative delirium. Material and methods This paper represents a prospective clinical observational study. Two consecutive groups of 250 consecutive patients took part in the study. Group A was the control group and group B was the melatonin group. In group B, the patients received prophylactic melatonin treatment. The main objectives were to observe the incidence of delirium, to identify any predictors of delirium, and to compare the two groups based on the delirium incidence. Results The incidence of delirium was 8.4% in the melatonin group vs. 20.8% in the control group (p = 0.001). Predictors of delirium in the melatonin group were age (p = 0.001) and higher EuroSCORE II value (p = 0.001). In multivariate analysis, age and EuroSCORE II value (p = 0.014) were predictors of postoperative delirium. Comparing the groups, the main predictors of delirium were age (p = 0.001), EuroSCORE II value (p = 0.001), cardio-pulmonary bypass (CPB) time (p = 0.001), aortic cross-clamping (ACC) time (p = 0.008), sufentanil dose (p = 0.001) and mechanical ventilation (p = 0.033). Conclusions Administration of melatonin significantly decreases the incidence of postoperative delirium after cardiac surgery. Prophylactic treatment with melatonin should be considered in every patient scheduled for cardiac surgery. PMID:26336494

  5. Determining the need for team-based training in delirium management: A needs assessment of surgical healthcare professionals.

    PubMed

    Sockalingam, Sanjeev; Tehrani, Hedieh; Kacikanis, Anna; Tan, Adrienne; Hawa, Raed; Anderson, Ruthie; Okrainec, Allan; Abbey, Susan

    2015-01-01

    The high incidence of delirium in surgical units is a serious quality concern, given its impact on morbidity and mortality. While successful delirium management depends upon interdisciplinary care, training needs for surgical teams have not been studied. A needs assessment of surgical units was conducted to determine perceived comfort in managing delirium, and interprofessional training needs for team-based care. We administered a survey to 106 General Surgery healthcare professionals (69% response rate) with a focus on attitudes towards delirium and team management. Although most respondents identified delirium as important to patient outcomes, only 61% of healthcare professionals indicated that a team-based approach was always observed in practice. Less than half had a clear understanding of their role in delirium care, while just over half observed team communication of delirium care plans during handover. This is the first observation of clear gaps in perceived team performance in a General Surgery setting.

  6. Cognitive and Brain Reserve and the Risk of Postoperative Delirium in Older Patients

    PubMed Central

    Saczynski, Jane S.; Inouye, Sharon K.; Kosar, Cyrus; Tommet, Doug; Marcantonio, Edward R.; Fong, Tamara; Hshieh, Tammy; Vasunilashorn, Sarinnapha; Metzger, Eran D.; Schmitt, Eva; Alsop, David C.; Jones, Richard N.

    2015-01-01

    Background Cognitive and brain reserve theories suggest that aspects of neural architecture or cognitive processes modify the impact of neuropathological processes on cognitive outcomes. While frequently studied in the context of dementia, reserve in delirium is relatively understudied. Methods We examined the association of three markers of brain reserve (head circumference, MRI-derived brain volume, and leisure time physical activity) and five markers of cognitive reserve (education, vocabulary, cognitive activities, cognitive demand of lifetime occupation, and interpersonal demand of lifetime occupation) and the risk of postoperative delirium in a prospective observational study of 566 older adults free of dementia undergoing scheduled surgery. Findings Twenty four percent of patients (135/566) developed delirium during the postoperative hospitalization period. Of the reserve markers examined, only the Wechsler Test of Adult Reading (WTAR) was significantly associated with the risk of delirium. A one-half standard deviation better performance on the WTAR was associated with a 38% reduction in delirium risk (P = 0·01); adjusted relative risk of 0·62, 95% confidence interval 0·45–0·85. Interpretation In this relatively large and well-designed study, most markers of reserve fail to predict delirium risk. The exception to this is the WTAR. Our findings suggest that the reserve markers that are important for delirium may be different from those considered to be important for dementia. PMID:25642414

  7. [Effectiveness of IPD treatment for delirium prevention in hospitalized elderly. A controlled randomized clinical trial].

    PubMed

    Bonaventura, Marino; Zanotti, Renzo

    2007-01-01

    Delirium is a common and serious complication for hospitalized elderly people. Early detection of risk and preventive treatment may significantly reduce delirium and its consequences. In Inouye's study of elderly people with delirium (1993), an interesting predictive model was proposed ,but never applied, for hospitalized elderly. The aim of this study was to test the effectiveness of IPD, a standardized package of caring activities, in the prevention of delirium in inpatient elderly The study consisted of an experimental controlled randomized trial with standardized treatment (Prevention of Delirium Interventions - IPD) with 30 subjects in the experimental group and 30 comparable subjects in the control group. Subjects were recruited if they obtained a score of 24 or less in the Mini Mental State Examination (MMSE). All the subjects have been assessed on the first, second, fourth and seventh day of their hospital stay according to the MMSE, Barthel Index, Tinetti Balance and Gait Scale, Neecham Confusion Scale, and Delirium Rating Scale. The method of assessment was the Confusion Assessment protocol. There was a statistically and clinically significant reduction in both the risk of delirium and related events in the treatment group compared to the control. Therefore, the IPD model proved to be highly effective in comparison to traditional care for elderly inpatients.

  8. PEDIATRIC DELIRIUM AND ASSOCIATED RISK FACTORS: A SINGLE-CENTER PROSPECTIVE OBSERVATIONAL STUDY

    PubMed Central

    Gerber, Linda M.; Sun, Xuming; Kearney, Julia; Patel, Anita; Greenwald, Bruce

    2016-01-01

    Objective To describe a single-institution pilot study regarding prevalence and risk factors for delirium in critically ill children. Design A prospective observational study, with secondary analysis of data collected during the validation of a pediatric delirium screening tool, the Cornell Assessment of Pediatric Delirium (CAPD). Setting This study took place in the pediatric intensive care unit (PICU) at an urban academic medical center. Patients 99 consecutive patients, ages newborn to 21 years. Intervention Subjects underwent a psychiatric evaluation for delirium based on the DSM-IV criteria. Measurements and Main Results Prevalence of delirium in this sample was 21%. In multivariate analysis, risk factors associated with the diagnosis of delirium were presence of developmental delay, need for mechanical ventilation, and age 2-5 years. Conclusions In our institution, pediatric delirium is a prevalent problem, with identifiable risk factors. Further large-scale prospective studies are required to explore multi-institutional prevalence, modifiable risk factors, therapeutic interventions, and effect on long-term outcomes. PMID:25647240

  9. Identifying pediatric emergence delirium by using the PAED Scale: a quality improvement project.

    PubMed

    Stamper, Matthew J; Hawks, Sharon J; Taicher, Brad M; Bonta, Juliet; Brandon, Debra H

    2014-04-01

    Pediatric emergence delirium is a postoperative phenomenon characterized by aberrant cognitive and psychomotor behavior, which can place the patient and health care personnel at risk for injury. A common tool for identifying emergence delirium is the Level of Consciousness-Richmond Agitation and Sedation Scale (LOC-RASS), although it has not been validated for use in the pediatric population. The Pediatric Anesthesia Emergence Delirium Scale (PAED) is a newly validated tool to measure emergence delirium in children. We chose to implement and evaluate the effectiveness and fidelity of using the PAED Scale to identify pediatric emergence delirium in one eight-bed postanesthesia care unit in comparison with the traditional LOC-RASS. The overall incidence of pediatric emergence delirium found by using the LOC-RASS with a retrospective chart review (3%) was significantly lower than the incidence found by using the LOC-RASS (7.5%) and PAED Scale (11.5%) during the implementation period. Our findings suggest that the PAED Scale may be a more sensitive measure of pediatric emergence delirium, and, in the future, we recommend that health care personnel at our facility use the PAED Scale rather than the LOC-RASS.

  10. A Clinical Update on Delirium: From Early Recognition to Effective Management

    PubMed Central

    Cerejeira, Joaquim; Mukaetova-Ladinska, Elizabeta B.

    2011-01-01

    Delirium is a neuropsychiatric syndrome characterized by altered consciousness and attention with cognitive, emotional and behavioural symptoms. It is particularly frequent in elderly people with medical or surgical conditions and is associated with adverse outcomes. Predisposing factors render the subject more vulnerable to a congregation of precipitating factors which potentially affect brain function and induce an imbalance in all the major neurotransmitter systems. Early diagnosis of delirium is crucial to improve the prognosis of patients requiring the identification of subtle and fluctuating signs. Increased awareness of clinical staff, particularly nurses, and routine screening of cognitive function with standardized instruments, can be decisive to increase detection rates of delirium. General measures to prevent delirium include the implementation of protocols to systematically identify and minimize all risk factors present in a particular clinical setting. As soon as delirium is recognized, prompt removal of precipitating factors is warranted together with environmental changes and early mobilization of patients. Low doses of haloperidol or olanzapine can be used for brief periods, for the behavioural control of delirium. All of these measures are a part of the multicomponent strategy for prevention and treatment of delirium, in which the nursing care plays a vital role. PMID:21994844

  11. Licensed Nurse and Nursing Assistant Recognition of Delirium in Nursing Home Residents With Dementia

    PubMed Central

    Steis, Melinda R; Behrens, Liza; Colancecco, Elise M; Mogle, Jacqueline; Mulhall, Paula M; Hill, Nikki L; Fick, Donna M; Kolankowski, Ann M

    2016-01-01

    Many nursing home residents experience delirium. Nursing home personnel, especially nursing assistants, have the opportunity to become familiar with residents’ normal cognitive function and to recognize changes in a resident’s cognitive function over time. The purpose of this study was to determine the accuracy of delirium recognition by licensed nurses and nursing assistants from eight nursing homes over a 12-month period. Participants were asked to complete five case vignette assessments at three different time points (in 6-month intervals) to test their ability to identify different subtypes of delirium and delirium superimposed on dementia (DSD). A total of 760 case vignettes were completed across the different time points. Findings reveal that staff recognition of delirium was poor. The case vignette describing hyperactive DSD was correctly identified by the greatest number participants, and the case vignette describing hypoactive DSD was correctly identified by the least number of participants. Recognition of the case vignette describing hypoactive delirium improved over time. Nursing assistants performed similarly to the licensed nurses, indicating that all licensed nursing home staff require further education to correctly recognize delirium in older adults. PMID:28042285

  12. Severe, Persistent and Fatal Delirium in Psychogeriatric Patients Admitted to a Psychiatric Hospital

    PubMed Central

    Jans, Ingrid S.; Oudewortel, Letty; Brandt, Paulien M.; van Gool, Willem A.

    2015-01-01

    Background/Aims Although delirium is generally regarded as a transient syndrome, persistence of delirium in patients with cognitive impairment – even with fatal outcome – has been reported as well. This study aims to describe the clinical features and neuropathological correlates of this type of delirium. Methods Inclusion criteria for this case series were: (1) severe persistent delirium until death, (2) history of cognitive decline and (3) consent for brain autopsy. Medical records were examined in combination with collected clinical data and neuropathological findings. Result In 15 patients, all living at home before admission, episodes with delirium lasted for 4.2 months on average. No distinct medical causes of persistent delirium could be identified. Pathological diagnoses included Alzheimer's disease and dementia with Lewy bodies as well as single cases of Creutzfeldt-Jakob disease and progressive supranuclear palsy. Conclusion Severe, persistent and fatal delirium in patients with cognitive impairment can occur relatively early in the disease trajectory and is associated with diverse neuropathologies. PMID:26195981

  13. Neural substrates of vulnerability to postsurgical delirium as revealed by presurgical diffusion MRI.

    PubMed

    Cavallari, Michele; Dai, Weiying; Guttmann, Charles R G; Meier, Dominik S; Ngo, Long H; Hshieh, Tammy T; Callahan, Amy E; Fong, Tamara G; Schmitt, Eva; Dickerson, Bradford C; Press, Daniel Z; Marcantonio, Edward R; Jones, Richard N; Inouye, Sharon K; Alsop, David C

    2016-04-01

    Despite the significant impact of postoperative delirium on surgical outcomes and the long-term prognosis of older patients, its neural basis has not yet been clarified. In this study we investigated the impact of premorbid brain microstructural integrity, as measured by diffusion tensor imaging before surgery, on postoperative delirium incidence and severity, as well as the relationship among presurgical cognitive performance, diffusion tensor imaging abnormalities and postoperative delirium. Presurgical diffusion tensor imaging scans of 136 older (≥70 years), dementia-free subjects from the prospective Successful Aging after Elective Surgery study were analysed blind to the clinical data and delirium status. Primary outcomes were postoperative delirium incidence and severity during the hospital stay, as assessed by the Confusion Assessment Method. We measured cognition before surgery using general cognitive performance, a composite score based on a battery of neuropsychological tests. We investigated the association between presurgical diffusion tensor imaging parameters of brain microstructural integrity (i.e. fractional anisotropy, axial, mean and radial diffusivity) with postoperative delirium incidence and severity. Analyses were adjusted for the following potential confounders: age, gender, vascular comorbidity status, and general cognitive performance. Postoperative delirium occurred in 29 of 136 subjects (21%) during hospitalization. Presurgical diffusion tensor imaging abnormalities of the cerebellum, cingulum, corpus callosum, internal capsule, thalamus, basal forebrain, occipital, parietal and temporal lobes, including the hippocampus, were associated with delirium incidence and severity, after controlling for age, gender and vascular comorbidities. After further controlling for general cognitive performance, diffusion tensor imaging abnormalities of the cerebellum, hippocampus, thalamus and basal forebrain still remained associated with delirium

  14. Emergence delirium with transient associative agnosia and expressive aphasia reversed by flumazenil in a pediatric patient.

    PubMed

    Drobish, Julie K; Kelz, Max B; DiPuppo, Patricia M; Cook-Sather, Scott D

    2015-06-01

    Multiple factors may contribute to the development of emergence delirium in a child. We present the case of a healthy 12-year-old girl who received preoperative midazolam with the desired anxiolytic effect, underwent a brief general anesthetic, and then exhibited postoperative delirium, consisting of a transient associative agnosia and expressive aphasia. Administration of flumazenil led to immediate and lasting resolution of her symptoms. We hypothesize that γ-aminobutyric acid type A receptor-mediated effects, most likely related to an atypical offset of midazolam, are an important subset of emergence delirium that is amenable to pharmacologic therapy with flumazenil.

  15. Revisiting the O complex: urinary incontinence, delirium and polypharmacy in elderly patients

    PubMed Central

    Hogan, D B

    1997-01-01

    Urinary incontinence, delirium and polypharmacy are common, challenging problems encountered in elderly patients. Review of the literature shows that these conditions are interrelated. For example, polypharmacy can lead to delirium, which, in turn, can lead to urinary incontinence. The drugs prescribed for urinary incontinence can precipitate delirium or contribute to polypharmacy. The underlying causes for these problems in elderly patients are frequently complex, and management in turn must often be multifactorial. The occurrence of these problems should lead to careful evaluation followed by thoughtful, responsive treatment. Brief updates are given with recommendations for management directed at primary care physicians. PMID:9347778

  16. Prevalence of delirium among patients at a cancer ward: Clinical risk factors and prediction by bedside cognitive tests.

    PubMed

    Grandahl, Mia Gall; Nielsen, Svend Erik; Koerner, Ejnar Alex; Schultz, Helga Holm; Arnfred, Sidse Marie

    2016-08-01

    Background Delirium is a frequent psychiatric complication to cancer, but rarely recognized by oncologists. Aims 1. To estimate the prevalence of delirium among inpatients admitted at an oncological cancer ward 2. To investigate whether simple clinical factors predict delirium 3. To examine the value of cognitive testing in the assessment of delirium. Methods On five different days, we interviewed and assessed patients admitted to a Danish cancer ward. The World Health Organization International Classification of Diseases Version 10, WHO ICD-10 Diagnostic System and the Confusion Assessment Method (CAM) were used for diagnostic categorization. Clinical information was gathered from medical records and all patients were tested with Mini Cognitive Test, The Clock Drawing Test, and the Digit Span Test. Results 81 cancer patients were assessed and 33% were diagnosed with delirium. All delirious participants were CAM positive. Poor performance on the cognitive tests was associated with delirium. Medical records describing CNS metastases, benzodiazepine or morphine treatment were associated with delirium. Conclusions Delirium is prevalent among cancer inpatients. The Mini Cognitive Test, The Clock Drawing Test, and the Digit Span Test can be used as screening tools for delirium among inpatients with cancer, but even in synergy, they lack specificity. Combining cognitive testing and attention to nurses' records might improve detection, yet further studies are needed to create a more detailed patient profile for the detection of delirium.

  17. The PiTSTOP study: a feasibility cluster randomized trial of delirium prevention in care homes for older people

    PubMed Central

    Siddiqi, Najma; Cheater, Francine; Collinson, Michelle; Farrin, Amanda; Forster, Anne; George, Deepa; Godfrey, Mary; Graham, Elizabeth; Harrison, Jennifer; Heaven, Anne; Heudtlass, Peter; Hulme, Claire; Meads, David; North, Chris; Sturrock, Angus; Young, John

    2016-01-01

    Background and objectives: delirium is a distressing but potentially preventable condition common in older people in long-term care. It is associated with increased morbidity, mortality, functional decline, hospitalization and significant healthcare costs. Multicomponent interventions, addressing delirium risk factors, have been shown to reduce delirium by one-third in hospitals. It is not known whether this approach is also effective in long-term care. In previous work, we designed a bespoke delirium prevention intervention, called ‘Stop Delirium!’ In preparation for a definitive trial of Stop Delirium, we sought to address key aspects of trial design for the particular circumstances of care homes. Design: a cluster randomized feasibility study with an embedded process evaluation. Setting and participants: residents of 14 care homes for older people in one metropolitan district in the UK. Intervention: Stop Delirium!: a 16-month-enhanced educational package to support care home staff to address key delirium risk factors. Control homes received usual care. Measurements: we collected data to determine the following: recruitment and attrition; delirium rates and variability between homes; feasibility of measuring delirium, resource use, quality of life, hospital admissions and falls; and intervention implementation and adherence. Results: two-thirds (215) of eligible care home residents were recruited. One-month delirium prevalence was 4.0% in intervention and 7.1% in control homes. Proposed outcome measurements were feasible, although our approach appeared to underestimate delirium. Health economic evaluation was feasible using routinely collected data. Conclusion: a definitive trial of delirium prevention in long-term care is needed but will require some further design modifications and pilot work. PMID:27207749

  18. Battery of behavioral tests in mice to study postoperative delirium

    PubMed Central

    Peng, Mian; Zhang, Ce; Dong, Yuanlin; Zhang, Yiying; Nakazawa, Harumasa; Kaneki, Masao; Zheng, Hui; Shen, Yuan; Marcantonio, Edward R.; Xie, Zhongcong

    2016-01-01

    Postoperative delirium is associated with increased morbidity, mortality and cost. However, its neuropathogenesis remains largely unknown, partially owing to lack of animal model(s). We therefore set out to employ a battery of behavior tests, including natural and learned behavior, in mice to determine the effects of laparotomy under isoflurane anesthesia (Anesthesia/Surgery) on these behaviors. The mice were tested at 24 hours before and at 6, 9 and 24 hours after the Anesthesia/Surgery. Composite Z scores were calculated. Cyclosporine A, an inhibitor of mitochondria permeability transient pore, was used to determine potential mitochondria-associated mechanisms of these behavioral changes. Anesthesia/Surgery selectively impaired behaviors, including latency to eat food in buried food test, freezing time and time spent in the center in open field test, and entries and duration in the novel arm of Y maze test, with acute onset and various timecourse. The composite Z scores quantitatively demonstrated the Anesthesia/Surgery-induced behavior impairment in mice. Cyclosporine A selectively ameliorated the Anesthesia/Surgery-induced reduction in ATP levels, the increases in latency to eat food, and the decreases in entries in the novel arm. These findings suggest that we could use a battery of behavior tests to establish a mouse model to study postoperative delirium. PMID:27435513

  19. Battery of behavioral tests in mice to study postoperative delirium.

    PubMed

    Peng, Mian; Zhang, Ce; Dong, Yuanlin; Zhang, Yiying; Nakazawa, Harumasa; Kaneki, Masao; Zheng, Hui; Shen, Yuan; Marcantonio, Edward R; Xie, Zhongcong

    2016-07-20

    Postoperative delirium is associated with increased morbidity, mortality and cost. However, its neuropathogenesis remains largely unknown, partially owing to lack of animal model(s). We therefore set out to employ a battery of behavior tests, including natural and learned behavior, in mice to determine the effects of laparotomy under isoflurane anesthesia (Anesthesia/Surgery) on these behaviors. The mice were tested at 24 hours before and at 6, 9 and 24 hours after the Anesthesia/Surgery. Composite Z scores were calculated. Cyclosporine A, an inhibitor of mitochondria permeability transient pore, was used to determine potential mitochondria-associated mechanisms of these behavioral changes. Anesthesia/Surgery selectively impaired behaviors, including latency to eat food in buried food test, freezing time and time spent in the center in open field test, and entries and duration in the novel arm of Y maze test, with acute onset and various timecourse. The composite Z scores quantitatively demonstrated the Anesthesia/Surgery-induced behavior impairment in mice. Cyclosporine A selectively ameliorated the Anesthesia/Surgery-induced reduction in ATP levels, the increases in latency to eat food, and the decreases in entries in the novel arm. These findings suggest that we could use a battery of behavior tests to establish a mouse model to study postoperative delirium.

  20. A New Frontier: Improving Nursing Care for People With Dementia and Delirium in Hospitals.

    PubMed

    Graham, Frederick

    2015-12-01

    Frederick Graham, a clinical nurse consultant from Princess Alexandra Hospital in Brisbane, Australia, presents this month's column focused on improving nursing care for people with dementia and delirium in hospitals.

  1. Self-disembowelment during delirium tremens: why early diagnosis is vital.

    PubMed

    Thomasson, Rachel; Craig, Vanessa; Guthrie, Elspeth

    2016-10-24

    Delirium tremens is a serious yet treatable complication of alcohol withdrawal. Timely diagnosis is critical as there are well-established treatment regimens that provide symptomatic relief within hours to days. We report the case of a 34-year-old man with an undisclosed history of alcohol dependency. He presented with paranoid beliefs and was transferred to a psychiatric inpatient unit with suspected schizophrenia. Classic features of delirium tremens such as sympathetic overdrive and visual hallucinations were not salient features of his presentation. Within 24 hours of admission, he sustained major self-inflicted abdominal stab wounds and extracted a metre of small bowel as a result of command hallucinations. The possibility of delirium tremens was raised by the receiving trauma team and he responded rapidly to benzodiazepines. Emergency jejunal reanastomosis was successful. This case highlights the fact that delirium tremens may present atypically and that associated command hallucinations can confer grave risks.

  2. Delirium and depression: Inter-relationship and overlap in elderly people

    PubMed Central

    O’Sullivan, Roisin; Inouye, Sharon K.; Meagher, David

    2017-01-01

    Delirium and depression are complex neuropsychiatric syndromes that are common in the elderly and associated with a variety of poor healthcare outcomes. Accurate detection is key to providing optimal care for these conditions but is complicated by their considerable clinical overlap. This includes shared symptom profiles as well as comorbidity. Careful assessment of symptom character as well as the context and course of disturbances can allow for more accurate diagnosis. Prior depressive illness is a common finding in patients with delirium, while depressive illness is a recognised sequel of delirium. Evidence points to similar pathophysiological mechanisms involving disturbances in stress and inflammatory responses, monoaminergic and melatonergic functions, that in turn point to avenues for therapeutic intervention. Development of better tools for systematic assessment for delirium and depression in populations at high risk by virtue of age, diminished cognitive reserve and frailty is a key target to achieve improved healthcare outcomes. PMID:26360863

  3. Delirium after Cardiac Surgery: A Pilot Study from a Single Tertiary Referral Center

    PubMed Central

    Kumar, Ashok K; Jayant, Aveek; Arya, VK; Magoon, Rohan; Sharma, Ridhima

    2017-01-01

    Background: Advances in cardiac surgery has shifted paradigm of management to perioperative psychological illnesses. Delirium is a state of altered consciousness with easy distraction of thoughts. The pathophysiology of this complication is not clear, but identification of risk factors is important for positive postoperative outcomes. The goal of the present study was to prospectively identify the incidence, motoric subtypes, and risk factors associated with development of delirium in cardiac surgical patients admitted to postoperative cardiac intensive care, using a validated delirium monitoring instrument. Materials and Methods: This is a prospective, observational study. This study included 120 patients of age 18–80 years, admitted to undergo cardiac surgery after applying inclusion and exclusion criteria. Specific preoperative, intraoperative, and postoperative data for possible risk factors were obtained. Once in a day, assessment of delirium was done. Continuous variables were measured as mean ± standard deviation, whereas categorical variables were described as proportions. Differences between groups were analyzed using Student's t-test, Mann–Whitney U-test, or Chi-square test. Variables with a P < 0.1 were then used to develop a predictive model using stepwise logistic regression with bootstrapping. Results: Delirium was seen in 17.5% patients. The majority of cases were of hypoactive delirium type (85.72%). Multiple risk factors were found to be associated with delirium, and when logistic regression with bootstrapping applied to these risk factors, five independent variables were detected. History of hypertension (relative risk [RR] =6.7857, P = 0.0003), carotid artery disease (RR = 4.5000, P < 0.0001) in the form of stroke or hemorrhage, noninvasive ventilation (NIV) use (RR = 5.0446, P < 0.0001), Intensive Care Unit (ICU) stay more than 10 days (RR = 3.1630, P = 0.0021), and poor postoperative pain control (RR = 2.4958, P = 0.0063) was associated

  4. Current approach to diagnosis and treatment of delirium after cardiac surgery

    PubMed Central

    Evans, Adam S.; Weiner, Menachem M.; Arora, Rakesh C.; Chung, Insung; Deshpande, Ranjit; Varghese, Robin; Augoustides, John; Ramakrishna, Harish

    2016-01-01

    Delirium after cardiac surgery remains a common occurrence that results in significant short- and long-term morbidity and mortality. It continues to be underdiagnosed given its complex presentation and multifactorial etiology; however, its prevalence is increasing given the aging cardiac surgical population. This review highlights the perioperative risk factors, tools to assist in diagnosing delirium, and current pharmacological and nonpharmacological therapy options. PMID:27052077

  5. Beyond Grand Rounds: A Comprehensive and Sequential Intervention to Improve Identification of Delirium

    PubMed Central

    Ramaswamy, Ravishankar; Dix, Edward F.; Drew, Janet E.; Diamond, James J.; Inouye, Sharon K.; Roehl, Barbara J. O.

    2011-01-01

    Purpose of the Study: Delirium is a widespread concern for hospitalized seniors, yet is often unrecognized. A comprehensive and sequential intervention (CSI) aiming to effect change in clinician behavior by improving knowledge about delirium was tested. Design and Methods: A 2-day CSI program that consisted of progressive 4-part didactic series, including evidence-based reviews of delirium recognition, prevention, and management, interspersed with interactive small group sessions and practical case conferences was conceptualized in consultation with a leading expert on delirium. Pretest and posttest instruments were designed to test the attendees on their knowledge and confidence around delirium identification. Results: An average of 71 people attended each didactic session. Among all responses, 50 pretests and posttests were matched based on numeric coding (6 MD/DOs, 34 RNs, and 10 others). Mean pretest and posttest scores were 7.9 and 10.8 points, respectively (maximum: 17), showing a positive change in knowledge scores after the intervention (2.9 points, p < .001). Improvement in knowledge scores was higher in the cohort attending 2 or more lectures (3.8 points, p < .001) compared with those attending only 1 lecture (1.3 points, p < .12). Confidence in identifying patients with delirium increased by 28% (p < .001), and self-assessed capacity to correctly administer the Confusion Assessment Method increased by 36% (p < .001). Implications: A novel CSI increased clinician knowledge about delirium identification and management and improved confidence and self-assessed capacity to identify delirium in the hospitalized elderly patients. This strategy, which incorporates multiple reinforcing modes of education, may ultimately be more effective in influencing clinician behavior when compared with traditional grand rounds. PMID:20855818

  6. Cortisol, Interleukins and S100B in Delirium in the Elderly

    ERIC Educational Resources Information Center

    van Munster, Barbara C.; Bisschop, Peter H.; Zwinderman, Aeilko H.; Korevaar, Johanna C.; Endert, Erik; Wiersinga, W. Joost; van Oosten, Hannah E.; Goslings, J. Carel; de Rooij, Sophia E. J. A.

    2010-01-01

    In independent studies delirium was associated with higher levels of cortisol, interleukin(IL)s, and S100B. The aim of this study was to simultaneously compare cortisol, IL-6, IL-8, and S100B levels in patients aged 65 years and older admitted for hip fracture surgery with and without delirium. Cortisol, IL-6, IL-8, and S100B were assayed in…

  7. Delirium following fesoterodine treatment for urgency incontinence in an 89-year old man

    PubMed Central

    Charbonneau, Jeannie Medeiros; Bisset, Rania; Nguyen, Patrick Viet-Quoc

    2016-01-01

    We describe the case of an 89-year-old man who developed delirium following the introduction of fesoterodine to treat his urgency incontinence. The patient started experiencing visual hallucinations approximately five days after starting fesoterodine 4 mg once daily. Delirium resolved after fesoterodine was stopped. Despite the apparent safe cognitive profile due to its pharmacodynamic properties, fesoterodine should be used with caution in the elderly, frail population. PMID:28255419

  8. Prevention and management of postoperative delirium among older patients on an orthopedic surgical unit: a best practice implementation project.

    PubMed

    Sykes, Pamela K

    2012-01-01

    Delirium is an acute state of confusion that is often seen in older patients after major orthopedic surgical procedures. It is associated with increased costs of care, morbidity, delayed functional recovery, and prolonged hospital stay. Identification of predictive risk factors, early diagnosis and treatment, and implementation of environmental controls can minimize the impact of postoperative delirium. This project measured pre- and post intervention compliance with best practice in the prevention and management of postoperative delirium.

  9. The Prevention and Treatment of Delirium in Elderly Patients Following Hip Fracture Surgery.

    PubMed

    Martocchia, Antonio; Curto, Martina; Comite, Fabrizia; Scaccianoce, Sergio; Girardi, Paolo; Ferracuti, Stefano; Nicoletti, Ferdinando; Falaschi, Paolo

    2015-01-01

    Osteoporotic hip fracture needs a specific approach and treatment, since elderly patients are at high risk for adverse outcomes after surgery. In particular, delirium often occurs in the peri-operative period, and it is associated with death, hospital-acquired complications, persistent cognitive impairments, poor functional recovery after surgery and increased healthcare costs. The pre-operative assessment of the risk factors for delirium improves the preventive measures. The delirium diagnostic tools should be included in the standard of orthogeriatric cure for hip fracture. Given the increasing complexity of the clinical pictures, we present a review of the available treatment options for delirium in patients with hip fracture. The metabolic pre-operative disorders and the management of co-morbid diseases are specific targets of treatment in order to optimize the outcomes after surgery. In particular, elderly patients with Alzheimer's disease are highly vulnerable to hip fracture and delirium, and they are severely frail with reduced physiologic reserves. An integrated approach combining environmental and pharmacological strategies is useful in the delirium treatment, with a close collaboration between the orthopedic and geriatric team.

  10. Symptoms and aetiology of delirium: a comparison of elderly and adult patients.

    PubMed

    Grover, S; Agarwal, M; Sharma, A; Mattoo, S K; Avasthi, A; Chakrabarti, S; Malhotra, S; Kulhara, P; Bas, D

    2013-06-01

    OBJECTIVE. To compare the symptoms of delirium as assessed by the Delirium Rating Scale-Revised-98 (DRS-R-98) and associated aetiologies in adult and elderly patients seen in a consultation-liaison service. METHODS. A total of 321 consecutive patients with a DSM-IV-TR diagnosis of delirium were assessed on the DRS-R-98 and a study-specific aetiology checklist. RESULTS. Of the 321 patients, 245 (76%) aged 18 to 64 years formed the adult group, while 76 (24%) formed the elderly group (≥ 65 years). The prevalence and severity of various symptoms of delirium as assessed using the DRS-R-98 were similar across the 2 groups, except for the adult group having statistically higher prevalence and severity scores for thought process abnormalities and lability of affect. For both groups and the whole sample, factor analysis yielded a 3-factor model for the phenomenology. In the 2 groups, the DRS-R-98 item loadings showed subtle differences across various factors. The 2 groups were similar for the mean number of aetiologies associated with delirium, the mean number being 3. However, the 2 groups differed with respect to hepatic derangement, substance intoxication, withdrawal, and postpartum causes being more common in the adult group, in contrast lung disease and cardiac abnormalities were more common in the elderly group. CONCLUSION. Adult and elderly patients with delirium are similar with respect to the distribution of various symptoms, motor subtypes, and associated aetiologies.

  11. Identification and rates of delirium in elderly medical inpatients from diverse language groups.

    PubMed

    Wand, Anne Pf; Thoo, William; Ting, Vicky; Baker, Janett; Sciuriaga, Hayley; Hunt, Glenn E

    2013-01-01

    A linguistically diverse cohort of 126 medical inpatients 65 y and over was recruited to determine rates of delirium after admission, associated outcomes, and staff detection of delirium. A clinical interview and cognitive and functional questionnaires were completed with the patient and their carer, and files were reviewed. The incidence of delirium at comprehensive assessment early after admission was 10.3% and the overall incidence 19.1% over the whole admission. Cognitive impairment was common (n = 80, 63.5%), including 61 patients (48.4%) who had dementia. Most patients (83%) with delirium had dementia. Staff recognized less than 21% of patients with delirium, 33% of patients with dementia, and 36% of cognitively impaired patients. There was no difference in outcomes between English and non-English speaking patients. Given the high prevalence and poor recognition of cognitive disorders in older people, routine cognitive screening should occur. Staff education should focus upon improving delirium detection and addressing the needs of cognitively impaired older inpatients.

  12. Combination of inhaled corticosteroid and bronchodilator-induced delirium in an elderly patient with lung disease.

    PubMed

    Moss, Jason M; Kemp, Debra W; Brown, Jamie N

    2014-02-01

    Steroid psychosis has been well described with oral glucocorticoids, however, our search of the literature did not identify an association between delirium and the combination of inhaled glucocorticoids and long-acting beta-agonists. We describe the occurrence of delirium with the combination of an inhaled glucocorticoid and bronchodilator. An elderly male described confusion and hallucinations within 1 week after initiation of budesonide/formoterol for chronic obstructive pulmonary disease. The combination inhaler was discontinued with resolution of symptoms. Several weeks later, the patient was hospitalized and restarted on the combination inhaler. The patient was alert and oriented on admission, however, confusion and hallucinations progressed throughout his hospital stay. The combination inhaler was discontinued and his confusion and hallucinations resolved by discharge. The temporal relationship of these events and a probable Naranjo association allows for reasonable assumption that the use of the budesonide/formoterol combination inhaler caused or contributed to the occurrences of delirium in this elderly patient. The onset of delirium was likely due to the systemic absorption of the glucocorticoid from lung deposition, complicated in an individual with several predisposing risk factors for delirium. Health care providers should be aware of this potential adverse drug reaction when prescribing inhaled medications to older patients at risk for delirium.

  13. Disturbed Serotonergic Neurotransmission and Oxidative Stress in Elderly Patients with Delirium

    PubMed Central

    Egberts, Angelique; Fekkes, Durk; Wijnbeld, Eline H.A.; van der Ploeg, Milly A.; van Saase, Jan L.C.M.; Ziere, Gijsbertus; van der Cammen, Tischa J.M.; Mattace-Raso, Francesco U.S.

    2015-01-01

    Background Oxidative stress and disturbances in serotonergic and dopaminergic neurotransmission may play a role in the pathophysiology of delirium. Aims In this study, we investigated levels of amino acids, amino acid ratios and levels of homovanillic acid (HVA) as indicators for oxidative stress and disturbances in neurotransmission. Methods Plasma levels of amino acids, amino acid ratios and HVA were determined in acutely ill patients aged ≥65 years admitted to the wards of Internal Medicine and Geriatrics of the Erasmus University Medical Center and the ward of Geriatrics of the Havenziekenhuis, Rotterdam, The Netherlands. Differences in the biochemical parameters between patients with and without delirium were investigated by analysis of variance in models adjusted for age, gender and comorbidities. Results Of the 86 patients included, 23 had delirium. In adjusted models, higher mean phenylalanine/tyrosine ratios (1.34 vs. 1.14, p = 0.028), lower mean tryptophan/large neutral amino acids ratios (4.90 vs. 6.12, p = 0.021) and lower mean arginine levels (34.8 vs. 45.2 µmol/l, p = 0.022) were found in patients with delirium when compared to those without. No differences were found in HVA levels between patients with and without delirium. Conclusion The findings of this study suggest disturbed serotonergic neurotransmission and an increased status of oxidative stress in patients with delirium. PMID:26955379

  14. Association between delirium superimposed on dementia and mortality in hospitalized older adults: A prospective cohort study

    PubMed Central

    Curiati, Jose A. E.; Jacob-Filho, Wilson

    2017-01-01

    Background Hospitalized older adults with preexisting dementia have increased risk of having delirium, but little is known regarding the effect of delirium superimposed on dementia (DSD) on the outcomes of these patients. Our aim was to investigate the association between DSD and hospital mortality and 12-mo mortality in hospitalized older adults. Methods and findings This was a prospective cohort study completed in the geriatric ward of a university hospital in São Paulo, Brazil. We included 1,409 hospitalizations of acutely ill patients aged 60 y and over from January 2009 to June 2015. Main variables and measures included dementia and dementia severity (Informant Questionnaire on Cognitive Decline in the Elderly, Clinical Dementia Rating) and delirium (Confusion Assessment Method). Primary outcomes were time to death in the hospital and time to death in 12 mo (for the discharged sample). Comprehensive geriatric assessment was performed at admission, and additional clinical data were documented upon death or discharge. Cases were categorized into four groups (no delirium or dementia, dementia alone, delirium alone, and DSD). The no delirium/dementia group was defined as the referent category for comparisons, and multivariate analyses were performed using Cox proportional hazards models adjusted for possible confounders (sociodemographic information, medical history and physical examination data, functional and nutritional status, polypharmacy, and laboratory covariates). Overall, 61% were women and 39% had dementia, with a mean age of 80 y. Dementia alone was observed in 13% of the cases, with delirium alone in 21% and DSD in 26% of the cases. In-hospital mortality was 8% for patients without delirium or dementia, 12% for patients with dementia alone, 29% for patients with delirium alone, and 32% for DSD patients (Pearson Chi-square = 112, p < 0.001). DSD and delirium alone were independently associated with in-hospital mortality, with respective hazard ratios

  15. Frailty is associated with delirium and mortality after transcatheter aortic valve implantation

    PubMed Central

    Assmann, Patricia; Kievit, Peter; van der Wulp, Kees; Verkroost, Michel; Noyez, Luc; Bor, Hans; Schoon, Yvonne

    2016-01-01

    Objective We hypothesised that frailty assessment is of additional value to predict delirium and mortality after transcatheter aortic valve implantation (TAVI). Methods Observational study in 89 consecutive patients who underwent TAVI. Inclusion from November 2012 to February 2014, follow-up until April 2014. Measurement of the association of variables from frailty assessment and cardiological assessment with delirium and mortality after TAVI, respectively. Results Incidence of delirium after TAVI: 25/89 (28%). Variables from frailty assessment protectively associated with delirium were: Mini Mental State Examination, (OR 0.79; 95% CI 0.65 to 0.96; p=0.02), Instrumental Activities of Daily Living (OR 0.79; 95% CI 0.63 to 0.99; p=0.04) and gait speed (OR 0.05; 95% CI 0.01 to 0.50; p=0.01). Timed Up and Go was predictively associated with delirium (OR 1.14; 95% CI 1.03 to 1.26; p=0.01). From cardiological assessment, pulmonary hypertension was protectively associated with delirium (OR 0.34; 95% CI 0.12 to 0.98; p=0.05). Multivariate logistic analysis: Nagelkerke R2=0.359, Mini Mental State Examination was independently associated with delirium. Incidence of mortality: 11/89 (12%). Variables predictively associated with mortality were: the summary score Frailty Index (HR 1.66, 95% CI 1.06 to 2.60; p=0.03), European System for Cardiac Operative Risk Evaluation (EuroSCORE) II (HR 1.14, 95% CI 1.06 to 1.22; p<0.001) and complications (HR 4.81, 95% CI 1.03 to 22.38; p=0.05). Multivariate Cox proportional hazards analysis: Nagelkerke R2=0.271, Frailty Index and EuroSCORE II were independently associated with mortality. Conclusions Delirium frequently occurs after TAVI. Variables from frailty assessment are associated with delirium and mortality, independent of cardiological assessment. Thus, frailty assessment may have additional value in the prediction of delirium and mortality after TAVI. PMID:28008356

  16. Postoperative Delirium after elective and emergency surgery: analysis and checking of risk factors. A study protocol

    PubMed Central

    Agnoletti, Vanni; Ansaloni, Luca; Catena, Fausto; Chattat, Rabbih; De Cataldis, Angelo; Di Nino, Gianfranco; Franceschi, Claudio; Gagliardi, Stefano; Melotti, Rita Maria; Potalivo, Antonella; Taffurelli, Mario

    2005-01-01

    Background Delirum is common in hospitalized elderly patients and may be associated with increased morbidity, length of stay and patient care costs. Delirium (acute confusional state) is defined as an acute disorder of attention and cognition. In elderly patients, delirium is often an early indicator of patho-physiological disturbances. Despite landmark studies dating back to the 1940s, the pathogenesis of Delirium remains poorly understood. Early investigators noted that Delirium was characterized by global cortical dysfunction that was associated predominantly with specific electroencephalographic changes. It's important to understand the risk factors and incidence of Delirium. Some of the risk factors are already identified in literature and can be summarized in the word "VINDICATE" which stands for: Vascular, Infections, Nutrition, Drugs, Injury, Cardiac, Autoimmune, Tumors, Endocrine. Aims of this study are: to re-evaluate the above mentioned clinical risk factors, adding some others selected from literature, and to test, as risk factors, a pattern of some genes associated to cognitive dysfunction and inflammation possibly related to postoperative Delirium. Design All patients admitted to our Emergency Unit who are meet our inclusion/exclusion criteria will be recruited. The arising of postoperative Delirium will select incidentally two groups (Delirium/non Delirium) and the forward analysis of correlate risk factors will be performed. As in a typical observational case/control study we will consider all the exposure factors to which our population are submitted towards the outcome (presence of Delirium). Our exposures are the following: ASA, Pain (SVS; VAS), Blood gas analysis (pH; Hb; pO2; pCO2), Residence pharmacological therapy (BDZ; hypnotics; narcotic drugs; alcohol; nitrous derivates), Body temperature, Arterial pressure, Heart frequency, Breath frequency, Na, K, Creatinin, Glicemia, Albumin, Hct, White blood cells, Glasgow Coma Scale (GCS), Cognitive

  17. Preoperative protein profiles in cerebrospinal fluid in elderly hip fracture patients at risk for delirium: A proteomics and validation study

    PubMed Central

    Westhoff, Dunja; Witlox, Joost; van Aalst, Corneli; Scholtens, Rikie M.; de Rooij, Sophia E.; van Munster, Barbara C.; de Jonghe, Jos F.M.; Houdijk, Alexander P.J.; Eikelenboom, Piet; van Westerloo, David J.; van de Beek, Diederik; van Gool, Willem A.; Koenderman, Leo

    2015-01-01

    Background A neuroinflammatory response is suggested to play an important role in delirium, a common complication in older hospitalized patients. We examined whether hip fracture patients who develop postoperative delirium have a different proteome in cerebrospinal fluid (CSF) prior to surgery. Methods Patients (≥ 75 years) were admitted for hip fracture surgery. CSF was collected during spinal anaesthesia; proteins were separated using gel electrophoresis and identified with mass spectrometry. We compared the proteome of patients with and without postoperative delirium. Findings were validated in an independent, comparable cohort using immuno-assays. Results In the derivation cohort 53 patients were included, 35.8% developed postoperative delirium. We identified differences in levels of eight CSF proteins between patients with and without subsequent delirium: complement factor C3, contactin-1, fibulin-1 and I-beta-1,3-N-acetylglucosaminyltransferase were significantly lower in patients with postoperative delirium, while neural cell adhesion molecule-2, fibrinogen, zinc-α-2-glycoprotein and haptoglobin levels were significantly higher. In the validation cohort 21.2% of 52 patients developed postoperative delirium. Immuno-assays confirmed contactin-1 results although not statistically significant. Complement factor C3 was significantly higher in patients with postoperative delirium. Conclusion Our results show the complexity of pathophysiological mechanisms involved in delirium and emphasizes the need of independent validation of findings. General significance This study highlights the challenges and inconsistent findings in studies of delirium, a serious complication in older patients. We analysed proteins in CSF, the most proximal fluid to the brain. All patients were free from delirium at the time of sampling. PMID:26675981

  18. Preoperative CSF Melatonin Concentrations and the Occurrence of Delirium in Older Hip Fracture Patients: A Preliminary Study

    PubMed Central

    Scholtens, Rikie M.; de Rooij, Sophia E. J. A.; Vellekoop, Annelies E.; Vrouenraets, Bart C.; van Munster, Barbara C.

    2016-01-01

    Background Delirium is characterized by disturbances in circadian rhythm. Melatonin regulates our circadian rhythm. Our aim was to compare preoperative cerebrospinal fluid (CSF) melatonin levels in patients with and without postoperative delirium. Methods Prospective cohort study with hip fracture patients ≥ 65 years who were acutely admitted to the hospital for surgical treatment and received spinal anaesthesia. CSF was collected after cannulation, before administering anaesthetics. Melatonin was measured by radioimmunoassay (RIA). Data on delirium was obtained from medical and nursing records. Nurses screened every shift for delirium using the Delirium Observation Screening Scale (DOSS). If the DOSS was ≥3, a psychiatrist was consulted to diagnose possible delirium using the DSM-IV criteria. At admission, demographic data, medical history, and information on functional and cognitive status was obtained. Results Seventy-six patients met the inclusion criteria. Sixty patients were included in the analysis. Main reasons for exclusion were technical difficulties, insufficient CSF or exogenous melatonin use. Thirteen patients (21.7%) experienced delirium during hospitalisation. Baseline characteristics did not differ between patients with and without postoperative delirium. In patients with and without postoperative delirium melatonin levels were 12.88 pg/ml (SD 6.3) and 11.72 pg/ml (SD 4.5) respectively, p-value 0.47. No differences between patients with and without delirium were found in mean melatonin levels in analyses stratified for cognitive impairment or age. Conclusion Preoperative CSF melatonin levels did not differ between patients with and without postoperative delirium. This suggests that, if disturbances in melatonin secretion occur, these might occur after surgery due to postoperative inflammation. PMID:27936113

  19. The diagnosis of delirium in an acute-care hospital in Moscow: what does the Pandora’s box contain?

    PubMed Central

    Tkacheva, Olga N; Runikhina, Nadezda K; Vertkin, Arkadiy L; Voronina, Irina V; Sharashkina, Natalia V; Mkhitaryan, Elen A; Ostapenko, Valentina S; Prokhorovich, Elena A; Freud, Tamar; Press, Yan

    2017-01-01

    Background Delirium, a common problem among hospitalized elderly patients, is not usually diagnosed by doctors for various reasons. The primary aim of this study was to evaluate the effect of a short training course on the identification of delirium and the diagnostic rate of delirium among hospitalized patients aged ≥65 years. The secondary aim was to identify the risk factors for delirium. Methods A prospective study was conducted in an acute-care hospital in Moscow, Russia. Six doctors underwent a short training course on delirium. Data collected included assessment by the confusion assessment method for the intensive care units, sociodemographic data, functional state before hospitalization, comorbidity, and hospitalization indices (indication for hospitalization, stay in intensive care unit, results of laboratory tests, length of hospitalization, and in-hospital mortality). Results Delirium was diagnosed in 13 of 181 patients (7.2%) who underwent assessment. Cognitive impairment was diagnosed more among patients with delirium (30.0% vs 6.1%, P=0.029); Charlson comorbidity index was higher (3.6±2.4 vs 2.3±1.8, P=0.013); and Barthel index was lower (43.5±34.5 vs 94.1±17.0, P=0.000). The length of hospitalization was longer for patients with delirium at 13.9±7.3 vs 8.8±4.6 days (P=0.0001), and two of the 13 patients with delirium died during hospitalization compared with none of the 168 patients without delirium (P=0.0001). Conclusion Although the rate of delirium was relatively low compared with studies from the West, this study proves that an educational intervention among doctors can bring about a significant change in the diagnosis of the condition. PMID:28260868

  20. A Prospective Comparison of Informant- and Performance-Based Dementia Screening Tools to Predict In-hospital Delirium

    PubMed Central

    Zeng, Lily; Josephson, S. Andrew; Fukuda, Keiko A.; Neuhaus, John; Douglas, Vanja C.

    2014-01-01

    Dementia is an important risk factor for delirium, but the optimal strategy for incorporating cognitive impairment into delirium risk assessment at the time of hospital admission is unknown. We compared two informant-based screening tools for dementia and mild cognitive impairment (AD8 and D=(MC)2) to the Mini Mental State Exam (MMSE) and Mini-cog in predicting hospital-acquired delirium. This prospective cohort study at an academic medical center consisted of 162 medical inpatients over age 50 without delirium upon admission. Each participant was evaluated using the MMSE, Mini-cog, AD8, and D=(MC)2 upon admission and was assessed daily for delirium. An MMSE ≤ 24 carried a 5.5 (95% CI 2.7 – 11.1) relative risk for delirium, whereas cognitive impairment detected by the Mini-cog, D=(MC)2 or AD8 carried a 2-fold risk. Adding the D=(MC)2 to the MMSE increased the sensitivity for predicting delirium from 52% (32 – 73) for the MMSE alone to 65% (46 – 85) if either test was positive. If both were positive, specificity was maximized at 97% (94 – 100) but sensitivity was 17% (2 – 33). The MMSE and Mini-cog identify a large proportion of patients at risk for hospital-acquired delirium, but the combination of performance- and an informant-based screens may maximize specificity and sensitivity. PMID:25350550

  1. Sleep disorders and acute nocturnal delirium in the elderly: a comorbidity not to be overlooked.

    PubMed

    Terzaghi, Michele; Sartori, Ivana; Rustioni, Valter; Manni, Raffaele

    2014-04-01

    Delirium is a disturbance of consciousness and cognition that results in a confusional state. It tends to fluctuate in intensity and is often observed in older patients. Sleep is a window of vulnerability for the occurrence of delirium and sleep disorders can play a role in its appearance. In particular, delirious episodes have been associated with obstructive sleep apnoea syndrome, which is reported to be frequent in the elderly. Hereby, we present a case-report documenting the sudden onset of a confusional state triggered by obstructive sleep apnoea-induced arousal, together with a review of the literature on the topic. We emphasise that, among the many pathogenic factors implicated in delirium, it is worth considering the possible link between nocturnal delirium and the occurrence of impaired arousals. Indeed, the complex confusional manifestations of delirium could be due, in part, to persistence of dysfunctional sleep activity resulting in an inability to sustain full arousal during behavioural wakefulness. Arousals can be triggered by sleep disturbances or other medical conditions. Clinicians should be aware that older patients may present disordered sleep patterns, and make investigation of sleep patterns and disorders potentially affecting sleep continuity a key part of their clinical workup, especially in the presence of cognitive comorbidities. Correct diagnosis and optimal treatment of sleep disorders and disrupted sleep can have a significant impact in the elderly, improving sleep quality and reducing the occurrence of abnormal sleep-related behaviours.

  2. Biomarkers of Delirium in a Low-Risk Community-Acquired Pneumonia-Induced Sepsis.

    PubMed

    Tomasi, Cristiane Damiani; Vuolo, Francieli; Generoso, Jaqueline; Soares, Márcio; Barichello, Tatiana; Quevedo, João; Ritter, Cristiane; Dal-Pizzol, Felipe

    2017-01-01

    There are different theories about the pathophysiology of sepsis-associated encephalopathy (SAE), and the majority of our knowledge was derived from critically ill patients. 7In less severe sepsis, it is probable that neuroinflammation can be a major aspect of SAE development. We hypothesized that in non-severe septic patients, blood biomarkers of inflammation, endothelial activation, coagulation, and brain function would be different when compared to patients with and without brain dysfunction. A total of 30 patients presenting with community-acquired pneumonia (CAP)-induced sepsis were included of which 10 (33 %) developed SAE. Eight medical patients admitted to the general ward, except due to sepsis or infection, which developed delirium were included as delirium, non-sepsis group. From all measured biomarkers, only brain-derived neurotrophic factor (BDNF), regulated upon activation normal T cell expressed, and presumably secreted (RANTES), and interleukin (IL)-10 where significantly different when compared to SAE and sepsis groups. In addition, SAE patients presented higher levels of BDNF, vascular cellular adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), platelet-derived growth factor (PDGF)-AB/BB and RANTES when compared to delirium patients. In conclusion, the profile of biomarkers differs between SAE, sepsis, and delirium patients, suggesting that pathways related to SAE are different from delirium and from sepsis itself.

  3. Reducing iatrogenic risks: ICU-acquired delirium and weakness--crossing the quality chasm.

    PubMed

    Vasilevskis, Eduard E; Ely, E Wesley; Speroff, Theodore; Pun, Brenda T; Boehm, Leanne; Dittus, Robert S

    2010-11-01

    ICUs are experiencing an epidemic of patients with acute brain dysfunction (delirium) and weakness, both associated with increased mortality and long-term disability. These conditions are commonly acquired in the ICU and are often initiated or exacerbated by sedation and ventilation decisions and management. Despite > 10 years of evidence revealing the hazards of delirium, the quality chasm between current and ideal processes of care continues to exist. Monitoring of delirium and sedation levels remains inconsistent. In addition, sedation, ventilation, and physical therapy practices proven successful at reducing the frequency and severity of adverse outcomes are not routinely practiced. In this article, we advocate for the adoption and implementation of a standard bundle of ICU measures with great potential to reduce the burden of ICU-acquired delirium and weakness. Individual components of this bundle are evidence based and can help standardize communication, improve interdisciplinary care, reduce mortality, and improve cognitive and functional outcomes. We refer to this as the "ABCDE bundle," for awakening and breathing coordination, delirium monitoring, and exercise/early mobility. This evidence-based bundle of practices will build a bridge across the current quality chasm from the "front end" to the "back end" of critical care and toward improved cognitive and functional outcomes for ICU survivors.

  4. [Citicoline as component of the therapy of postoperative delirium in neurosurgical patients].

    PubMed

    Popugaev, K A; Savin, I A; Sokolova, E Iu; Oshorov, A V; Kadashev, B A; Kalinin, P L; Kutin, M A

    2013-01-01

    Delirium is a clinical sign of acute cerebral dysfunction. It is characterized by consciousness alterations with attention impairment and mentally disorganization. Frequency of delirium is 40-80% in general intensive care and more in patients in neurointensive care unit. We tried to assess citicoline (Ceraxon, Nycomed) safety and efficacy in treatment of postoperative delirium in patients with tumors of chiasm-sellar area of brain. 12 patients were included in citicoline group and 8--in control group. In both group combined type of delirium was common: 83.3% and 75%, accordingly. Citicoline didn't influence on delirium duration. Median of duration of mechanical ventilation was 1.5 and 6 days; mean and standard deviation were 10.5 +/- 15.4 and 17.5 +/- 27.9 days. Median of length of stay in ICU was 7 and 9.5 days; mean and standard deviation were 25.4 +/- 33.1 and 14.9 +/- 15.1 days. These results show that citicoline didn't influence on duration of mechanical ventilation and length of stay in ICU. Outcomes were similar in both groups, but frequency of full functional state recovery in citicoline group was significantly higher: 5 (41.7%) to 2 (25%) in control group (p < 0.05). We consider that citicoline therapy is safe for patients with tumors of chiasm-sellar area and lead to increasing of frequency of full functional state recovery.

  5. [Delirium in a 73-year-old man after many years of unwise use of betahistine].

    PubMed

    Hoenders, H J R; Wilterdink, J

    2004-11-20

    A 73-year-old man was admitted because of delirium that had already persisted for 5 days. The physical examination and extensive tests did not reveal any somatic pathology. The only drug he used was betahistine, taken for several years because of supposed Ménière's disease. After withdrawal of betahistine and treatment with haloperidol the patient recovered completely within a few days. A new delirium was induced when, after discharge from the hospital, betahistine was restarted because of dizziness. There was again a complete remission after betahistine was stopped and haloperidol was restarted. Betahistine is not known to induce delirium, but an investigation in side-effects databases did reveal several cases in which delirium might have been present, even though the term was not actually used. In this case, delirium was possibly caused by the combination of an elevated betahistine plasma level and a damaged blood-brain barrier due to cerebral infarctions, which were revealed by CT and MRI.

  6. Comparison of cognitive and neuropsychiatric profiles in hospitalised elderly medical patients with delirium, dementia and comorbid delirium–dementia

    PubMed Central

    Leonard, Maeve; McInerney, Shane; McFarland, John; Condon, Candice; Awan, Fahad; O'Connor, Margaret; Reynolds, Paul; Meaney, Anna Maria; Adamis, Dimitrios; Dunne, Colum; Cullen, Walter; Trzepacz, Paula T; Meagher, David J

    2016-01-01

    Objectives Differentiation of delirium and dementia is a key diagnostic challenge but there has been limited study of features that distinguish these conditions. We examined neuropsychiatric and neuropsychological symptoms in elderly medical inpatients to identify features that distinguish major neurocognitive disorders. Setting University teaching hospital in Ireland. Participants and measures 176 consecutive elderly medical inpatients (mean age 80.6±7.0 years (range 60–96); 85 males (48%)) referred to a psychiatry for later life consultation-liaison service with Diagnostic and Statistical Manual of Mental Disorders (DSM) IV delirium, dementia, comorbid delirium–dementia and cognitively intact controls. Participants were assessed cross-sectionally with comparison of scores (including individual items) for the Revised Delirium Rating Scale (DRS-R98), Cognitive Test for Delirium (CTD) and Neuropsychiatric Inventory (NPI-Q). Results The frequency of neurocognitive diagnoses was delirium (n=50), dementia (n=32), comorbid delirium–dementia (n=62) and cognitively intact patients (n=32). Both delirium and comorbid delirium–dementia groups scored higher than the dementia group for DRS-R98 and CTD total scores, but all three neurocognitively impaired groups scored similarly in respect of total NPI-Q scores. For individual DRS-R98 items, delirium groups were distinguished from dementia groups by a range of non-cognitive symptoms, but only for impaired attention of the cognitive items. For the CTD, attention (p=0.002) and vigilance (p=0.01) distinguished between delirium and dementia. No individual CTD item distinguished between comorbid delirium–dementia and delirium. For the NPI-Q, there were no differences between the three neurocognitively impaired groups for any individual item severity. Conclusions The neurocognitive profile of delirium is similar with or without comorbid dementia and differs from dementia without delirium. Simple tests of attention and

  7. Risk Factors for Delirium During Acute and Subacute Stages of Various Disorders in Patients Admitted to Rehabilitation Units

    PubMed Central

    2016-01-01

    Objective To assess the risk factors for delirium in patients admitted to a rehabilitation unit for acute or subacute neurological or musculoskeletal disorders. Methods We reviewed the medical records of 537 patients admitted to a rehabilitation unit and selected 398 patients in the acute or subacute stage of various neurological or musculoskeletal disorders. Among them, patients who had suffered from delirium were categorized into the delirium group (n=65), and the other patients were categorized into the non-delirium group (n=333). As potential risk factors for delirium, the patients' diagnosis, underlying disease, demographic data, hospital stay duration, surgery, and laboratory findings were reviewed, and the differences between the two groups with respect to independent risk factors were analyzed. Results The average age in the delirium group was higher; the hospital stay and pre-transfer periods were longer. A large proportion of the patients were admitted for musculoskeletal disorders, and many patients had diabetes mellitus, dementia, and depression as underlying diseases. Laboratory tests revealed increases in the white blood cells (WBC), glucose, blood urea nitrogen (BUN), total bilirubin, aspartate transaminase (AST), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels in the delirium group, while the hemoglobin, calcium, phosphorus, protein, albumin, and potassium levels were decreased. Depression, musculoskeletal disorders, traumatic brain injury, elevated WBC, BUN, AST, and CRP levels, and decreased potassium and phosphorus levels were identified as independent risk factors for delirium. Conclusion Risk factors treatable before delirium onset were identified in rehabilitation patients in acute and subacute stages of various disorders. Early diagnosis and prevention of these risk factors could decrease delirium occurrence and increase rehabilitation effectiveness. PMID:28119839

  8. How do doctors and nurses manage delirium in intensive care units? A qualitative study using focus groups

    PubMed Central

    Palacios-Ceña, Domingo; Cachón-Pérez, José Miguel; Martínez-Piedrola, Rosa; Gueita-Rodriguez, Javier; Perez-de-Heredia, Marta; Fernández-de-las-Peñas, Cesar

    2016-01-01

    Objectives The aim of this study was to explore the experiences of doctors and nurses caring for patients with delirium in the intensive care unit (ICU) and to describe the process of delirium management. Setting This study was performed in 5 ICUs located within 4 hospitals in Madrid (Spain). Participants Purposeful sampling was performed which included (1) doctors and nurses working in ICUs, (2) with >1 year experience in the ICU and (3) clinical experience with delirium. 38 professionals participated (19 doctors, 19 nurses), including 22 women and 16 men. The total mean age was 39 years. Design A qualitative study using focus groups. Methods 7 focus groups were held to collect data: 3 nurse focus groups, 3 doctor focus groups and 1 mixed focus group. Each group comprised 6–10 participants. A semistructured questions guide was used. Thematic analysis methods were used to analyse the data. Results 3 themes were identified: (1) the professional perspective on delirium; (2) implementing pharmacological and non-pharmacological treatment for delirium and (3) work organisation in the ICU. The professionals regarded patients with delirium with uncertainty, and felt they were often underdiagnosed and poorly managed. Doctors displayed discrepancies regarding pharmacological prescriptions and decision-making. The choice of medication was determined by experience. Nurses felt that, for many doctors, delirium was not considered a matter of urgency in the ICU. Nurses encountered difficulties when applying verbal restraint, managing sleep disorders and providing early mobilisation. The lack of a delirium protocol generates conflicts regarding what type of care management to apply, especially during the night shift. A degree of group pressure exists which, in turn, influences the decision-making process and patient care. Conclusions Patients with delirium represent complex cases, requiring the implementation of specific protocols. These results serve to improve the process

  9. Post-operative delirium after hip fracture treatment - a review of the current literature

    PubMed Central

    Kyziridis, Theocharis Chr.

    2006-01-01

    Delirium is a common accompaniment of physical illness in old age, affecting approximately one out of five of those admitted to medical wards, the number being higher for elderly with fractured femurs. Although its existence has long been recognized its exact pathophysiology has not yet been fully elucidated. The present article presents up-to-date information concerning the etiology, pathophysiology, prevention and treatment of the post-operative delirium after hip-fracture treatment. The fact that its diagnosis remains mainly clinical requiring a high index of suspicion, both from nursing and medical staff, results in important under-recognition of the syndrome. Delirium is a medical emergency and if not promptly and urgently treated, or even better prevented, may have serious consequences for the patient and the family members. Proper measures for its prevention and treatment result in shorter hospital stay of the patients, less financial cost and better surgical outcome and rehabilitation of the elderly patient. PMID:19742275

  10. Best Practices for Managing Pain, Sedation, and Delirium in the Mechanically Ventilated Patient.

    PubMed

    Garrett, Kitty M

    2016-12-01

    Nursing management of pain, agitation, and delirium in mechanically ventilated patients is a challenge in critical care. Oversedation can lead to delayed extubation, prolonged ventilator days, unnecessary neurologic testing, and complications such as weakness and delirium. Undersedation can lead to self-extubation, invasive line removal, unnecessary patient distress, and injury to self or others. Acquiring an optimal level of sedation requires the bedside nurse to be more vigilant than ever with patient assessment and medication titration. This article provides a historical perspective of the management of pain, agitation, and delirium, and disseminates information contained in revised Society for Critical Care Medicine Clinical Practice Guidelines (January 2013) to promote their implementation in day-to-day nursing care.

  11. Managing Delirium In The Emergency Department: Tools For Targeting Underlying Etiology.

    PubMed

    Wong, Nelson; Abraham, Gallane

    2015-10-01

    Delirium represents the complex junction between vulnerable patients, medical conditions, and environmental factors. Given the varied presentations of this disorder and the emergency department clinical environment, recognition and treatment may be challenging. Delirium can be diagnosed using validated standardized screening tools such as the Confusion Assessment Method. Management of delirium is directed towards rapidly treating the underlying medical condition while preventing and managing the behavioral symptoms with nonpharmacological (first-line) and pharmacological (second-line) interventions. In the severely agitated patient, pharmacological treatment tailored to the patient's age and comorbidities may be required as the initial treatment to facilitate evaluation and management of the underlying medical condition. Effective risk stratification and triage tools can positively impact patient and staff safety, as well as patient outcomes.

  12. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium.

    PubMed

    Aldecoa, César; Bettelli, Gabriella; Bilotta, Federico; Sanders, Robert D; Audisio, Riccardo; Borozdina, Anastasia; Cherubini, Antonio; Jones, Christina; Kehlet, Henrik; MacLullich, Alasdair; Radtke, Finn; Riese, Florian; Slooter, Arjen J C; Veyckemans, Francis; Kramer, Sylvia; Neuner, Bruno; Weiss, Bjoern; Spies, Claudia D

    2017-04-01

    The purpose of this guideline is to present evidence-based and consensus-based recommendations for the prevention and treatment of postoperative delirium. The cornerstones of the guideline are the preoperative identification and handling of patients at risk, adequate intraoperative care, postoperative detection of delirium and management of delirious patients. The scope of this guideline is not to cover ICU delirium. Considering that many medical disciplines are involved in the treatment of surgical patients, a team-based approach should be implemented into daily practice. This guideline is aimed to promote knowledge and education in the preoperative, intraoperative and postoperative setting not only among anaesthesiologists but also among all other healthcare professionals involved in the care of surgical patients.

  13. The Association of Serum Levels of Brain-Derived Neurotrophic Factor with the Occurrence of and Recovery from Delirium in Older Medical Inpatients

    PubMed Central

    Williams, John; Finn, Karen; Melvin, Vincent; Meagher, David; McCarthy, Geraldine

    2017-01-01

    Limited studies of the association between BDNF levels and delirium have given inconclusive results. This prospective, longitudinal study examined the relationship between BDNF levels and the occurrence of and recovery from delirium. Participants were assessed twice weekly using MoCA, DRS-R98, and APACHE II scales. BDNF levels were estimated using an ELISA method. Delirium was defined with DRS-R98 (score > 16) and recovery from delirium as ≥2 consecutive assessments without delirium prior to discharge. We identified no difference in BDNF levels between those with and without delirium. Excluding those who never developed delirium (n = 140), we examined the association of BDNF levels and other variables with delirium recovery. Of 58 who experienced delirium, 39 remained delirious while 19 recovered. Using Generalized Estimating Equations models we found that BDNF levels (Wald χ2 = 7.155; df: 1, p = 0.007) and MoCA (Wald χ2 = 4.933; df: 1, p = 0.026) were associated with recovery. No significant association was found for APACHE II, dementia, age, or gender. BDNF levels do not appear to be directly linked to the occurrence of delirium but recovery was less likely in those with continuously lower levels. No previous study has investigated the role of BDNF in delirium recovery and these findings warrant replication in other populations. PMID:28280733

  14. The Association of Serum Levels of Brain-Derived Neurotrophic Factor with the Occurrence of and Recovery from Delirium in Older Medical Inpatients.

    PubMed

    Williams, John; Finn, Karen; Melvin, Vincent; Meagher, David; McCarthy, Geraldine; Adamis, Dimitrios

    2017-01-01

    Limited studies of the association between BDNF levels and delirium have given inconclusive results. This prospective, longitudinal study examined the relationship between BDNF levels and the occurrence of and recovery from delirium. Participants were assessed twice weekly using MoCA, DRS-R98, and APACHE II scales. BDNF levels were estimated using an ELISA method. Delirium was defined with DRS-R98 (score > 16) and recovery from delirium as ≥2 consecutive assessments without delirium prior to discharge. We identified no difference in BDNF levels between those with and without delirium. Excluding those who never developed delirium (n = 140), we examined the association of BDNF levels and other variables with delirium recovery. Of 58 who experienced delirium, 39 remained delirious while 19 recovered. Using Generalized Estimating Equations models we found that BDNF levels (Wald χ(2) = 7.155; df: 1, p = 0.007) and MoCA (Wald χ(2) = 4.933; df: 1, p = 0.026) were associated with recovery. No significant association was found for APACHE II, dementia, age, or gender. BDNF levels do not appear to be directly linked to the occurrence of delirium but recovery was less likely in those with continuously lower levels. No previous study has investigated the role of BDNF in delirium recovery and these findings warrant replication in other populations.

  15. Preoperative plasma leptin levels predict delirium in elderly patients after hip fracture surgery.

    PubMed

    Chen, Xue-Wu; Shi, Jun-Wu; Yang, Ping-Shan; Wu, Zhu-Qi

    2014-07-01

    Leptin is considered to be a modulator of the immune response. Hypoleptinemia increases the risk for Alzheimer's disease and vascular dementia. The present study aimed to investigate the ability of plasma leptin level to predict delirium in elderly patients after hip fracture surgery. Postoperative delirium (pod) was evaluated using the Confusion Assessment Method. Prolonged postoperative delirium (ppod) was defined as delirium lasting more than 4 weeks. Plasma leptin levels of 186 elderly patients and 186 elderly controls were measured by an enzyme-linked immunosorbent assay. Plasma leptin level was substantially lower in patients than in controls (4.6±2.2ng/ml vs. 7.5±1.8ng/ml, P<0.001). It was identified as an independent predictor for pod [odds ratio, 0.385; 95% confidence interval (CI), 0.286-0.517; P<0.001] and ppod (odds ratio, 0.283; 95% CI, 0.152-0.527; P<0.001) using a multivariate analysis, and had high area under receiver operating characteristic curve for pod [area under curve (AUC), 0.850; 95% CI, 0.790-0.898] and ppod (AUC, 0.890; 95% CI, 0.836-0.931). The predictive value of leptin was markedly bigger than that of age for pod (AUC, 0.705; 95% CI, 0.634-0.770; P=0.002) and ppod (AUC, 0.713; 95% CI, 0.642-0.777; P=0.019). In a combined logistic-regression model, leptin improved the AUC of age to 0.890 (95% CI, 0.836-0.931) (P<0.001) for pod and 0.910 (95% CI, 0.860-0.947) (P=0.005) for ppod. Thus, preoperative plasma leptin level may be a useful, complementary tool to predict delirium and also prolonged delirium in elderly patients after hip fracture surgery.

  16. A Comparative Study of Dexmedetomidine and Midazolam in Reducing Delirium Caused by Ketamine

    PubMed Central

    Kumar, Rajeev; Tripathi, Aditya Kumar; Mehta, Ranbeer Kumar

    2016-01-01

    Introduction Ketamine is a well known agent for sedation for short surgical procedures due to its very good analgesic action. But it has cardio stimulatory response and recovery from anaesthesia after Ketamine use is complicated by delirium and hallucination. In studies it is proved that these side effects can be reduced by premedication with benzodiazepines. The α2 adrenoceptor agonists are becoming popular for their properties like haemodynamic stability and reducing anaesthetic requirement. Aim This study was planned to see the effects of Dexmedetomidine on emergent reaction of Ketamine, when used as premedication agent with Ketamine for conducting short surgeries in adult patients. Materials and Methods Study was conducted in 90 ASA class I and II male and female patients of age between 18–40 undergoing short procedures like laparoscopic ligation, skin grafting, dilatation and curettage, endoscopic procedures, excision of small swelling, etc. Patients were randomly divided into three groups of 30 each as follows: Group K: after premedication with inj. glycopyrrolate 0.01mg/kg, inj. Ketamine 2mg/kg, Group M: after premedication with inj. glycopyrrolate 0.01mg/kg and inj midazolam 0.05mg/kg, inj. Ketamine 2mg/kg, Group D: after premedication with inj glycopyrrolate 0.01 mg/kg and inj. Dexmedetomidine 0.5μg/kg, Ketamine 2mg/kg was given. Observations were made for cardiovascular response to invasive procedure, post anaesthetic anxiety and delirium with help of Memorial Delirium Assessment scale (MDAS). Results Midazolam reduced delirium to a greater level, but in comparison to control group and midazolam group, dexmedetomidine reduced delirium to a much greater level (p-value<0.001). Postoperative pain was less in Dexmedetomidine group (p-value< 0.001). Conclusion Dexmedetomidine reduced delirium caused by Ketamine when used as a premedication agent. It produced more haemodynamic stable patients. Postoperative analgesia was also better. PMID:27656531

  17. A case of infant delirium in the neonatal intensive care unit.

    PubMed

    Edwards, L E; Hutchison, L B; Hornik, C D; Smith, P B; Cotten, C M; Bidegain, M

    2017-03-16

    Infant delirium is an under-recognized clinical entity in neonatal intensive care, and earlier identification and treatment could minimize morbidities associated with this condition. We describe a case of a 6-month-old former 32 weeks gestation infant undergoing a prolonged mechanical ventilation course diagnosed with delirium related to the combination of his underlying illness and the use of multiple sedative and analgesic mediations. Initiation of the atypical antipsychotic risperidone allowed for weaning from continuous infusions of benzodiazepines and opiods, and lower dosages of bolus-dosed sedation and analgesics. The patient experienced no adverse side effects from use of this neuroleptic.

  18. Risperidone in a child with untractable emergency delirium: a case report

    PubMed Central

    2016-01-01

    A 6-year-old boy was scheduled for thoracic magnetic resonance imaging under deep sedation with midazolam 1.8 mg and propofol 100 µg/kg/min via intravenous injection. He showed emergence delirium in the post-anesthesia care unit. The staff attempted to calm him by administering flumazenil as an antidote for midazolam, propofol for further sedation, and meperidine. However, this was not successful. A psychiatrist recommended the use of antipsychotics. Administration of risperidone led to immediate resolution of the boy's symptoms and relaxed him. The use of antipsychotic drugs is not common for anesthesiologists, but should be considered for treating uncontrolled emergence delirium after anesthesia. PMID:27924205

  19. Slow Gait Speed and Rapid Renal Function Decline Are Risk Factors for Postoperative Delirium after Urological Surgery

    PubMed Central

    Sato, Tendo; Okamoto, Teppei; Yamamoto, Hayato; Hosogoe, Shogo; Tobisawa, Yuki; Yoneyama, Tohru; Hashiba, Eiji; Yoneyama, Takahiro; Hashimoto, Yasuhiro; Koie, Takuya; Hirota, Kazuyoshi; Ohyama, Chikara

    2016-01-01

    Objectives The aim of this study was to identify risk factors associated with postoperative delirium in patients undergoing urological surgery. Methods We prospectively evaluated pre- and postoperative risk factors for postoperative delirium in consecutive 215 patients who received urological surgery between August 2013 and November 2014. Preoperative factors included patient demographics, comorbidities, and frailty assessment. Frailty was measured by handgrip strength, fatigue scale of depression, fall risk assessment, and gait speed (the timed Get-up and Go test). Postoperative factors included types of anesthesia, surgical procedure, renal function and serum albumin decline, blood loss, surgery time, highest body temperature, and complications. Uni- and multivariate logistic regression analyses were performed to assess pre- and postoperative predictors for the development of postoperative delirium. Results Median age of this cohort was 67 years. Ten patients (4.7%) experienced postoperative delirium. These patients were significantly older, had weak handgrip strength, a higher fall risk assessment score, slow gait speed, and greater renal function decline compared with patients without delirium. Multivariate analysis revealed slow gait speed (>13.0 s) and rapid renal function decline (>30%) were independent risk factors for postoperative delirium. Conclusions Slow gait speed and rapid renal function decline after urological surgery are significant factors for postoperative delirium. These data will be helpful for perioperative patient management. This study was registered as a clinical trial: UMIN: R000018809. PMID:27145178

  20. Plasma concentrations of magnesium and vitamin B-1 in alcoholism and delirium tremens. Pathogenic and prognostic implications.

    PubMed

    Hoes, M J

    1981-01-01

    Plasma concentrations of magnesium were low in 32 alcoholics and 19 patients with delirium tremens. Vitamin B 1 was lowered only in delirium tremens. After discharge, 39 patients were in remission and 12 present signs of alcoholic encephalopathy. The development of encephalopathy can be predicted when delirium tremens is associated with a low plasma concentration of magnesium and vitamin B 1 and admission. One can thus conclude that encephalopathy after discharge is not caused in alcoholics by deficiencies in magnesium or vitamine B 1 or both together.

  1. Beyond Urinary Tract Infections (UTIs) and Delirium: A Systematic Review of UTIs and Neuropsychiatric Disorders.

    PubMed

    Chae, Jung Hee Jennifer; Miller, Brian J

    2015-11-01

    Urinary tract infections (UTIs) are among the most common bacterial infections. Although comorbid UTI in geriatric patients with delirium or dementia is well known, the prevalence and scope of the association with other neuropsychiatric disorders is unclear. We performed a systematic review of the association between UTIs and delirium, dementia, psychotic disorders, and mood disorders in hospitalized patients. We identified studies by searching PubMed, PsycInfo, and Web of Knowledge, and the reference lists of identified studies and review papers. Seventeen publications met the inclusion criteria. The primary findings were: (1) 88% of publications reported a positive association between UTIs and neuropsychiatric disorders; (2) 47% reported that the clinical course of a neuropsychiatric disorder may be precipitated or exacerbated by a UTI; (3) the mean weighted prevalence of UTIs in subjects was 19.4% for delirium, 11.2% for dementia, 21.7% for nonaffective psychotic disorders, and 17.8% for mood disorders. Our findings, which must be interpreted carefully given the heterogeneity among the studies, suggest that UTIs are highly comorbid in hospitalized patients and may precipitate or exacerbate some neuropsychiatric disorders. The association extends beyond geriatric patients with delirium, affects males and females, and includes adults with psychotic and mood disorders. These findings underscore the important interface between physical and mental health. Potential underlying mechanisms are also reviewed, including complex interactions between the immune system and the brain.

  2. Prevention of Post-operative Delirium in the Elderly Using Pharmacological Agents

    PubMed Central

    Tremblay, Patrice; Gold, Susan

    2016-01-01

    Introduction Post-operative delirium (POD) is a serious surgical complication that can cause significant morbidity and mortality. It is associated with prolonged hospital stay, delayed admission to rehabilitation programs, persistent cognitive deficits, marked health-care costs, and more. The pathophysiology is multi-factorial and not completely understood, which complicates the optimal management. Non-pharmacological measures have been the mainstay of treatment, but there has been an ongoing interest in the medical literature on the prevention of post-operative delirium using medications. The purpose of this review is to critically analyze the current evidence on pharmacological prevention of POD. Methods A literature review was conducted using PubMed and Embase databases, using the following search terms: delirium, anti-psychotics, cholinesterase inhibitors, and statins. Results A total of 1,152 articles were screened and 25 articles were reviewed. Fourteen articles found a reduced incidence of post-operative delirium using pharmacological agents: eight with antipsychotics, two with statins, one with melatonin, one with dexamethasone, one with gabapentin, and one with diazepam. However, study designs, methodological issues, or authors’ interpretations raise questions on these conclusions. Conclusions Further double-blinded randomized clinical trials should be conducted before administering pharmacological agents to reduce POD in a non-research setting. PMID:27729950

  3. Hazards of Hospitalization: Hospitalists and Geriatricians Educating Medical Students about Delirium and Falls in Geriatric Inpatients

    ERIC Educational Resources Information Center

    Lang, Valerie J.; Clark, Nancy S.; Medina-Walpole, Annette; McCann, Robert

    2008-01-01

    Geriatric patients are at increased risk for complications from delirium or falls during hospitalization. Medical education, however, generally places little emphasis on the hazards of hospitalization for older inpatients. Geriatricians conducted a faculty development workshop for hospitalists about the hazards of hospitalization for geriatric…

  4. AACN CSI Academy, part 3: Introducing the Massachusetts CSI Nursing Delirium Collaborative.

    PubMed

    DiLibero, Justin; Edwards, Erica; Hanson, Dave

    2015-11-01

    In the final installment of our three-part series, we reveal how the Boston cohort of the American Association of Critical-Care Nurses (AACN) Clinical Scene Investigator (CSI) Academy launched a collective to improve patient safety and quality outcomes related to delirium.

  5. Deconstructing Dementia and Delirium Hospital Practice: Using Cultural Historical Activity Theory to Inform Education Approaches

    ERIC Educational Resources Information Center

    Teodorczuk, Andrew; Mukaetova-Ladinska, Elizabeta; Corbett, Sally; Welfare, Mark

    2015-01-01

    Older patients with dementia and delirium receive suboptimal hospital care. Policy calls for more effective education to address this though there is little consensus on what this entails. The purpose of this clarification study is to explore how practice gaps are constructed in relation to managing the confused hospitalised older patient. The…

  6. Public health model identifies recruitment barriers among older adults with delirium and dementia.

    PubMed

    Bull, Margaret J; Boaz, Lesley; Sjostedt, Jennifer M

    2014-01-01

    Recruiting older adults and their family caregivers into research studies presents challenges. Although the literature notes some general recruitment challenges, no studies specifically address the unique challenges of recruiting older adults who have Alzheimer's Disease (AD) and their family caregivers in studies about delirium or suggest using a framework to identify barriers to recruiting this population. In conducting a pilot study about preparing family caregivers to detect delirium symptoms in older adults with (AD) the researchers used the Public Health Model for identifying barriers to recruitment. The goals of this methodological article are to: (1) briefly describe the methodology of the pilot study to illustrate how the Public Health Model was applied in the context of the present study and (2) discuss the benefits of the Public Health Model for identifying the barriers to recruitment in a study that prepared family caregivers to detect delirium symptoms in older adults with AD. The Public Health Model helped us to identify four specific barriers to recruitment (lack of knowledge about delirium, desire to maintain normalcy, protective caregiving behaviors, and older adult's fears) and ways to overcome them. The Public Health Model might also help other researchers address similar issues.

  7. Delirium Outcomes in a Randomized Trial of Blood Transfusion Thresholds Among Hospitalized Older Patients with Hip Fracture

    PubMed Central

    Gruber-Baldini, Ann L; Marcantonio, Edward; Orwig, Denise; Magaziner, Jay; Terrin, Michael; Barr, Erik; Brown, Jessica Pelletier; Paris, Barbara; Zagorin, Aleksandra; Roffey, Darren M.; Zakriya, Khwaja; Blute, Mary-Rita; Hebel, J. Richard; Carson, Jeffrey L.

    2013-01-01

    Objectives To determine if a higher blood transfusion threshold would prevent new or worsening delirium symptoms in the hospital after hip fracture surgery. Design Ancillary study to a randomized clinical trial. Setting Thirteen hospitals in United States and Canada. Participants One-hundred-thirty-nine hospitalized hip fracture patients, age ≥50, with cardiovascular disease or risk factors, and hemoglobin<10 g/dL within 3 days of surgery, recruited in an ancillary study of “Transfusion Trigger Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair (FOCUS) trial.” Intervention Treatment groups: 1) Liberal: received one unit of packed red blood cells and as much blood as needed to maintain hemoglobin >10 g/dL; 2) Restrictive: received transfusions if developed symptoms of anemia or hemoglobin fell below 8 g/dL. Measurements Delirium assessments performed pre-randomization and up to three times post-randomization. Primary outcome: Severity of delirium using Memorial Delirium Assessment Scale (MDAS) scale. Secondary outcome: presence or absence of delirium defined by Confusion Assessment Method Diagnostic Algorithm (CAM). Results Mean age was 81.5 (SD=9.1). Liberal group received a median 2 units and Restrictive group 0 units of blood. Hemoglobin concentration on day 1 post randomization was 1.4 g/dL higher in the Liberal group. Treatment groups did not significantly differ at any time point or over time on either MDAS delirium severity (p=0.28) or CAM delirium presence (p=0.83). Conclusion Blood transfusion to maintain hemoglobin >10 g/dL alone is unlikely to influence delirium severity or rate in postoperative hip fracture patients with hemoglobin concentration <10 g/dL. Trial Registration ClinicalTrials.gov identifier: NCT00071032 http://clinicaltrials.gov/ct2/show/NCT00071032 PMID:23898894

  8. A systematic review and meta-analysis of the association between the apolipoprotein E genotype and delirium.

    PubMed

    Adamis, Dimitrios; Meagher, David; Williams, John; Mulligan, Owen; McCarthy, Geraldine

    2016-04-01

    The role of apolipoprotein E (APOE) in Alzheimer's disease and other dementias has been investigated intensively. However, the relationship between APOE and delirium has only recently been explored in studies that have included relatively small samples. A meta-analysis of the published pooled data is timely to explore the relationship between APOE and delirium and to inform further research in this topic. PubMed, EBSCOhost, Google Scholar, Scopus, all EBM Reviews (OVID) and the Cochrane Database of Systematic Reviews were searched with relevant keywords and from the references of relevant papers. Ten papers were found that examined the relationship between APOE and delirium. Data were extracted from eight of them and pooled for meta-analysis using random effects with R software. Data from 1762 participants, of whom 479 (27.2%) were diagnosed with delirium, showed low heterogeneity (Q=13.11, d.f.=7, P=0.07; I=44.86%). The possession of the APOE ε4 allele has a small (log odds ratio: 0.18, 95% confidence interval: 0.23-0.59), nonsignificant (P=0.38) effect on the presence of delirium. No publication bias was identified. The metapower of the pooled data was low (α=0.05, power=0.65). On analysing the studies to date, it seems that there is no association between APOE and the occurrence of delirium. We suggest that further studies are needed with greater number of patients to clarify any association as well as to examine for other patterns of association including relevance for subgroups of patients who develop delirium and for effects on the phenotype of delirium and the outcomes.

  9. Effect of melatonin on incidence of delirium among patients with hip fracture: a multicentre, double-blind randomized controlled trial

    PubMed Central

    de Jonghe, Annemarieke; van Munster, Barbara C.; Goslings, J. Carel; Kloen, Peter; van Rees, Carolien; Wolvius, Reinder; van Velde, Romuald; Levi, Marcel; de Haan, Rob J.; de Rooij, Sophia E.

    2014-01-01

    Background: Disturbance of the sleep–wake cycle is a characteristic of delirium. In addition, changes in melatonin rhythm influence the circadian rhythm and are associated with delirium. We compared the effect of melatonin and placebo on the incidence and duration of delirium. Methods: We performed this multicentre, double-blind, randomized controlled trial between November 2008 and May 2012 in 1 academic and 2 nonacademic hospitals. Patients aged 65 years or older who were scheduled for acute hip surgery were eligible for inclusion. Patients received melatonin 3 mg or placebo in the evening for 5 consecutive days, starting within 24 hours after admission. The primary outcome was incidence of delirium within 8 days of admission. We also monitored the duration of delirium. Results: A total of 452 patients were randomly assigned to the 2 study groups. We subsequently excluded 74 patients for whom the primary end point could not be measured or who had delirium before the second day of the study. After these postrandomization exclusions, data for 378 patients were included in the main analysis. The overall mean age was 84 years, 238 (63.0%) of the patients lived at home before admission, and 210 (55.6%) had cognitive impairment. We observed no effect of melatonin on the incidence of delirium: 55/186 (29.6%) in the melatonin group v. 49/192 (25.5%) in the placebo group; difference 4.1 (95% confidence interval −0.05 to 13.1) percentage points. There were no between-group differences in mortality or in cognitive or functional outcomes at 3-month follow-up. Interpretation: In this older population with hip fracture, treatment with melatonin did not reduce the incidence of delirium. Trial registration: Netherlands Trial Registry, NTR1576: MAPLE (Melatonin Against PLacebo in Elderly patients) study; www.trialregister.nl/trialreg/admin/rctview.asp?TC=1576 PMID:25183726

  10. Delirium and Sedation in the Intensive Care Unit (ICU): survey of behaviors and attitudes of 1,384 healthcare professionals

    PubMed Central

    Patel, RP; Gambrell, M; Speroff, T; Scott, TA; Pun, BT; Okahashi, J; Strength, C; Pandharipande, P; Girard, TD; Burgess, H; Dittus, RS; Bernard, GR; Ely, EW

    2013-01-01

    Objective A 2001 survey found that most healthcare professionals considered ICU delirium as a serious problem, but only 16% used a validated delirium screening tool. Our objective was to assess beliefs and practices regarding ICU delirium and sedation management. Design and Setting Between October 2006 and May 2007, a survey was distributed to ICU practitioners in 41 North American hospitals, 7 international critical care meetings and courses, and the American Thoracic Society email database Study Participants A convenience sample of 1,384 health care professionals including 970 physicians, 322 nurses, 23 respiratory care practitioners, 26 pharmacists, 18 nurse practitioners and physicians’ assistants, and 25 others. Results A majority [59% (766/1300)] estimated that over 1 in 4 adult mechanically ventilated patients experience delirium. Over half [59% (774/1302)] screen for delirium, with 33% of those respondents (258/774) using a specific screening tool. A majority of respondents use a sedation protocol, but 29% (396/1355) still do not. A majority (76%, 990/1309) has a written policy on spontaneous awakening trials (SATs), but the minority of respondents (44%, 446/1019) practice SATs on more than half of ICU days. Conclusions Delirium is considered a serious problem by a majority of healthcare professionals, and the percent of practitioners using a specific screening tool has increased since the last published survey data. While most respondents have adopted specific sedation protocols and have an approved approach to stopping sedation daily, few report even modest compliance with daily cessation of sedation. PMID:19237884

  11. Treating an Established Episode of Delirium in Palliative Care: Expert Opinion and Review of the Current Evidence Base With Recommendations for Future Development

    PubMed Central

    Pereira, José L.; Davis, Daniel H.J.; Currow, David C.; Meagher, David; Rabheru, Kiran; Wright, David; Bruera, Eduardo; Hartwick, Michael; Gagnon, Pierre R.; Gagnon, Bruno; Breitbart, William; Regnier, Laura; Lawlor, Peter G.

    2014-01-01

    Context Delirium is a highly prevalent complication in patients in palliative care settings, especially in the end-of-life context. Objectives To review the current evidence base for treating episodes of delirium in palliative care settings and propose a framework for future development. Methods We combined multidisciplinary input from delirium researchers and other purposely selected stakeholders at an international delirium study planning meeting. This was supplemented by a literature search of multiple databases and relevant reference lists to identify studies regarding therapeutic interventions for delirium. Results The context of delirium management in palliative care is highly variable. The standard management of a delirium episode includes the investigation of precipitating and aggravating factors followed by symptomatic treatment with drug therapy. However, the intensity of this management depends on illness trajectory and goals of care in addition to the local availability of both investigative modalities and therapeutic interventions. Pharmacologically, haloperidol remains the practice standard by consensus for symptomatic control. Dosing schedules are derived from expert opinion and various clinical practice guidelines as evidence-based data from palliative care settings are limited. The commonly used pharmacologic interventions for delirium in this population warrant evaluation in clinical trials to examine dosing and titration regimens, different routes of administration, and safety and efficacy compared with placebo. Conclusion Delirium treatment is multidimensional and includes the identification of precipitating and aggravating factors. For symptomatic management, haloperidol remains the practice standard. Further high-quality collaborative research investigating the appropriate treatment of this complex syndrome is needed. PMID:24480529

  12. Outcomes of an innovative model of acute delirium care: the Geriatric Monitoring Unit (GMU)

    PubMed Central

    Chong, Mei Sian; Chan, Mark; Tay, Laura; Ding, Yew Yoong

    2014-01-01

    Objective Delirium is associated with poor outcomes following acute hospitalization. The Geriatric Monitoring Unit (GMU) is a specialized five-bedded unit for acute delirium care. It is modeled after the Delirium Room program, with adoption of core interventions from the Hospital Elder Life Program and use of evening light therapy to consolidate circadian rhythms and improve sleep in older inpatients. This study examined whether the GMU program improved outcomes in delirious patients. Method A total of 320 patients, including 47 pre-GMU, 234 GMU, and 39 concurrent control subjects, were studied. Clinical characteristics, cognitive status, functional status (Modified Barthel Index [MBI]), and chemical restraint-use data were obtained. We also looked at in-hospital complications of falls, pressure ulcers, nosocomial infection rate, and discharge destination. Secondary outcomes of family satisfaction (for the GMU subjects) were collected. Results There were no significant demographic differences between the three groups. Pre-GMU subjects had longer duration of delirium and length of stay. MBI improvement was most evident in the GMU compared with pre-GMU and control subjects (19.2±18.3, 7.5±11.2, 15.1±18.0, respectively) (P<0.05). The GMU subjects had a zero restraint rate, and pre-GMU subjects had higher antipsychotic dosages. This translated to lower pressure ulcer and nosocomial infection rate in the GMU (4.1% and 10.7%, respectively) and control (1.3% and 7.7%, respectively) subjects compared with the pre-GMU (9.1% and 23.4%, respectively) subjects (P<0.05). No differences were observed in mortality or discharge destination among the three groups. Caregivers of GMU subjects felt the multicomponent intervention to be useful, with scheduled activities voted the most beneficial in patient’s recovery from the delirium episode. Conclusion This study shows the benefits of a specialized delirium management unit for older persons. The GMU model is thus a relevant

  13. Test-Retest Reliability of a Serious Game for Delirium Screening in the Emergency Department

    PubMed Central

    Tong, Tiffany; Chignell, Mark; Tierney, Mary C.; Lee, Jacques S.

    2016-01-01

    Introduction: Cognitive screening in settings such as emergency departments (ED) is frequently carried out using paper-and-pencil tests that require administration by trained staff. These assessments often compete with other clinical duties and thus may not be routinely administered in these busy settings. Literature has shown that the presence of cognitive impairments such as dementia and delirium are often missed in older ED patients. Failure to recognize delirium can have devastating consequences including increased mortality (Kakuma et al., 2003). Given the demands on emergency staff, an automated cognitive test to screen for delirium onset could be a valuable tool to support delirium prevention and management. In earlier research we examined the concurrent validity of a serious game, and carried out an initial assessment of its potential as a delirium screening tool (Tong et al., 2016). In this paper, we examine the test-retest reliability of the game, as it is an important criterion in a cognitive test for detecting risk of delirium onset. Objective: To demonstrate the test-retest reliability of the screening tool over time in a clinical sample of older emergency patients. A secondary objective is to assess whether there are practice effects that might make game performance unstable over repeated presentations. Materials and Methods: Adults over the age of 70 were recruited from a hospital ED. Each patient played our serious game in an initial session soon after they arrived in the ED, and in follow up sessions conducted at 8-h intervals (for each participant there were up to five follow up sessions, depending on how long the person stayed in the ED). Results: A total of 114 adults (61 females, 53 males) between the ages of 70 and 104 years (M = 81 years, SD = 7) participated in our study after screening out delirious patients. We observed a test-retest reliability of the serious game (as assessed by correlation r-values) between 0.5 and 0.8 across adjacent

  14. Test-Retest Reliability of a Serious Game for Delirium Screening in the Emergency Department.

    PubMed

    Tong, Tiffany; Chignell, Mark; Tierney, Mary C; Lee, Jacques S

    2016-01-01

    Introduction: Cognitive screening in settings such as emergency departments (ED) is frequently carried out using paper-and-pencil tests that require administration by trained staff. These assessments often compete with other clinical duties and thus may not be routinely administered in these busy settings. Literature has shown that the presence of cognitive impairments such as dementia and delirium are often missed in older ED patients. Failure to recognize delirium can have devastating consequences including increased mortality (Kakuma et al., 2003). Given the demands on emergency staff, an automated cognitive test to screen for delirium onset could be a valuable tool to support delirium prevention and management. In earlier research we examined the concurrent validity of a serious game, and carried out an initial assessment of its potential as a delirium screening tool (Tong et al., 2016). In this paper, we examine the test-retest reliability of the game, as it is an important criterion in a cognitive test for detecting risk of delirium onset. Objective: To demonstrate the test-retest reliability of the screening tool over time in a clinical sample of older emergency patients. A secondary objective is to assess whether there are practice effects that might make game performance unstable over repeated presentations. Materials and Methods: Adults over the age of 70 were recruited from a hospital ED. Each patient played our serious game in an initial session soon after they arrived in the ED, and in follow up sessions conducted at 8-h intervals (for each participant there were up to five follow up sessions, depending on how long the person stayed in the ED). Results: A total of 114 adults (61 females, 53 males) between the ages of 70 and 104 years (M = 81 years, SD = 7) participated in our study after screening out delirious patients. We observed a test-retest reliability of the serious game (as assessed by correlation r-values) between 0.5 and 0.8 across adjacent

  15. Angel's Trumpet (Datura stramonium) poisoning and delirium in adolescents in Winnipeg, Manitoba: Summer 2006.

    PubMed

    Wiebe, Tannis H; Sigurdson, Eric S; Katz, Laurence Y

    2008-03-01

    Over the course of the summer of 2006, four adolescent patients were hospitalized because of intentional Datura stramonium (Angel's Trumpet) ingestion. Their records were reviewed for the presence of signs and symptoms of toxicity, clinical course, treatment and outcome. All four patients had a decreased level of consciousness measured by the Glasgow Coma Scale, visual hallucinations, dilated pupils and agitation. The changes in mental status are characteristic of delirium. All four patients were known to abuse substances. The average length of hospitalization was two days. No serious complications were encountered during hospitalization and a full recovery was noted in all patients. The use of sedation and restraints were sufficient treatment modalities. Health care workers should consider anticholinergic plant ingestion as a cause for abrupt onset of delirium.

  16. A Lilliputian army under the floorboards: persistent delirium with complete though prolonged recovery

    PubMed Central

    Wakefield, Dominique; Thompson, Louise; Bruce, Stuart

    2014-01-01

    We report the case of an 83-year-old man who presented with a history of fluctuating delirium of insidious onset, secondary to an amoebic liver abscess more than 30 years after acute exposure. We describe a 2-year clinical journey that started with a fall and was additionally complicated by severe weight loss and acute kidney injury (AKI). The likely prognosis for such a combination of comorbidities in an older person is for lasting morbidity, institutionalisation and significant mortality. However, the case demonstrates that with timely assessment and care complete recovery is possible though it may take many months. It reminds us of the catalytic implications of falls for older persons and to maintain a differential diagnostic approach to delirium of insidious onset avoiding misdiagnosis as dementia with which it may be associated. Our case report includes extracts from the patient's own account providing added insight into such experiences. PMID:24792019

  17. The psychiatrist in the surgical intensive care unit. I. Postoperative delirium.

    PubMed

    Nadelson, T

    1976-02-01

    Delirium has been defined as a condition of cerebral insufficiency consisting of impairment of cognitive processes, with a characteristic slowing of the electroencephalographic pattern. Present also is a global "clouding" of consciousness, resulting from a potentially reversible impairment of ability to maintain attention. In these states there is usually a simultaneous diminution of the ability to think, perceive, and remember. Although drowsiness may be a part of this state, patients can be awake and yet delirious, with diminished consciousness of their surroundings. Postoperative delirium is seen more often in patients over 50 years of age, in those who are "vigilant" or overalert, and in those undergoing more complex surgery. Adverse influences in the postoperative period are certain drugs and the psychological stresses engendered by the ICU environment. Appropriate management obtains from attention to the impact of the strange enviornment on the patient.

  18. Alcoholic delirium tremens with hollow viscus perforation scheduled for emergency laparotomy

    PubMed Central

    Talikoti, Anand T; Sindhu, BS; Kavyashree, SP; Kumar, KS Kishore

    2012-01-01

    Alcohol is a drug consumed at some time in life by up to 80% of the population according to western statistics. Wide differences in socioeconomic status in India contribute to various degrees and severity of alcoholism and its associated complications. The symptoms of alcohol withdrawal range from such minor ones as insomnia and tremulousness to severe complications such as withdrawal seizures and delirium tremens. Although alcohol withdrawal syndrome has been reported in the literature in post-operative periods and in Intensive Care Unit, there is paucity of information on treatment and preparation of a patient with alcohol withdrawal syndrome coming for emergency surgical procedures. The surgical stress and deranged liver function in such cases poses an additional challenge to the anaesthesiologist. Here, we report the successful management of a case of acute alcoholic delirium tremens who presented with hollow viscous perforation for emergency exploratory laparotomy. PMID:22701216

  19. Pain, Delirium and Physical Function in Skilled Nursing Home Patients with Dementia

    PubMed Central

    Kolanowski, Ann; Mogle, Jacqueline; Fick, Donna M.; Hill, Nikki; Mulhall, Paula; Nadler, Jamie; Colancecco, Elise; Behrens, Liza

    2014-01-01

    Objective Skilled Nursing Facilities (SNFs) are major sites of post-acute care for patients with dementia. A recent Office of the Inspector General report indicated that outcomes in SNFs are sub-optimal due to poor-quality treatment, including the failure to provide needed care. Pain is frequently un-recognized and un-treated in patients with dementia. The aim of this exploratory study was to examine the effect daily pain has on delirium and physical function in patients with dementia in SNFs. The association of daily pain with discharge disposition was also examined. Design Secondary analysis of data from an on-going randomized clinical trial. Setting Eight SNFs located in central and northeast Pennsylvania. Participants One hundred and three SNF patients with adjudicated dementia and delirium diagnoses and a mean age of 86 (±6.8) years; most were female (66%) and Caucasian (98%). Measurements Measures of pain (Pain Assessment in Advanced Dementia), delirium (Confusion Assessment Method), and physical function (Barthel Index) were taken daily for 30 days or until discharge. Results On days when participants experienced greater than their average level of pain they also experienced more delirium symptoms (p < .001) and lower physical function (p < .001). Participants with higher levels of average daily pain were more likely to die (OR = 6.306, 95% CI: 1.914–20.771, p = .003) or be placed in a nursing home (OR= 4.77, 95% CI:1.7–13.2, p=.003) compared to returning to the community at 3-month follow-up. Conclusion Greater attention to pain in patients with dementia may be a potential solution to some of the quality problems and high costs of care in SNFs PMID:25239018

  20. Performance and agreement of risk stratification instruments for postoperative delirium in persons aged 50 years or older.

    PubMed

    Jansen, Carolien J; Absalom, Anthony R; de Bock, Geertruida H; van Leeuwen, Barbara L; Izaks, Gerbrand J

    2014-01-01

    Several risk stratification instruments for postoperative delirium in older people have been developed because early interventions may prevent delirium. We investigated the performance and agreement of nine commonly used risk stratification instruments in an independent validation cohort of consecutive elective and emergency surgical patients aged ≥50 years with ≥1 risk factor for postoperative delirium. Data was collected prospectively. Delirium was diagnosed according to DSM-IV-TR criteria. The observed incidence of postoperative delirium was calculated per risk score per risk stratification instrument. In addition, the risk stratification instruments were compared in terms of area under the receiver operating characteristic (ROC) curve (AUC), and positive and negative predictive value. Finally, the positive agreement between the risk stratification instruments was calculated. When data required for an exact implementation of the original risk stratification instruments was not available, we used alternative data that was comparable. The study population included 292 patients: 60% men; mean age (SD), 66 (8) years; 90% elective surgery. The incidence of postoperative delirium was 9%. The maximum observed incidence per risk score was 50% (95%CI, 15-85%); for eight risk stratification instruments, the maximum observed incidence per risk score was ≤25%. The AUC (95%CI) for the risk stratification instruments varied between 0.50 (0.36-0.64) and 0.66 (0.48-0.83). No AUC was statistically significant from 0.50 (p≥0.11). Positive predictive values of the risk stratification instruments varied between 0-25%, negative predictive values between 89-95%. Positive agreement varied between 0-66%. No risk stratification instrument showed clearly superior performance. In conclusion, in this independent validation cohort, the performance and agreement of commonly used risk stratification instruments for postoperative delirium was poor. Although some caution is needed

  1. The incidence of delirium after cardiac surgery in the elderly: protocol for a systematic review and meta-analysis

    PubMed Central

    Liao, Yulin; Flaherty, Joseph H; Yue, Jirong; Wang, Yanyan; Deng, Chuanyao; Chen, Ling

    2017-01-01

    Introduction Delirium is one of the most common complications after cardiac surgery in the elderly. Future studies aimed at preventing postoperative delirium will need an accurate estimate of incidence. However, there are no available systematic reviews on the incidence, and reports of incidence of postoperative delirium after a cardiac operation vary widely with significant heterogeneity. Therefore, we aim to perform a systematic review and meta-analysis to determine the most accurate incidence possible of postoperative delirium in individuals aged >65 years after cardiac surgery. Methods and analyses We will undertake a comprehensive literature search among PubMed, EMBASE, the Cochrane Library, PsycINFO and CINAHL, from their inception to January 2017. Prospective cohort and cross sectional studies that described the incidence of delirium will be eligible for inclusion. The primary outcome will be the incidence of delirium. Risk of bias and methodological quality for the included studies will be assessed using a risk of bias tool for prevalence studies and the Cochrane guidelines. Heterogeneity of the estimates across studies will be assessed. Incidence data will be pooled by selective or emergency surgery. This systematic review will be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Ethics and dissemination This proposed systematic review and meta-analysis is based on published data, and thus there is no requirement for ethics approval. The study will provide an up to date and accurate incidence of postoperative delirium among the older population after cardiac surgery, which is necessary for future research in this area. The findings of this study will be presented at conferences and disseminated through publication in a peer reviewed journal. Trial registration number CRD42016047773. PMID:28360251

  2. Drugs of anesthesia acting on central cholinergic system may cause post-operative cognitive dysfunction and delirium.

    PubMed

    Praticò, C; Quattrone, D; Lucanto, T; Amato, A; Penna, O; Roscitano, C; Fodale, V

    2005-01-01

    Given the progressive and constant increase of average life expectancy, an increasing number of elderly patients undergo surgery. After surgery, elderly patients often exhibit a transient reversible state of cerebral cognitive alterations. Among these cognitive dysfunctions, a state of delirium may develop. Delirium is an aetiologically non-specific syndrome characterised by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behaviour and the sleep-wake cycle. Delirium appears to occur in 10-26% of general medical patients over 65, and is frequently associated with a significant increase in morbidity and mortality. During hospitalization, mortality rates have been estimated to be 10-26% of patients who developed post-operative delirium, and 22-76% during the following months. Over the last few decades, post-operative delirium has been associated with several pre-operative predictor factors, as well as age (50 years and older), alcohol abuse, poor cognitive and functional status, electrolyses or glucose abnormalities, and type of surgery. The uncertain pathogenesis of post-operative cognitive dysfunctions and delirium has not permitted a causal approach to developing an effective treatment. General anesthesia affects brain function at all levels, including neuronal membranes, receptors, ion channels, neurotransmitters, cerebral blood flow and metabolism. The functional equivalents of these impairments involve mood, memory, and motor function behavioural changes. These dysfunctions are much more evident in the occurrence of stress-regulating transmission and in the alteration of intra-cellular signal transduction systems. In addition, more essential cellular processes, that play an important role in neurotransmitter synthesis and release, such as intra-neuronal signal transduction and second messenger system, may be altered. Keeping in mind the functions of the central muscarinic cholinergic system and its multiple

  3. Morphine for Intravenous Patient-Controlled Analgesia May Inhibit Delirium Tremens

    PubMed Central

    Chan, Chia-Ta; Liao, Wen-Wei; Huang, William

    2015-01-01

    Abstract Alcoholism is common among trauma patients and often lacks the appropriate monitoring. Alcohol withdrawal syndrome (AWS), including delirium tremens (DT), can be associated with significant postoperative morbidity and mortality. However, appropriate acute pain management may protect against delirium; the administration of intravenous patient-controlled analgesia (IV - PCA) may not only alleviate pain, but also reduce the incidence of post-operative delirium. IV-PCA is widely used today; however, little attention has been paid to its influence on the development of AWS or DT post-surgery. Here we present a case in which the administration of IV-PCA may have delayed the onset of DT that interfered with postoperative care and the initiation of psychiatric consultation. The literature was reviewed to determine the potential mechanisms behind the effects of IV-PCA on the onset of AWS or DT. IV-PCA may delay the onset of DT. It is imperative to take into consideration trauma patients’ psychiatric history including answers to questions on alcoholism, so that when an IV-PCA is administered and then discontinued, adequate interventions to prevent further morbidity associated with AWS and DT can be initiated in sufficient time. PMID:26512587

  4. Anticholinergic Exposure During Rehabilitation: Cognitive and Physical Function Outcomes in Patients With Delirium Superimposed On Dementia

    PubMed Central

    Kolanowski, Ann; Mogle, Jacqueline; Fick, Donna M.; Campbell, Noll; Hill, Nikki; Mulhall, Paula; Behrens, Liza; Colancecco, Elise; Boustani, Malaz; Clare, Linda

    2015-01-01

    Objectives We examined the association between anticholinergic medication exposure and subsequent cognitive and physical function in patients with delirium superimposed on dementia during rehabilitation. We also examined length of stay and discharge disposition by anticholinergic medication exposure. Design In this secondary analysis we used control group data from an ongoing randomized clinical trial. Setting/Participants Participants with delirium and dementia were enrolled at admission to post-acute care. These 99 participants had a mean age of 86.11 (± 6.83) years; 67.6% were female; 98% were Caucasian; and 33% were positive for at least one APOE e4 allele. Measures We obtained daily measures of cognitive and physical function using: Digit Span; memory, orientation and attention items from the Montreal Cognitive Assessment; CLOX; Confusion Assessment Method; and Barthel Index. Anticholinergic medication exposure was measured weekly using the Anticholinergic Cognitive Burden Scale. Results Using multilevel models for time we found that greater use of clinically relevant anticholinergic medications in the previous week reduced cognitive and physical function, as measured by Digit Span Backwards and the Barthel Index, in the current week. There was no effect of anticholinergic medication use on delirium severity, and APOE status did not moderate any outcomes. Greater use of clinically relevant anticholinergic medications was related to longer length of stay but not discharge disposition. Conclusion For vulnerable older adults, anticholinergic exposure represents a potentially modifiable risk factor for poor attention, working memory, physical function and greater length of stay during rehabilitation. PMID:26419732

  5. Potential use of melatonin in sleep and delirium in the critically ill.

    PubMed

    Bellapart, J; Boots, R

    2012-04-01

    Intensive care delirium is a well-recognized complication in critically ill patients. Delirium is an independent risk factor for death in the intensive care unit (ICU), leading to oversedation, increased duration of mechanical ventilation, and increased length of stay. Although there has not been a direct causal relationship shown between sleep deprivation and delirium, many studies have demonstrated that critically ill patients have an altered sleep pattern, abnormal levels of melatonin, and loss of circadian rhythms. Melatonin has a major role in control of circadian rhythm and sleep regulation and other effects on the immune system, neuroprotection, and oxidant/anti-oxidant activity. There has been interest in the use of exogenous melatonin as a measure to improve sleep. However, there are only a few studies of melatonin in ICU patients and these use heterogeneous methodologies. Therefore, it is not possible at this stage to make any clear recommendations regarding the clinical use of melatonin in this setting. There is a need for well-designed randomized controlled trials examining the role of melatonin in ICU.

  6. Factors associated with sudden death of individuals requiring restraint for excited delirium.

    PubMed

    Stratton, S J; Rogers, C; Brickett, K; Gruzinski, G

    2001-05-01

    The purpose of this article is to identify and rank factors associated with sudden death of individuals requiring restraint for excited delirium. Eighteen cases of such deaths witnessed by emergency medical service (EMS) personnel are reported. The 18 cases reported were restrained with the wrists and ankles bound and attached behind the back. This restraint technique was also used for all 196 surviving excited delirium victims encountered during the study period. Unique to these data is a description of the initial cardiopulmonary arrest rhythm in 72% of the sudden death cases. Associated with all sudden death cases was struggle by the victim with forced restraint and cessation of struggling with labored or agonal breathing immediately before cardiopulmonary arrest. Also associated was stimulant drug use (78%), chronic disease (56%), and obesity (56%). The primary cardiac arrest rhythm of ventricular tachycardia was found in 1 of 13 victims with confirmed initial cardiac rhythms, with none found in ventricular fibrillation. Our findings indicate that unexpected sudden death when excited delirium victims are restrained in the out-of-hospital setting is not infrequent and can be associated with multiple predictable but usually uncontrollable factors.

  7. A small exploratory study of the reaction of older people to an episode of delirium.

    PubMed

    Schofield, I

    1997-05-01

    Delirium or an acute confusional state, occurs as a result of disease or physiological imbalance secondary to impaired brain function. One of its main clinical features is widespread cognitive impairment, which causes patients to become disconnected from their immediate surroundings and misinterpret reality. It has a sudden onset and its duration is relatively brief. Some authors take the view that delirium might be interpreted as a precursor to dementia. The aim of the study was to retrospectively explore older peoples' experience of an episode of delirium. In particular, whether they knew what had caused and cured it; and whether it had left them with any unresolved feelings of anxiety. A cross sectional design using grounded theory methodology was chosen, as being the most appropriate method for exploring this issue. A sample of 19 patients was selected using predetermined criteria, and engaged in a semi-structured interview with the researcher, in the ward environment. The interviews were audiotaped, transcribed, and analysed using the constant comparison method. Those interviewees who had illusions and hallucinations, were often able to describe their experiences in detail. They ranged from being pleasant and entertaining, to horrible and frightening. They were also able to remember short verbal commands from nurses during the episode of altered perception. Others remembered, or chose not to remember, very little. Few interviewees appeared to know exactly what had caused and cured the delirium, although some were able to tentatively connect the experience to their present medical condition. There also appeared to be little evidence of therapeutic communication with nursing staff once the episode of delirium had resolved. Although no one connected the experience with dementia, there did seem to be some evidence of mildly disturbed feelings, on reflecting back over the episode. As interviewees were generally willing to discuss their experiences with the

  8. A comparison of single-dose dexmedetomidine or propofol on the incidence of emergence delirium in children undergoing general anaesthesia for magnetic resonance imaging.

    PubMed

    Bong, C L; Lim, E; Allen, J C; Choo, W L H; Siow, Y N; Teo, P B Y; Tan, J S K

    2015-04-01

    Emergence delirium is a significant problem in children regaining consciousness following general anaesthesia. We compared the emergence characteristics of 120 patients randomly assigned to receive a single intravenous dose of dexmedetomidine 0.3 μg.kg(-1) , propofol 1 mg.kg(-1) , or 10 ml saline 0.9% before emerging from general anaesthesia following a magnetic resonance imaging scan. Emergence delirium was diagnosed as a score of 10 or more on the Paediatric Anaesthesia Emergence Delirium scale. The incidence of emergence delirium was 42.5% in the dexmedetomidine group, 33.3% in the propofol group and 41.5% in the saline group (p = 0.671). Three patients in the dexmedetomidine group, none in the propofol group and two in the saline group required pharmacological intervention for emergence delirium (p = 0.202). Administration of neither dexmedetomidine nor propofol significantly reduced the incidence, or severity, of emergence delirium. The only significant predictor for emergence delirium was the time taken to awaken from general anaesthesia, with every minute increase in wake-up time reducing the odds of emergence delirium by 7%.

  9. Impact of a multifaceted program to prevent postoperative delirium in the elderly: the CONFUCIUS stepped wedge protocol

    PubMed Central

    2011-01-01

    Background Postoperative delirium is common in the elderly and is associated with a significant increase in mortality, complications, length of hospital stay and admission in long care facility. Although several interventions have proved their effectiveness to prevent it, the Cochrane advises an assessment of multifaceted intervention using rigorous methodology based on randomized study design. Our purpose is to present the methodology and expected results of the CONFUCIUS trial, which aims to measure the impact of a multifaceted program on the prevention of postoperative delirium in elderly. Method/Design Study design is a stepped wedge cluster randomized trial within 3 surgical wards of three French university hospitals. All patients aged 75 and older, and admitted for scheduled surgery will be included. The multifaceted program will be conducted by mobile geriatric team, including geriatric preoperative consultation, training of the surgical staff and implementation of the Hospital Elder Life Program, and morbidity and mortality conference related to delirium cases. The primary outcome is based on postoperative delirium rate within 7 days after surgery. This program is planned to be implemented along four successive time periods within all the surgical wards. Each one will be affected successively to the control arm and to the intervention arm of the trial and the order of program introduction within each surgical ward will be randomly assigned. Based on a 20% reduction of postoperative delirium rate (ICC = 0.25, α = 0.05, β = 0.1), three hundred sixty patients will be included i.e. thirty patients per service and per time period. Endpoints comparison between intervention and control arms of the trial will be performed by considering the cluster and time effects. Discussion Better prevention of delirium is expected from the multifaceted program, including a decrease of postoperative delirium, and its consequences (mortality, morbidity, postoperative

  10. Validation and psychometric properties of the Delirium Motor Subtype Scale in elderly hip fracture patients (Dutch version).

    PubMed

    Slor, Chantal J; Adamis, Dimitrios; Jansen, René W M M; Meagher, David J; Witlox, Joost; Houdijk, Alexander P J; de Jonghe, Jos F M

    2014-01-01

    The Delirium Motor Subtype Scale (DMSS) was developed to capture all the previous different approaches to delirium motor subtyping into one new instrument and emphasize disturbances of motor activity rather than associated psychomotoric symptoms. We investigated reliability and validity of the DMSS Dutch version. Elderly patients who had undergone hip fracture surgery received the DMSS and the Delirium Rating Scale Revised-98 (DRS-R-98). A diagnosis of delirium was defined according to the Confusion Assessment Method (CAM). Among 146 patients, 46 (32%) patients were diagnosed with delirium (mean age 86.3 years; SD 5.2). The internal consistency of the DMSS was acceptable (Cronbach's alpha=0.72). If an item was removed at random the internal consistency of the scale remained the same. Similarly the concurrent validity of DMSS was good (Cohen's kappa=0.73) while for each motor subtype the Cohen's kappa ranged from 0.58 to 0.85. The sensitivity and specificity of DMSS to detect each subtype ranged from 0.56 to 1 and from 0.88 to 0.98, respectively. This study suggests that the Dutch version of the DMSS is a reliable and valid instrument. The DMSS has scientific validity that could allow for greater precision in further research on motor subtypes.

  11. A comparison of single dose dexmedetomidine with propofol for the prevention of emergence delirium after desflurane anaesthesia in children.

    PubMed

    Makkar, J K; Bhatia, N; Bala, I; Dwivedi, D; Singh, P M

    2016-01-01

    Emergence delirium is a common problem in children recovering from general anaesthesia. We performed a study comparing emergence characteristics in 100 patients who were randomly allocated to receive either 0.3 μg.kg(-1) dexmedetomidine, 1 mg.kg(-1) propofol or saline 0.9% and undergoing infra-umbilical surgery. The Pediatric Anesthesia Emergence Delirium scale was used to grade emergence delirium. Emergence delirium occurred in 9.4% of children in the dexmedetomidine group compared with 13.9% in the propofol group and 40.6% in the control group (p = 0.004). In the dexmedetomidine group, sedation occurred in 62.5% of children at 10 min after transfer to the recovery area, compared with 44.4% in the propofol group and 12.5% in the control group (p = 0.010). We conclude that dexmedetomidine significantly reduced the incidence of emergence delirium but this was at the expense of a greater incidence of sedation in the recovery period.

  12. Delirium, in 405 articles of medical (non-surgical or ICU) inpatients: unproven speed of onset and recovery

    PubMed Central

    Regal, Paul Jay

    2017-01-01

    Purpose There is agreement in the medical literature that delirium is of sudden or rapid onset. Although the speed of recovery cannot be used for initial diagnosis, recovery speed provides a test of diagnostic criteria. The aim of this study was to determine whether articles on delirium among medical inpatients proved sudden onset and rapid recovery. Methods The literature was searched for studies with at least 50 patients on medical or geriatric wards. Excluded were postoperative, critical care, and nursing home studies. Speed of onset was extracted as either the interval between symptom onset and diagnosis or between hospital admission and diagnosis of incident delirium. Mean or median days to recovery from delirium and the scale used to measure recovery were identified. Results Four-hundred and five articles were analyzed with 789,709 patients. The median article had 220 patients. Onset could only be extracted in 11 articles (2.7%): mean onset was 3.09±2.38 days. Median onset was 3.0 days, which conforms to Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Only 56 of 405 articles (13.8%) reported timing of recovery but mean or median recovery was available in 25 of 405 (6.2%): 6.56±4.80 days. Conclusion Medical delirium articles have failed to establish rapid onset and rapid recovery. PMID:28243074

  13. How nurses understand and care for older people with delirium in the acute hospital: a Critical Discourse Analysis.

    PubMed

    Schofield, Irene; Tolson, Debbie; Fleming, Valerie

    2012-06-01

    Delirium is a common presentation of deteriorating health in older people. It is potentially deleterious in terms of patient experience and clinical outcomes. Much of what is known about delirium is through positivist research, which forms the evidence base for disease-based classification systems and clinical guidelines. There is little systematic study of nurses' day-to-day practice of nursing patients with delirium. The aim was to uncover the kinds of knowledge that informs nurses' care and to explicate the basis of that knowledge. Critical Discourse Analysis is underpinned by the premise that powerful interests within society mediate how social practices are constructed. Links were made between the grammatical and lexical features of nurses' language about care in interviews and naturalistic settings, and the healthcare context. Care focused on the continuous surveillance of patients with delirium by nurses themselves or vicariously through other patients, and containment. Nurses influenced by major discourses of risk reduction and safety, constructed patients with delirium as risk objects. The philosophy of person-centred and dignified care advocated in nursing literature and government policy is an emerging discourse, though little evident in the data. The current dominant discourses on safety must give space to discourses of dignity and compassion.

  14. Brain atrophy and white matter hyperintensities are not significantly associated with incidence and severity of postoperative delirium in older persons without dementia

    PubMed Central

    Cavallari, Michele; Hshieh, Tammy T.; Guttmann, Charles R.G.; Ngo, Long H.; Meier, Dominik S.; Schmitt, Eva M.; Marcantonio, Edward R.; Jones, Richard N.; Kosar, Cyrus M.; Fong, Tamara G.; Press, Daniel; Inouye, Sharon K.; Alsop, David C.

    2015-01-01

    Postoperative delirium is a common complication in older people, and is associated with increased mortality, morbidity, institutionalization and caregiver burden. Although delirium is an acute confusional state characterized by global impairments in attention and cognition, it has been implicated in permanent cognitive impairment and dementia. The pathogenesis of delirium, as well as the mechanisms leading to these disabling consequences, remains unclear. The present study is the first to address the potential predisposing role of brain morphological changes towards postoperative delirium in a large prospective cohort of patients undergoing elective surgery using state-of-the-art magnetic resonance imaging (MRI) techniques conducted before admission. We investigated the association of MRI-derived quantitative measures of white matter damage, global brain and hippocampal volume with the incidence and severity of delirium. Pre-surgical white matter hyperintensities (WMH), whole brain and hippocampal volume were measured in 146 consecutively enrolled subjects, ≥70 years old, without dementia who were undergoing elective surgery. These three pre-surgical MRI indices were tested as predictors of incidence and severity of subsequent delirium. Out of 146 subjects, 32 (22%) developed delirium. We found no statistically significant differences in WMH, whole brain or hippocampal volume between subjects with and without delirium. Both unadjusted and adjusted (age, gender, vascular comorbidity, general cognitive performance) regression analyses demonstrated no statistically significant association between any of the MRI measures with respect to delirium incidence or severity. In persons without dementia, preexisting cerebral white matter hyperintensities, general and hippocampal atrophy may not predispose to postoperative delirium or worsen its severity. PMID:25824618

  15. Novel risk markers and long-term outcomes of delirium: The Successful Aging after Elective Surgery (SAGES) Study Design and Methods

    PubMed Central

    Schmitt, Eva M.; Marcantonio, Edward R.; SM; Alsop, David C.; Jones, Richard N.; Rogers, Selwyn O.; Fong, Tamara G.; Metzger, Eran; Inouye, Sharon K.

    2012-01-01

    Objectives Delirium--a costly, life-threatening, and potentially preventable condition--is a common complication for older adults following major surgery. While the basic epidemiology of delirium after surgery has been defined, the contribution of delirium to long-term outcomes remains uncertain, and novel biomarkers from plasma and neuroimaging have yet to be examined. This program project was designed to contribute to our understanding of the complex multifactorial syndrome of delirium. Design Long-term prospective cohort study. Setting 3 academic medical centers (2 hospitals and 1 coordinating center). Participants Patients without recognized dementia (targeted cohort = 550 patients) age 70 and older scheduled to undergo elective major surgery are assessed at baseline prior to surgery, daily during their hospital stay, and for 18-36 months after discharge. Measurements The Successful Aging after Elective Surgery (SAGES) study is an innovative, interdisciplinary study that includes biomarkers, neuroimaging, cognitive reserve markers, and serial neuropsychological testing to examine the contribution of delirium to long-term cognitive and functional decline. The primary goal is to examine the contribution of delirium to long-term cognitive and functional decline. In addition, novel risk markers, for delirium are being examined, including plasma biomarkers (e.g., cytokines, proteomics), advanced neuroimaging markers (e.g., volumetric, white matter hyperintensity, noncontrast blood flow, and diffusion tensor measures) and cognitive reserve markers (e.g., education, occupation, lifetime activities). Conclusion Results from this study will contribute to a fuller understanding of the etiology and prognosis of delirium. Ultimately, we hope this project will provide the groundwork for future development of prevention and treatment strategies for delirium, designed to minimize the long-term negative impact of delirium in older adults. PMID:22999782

  16. The validity and reliability of the Portuguese versions of three tools used to diagnose delirium in critically ill patients

    PubMed Central

    Gusmao-Flores, Dimitri; Salluh, Jorge Ibrain Figueira; Dal-Pizzol, Felipe; Ritter, Cristiane; Tomasi, Cristiane Damiani; de Lima, Marco Antônio Sales Dantas; Santana, Lauro Reis; Lins, Rita Márcia Pacheco; Lemos, Patrícia Pimenta; Serpa, Gisele Vasconcelos; Oliveira, Jenisson; Chalhub, Ricardo Ávila; Pitrowsky, Melissa Tassano; Lacerda, Acioly L.T.; Koenen, Karestan C.; Quarantini, Lucas C.

    2011-01-01

    OBJECTIVES: The objectives of this study are to compare the sensitivity and specificity of three diagnostic tools for delirium (the Intensive Care Delirium Screening Checklist, the Confusion Assessment Method for Intensive Care Units and the Confusion Assessment Method for Intensive Care Units Flowsheet) in a mixed population of critically ill patients, and to validate the Brazilian Portuguese Confusion Assessment Method for Intensive Care Units. METHODS: The study was conducted in four intensive care units in Brazil. Patients were screened for delirium by a psychiatrist or neurologist using the Diagnostic and Statistical Manual of Mental Disorders. Patients were subsequently screened by an intensivist using Portuguese translations of the three tools. RESULTS: One hundred and nineteen patients were evaluated and 38.6% were diagnosed with delirium by the reference rater. The Confusion Assessment Method for Intensive Care Units had a sensitivity of 72.5% and a specificity of 96.2%; the Confusion Assessment Method for Intensive Care Units Flowsheet had a sensitivity of 72.5% and a specificity of 96.2%; the Intensive Care Delirium Screening Checklist had a sensitivity of 96.0% and a specificity of 72.4%. There was strong agreement between the Confusion Assessment Method for Intensive Care Units and the Confusion Assessment Method for Intensive Care Units Flowsheet (kappa coefficient = 0.96). CONCLUSION: All three instruments are effective diagnostic tools in critically ill intensive care unit patients. In addition, the Brazilian Portuguese version of the Confusion Assessment Method for Intensive Care Units is a valid and reliable instrument for the assessment of delirium among critically ill patients. PMID:22086522

  17. Association of Cognitive and Noncognitive Symptoms of Delirium: A Study from Consultation-liaison Psychiatry Set-up

    PubMed Central

    Grover, Sandeep; Mehra, Aseem; Chakrabarti, Subho; Avasthi, Ajit

    2016-01-01

    Aims: This study aims to evaluate the cognitive functions of patients with delirium using Hindi Mental Status Examination (HMSE), to study the correlation of cognitive functions assessed by HMSE with noncognitive symptoms as assessed using Delirium Rating Scale-Revised 1998 (DRS-R-98) and to study the association of cognitive functions assessed using HMSE and DRS-R98. Methods: A total of 76 consecutive patients fulfilling the diagnosis of delirium were evaluated on DRS-R-98, HMSE, and Short Informant Questionnaire on Cognitive Decline in the Elderly (retrospective IQCODE). Results: The mean DRS-R-98 score 33.9 (standard deviation [SD] - 7.2) and the mean DRS-R-98 severity score was 25.9 (SD - 7.2). The mean score on HMSE was 19.3 (7.98). There were significant correlations of all the domains of HMSE with DRS-R-98 total score, DRS-R-98 severity score, DRS-R-98 cognitive subscale score, DRS-R-98 noncognitive domain subscale score, and DRS severity score without attention score. When the association of each item of DRS-R-98 and HMSE was evaluated, except for the items of delusions, lability of affect and motor retardation, there were significant negative association between all the items of DRS-R-98 and HMSE, indicating that higher severity of cognitive symptoms as assessed on HMSE is associated with higher severity of all the cognitive symptoms and most of the noncognitive symptoms as assessed by DRS-R-98. Conclusion: The present study suggests that attention deficits in patients with delirium influence the severity of cognitive and noncognitive symptoms of delirium. Further, the present study suggests an increase in the severity of cognitive symptoms in other domains is also associated with an increase in the severity of noncognitive symptoms of delirium. PMID:28163496

  18. Antipsychotic Drug Use and Screening for Delirium in Mechanically Ventilated Patients in Canadian Intensive Care Units: An Observational Study

    PubMed Central

    Thiboutot, Zoé; Perreault, Marc M; Williamson, David R; Rose, Louise; Mehta, Sangeeta; Guenette, Melanie D; Cook, Deborah; Burry, Lisa

    2016-01-01

    Background: Critically ill patients frequently experience delirium, and antipsychotic drugs are often used to manage symptoms. Objectives: To describe the use of antipsychotic drugs and delirium screening tools in mechanically ventilated, critically ill adult patients in Canadian intensive care units (ICUs) and to identify factors associated with the use of antipsychotic drugs. Methods: Pharmacists from 51 Canadian ICUs prospectively collected data on antipsychotic use and delirium screening in all patients for whom invasive mechanical ventilation was initiated during a chosen 2-week period occurring sometime in 2008 or 2009. Results: Data were collected for a total of 712 patients, of whom 115 (16.2%) received at least one dose of an antipsychotic. The antipsychotic prescribed, the total daily dose, and the administration schedule varied across sites. Delirium screening tools, validated for use in mechanically ventilated patients and endorsed by professional society guidelines, were part of routine care in a minority of ICUs (7/51 [13.7%]), and delirium screening was documented for few patients overall (41/712 patients [5.8%]). In a multivariable analysis, administration of antipsychotics was independently associated with longer duration of mechanical ventilation (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.07–1.17), daily interruption of sedation (OR 1.71, 95% CI 1.01–2.90), and use of physical restraints (OR 2.15, 95% CI 1.27–3.65). Conclusion: A minority of mechanically ventilated patients in Canadian ICUs received antipsychotic drugs, and screening for delirium with validated tools was rare. Antipsychotic drug use was independently associated with longer duration of mechanical ventilation, daily interruption of sedation, and use of physical restraints. PMID:27168631

  19. Delirium is a predictor of in-hospital mortality in elderly patients with community acquired pneumonia.

    PubMed

    Pieralli, Filippo; Vannucchi, Vieri; Mancini, Antonio; Grazzini, Maddalena; Paolacci, Giulia; Morettini, Alessandro; Nozzoli, Carlo

    2014-03-01

    Community acquired pneumonia (CAP) is a common reason for hospitalization and death in elderly people. Many predictors of in-hospital outcome have been studied in the general population with CAP. However, data are lacking on the prognostic significance of conditions unique to older patients, such as delirium and the coexistence of multiple comorbidities. The aim of this study was to evaluate predictors of in-hospital outcome in elderly patients hospitalized for CAP. In this retrospective study, consecutive patients with CAP aged ≥65 years were enrolled between January 2011 and June 2012 in two general wards. Clinical and laboratory characteristics were collected from electronic medical records. The end-point of the study was the occurrence of in-hospital death. 443 patients (mean age 81.8 ± 7.5, range 65-99 years) were enrolled. More than 3 comorbidities were present in 31 % of patients. Mean confusion, blood urea nitrogen, respiratory rate, blood pressure and age ≥65 years (CURB-65) score was 2.5 ± 0.7 points. Mean length of stay was 7.6 ± 5.7 days. In-hospital death occurred in 54 patients (12.2 %). At multivariate analysis, independent predictors of in-hospital death were: chronic obstructive pulmonary disease (COPD) (OR 6.21, p = 0.005), occurrence of at least one episode of delirium (OR 5.69, p = 0.017), male sex (OR 5.10, p < 0.0001), and CURB-65 score (OR 3.98, p < 0.0001). Several predictors of in-hospital death (COPD, male gender, CURB-65) in patients with CAP older than 65 years are similar to those of younger patients. In this cohort of elderly patients, the occurrence of delirium was highly prevalent and represented a distinctive predictor of death.

  20. Excited Delirium and Sudden Death: A Syndromal Disorder at the Extreme End of the Neuropsychiatric Continuum

    PubMed Central

    Mash, Deborah C.

    2016-01-01

    Over the past decade, the excited delirium syndrome (ExDS) has raised continued controversy regarding the cause and manner of death of some highly agitated persons held in police custody, restrained or incapacitated by electrical devices. At autopsy, medical examiners have difficulty in identifying an anatomic cause of death, but frequently cite psychostimulant intoxication as a contributing factor. The characteristic symptoms of ExDS include bizarre and aggressive behavior, shouting, paranoia, panic, violence toward others, unexpected physical strength, and hyperthermia. Throughout the United States and Canada, these cases are most frequently associated with cocaine, methamphetamine, and designer cathinone abuse. Acute exhaustive mania and sudden death presents with behavioral symptoms that are identical to what is described for ExDS in psychostimulant abusers. Bell's mania or acute exhaustive mania was first described in the 1850's by American psychiatrist Luther Bell in institutionalized psychiatric patients. This rare disorder of violent mania, elevated body temperature and autonomic collapse continued to be described by others in the psychiatric literature, but with different names until the first cases of ExDS were seen at the beginning of the cocaine epidemic by medical examiners. The neurochemical pathology examination of brain tissues after death revealed a loss of dopamine transporter regulation together with increases in heat shock protein 70 (hsp70) expression as a biomarker of hyperthermia. The similarity in the behavioral symptoms between extremely agitated psychostimulant abusers and unmedicated psychiatric patients suggests that a genetic disorder that leads to dysregulated central dopamine transporter function could be a precipitating cause of the acute delirium and sudden death. While the precise cause and mechanism of lethality remains controversial, the likely whys and wherefores of sudden death of ExDS victims are seen to be

  1. Rethinking Critical Care: Decreasing Sedation, Increasing Delirium Monitoring, and Increasing Patient Mobility

    PubMed Central

    Bassett, Rick; Adams, Kelly McCutcheon; Danesh, Valerie; Groat, Patricia M.; Haugen, Angie; Kiewel, Angi; Small, Cora; Van-Leuven, Mark; Venus, Sam; Ely, E. Wesley

    2016-01-01

    Background/Methods Sedation management, delirium monitoring, and mobility programs are key features of recent evidence-based critical care guidelines and care bundles, yet implementation in the intensive care unit (ICU) remains highly variable. The Institute for Healthcare Improvement’s Rethinking Critical Care (IHI-RCC) program was established to reduce harm of critically ill patients by decreasing sedation, increasing monitoring and management of delirium, and increasing patient mobility. It involved one live case study and five iterations of an in-person seminar over 33 months (March 2011 to November 2013) that emphasized interdisciplinary teamwork and culture change. IHI-RCC has involved over 650 participants from 215 organizations. This report describes a convenience sample of five participating organizations chosen in advance of knowing their clinical outcomes. Results Qualitative descriptions of the changes tested at each of the five case study sites are provided, demonstrating the necessary teamwork, improved processes, and increased reliability of daily work. These sites all worked to implement the Richmond Agitation Sedation Scale (RASS) and Confusion Assessment Method for the ICU (CAM-ICU) within the context of a bundled interventional care plan; they then tracked length of stay in the ICU and duration of mechanical ventilation, which are reported. Discussion Changing critical care practices requires an interdisciplinary approach addressing cultural, psychological, and practical issues. The IHI-RCC program is based on testing changes on a small scale, building highly effective interdisciplinary rounds, frequent data feedback to the frontline, and use of in-person demonstrations. Key lessons are emerging about effectively caring for critically ill patients in light of data about the harm of over-sedation, unrecognized and unaddressed delirium, and immobility. PMID:25976892

  2. Comparative effectiveness of quetiapine and haloperidol in delirium: A single blind randomized controlled study

    PubMed Central

    Grover, Sandeep; Mahajan, Sudhir; Chakrabarti, Subho; Avasthi, Ajit

    2016-01-01

    AIM To evaluate the effectiveness of quetiapine and haloperidol in patients of delirium referred to psychiatry consultation liaison services. METHODS The study followed a single blind randomised controlled trial design. Thirty-two patients in the haloperidol group and 31 patients in the quetiapine group were assessed at the baseline and 6 consecutive days. Flexible dosing regimen (haloperidol: 0.25-1.25 mg; quetiapine 12.5-75 mg/d) was used. Delirium Rating Scale-Revised-98 (DRS-R-98) and mini mental status examination (MMSE) were the primary and secondary efficacy measures respectively. RESULTS Baseline DRS-R-98 severity score and MMSE scores did not differ between the 2 study groups. From baseline to day 6, there was significant reduction in the total DRS-R-98 scores, DRS-R-98 cognitive domain scores, DRS-R-98 non-cognitive domain scores and significant increase in the MMSE scores in both the groups. Both the groups did not differ on any of the assessments in terms of DRS-R98 and MMSE scores. The effectiveness of both the medications was similar in adult and elderly (≥ 60 years) patients. At the end of the trial, 68.75% and 67.74% of subjects in the haloperidol and quetiapine group respectively had mean DRS-R-98 scores below 10. By 6th day, 12 (37.5%) patients in haloperidol group and 9 (29.03%) patients in the quetiapine group had DRS-R98 score of “0” with no significant difference between the two groups (P = 0.47). CONCLUSION Quetiapine is as effective as haloperidol in the management of delirium. PMID:27679777

  3. Risk, diagnosis and treatment to postoperative delirium in elderly patients with gastrointestinal cancers.

    PubMed

    Ma, Li-Na; Zhang, Rui-Li

    2015-01-01

    In recent years, more elderly patients with gastrointestinal cancers have been undergoing surgery. As one of main postoperative complications, postoperative delirium (POD) is harmful and difficult to prevent and treat. Prevention, diagnosis and treatment to POD properly and ptomptly can promote the patient's overall recovery. However, health care providers still have many problems for POD to face in elderly,with gastrointestinal cancers during the clinical care. In this paper, Etiology, damages, prevention, diagnosis and treatment of POD in elderly with gastrointestinal cancer were reviewed, and the prospect of POD was also discussed.

  4. Development of Android apps for cognitive assessment of dementia and delirium.

    PubMed

    Weir, Alexander J; Paterson, Craig A; Tieges, Zoe; MacLullich, Alasdair M; Parra-Rodriguez, Mario; Della Sala, Sergio; Logie, Robert H

    2014-01-01

    The next generation of medical technology applications for hand-held portable platforms will provide a core change in performance and sophistication, transforming the way health care professionals interact with patients. This advance is particularly apparent in the delivery of cognitive patient assessments, where smartphones and tablet computers are being used to assess complex neurological conditions to provide objective, accurate and reproducible test results. This paper reports on two such applications (apps) that have been developed to assist healthcare professionals with the detection and diagnosis of dementia and delirium.

  5. Evidence-based clinical audit criteria for the prevention and management of delirium in the postoperative patient with a hip fracture.

    PubMed

    Holly, Cheryl; Rittenmeyer, Leslie; Weeks, Susan Mace

    2014-01-01

    Delirium is a frequent, yet often unrecognized, occurrence in elderly hospitalized patients. In patients with hip fracture, the incidence of delirium is reported to be as high as 62% and even greater if over 65 years of age. One approach to the prevention and management of postoperative delirium in elderly patients with hip fracture is the clinical audit. A clinical audit is a retrospective assessment of clinical care of patients and is guided by criteria that are evidence-based statements of best practice. The use of measurable, objective criterion, with an agreed standard of performance is the hallmark of an audit. The clinical audit criteria presented in this article for the prevention and management of delirium in hospitalized elderly with hip fracture were determined by a compilation of systematic reviews and existing evidence-based clinical guidelines. The following 5 audit criteria are discussed: (1) All elderly patients with a hip fracture are assessed for risk factors for developing delirium daily using a valid and reliable tool; (2) the environment of the patient with hip fracture is assessed daily for conduciveness to maintaining sensory orientation; (3) all patients with hip fracture receive essential nursing care; (4) appropriate clinical criteria are applied to confirm a diagnosis of delirium in patients with hip fracture; and (5) nonpharmacologic interventions are employed before pharmacologic interventions in patients with hip fracture with a diagnosis of delirium.

  6. Is it My Job? The Role of RNs in the Assessment and Identification of Delirium in Hospitalized Older Adults: An Exploratory Qualitative Study.

    PubMed

    Coyle, Miriam Anne; Burns, Pippa; Traynor, Victoria

    2017-04-01

    Delirium is characterized by acute and fluctuating cognitive decline, which is often missed in older adults who are assumed to be experiencing age-related changes or dementia. Delirium affects up to 50% of hospitalized older adults. The aim of the current study was to (a) explore current practices of RNs in assessing and identifying delirium in hospitalized older adults and (b) inform new educational initiatives. Qualitative methods were adopted using eight semi-structured group interviews with 24 RNs. Thematic analysis revealed a dichotomy in practice where RNs described delirium assessment and identification as (a) It's Not My Job, (b) It is My Job, and (c) It's Complex. The imperative to improve delirium assessment and identification to create safer and more caring health care environments means the current findings provide important evidence to build into practice and education strategies. The current authors have developed engaging educational interventions and begun implementation at the study site to develop delirium assessment and identification capacity, which moves clinicians beyond awareness and aims at practice adherence or the consistent application of evidence-based delirium assessment. [Journal of Gerontological Nursing, 43(4), 29-37.].

  7. Making Hospitals Safer for Older Adults: Updating Quality Metrics by Understanding Hospital-Acquired Delirium and Its Link to Falls

    PubMed Central

    Lee, Eric A; Gibbs, Nancy E; Fahey, Linda; Whiffen, Teri L

    2013-01-01

    The medical care of hospitalized geriatric patients must differ from the care of younger adults. Because of reduced “reserve capacity,” hospitalized older adults are at high risk of development of geriatric syndromes such as delirium and falls. Geriatric syndromes often lead to functional decline and dependence. Patients who experience geriatric syndromes in the hospital are more likely to have a longer length of stay, higher risk of readmissions, and worse medical outcomes. Incident delirium in hospitalized geriatric patients has been shown to be preventable by intervening in established risk factors. Prevention of hospital-related falls has not been consistently demonstrated. Analysis from Kaiser Permanente data demonstrated a correlation with delirium and hospital-related falls. We propose that age-specific quality metrics should be made to reduce the risk of the development of geriatric syndromes in hospitalized older adults. By preventing delirium, we believe that health care practitioners can reduce hospital-related falls in geriatric patients and improve the quality of care delivered to hospitalized older adults. An illustrative fictional case study is presented. PMID:24361018

  8. Effect of preoperative oral midazolam sedation on separation anxiety and emergence delirium among children undergoing dental treatment under general anesthesia

    PubMed Central

    El Batawi, Hisham Yehia

    2015-01-01

    Aim: To investigate the possible effects of preoperative oral Midazolam on parental separation anxiety, emergence delirium, and post-anesthesia care unit time on children undergoing dental rehabilitation under general anesthesia. Methods: Randomized, prospective, double-blind study. Seventy-eight American Society of Anesthesiology (ASA) I children were divided into two groups of 39 each. Children of the first group were premedicated with oral Midazolam 0.5 mg/kg, while children of the control group were premedicated with a placebo. Scores for parental separation, mask acceptance, postoperative emergence delirium, and time spent in the post-anesthesia care unit were compared statistically. Results: The test group showed significantly lower parental separation scores and high acceptance rate for anesthetic mask. There was no significant difference between the two groups regarding emergence delirium and time spent in post-anesthesia care unit. Conclusions: Preoperative oral Midazolam could be a useful adjunct in anxiety management for children suffering dental anxiety. The drug may not reduce the incidence of postoperative emergence delirium. The suggested dose does not seem to affect the post-anesthesia care unit time. PMID:25992332

  9. 'A post-transplant person': Narratives of heart or lung transplantation and intensive care unit delirium.

    PubMed

    Flynn, Katy; Daiches, Anna; Malpus, Zoey; Yonan, Nizar; Sanchez, Melissa

    2014-07-01

    Exploring patients' narratives can lead to new understandings about perceived illness states. Intensive Care Unit delirium is when people experience transitory hallucinations, delusions or paranoia in the Intensive Care Unit and little is known about how this experience affects individuals who have had a heart or lung transplant. A total of 11 participants were recruited from two heart and lung transplant services and were invited to tell their story of transplant and Intensive Care Unit delirium. A narrative analysis was conducted and the findings were presented as a shared story. This shared story begins with death becoming prominent before the transplant: 'you live all the time with Mr Death on your shoulder'. Following the operation, death permeates all aspects of dream worlds, as dreams in intensive care 'tunes into the subconscious of your fears'. The next part of the shared story offers hope of restitution; however, this does not last as reality creeps in: 'I thought it was going to be like a miracle cure'. Finally, the restitution narrative is found to be insufficient and individuals differ in the extent to which they can achieve resolution. The societal discourse of a transplant being a 'gift', which gives life, leads to internalised responsibility for the 'success' or 'failure' of the transplant. Participants describe how their experiences impact their sense of self: 'a post-transplant person'. The clinical implications of these findings are discussed.

  10. Management of Levofloxacin Induced Anaphylaxis and Acute Delirium in a Palliative Care Setting

    PubMed Central

    Ghoshal, Arunangshu; Damani, Anuja; Salins, Naveen; Deodhar, Jayita; Muckaden, Mary Ann

    2015-01-01

    Levofloxacin is a commonly prescribed antibiotic for managing chest and urinary tract infections in a palliative care setting. Incidence of Levofloxacin-associated anaphylaxis is rare and delirium secondary to Levofloxacin is a seldom occurrence with only few published case reports. It is an extremely rare occurrence to see this phenomenon in combination. Early identification and prompt intervention reduces both mortality and morbidity. A 17-year-old male with synovial sarcoma of right thigh with chest wall and lung metastasis and with no prior psychiatric morbidity presented to palliative medicine outpatient department with community-acquired pneumonia. He was initiated on intravenous (IV) Ceftriaxone and IV Levofloxacin. Post IV Levofloxacin patient developed anaphylaxis and acute delirium necessitating IV Hydrocortisone, IV Chlorpheneramine, Oxygen and IV Haloperidol. Early detection and prompt intervention helped in complete recovery. Patient was discharged to hospice for respite after 2 days of hospitalization and then discharged home. Acute palliative care approach facilitated management of two life-threatening medical complications in a palliative care setting improving both quality and length of life. PMID:25709191

  11. Spinal anesthesia reduces postoperative delirium in opium dependent patients undergoing coronary artery bypass grafting.

    PubMed

    Tabatabaie, O; Matin, N; Heidari, A; Tabatabaie, A; Hadaegh, A; Yazdanynejad, S; Tabatabaie, K

    2015-01-01

    We investigated the effect of high spinal anesthesia on postoperative delirium in opium dependent patients undergoing coronary artery bypass grafting (CABG). The study was conducted in a tertiary referral university hospital on a population of 60 opium dependent patients undergoing CABG surgery. Patients were divided into two groups based on anesthesia protocol. One group were given general anesthesia (GA Group), the other group additionally received intrathecal morphine and bupivacaine (SGA Group). Postoperative delirium (POD) was defined as the main outcome of interest. Incidence of POD was significantly higher in patients of GA Group as compared with those in SGA Group (47% and 17% for GA and SGA respectively; P-value = 0.01). Time to extubation was on average 2.2 h shorter in SGA than in GA (7.1 h and 9.3 h respectively, P-value < 0.001). Intrathecal morphine and bupivacaine reduced the risk of POD after CABG in a population of opium dependent patients.

  12. Pituitary apoplexy associated with cortisol-induced hyperglycemia and acute delirium.

    PubMed

    Weng, Yi-Ming; Chang, Meng-Wei; Weng, Chia-Sui

    2008-11-01

    Pituitary apoplexy indicates pituitary adenoma hemorrhage, which could result in acute pituitary insufficiency and mortality. The typical symptoms are headache, visual disturbance, nausea, vomiting, altered mental status, and panhypopituitarism. However, cortisol-induced hyperglycemia and acute delirium could be an initial presentation of a pituitary adenoma hemorrhage with stormy release of the adrenocorticotrophic hormone. A 28-year-old woman presented with severe vomiting, irritable state, and delusion. She had medical history of irregular menstrual cycles and marked body weight gain after her second childbirth 8 years ago. She was diagnosed of diabetic ketoacidosis 2 days before this visiting at local medical department. On physical examination, Cushing appearance without definite neurological deficit was disclosed. Further blood tests revealed high blood sugar, cortisol, and adrenocorticotrophic hormone levels without evidence of diabetic ketoacidosis. The brain computed tomography and magnetic resonance imaging showed pituitary macroadenoma and pituitary hemorrhage. Cushing disease with pituitary apoplexy was then diagnosed. Conservative management with delayed neurosurgery was applied. The patient became clear with normalized cortisol and blood sugar levels soon after. Follow-up computed tomography scan of the brain revealed no progression of tumor bleeding or mass effect. To our knowledge, pituitary apoplexy associated with cortisol-induced hyperglycemia and acute delirium has never been reported before. This case reminds us of pituitary apoplexy and its rare manifestations.

  13. Effect of melatonin on duration of delirium in organophosphorus compound poisoning patients: A double-blind randomised placebo controlled trial

    PubMed Central

    Vijayakumar, HN; Ramya, K; Duggappa, Devika Rani; Gowda, KM Veeranna; Sudheesh, K; Nethra, SS; Raghavendra Rao, RS

    2016-01-01

    Background and Aims: Organophosphate compound poisoning (OPCP) is associated with high incidence of delirium. Melatonin has been tried in the treatment of delirium and has shown a beneficial effect in OPCP. This study was conducted to know the effect of melatonin on duration of delirium and recovery profile in OPCP patients. Methods: Double-blind randomised placebo control trial in which 56 patients of OPCP confirmed by history and syndrome of OPCP with low plasma pseudocholinesterase, aged >18 years and weighing between 50 and 100 kg, and Acute Physiology and Chronic Health Evaluation II score of <20 were studied. Group M (n = 26) received tablet melatonin 3 mg and Group C (n = 30) received placebo tablet at 9 PM, every night throughout the Intensive Care Unit (ICU) stay. Delirium was assessed using the Confusion Assessment Method for ICU, thrice a day. Sedation was provided with injection midazolam, fentanyl and lorazepam. Duration of mechanical ventilation, vital parameters, ICU stay, sedative and atropine requirement, were recorded. Results: The time taken to be delirium free was significantly lower in Group M (6 ± 2.92 days) compared to Group C (9.05 ± 2.75 days) (P = 0.001) and prevalence of delirium was significantly decreased in Group M compared to Group C from day 3 onwards. The requirement of midazolam (Group M - 2.98 ± 4.99 mg/day, Group C - 9.68 ± 9.17 mg/day, P < 0.001) and fentanyl (Group M - 94.09 ± 170.05 μg/day, Group C - 189.33 ± 156.38 μg/day, P = 0.03) decreased significantly in Group M. There was no significant difference in the average atropine consumption (P = 0.27), duration of mechanical ventilation (P = 0.26), ICU stay (P = 0.21) and the number of patients requiring mechanical ventilation (P = 0.50). Conclusion: Orally given melatonin in organophosphate compound poisoning patients reduces the duration of delirium and the requirement of sedation and analgesia. PMID:27942054

  14. Impact of dexmedetomidine on the incidence of delirium in elderly patients after cardiac surgery: A randomized controlled trial

    PubMed Central

    Nie, Xiao-Lu; Zhang, Yan; Li, Xue-Ying; Li, Li-Huan; Ma, Daqing

    2017-01-01

    Background Delirium is a frequent complication after cardiac surgery and its occurrence is associated with poor outcomes. The purpose of this study was to investigate the impact of perioperative dexmedetomidine administration on the incidence of delirium in elderly patients after cardiac surgery. Methods This randomized, double-blinded, and placebo-controlled trial was conducted in two tertiary hospitals in Beijing between December 1, 2014 and July 19, 2015. Eligible patients were randomized into two groups. Dexmedetomidine (DEX) was administered during anesthesia and early postoperative period for patients in the DEX group, whereas normal saline was administered in the same rate for the same duration for patients in the control (CTRL) group. The primary endpoint was the incidence of delirium during the first five days after surgery. Secondary endpoints included the cognitive function assessed on postoperative days 6 and 30, the overall incidence of non-delirium complications within 30 days after surgery, and the all-cause 30-day mortality. Results Two hundred eighty-five patients were enrolled and randomized. Dexmedetomidine did not decrease the incidence of delirium (4.9% [7/142] in the DEX group vs 7.7% [11/143] in the CTRL group; OR 0.62, 95% CI 0.23 to 1.65, p = 0.341). Secondary endpoints were similar between the two groups; however, the incidence of pulmonary complications was slightly decreased (OR 0.51, 95% CI 0.26 to 1.00, p = 0.050) and the percentage of early extubation was significantly increased (OR 3.32, 95% CI 1.36 to 8.08, p = 0.008) in the DEX group. Dexmedetomidine decreased the required treatment for intraoperative tachycardia (21.1% [30/142] in the DEX group vs 33.6% [48/143] in the CTRL group, p = 0.019), but increased the required treatment for postoperative hypotension (84.5% [120/142] in the DEX group vs 69.9% [100/143] in the CTRL group, p = 0.003). Conclusions Dexmedetomidine administered during anesthesia and early postoperative period

  15. Association between Serum IGF-I levels and Postoperative Delirium in Elderly Subjects Undergoing Elective Knee Arthroplasty.

    PubMed

    Yen, Timothy E; Allen, John C; Rivelli, Sarah K; Patterson, Stephanie C; Metcalf, Meredith R; Flink, Benjamin J; Mirrakhimov, Aibek E; Lagoo, Sandhya A; Vail, Thomas P; Young, Christopher C; Moon, Richard E; Trzepacz, Paula T; Kwatra, Madan M

    2016-02-05

    Evidence is mixed for an association between serum insulin-like growth factor-I (IGF-I) levels and postoperative delirium (POD). The current study assessed preoperative serum IGF-I levels as a predictor of incident delirium in non-demented elderly elective knee arthroplasty patients. Preoperative serum levels of total IGF-I were measured using a commercially available Human IGF-I ELISA kit. POD incidence and severity were determined using DSM-IV criteria and the Delirium Rating Scale-Revised-98 (DRS-R98), respectively. Median IGF-I levels in delirious (62.6 ng/ml) and non-delirious groups (65.9 ng/ml) were not significantly different (p = 0.141). The ratio (95% CI) of geometric means, D/ND, was 0.86 (0.70, 1.06). The Hodges-Lehmann median difference estimate was 7.23 ng/mL with 95% confidence interval (-2.32, 19.9). In multivariate logistic regression analysis IGF-I level was not a significant predictor of incident POD after correcting for medical comorbidities. IGF-I levels did not correlate with DRS-R98 scores for delirium severity. In conclusion, we report no evidence of association between serum IGF-I levels and incidence of POD, although the sample size was inadequate for a conclusive study. Further efforts to investigate IGF-I as a delirium risk factor in elderly should address comorbidities and confounders that influence IGF-I levels.

  16. Delirium superimposed on dementia: a quantitative and qualitative evaluation of informal caregivers and health care staff experience

    PubMed Central

    Morandi, Alessandro; Lucchi, Elena; Turco, Renato; Morghen, Sara; Guerini, Fabio; Santi, Rossana; Gentile, Simona; Meagher, David; Voyer, Philippe; Fick, Donna M.; Schmitt, Eva M.; Inouye, Sharon K.; Trabucchi, Marco; Bellelli, Giuseppe

    2015-01-01

    Objective Delirium superimposed on dementia (DSD) is common and potentially distressing for patients, caregivers, and health care staff. We quantitatively and qualitatively assessed the experience of informal caregiver and staff (staff nurses, nurse aides, physical therapists) caring for patients with DSD. Methods Caregivers’ and staff experience was evaluated three days after DSD resolution (T0) with a standardized questionnaire (quantitative interview) and open-ended questions (qualitative interview); caregivers were also evaluated at 1-month follow-up (T1). Results A total of 74 subjects were included; 33 caregivers and 41 health care staff (8 staff nurses, 20 physical therapists, 13 staff nurse aides/health care assistants). Overall, at both T0 and T1, the distress level was moderate among caregivers and mild among health care staff. Caregivers reported, at both T0 and T1, higher distress related to deficits of sustained attention and orientation, hypokinesia/psychomotor retardation, incoherence and delusions. The distress of health care staff related to each specific item of the Delirium-O-Meter was relatively low except for the physical therapists who reported higher level of distress on deficits of sustained/shifting attention and orientation, apathy, hypokinesia/psychomotor retardation, incoherence, delusion, hallucinations, anxiety/fear. The qualitative evaluation identified important categories of caregivers ‘and staff feelings related to the delirium experience. Conclusions This study provides information on the implication of the experience of delirium on caregivers and staff. The distress related to DSD underlines the importance of providing continuous training, support and experience for both the caregivers and health care staff to improve the care of patients with delirium superimposed on dementia. PMID:26286892

  17. Consequence of dexmedetomidine on emergence delirium following sevoflurane anesthesia in children with cerebral palsy

    PubMed Central

    Liu, Yang; Kang, Dao-Lin; Na, He-Yi; Li, Bi-Lian; Xu, Ying-Yi; Ni, Jin; Wu, Jun-Zheng

    2015-01-01

    Children with cerebral palsy can demonstrate irritability following emergence from general anaesthesia. As well, an elevated rate of emergence delirium (ED) in children has been associated with the application of sevoflurane. The current study’s intent is to administer dexmedetomidine, in a single dosage administration, at the initial phase of sevoflurane based anesthesia with regard to the occurrence and severity of ED in children afflicted with cerebral palsy. Participating in the study (American Society of Anesthesiologists I-II) are eighty children ranging in ages two through twelve years. They would be anaesthetised with sevoflurane based anesthesia while undergoing lower limb surgical procedures. The participants were equally distributed to either Group c or Group D. Group C was administered 10 ml saline 0.9%, and Group D was administered dexmedetomidine 0.5 μg•kg-1. Five minutes prior to commencement of the surgical procedures, the participants received the prescribed pharmaceutical dosages under the anesthesia of sevoflurane. In order to sustain the BIS values in a range of 45 and 55, at 60 second increments, endtidal sevoflurane concentrations (ETsev) were modified. After conclusion of the surgical procedures, in post anesthesia care unit (PACU), the frequency of ED was gauged with Aonos four point scale and the severity of ED was gauged with pediatric anesthesia emergence delirium scale upon admission (T0), after intervals of five minutes (T5), fifteen minutes (T15) and thirty minutes (T30). Extubation time, emergence time and length of at stay at the PACU were assessed. Relative to Group C, participants of Group D exhibited noticeably shortened times of emergence, extubation and PACU duration of stay. Prior to surgical incision, ETsev was elevated in the control group, (1.9±0.2 vs 1.6±0.3; P = 0.023) and amid the initial 20 minutes following the surgical incision (1.6±0.2 vs 1.1±0.2; P = 0.016). At intervals of commencement, T0, of five minutes

  18. Consequence of dexmedetomidine on emergence delirium following sevoflurane anesthesia in children with cerebral palsy.

    PubMed

    Liu, Yang; Kang, Dao-Lin; Na, He-Yi; Li, Bi-Lian; Xu, Ying-Yi; Ni, Jin; Wu, Jun-Zheng

    2015-01-01

    Children with cerebral palsy can demonstrate irritability following emergence from general anaesthesia. As well, an elevated rate of emergence delirium (ED) in children has been associated with the application of sevoflurane. The current study's intent is to administer dexmedetomidine, in a single dosage administration, at the initial phase of sevoflurane based anesthesia with regard to the occurrence and severity of ED in children afflicted with cerebral palsy. Participating in the study (American Society of Anesthesiologists I-II) are eighty children ranging in ages two through twelve years. They would be anaesthetised with sevoflurane based anesthesia while undergoing lower limb surgical procedures. The participants were equally distributed to either Group c or Group D. Group C was administered 10 ml saline 0.9%, and Group D was administered dexmedetomidine 0.5 μg•kg(-1). Five minutes prior to commencement of the surgical procedures, the participants received the prescribed pharmaceutical dosages under the anesthesia of sevoflurane. In order to sustain the BIS values in a range of 45 and 55, at 60 second increments, endtidal sevoflurane concentrations (ETsev) were modified. After conclusion of the surgical procedures, in post anesthesia care unit (PACU), the frequency of ED was gauged with Aonos four point scale and the severity of ED was gauged with pediatric anesthesia emergence delirium scale upon admission (T0), after intervals of five minutes (T5), fifteen minutes (T15) and thirty minutes (T30). Extubation time, emergence time and length of at stay at the PACU were assessed. Relative to Group C, participants of Group D exhibited noticeably shortened times of emergence, extubation and PACU duration of stay. Prior to surgical incision, ETsev was elevated in the control group, (1.9±0.2 vs 1.6±0.3; P = 0.023) and amid the initial 20 minutes following the surgical incision (1.6±0.2 vs 1.1±0.2; P = 0.016). At intervals of commencement, T0, of five minutes

  19. Delirium Superimposed on Dementia Strongly Predicts Worse Outcomes in Older Rehabilitation Inpatients

    PubMed Central

    Morandi, Alessandro; Davis, Daniel; Fick, Donna M.; Turco, Renato; Boustani, Malaz; Lucchi, Elena; Guerini, Fabio; Morghen, Sara; Torpilliesi, Tiziana; Gentile, Simona; MacLullich, Alasdair M.; Trabucchi, Marco; Bellelli, Giuseppe

    2014-01-01

    Objective Delirium superimposed on dementia (DSD) is common in many settings. Nonetheless, little is known about the association between DSD and clinical outcomes. The study aim was to evaluate the association between DSD and related adverse outcomes at discharge from rehabilitation and at 1-year follow-up in older inpatients undergoing rehabilitation. Design Prospective cohort study. Setting Hospital rehabilitation unit. Participants A total of 2642 patients aged 65 years or older admitted between January 2002 and December 2006. Measurements Dementia predating rehabilitation admission was detected by DSM-III-R criteria. Delirium was diagnosed with the DSM-IV-TR. The primary outcome was that of walking dependence (Barthel Index mobility subitem score of <15) captured as a trajectory from discharge to 1-year follow-up. A mixed-effects multivariate logistic regression model was used to analyze the association between DSD and outcome, after adjusting for relevant covariates. Secondary outcomes were institutionalization and mortality at 1-year follow-up, and logistic regression models were used to analyze these associations. Results The median age was 77 years (interquartile range: 71–83). The prevalence of DSD was 8%, and the prevalence of delirium and dementia alone were 4% and 22%, respectively. DSD at admission was found to be significantly associated with almost a 15-fold increase in the odds of walking dependence (odds ratio [OR] 15.5; 95% Confidence Interval [CI] 5.6–42.7; P < .01). DSD was also significantly associated with a fivefold increase in the risk of institutionalization (OR 5.0; 95% CI 2.8–8.9; P < .01) and an almost twofold increase in the risk of mortality (OR 1.8; 95% CI 1.1–2.8; P = .01). Conclusions DSD is a strong predictor of functional dependence, institutionalization, and mortality in older patients admitted to a rehabilitation setting, suggesting that strategies to detect DSD routinely in practice should be developed and DSD should

  20. Anticholinergic delirium following Datura stramonium ingestion: Implications for the Internet age.

    PubMed

    Vearrier, David; Greenberg, Michael I

    2010-07-01

    Recreational use of Datura to deliberately induce an anticholinergic delirium is not uncommon. We present a case of Datura intoxication in a young adult who learned about the recreational use of Datura on the Internet and subsequently purchased Datura stramonium seeds from an online vendor. Using the Google search engine, we conducted searches for "Datura," "jimson weed" and "Datura seeds" and reviewed the first 200 search results for each search term. We found 16 websites recommending the recreational use of Datura, 12 vendors selling seeds of genus Datura and one website that both promoted the recreational use of Datura and also sold Datura stramonium leaves. The promotion of recreational use of Datura on the Internet represents a danger to public health and the ability to purchase Datura seeds from Internet vendors may increase the prevalence of Datura abuse.

  1. Anticholinergic delirium following Datura stramonium ingestion: Implications for the Internet age

    PubMed Central

    Vearrier, David; Greenberg, Michael I

    2010-01-01

    Recreational use of Datura to deliberately induce an anticholinergic delirium is not uncommon. We present a case of Datura intoxication in a young adult who learned about the recreational use of Datura on the Internet and subsequently purchased Datura stramonium seeds from an online vendor. Using the Google search engine, we conducted searches for “Datura,” “jimson weed” and “Datura seeds” and reviewed the first 200 search results for each search term. We found 16 websites recommending the recreational use of Datura, 12 vendors selling seeds of genus Datura and one website that both promoted the recreational use of Datura and also sold Datura stramonium leaves. The promotion of recreational use of Datura on the Internet represents a danger to public health and the ability to purchase Datura seeds from Internet vendors may increase the prevalence of Datura abuse. PMID:20930988

  2. Emergence Delirium With Post-traumatic Stress Disorder Among Military Veterans.

    PubMed

    Nguyen, Son; Pak, Mila; Paoli, Daniel; Neff, Donna F

    2016-12-08

    The clinical characteristics of emergence delirium (ED) associated with post-traumatic stress disorder (PTSD) among military veterans encompass transient agitation, restlessness, disorientation, and violent verbal and physical behaviors due to re-experiencing of PTSD-related incidents. Two cases of ED after general anesthesia associated with PTSD are presented. Different anesthesia methods were applied for the two cases. A traditional medical approach appeared not to prevent the incidence of ED. In the second case, dexmedetomidine infusion along with verbal coaching was effective in preventing ED for a veteran known to have "wild wake-ups" with prior anesthetics. Further clinical studies in effectively utilizing dexmedetomidine in this population with PTSD at high risk for ED are warranted.

  3. "Nabucco" by Giuseppe Verdi: A Case of Delirium in an Italian Romantic Opera.

    PubMed

    Cambioli, Luca; Bava, Mattia; Bellelli, Giuseppe; Clerici, Massimo; Cesana, Giancarlo; Riva, Michele Augusto

    2017-01-01

    Italian operas can provide relevant information on the medical knowledge during the Romantic Age, especially in the field of neuroscience. One of the most renowned operas, "Nabucco" by Giuseppe Verdi (1813-1901) may provide us with some information on the state of knowledge on neuropsychiatric diseases in the first part of the nineteenth century. The main character of this opera, the Assyrian king Nabucco suffers from delirium. Psychic signs and symptoms attributed to Nabucco in Verdi's opera could have been influenced by a better knowledge of neuropsychiatric diseases in the nineteenth century. Furthermore, the representation of Nabucco's mental illness in the opera could also have been influenced by direct experiences of Verdi himself, who seems to have suffered from recurrent depressive episodes in that period, and for the rest of his life.

  4. Emergence Delirium With Post-traumatic Stress Disorder Among Military Veterans

    PubMed Central

    Nguyen, Son; Paoli, Daniel; Neff, Donna F

    2016-01-01

    The clinical characteristics of emergence delirium (ED) associated with post-traumatic stress disorder (PTSD) among military veterans encompass transient agitation, restlessness, disorientation, and violent verbal and physical behaviors due to re-experiencing of PTSD-related incidents. Two cases of ED after general anesthesia associated with PTSD are presented. Different anesthesia methods were applied for the two cases. A traditional medical approach appeared not to prevent the incidence of ED. In the second case, dexmedetomidine infusion along with verbal coaching was effective in preventing ED for a veteran known to have “wild wake-ups” with prior anesthetics. Further clinical studies in effectively utilizing dexmedetomidine in this population with PTSD at high risk for ED are warranted. PMID:28083465

  5. Efficacy of Non-Pharmacological Interventions to Prevent and Treat Delirium in Older Patients: A Systematic Overview. The SENATOR project ONTOP Series

    PubMed Central

    Abraha, Iosief; Trotta, Fabiana; Rimland, Joseph M.; Cruz-Jentoft, Alfonso; Lozano-Montoya, Isabel; Soiza, Roy L.; Pierini, Valentina; Dessì Fulgheri, Paolo; Lattanzio, Fabrizia; O’Mahony, Denis; Cherubini, Antonio

    2015-01-01

    Background Non-pharmacological intervention (e.g. multidisciplinary interventions, music therapy, bright light therapy, educational interventions etc.) are alternative interventions that can be used in older subjects. There are plenty reviews of non-pharmacological interventions for the prevention and treatment of delirium in older patients and clinicians need a synthesized, methodologically sound document for their decision making. Methods and Findings We performed a systematic overview of systematic reviews (SRs) of comparative studies concerning non-pharmacological intervention to treat or prevent delirium in older patients. The PubMed, Cochrane Database of Systematic Reviews, EMBASE, CINHAL, and PsychINFO (April 28th, 2014) were searched for relevant articles. AMSTAR was used to assess the quality of the SRs. The GRADE approach was used to assess the quality of primary studies. The elements of the multicomponent interventions were identified and compared among different studies to explore the possibility of performing a meta-analysis. Risk ratios were estimated using a random-effects model. Twenty-four SRs with 31 primary studies satisfied the inclusion criteria. Based on the AMSTAR criteria twelve reviews resulted of moderate quality and three resulted of high quality. Overall, multicomponent non-pharmacological interventions significantly reduced the incidence of delirium in surgical wards [2 randomized trials (RCTs): relative risk (RR) 0.71, 95% Confidence Interval (CI) 0.59 to 0.86, I2=0%; (GRADE evidence: moderate)] and in medical wards [2 CCTs: RR 0.65, 95%CI 0.49 to 0.86, I2=0%; (GRADE evidence: moderate)]. There is no evidence supporting the efficacy of non-pharmacological interventions to prevent delirium in low risk populations (i.e. low rate of delirium in the control group)[1 RCT: RR 1.75, 95%CI 0.50 to 6.10 (GRADE evidence: very low)]. For patients who have developed delirium, the available evidence does not support the efficacy of multicomponent

  6. Narrative-based educational nursing intervention for managing hospitalized older adults at risk for delirium: field testing and qualitative evaluation.

    PubMed

    Bélanger, Louise; Ducharme, Francine

    2015-01-01

    Though delirium is a common complication among hospitalized older adults and the nursing care required in these situations is complex, the subject has received little attention in the literature on continuing nursing education. A study was undertaken to field test and qualitatively evaluate a narrative-based educational intervention for nurses in hospital units with a high incidence of delirium. Triangulated data collection allowed carrying out a qualitative evaluation of the intervention process and outcomes. Process evaluation showed that the intervention was facilitated by the participants' attitudes and diversity of experience, as well as by the use of real care situations, which allowed integrating theory and practice. Outcome evaluation brought to light numerous elements of empirical, ethical and esthetic knowledge expressed by the participants. Study results evidence the applicability of such interventions as part of continuing nursing education and their contribution to knowledge development.

  7. Delirium tremens

    MedlinePlus

    ... may get worse quickly, and can include: Body tremors Changes in mental function Agitation, irritability Confusion , disorientation ... eye muscle movement Rapid heart rate Rapid muscle tremors The following tests may be done: Blood magnesium ...

  8. An Empirical Method of Detecting Time-Dependent Confounding: An Observational Study of Next Day Delirium in a Medical ICU.

    PubMed

    Murphy, T E; Van Ness, P H; Araujo, K L B; Pisani, M A

    Longitudinal research on older persons in the medical intensive care unit (MICU) is often complicated by the time-dependent confounding of concurrently administered interventions such as medications and intubation. Such temporal confounding can bias the respective longitudinal associations between concurrently administered treatments and a longitudinal outcome such as delirium. Although marginal structural models address time-dependent confounding, their application is non-trivial and preferably justified by empirical evidence. Using data from a longitudinal study of older persons in the MICU, we constructed a plausibility score from 0 - 10 where higher values indicate higher plausibility of time-dependent confounding of the association between a time-varying explanatory variable and an outcome. Based on longitudinal plots, measures of correlation, and longitudinal regression, the plausibility scores were compared to the differences in estimates obtained with non-weighted and marginal structural models of next day delirium. The plausibility scores of the three possible pairings of daily doses of fentanyl, haloperidol, and intubation indicated the following: low plausibility for haloperidol and intubation, moderate plausibility for fentanyl and haloperidol, and high plausibility for fentanyl and intubation. Comparing multivariable models of next day delirium with and without adjustment for time-dependent confounding, only intubation's association changed substantively. In our observational study of older persons in the MICU, the plausibility scores were generally reflective of the observed differences between coefficients estimated from non-weighted and marginal structural models.

  9. Safety and efficacy of flumazenil for reversal of iatrogenic benzodiazepine-associated delirium toxicity during treatment of alcohol withdrawal, a retrospective review at one center.

    PubMed

    Moore, Philip W; Donovan, J Ward; Burkhart, Keith K; Waskin, Jeffrey A; Hieger, Michelle A; Adkins, Audrey R; Wert, Yijin; Haggerty, David A; Rasimas, J J

    2014-06-01

    Both alcohol withdrawal syndrome (AWS) and benzodiazepines can cause delirium. Benzodiazepine-associated delirium can complicate AWS and prolong hospitalization. Benzodiazepine delirium can be diagnosed with flumazenil, a GABA-A receptor antagonist. By reversing the effects of benzodiazepines, flumazenil is theorized to exacerbate symptoms of AWS and precludes its use. For patients being treated for alcohol withdrawal, flumazenil can diagnose and treat benzodiazepine delirium without precipitating serious or life-threatening adverse events. Hospital admission records were retrospectively reviewed for patients with the diagnosis of AWS who received both benzodiazepines and flumazenil from December 2006 to June 2012 at a university-affiliated inpatient toxicology center. The day of last alcohol consumption was estimated from available blood alcohol content or subjective history. Corresponding benzodiazepine, flumazenil, and adjunctive sedative pharmacy records were reviewed, as were demographic, clinical course, and outcome data. Eighty-five patients were identified (average age 50.3 years). Alcohol concentrations were detectable for 42 patients with average 261 mg/dL (10-530 mg/dL). Eighty patients were treated with adjunctive agents for alcohol withdrawal including antipsychotics (n = 57), opioids (n = 27), clonidine (n = 35), and phenobarbital (n = 23). Average time of flumazenil administration was 4.7 days (1-11 days) after abstinence, and average dose was 0.5 mg (0.2-1 mg). At the time of flumazenil administration, delirium was described as hypoactive (n = 21), hyperactive (n = 15), mixed (n = 41), or not specified (n = 8). Response was not documented in 11 cases. Sixty-two (72.9 %) patients had significant objective improvement after receiving flumazenil. Fifty-six patients required more than one dose (average 5.6 doses). There were no major adverse events and minor adverse effects included transiently increased anxiety

  10. Communication Capacity Scale and Agitation Distress Scale to measure the severity of delirium in terminally ill cancer patients: a validation study.

    PubMed

    Morita, T; Tsunoda, J; Inoue, S; Chihara, S; Oka, K

    2001-05-01

    Although valid measurement of the severity of terminal delirium is of great importance in palliative care settings, existing instruments have considerable limitations. In order to quantify patients' communication capacity and agitated behaviour, two new operational observer-rating scales, the Communication Capacity Scale (Communication Scale) and Agitation Distress Scale (Agitation Scale), were validated. Thirty terminally ill cancer patients diagnosed with delirium were evaluated simultaneously by two palliative care physicians blinded to each other's coding using the Communication Scale and Agitation Scale. In addition, the Memorial Delirium Assessment Scale (MDAS), Delirium Rating Scale (DRS) and Sedation Scale were rated by one researcher. Both scales achieved high internal consistency and inter-rater reliability with Cronbach's alpha coefficients of 0.91 and 0.96, and Cohen's kappa values on each item of 0.72-1.00. The principal components analysis resulted in the emergence of only one component for each scale. The total score on the Communication Scale was highly associated with that of the MDAS (rho = 0.78), Sedation Scale (rho = 0.86), and cognitive items from the MDAS and DRS (rho = 0.83). The whole score on the Agitation Scale was significantly correlated with that of the DRS (rho = 0.61) and agitation items from the MDAS and DRS (rho = 0.61). In conclusion, the Communication Scale and Agitation Scale have acceptable reliability and validity to quantify patients' communication capacity and agitation symptoms of terminally ill cancer patients with delirium.

  11. The cost-effectiveness of multi-component interventions to prevent delirium in older people undergoing surgical repair of hip fracture.

    PubMed

    Akunne, Anayo; Davis, Sarah; Westby, Maggie; Young, John

    2014-02-01

    This article summarizes the detailed cost-effectiveness analysis of delirium prevention interventions in people undergoing surgical repair of hip fracture. We compared a multi-component delirium prevention intervention with usual care using a model based on a decision tree analysis. The model was used to estimate the incremental net monetary benefit (INMB). The robustness of the cost-effectiveness result was explored using deterministic and probabilistic sensitivity analyses. The multi-component prevention intervention was cost-effective when compared to usual care. It was associated with an INMB of £8,180 using a cost-effectiveness threshold of £20,000 per QALY. It remained cost-effective in the majority of the deterministic sensitivity analyses and was cost-effective in 96.4 % of the simulations carried out in the probabilistic sensitivity analysis. We have demonstrated the cost-effectiveness of a multi-component delirium prevention intervention that targets modifiable risk factors for delirium in older people undergoing surgical repair of hip fracture. It is an attractive intervention for practitioners and health care policy makers as they address the double burden of hip fracture and delirium.

  12. Delirium Accompanied by Cholinergic Deficiency and Organ Failure in a 73-Year-Old Critically Ill Patient: Physostigmine as a Therapeutic Option

    PubMed Central

    Zujalovic, Benedikt; Barth, Eberhard

    2015-01-01

    Delirium is a common problem in ICU patients, resulting in prolonged ICU stay and increased mortality. A cholinergic deficiency in the central nervous system is supposed to be a relevant pathophysiologic process in delirium. Acetylcholine is a major transmitter of the parasympathetic nervous system influencing several organs (e.g., heart and kidneys) and the inflammatory response too. This perception might explain that delirium is not an individual symptom, but rather a part of a symptom complex with various disorders of the whole organism. The cholinergic deficiency could not be quantified up to now. Using the possibility of bedside determination of the acetylcholinesterase activity (AChE activity), we assumed to objectify the cholinergic homeostasis within minutes. As reported here, the postoperative delirium was accompanied by a massive hemodynamic and renal deterioration of unclear genesis. We identified the altered AChE activity as a plausible pathophysiological mechanism. The pharmacological intervention with the indirect parasympathomimetic physostigmine led to a quick and lasting improvement of the patient's cognitive, hemodynamic, and renal status. In summary, severe delirium is not always an attendant phenomenon of critical illness. It might be causal for multiple organ deterioration if it is based on cholinergic deficiency and has to be treated at his pathophysiological roots whenever possible. PMID:26550498

  13. Deconstructing dementia and delirium hospital practice: using cultural historical activity theory to inform education approaches.

    PubMed

    Teodorczuk, Andrew; Mukaetova-Ladinska, Elizabeta; Corbett, Sally; Welfare, Mark

    2015-08-01

    Older patients with dementia and delirium receive suboptimal hospital care. Policy calls for more effective education to address this though there is little consensus on what this entails. The purpose of this clarification study is to explore how practice gaps are constructed in relation to managing the confused hospitalised older patient. The intent is to inform educational processes in the work-place beyond traditional approaches such as training. Adopting grounded theory as a research method and working within a social constructionist paradigm we explored the practice gaps of 15 healthcare professionals by interview and conducted five focus groups with patients, carers and Liaison mental health professionals. Data were thematically analysed by constant comparison and theoretical sampling was undertaken until saturation reached. Categories were identified and pragmatic concepts developed grounded within the data. Findings were then further analysed using cultural historical activity theory as a deductive lens. Practice gaps in relation to managing the confused older patient are determined by factors operating at individual (knowledge and skill gaps, personal philosophy, task based practice), team (leadership, time and ward environmental factors) and organisational (power relationships, dominance of medical model, fragmentation of care services) levels. Conceptually, practice appeared to be influenced by socio-cultural ward factors and compounded by a failure to join up existing "patient" knowledge amongst professionals. Applying cultural historical activity theory to further illuminate the findings, the central object is defined as learning about the patient and the mediating artifacts are the care relationships. The overarching medical dominance emerges as an important cultural historical factor at play and staff rules and divisions of labour are exposed. Lastly key contradictions and tensions in the system that work against learning about the patient are

  14. Post-operative delirium is an independent predictor of 30-day hospital readmission after spine surgery in the elderly (≥65years old): A study of 453 consecutive elderly spine surgery patients.

    PubMed

    Elsamadicy, Aladine A; Wang, Timothy Y; Back, Adam G; Lydon, Emily; Reddy, Gireesh B; Karikari, Isaac O; Gottfried, Oren N

    2017-03-02

    In the last decade, costs of U.S. healthcare expenditures have been soaring, with billions of dollars spent on hospital readmissions. Identifying causes and risk factors can reduce soaring readmission rates and help lower healthcare costs. The aim of this is to determine if post-operative delirium in the elderly is an independent risk factor for 30-day hospital readmission after spine surgery. The medical records of 453 consecutive elderly (≥65years old) patients undergoing spine surgery at Duke University Medical Center from 2008 to 2010 were reviewed. We identified 17 (3.75%) patients who experienced post-operative delirium according to DSM-V criteria. Patient demographics, comorbidities, and post-operative complication rates were collected for each patient. Elderly patients experiencing post-operative delirium had an increased length of hospital stay (10.47days vs. 5.70days, p=0.009). Complication rates were similar between the cohorts with the post-operative delirium patients having increased UTI and superficial surgical site infections. In total, 12.14% of patients were re-admitted within 30-days of discharge, with post-operative delirium patients experiencing approximately a 4-fold increase in 30-day readmission rates (Delirium: 41.18% vs. No Delirium: 11.01%, p=0.002). In a multivariate logistic regression analysis, post-operative delirium is an independent predictor of 30-day readmission after spine surgery in the elderly (p=0.03). Elderly patients experiencing post-operative delirium after spine surgery is an independent risk factor for unplanned readmission within 30-days of discharge. Preventable measures and early awareness of post-operative delirium in the elderly may help reduce readmission rates.

  15. Development and Usability Evaluation of the Mobile Delirium Assessment App Based on Confusion Assessment Method for Intensive Care Unit (CAM-ICU).

    PubMed

    Ji, Meihua; Wu, Ying; Chang, Polun; Yang, Xin; Yang, Fangyu; Xu, Shuang

    2015-01-01

    Delirium is a common complication among patients in ICU settings. The accuracy of using the assessment tool CAM-ICU to detect delirium is relatively low during routine practice among bedside nurses. The aim of this study is to develop a mobile application (app) to detect delirium in early stage and to test its usability among ICU nurses. The app was developed with Java and installed on a mobile device. A questionnaire was created based on the Technology Acceptance Model (TAM) measuring their response to the four domains of TAM: perceived usefulness (PU), perceived ease of use (PEOU), attitudes towards usage (ATU) and behavioral intention to use (BIU). One hundred and two ICU nurses completed the survey. The result indicated that the app we developed has easy to use interfaces and is easier to use compared to the regular CAM-ICU.

  16. Nurse-led change: a statewide multidisciplinary collaboration targeting intensive care unit delirium.

    PubMed

    Dammeyer, Jennifer A; Mapili, Christina D; Palleschi, Maria Teresa; Eagle, Sommer; Browning, Linda; Heck, Kara; March, Adam; Clark, Patricia; George, Christine

    2012-01-01

    For more than a decade, research has demonstrated both the widespread prevalence and negative outcomes associated with intensive care unit delirium. Hospitals are, therefore, being called to institute evidence-based protocols to prevent and manage its occurrence. Integrating evidence-based practice into bedside care can be a challenge. Having information ready and accessible is essential to implementing successful change. The state of Michigan, through the Michigan Health and Hospital Association Keystone Center, has historically gathered evidence and formulated processes to facilitate evidence implementation in statewide intensive care units. Toolkits have been developed to facilitate the spread of information and are used as a starting point for sites. This approach has been proven successful in reduction of ventilator-associated pneumonias and catheter-related blood stream infections, while in partnership with Johns Hopkins University. The purpose of this article is to describe the creation of evidence-based toolkits used to facilitate successful statewide changes in practice using an interprofessional team including nurses, physicians, and pharmacists. The content reflects a step-wise approach to not only engage and educate staff, but also strategies to execute and evaluate the effectiveness.

  17. Case reports with a child psychiatric exploration of catatonia, autism, and delirium.

    PubMed

    Schieveld, Jan N M

    2006-01-01

    This chapter starts with some remarks on the conceptual history of catatonia, which begins with Kahlbaum and continues with Kraeplin, Bleuler, and Leonhard. The Diagnostic and Statistical Manual, 4th ed., Text Revision, criteria for catatonia and the multicausal origin of the disorder are discussed. So, not only schizophrenia and mood disorders associated with catatonia, which is the primary form, are introduced but also an extensive list of somatic disorders-resulting in secondary catatonia-along with the work of Gelenberg and Wing. Next, two very difficult cases, of boys with autism, catatonia, and one of them with mental retardation as well, are presented. Major textbooks, PubMed, and Medline were used for a select literature search. The results show the main and really relevant but scarce data concerning primary and secondary catatonia. In the discussion the topics are this dearth in knowledge, the concept of catatonia and its similarities with delirium, and the relation catatonia-autism, and where to find the data. The conclusions summarize the main points and end with a gentle reminder, or is it an appeal?

  18. Pharmacologic, physiologic, and psychological characteristics associated with emergence delirium in combat veterans.

    PubMed

    Wilson, John Tyler

    2014-10-01

    The goal of this research was to investigate, through active-duty Army anesthesia providers, their perceptions on emergence delirium (ED) in US combat veterans. Specifically, the pharmacologic, physiologic, and psychological characteristics associated with ED. An online survey was sent to all active-duty Army anesthesia providers with a response rate of 34%. Results indicated that the providers overwhelmingly agreed that ED was related to type of anesthetic used (67.1%) with potent inhalational agents and ketamine ranking highest (88.6% and 63.6%, respectively). Providers also overwhelmingly considered both physiologic and psychological factors (86.8% and 97.1%, respectively) as producing ED in combat veterans. Young age (57.5%) and traumatic brain injury (54.2%) were believed to be the most likely physiologic factors, with posttraumatic stress disorder (88%) and anxiety (84.8%) rated highest for psychological factors related to ED. This study emphasizes the need to develop a prospective clinical database involving all military anesthesia providers that could collect demographic, pharmacologic, psychological, and physiologic information on all combat veterans undergoing anesthesia. This kind of longitudinal data would provide answers to many of the unanswered questions that we currently have regarding combat veterans and ED.

  19. Critical care nursing and delirium management in the mentally ill client.

    PubMed

    Bone, Yolanda; Smith, George Byron

    2012-03-01

    The critical care environment is an experience of stress for the patient and the practitioner. Turbulence can occur during the critical care course, which can cause exacerbation of chronic conditions. These exacerbations can lead to delirium and/or psychosis. Nursing professionals must be alert to changes in all conditions which increase morbidity and mortality in the critical care patient. Although critical care nurses may feel unable to care for the psychiatric needs of clients with a chronic mental disorder, implementing tools to aid in assessment will empower the nurses. Truly, the key to viewing all clients is wholly, rather than by diagnosis. Critical care nurses care for clients with many comorbidities and illnesses. Many conditions may be a new experience. Mental disorders should not be viewed as being out of the scope of the critical care nurse. On the contrary, mental disorders are chronic conditions, not unlike diabetes mellitus or congestive heart failure. What the critical care nurse needs is a knowledge base in order to feel more comfortable in caring for these clients. Knowledge is empowerment.

  20. Clinical monitoring scales in acute brain injury: assessment of coma, pain, agitation, and delirium.

    PubMed

    Riker, Richard R; Fugate, Jennifer E

    2014-12-01

    Serial clinical examination represents the most fundamental and basic form of neurological monitoring, and is often the first and only form of such monitoring in patients. Even in patients subjected to physiological monitoring using a range of technologies, the clinical examination remains an essential tool to follow neurological progress. Key aspects of the clinical examination have now been systematized into scoring schemes, and address consciousness, pain, agitation, and delirium (PAD). The Glasgow Coma Scale has been the traditional tool to measure consciousness, but the full outline of unresponsiveness (FOUR) score has recently been validated in a variety of settings, and at present, both represent clinically useful tools. Assessment of PAD in neurologically compromised patients present special challenges. For pain, the Numeric Rating Scale is the preferred initial approach, with either the Behavioral Pain Scale or the Critical Care Pain Observation Tool in subjects who are not able to respond. The Nociception Coma Scale-Revised may be useful in patients with severe disorders of consciousness. Conventional sedation scoring tools for critical care, such as the Richmond Area Sedation Scale (RASS) and Sedation-Agitation Scale (SAS) may provide reasonable tools in some neurocritical care patients. The use of sedative drugs and neuromuscular blockers may invalidate the use of some clinical examination tools in others. The use of sedation interruption to assess neurological status can result in physiological derangement in unstable patients (such as those with uncontrolled intracranial hypertension), and is not recommended.

  1. Comparative simultaneous measurement of cerebrospinal fluid 5-hydroxyindoleacetic acid and blood serotonin levels in delirium tremens and clozapine-induced delirious reaction.

    PubMed

    Banki, C M; Vojnik, M

    1978-05-01

    Cerebrospinal fluid 5-hydroxyindoleacetic acid and total blood serotonin levels were measured simultaneously in 11 female patients with delirium tremens and nine schizophrenic women with clozapine-induced acute delirium. Both groups had significantly raised levels of 5HIAA in CSF and significantly reduced blood 5HT levels as compared with normal control subjects, symptom-free alcoholics, or clozapine-treated schizophrenics. The two delirious groups were not distinguishable from each other in respect of their CSF 5HIAA or blood 5HT values. After clinical recovery both values returned to normal levels.

  2. Survival Prediction for Terminally Ill Cancer Patients: Revision of the Palliative Prognostic Score with Incorporation of Delirium

    PubMed Central

    Maltoni, Marco; Miceli, Rosalba; Mariani, Luigi; Caraceni, Augusto; Amadori, Dino; Nanni, Oriana

    2011-01-01

    Purpose. An existing and validated palliative prognostic (PaP) score predicts survival in terminally ill cancer patients based on dyspnea, anorexia, Karnofsky performance status score, clinical prediction of survival, total WBC, and lymphocyte percentage. The PaP score assigns patients to three different risk groups according to a 30-day survival probability—group A, >70%; group B, 30%–70%; group C, <30%. The impact of delirium is known but was not incorporated into the PaP score. Materials and Methods. Our aim was to incorporate information on delirium into the PaP score based on a retrospective series of 361 terminally ill cancer patients. We followed the approach of “validation by calibration,” proposed by van Houwelingen and later adapted by Miceli for achieving score revision with inclusion of a new variable. The discriminating performance of the scores was estimated using the K statistic. Results. The prognostic contribution of delirium was confirmed as statistically significant (p < .001) and the variable was accordingly incorporated into the PaP score (D-PaP score). Following this revision, 30-day survival estimates in groups A, B, and C were 83%, 50%, and 9% for the D-PaP score and 87%, 51%, and 16% for the PaP score, respectively. The overall performance of the D-PaP score was better than that of the PaP score. Conclusion. The revision of the PaP score was carried out by modifying the cutoff values used for prognostic grouping without, however, affecting the partial scores of the original tool. The performance of the D-PaP score was better than that of the PaP score and its key feature of simplicity was maintained. PMID:22042788

  3. Creative Music Therapy in an Acute Care Setting for Older Patients with Delirium and Dementia

    PubMed Central

    Cheong, Chin Yee; Tan, Jane An Qi; Foong, Yi-Lin; Koh, Hui Mien; Chen, Denise Zhen Yue; Tan, Jessie Joon Chen; Ng, Chong Jin; Yap, Philip

    2016-01-01

    Background/Aims The acute hospital ward can be unfamiliar and stressful for older patients with impaired cognition, rendering them prone to agitation and resistive to care. Extant literature shows that music therapy can enhance engagement and mood, thereby ameliorating agitated behaviours. This pilot study evaluates the impact of a creative music therapy (CMT) programme on mood and engagement in older patients with delirium and/or dementia (PtDD) in an acute care setting. We hypothesize that CMT improves engagement and pleasure in these patients. Methods Twenty-five PtDD (age 86.5 ± 5.7 years, MMSE 6/30 ± 5.4) were observed for 90 min (30 min before, 30 min during, and 30 min after music therapy) on 3 consecutive days: day 1 (control condition without music) and days 2 and 3 (with CMT). Music interventions included music improvisation such as spontaneous music making and playing familiar songs of patient's choice. The main outcome measures were mood and engagement assessed with the Menorah Park Engagement Scale (MPES) and Observed Emotion Rating Scale (OERS). Results Wilcoxon signed-rank test showed a statistically significant positive change in constructive and passive engagement (Z = 3.383, p = 0.01) in MPES and pleasure and general alertness (Z = 3.188,p = 0.01) in OERS during CMT. The average pleasure ratings of days 2 and 3 were higher than those of day 1 (Z = 2.466, p = 0.014). Negative engagement (Z = 2.582, p = 0.01) and affect (Z = 2.004, p = 0.045) were both lower during CMT compared to no music. Conclusion These results suggest that CMT holds much promise to improve mood and engagement of PtDD in an acute hospital setting. CMT can also be scheduled into the patients' daily routines or incorporated into other areas of care to increase patient compliance and cooperation. PMID:27489560

  4. Development and validation of the Thai version of the 4 ‘A’s Test for delirium screening in hospitalized elderly patients with acute medical illnesses

    PubMed Central

    Kuladee, Sanchai; Prachason, Thanavadee

    2016-01-01

    Background The English version of the 4 ‘A’s Test (4AT) is a rapid screening tool for delirium with a high sensitivity and specificity among hospitalized elderly patients. Objective To develop the Thai version of the 4AT (4AT-T) and assess its validity. Subjects and setting A total of 97 elderly patients aged 60 years or above who were admitted to the general medical wards were included. Methods Both authors independently translated the English version of the 4AT into Thai and thereafter developed a single reconciled forward translation by consensus. Back translation was performed by a bilingual native English speaker and it was then reviewed to ensure its agreement with the original one. After 24 hours of admission, subjects were enrolled and clinical data collected. Definite diagnosis of delirium was made by a psychiatrist using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text-Revision criteria and the 6-item Thai Delirium Rating Scale; the 4AT was then administered to participants by nurses within 30 minutes. A 4AT score ≥4 was considered positive for delirium screening. The optimal cut-off point of the 4AT-T was identified by Youden’s index. Results In all, 24 out of 97 participants met the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text-Revision criteria for delirium. At a cut-off score of 4 or greater, the 4AT-T exhibited satisfactory diagnostic performance with a sensitivity of 83.3% (95% confidence interval (CI): 62.6%–95.3%) and specificity of 86.3% (95% CI: 76.3%–93.2%). The area under the receiver operating characteristic curve was 0.92. The specified score provided maximal Youden’s index, suggesting an optimal criterion value for delirium screening. Conclusion The 4AT-T is a valid delirium-screening instrument for hospitalized elderly patients with acute medical illnesses. PMID:26966365

  5. The importance of depression and alcohol use in coronary artery bypass graft surgery patients: risk factors for delirium and poorer quality of life

    PubMed Central

    Humphreys, Joanne M; Denson, Linley A; Baker, Robert A; Tully, Phillip J

    2016-01-01

    Objective To investigate whether depression, anxiety and stress increase the risk for delirium and poor quality of life (QOL) after coronary artery bypass (CABG) surgery. Methods A total of 180 CABG patients (mean age of 63.5 ± 10.1 years, 82.2% males) completed baseline and postoperative self-report questionnaires to assess distress and QOL. Incident delirium was diagnosed postoperatively with a structured clinical interview and patients were monitored every day post-operatively for confusion and disturbance in consciousness. Results Delirium developed in 63 persons (35% of sample). After adjustment for covariates, delirium was significantly associated with depression [odds ratio (OR): 1.08; 95% confidence interval (CI): 1.03–1.13, P = 0.003], anxiety (OR: 1.07; 95% CI: 1.02–1.13, P = 0.01) and stress (OR: 1.05; 95% CI: 1.00–1.09, P = 0.03). Preoperative depression scores were associated with poorer QOL including bodily pain (β = −0.39, P = 0.013), vitality (β = −0.32, P = 0.020), social functioning (β = −0.51, P ≤ 0.001), emotional role function (β = −0.44, P = 0.003) and general health (β = −0.33, P = 0.038). Among the covariates, harmful levels of alcohol use was consistently associated with poorer QOL. Conclusions Depression and harmful levels of alcohol use were consistently associated with poorer QOL whereas depression, anxiety and stress were associated with delirium risk. These findings point to further research examining depression and harmful levels of alcohol use in coronary heart disease populations undergoing coronary revascularization. PMID:26918013

  6. Geriatric falls in the context of a hospital fall prevention program: delirium, low body mass index, and other risk factors

    PubMed Central

    Mazur, Katarzyna; Wilczyński, Krzysztof; Szewieczek, Jan

    2016-01-01

    Background Inpatient geriatric falls are a frequent complication of hospital care that results in significant morbidity and mortality. Objective Evaluate factors associated with falls in geriatric inpatients after implementation of the fall prevention program. Methods Prospective observational study comprised of 788 consecutive patients aged 79.5±7.6 years ( χ¯ ± standard deviation) (66% women and 34% men) admitted to the subacute geriatric ward. Comprehensive geriatric assessment (including Mini-Mental State Examination, Barthel Index of Activities of Daily Living, and modified Get-up and Go Test) was performed. Confusion Assessment Method was used for diagnosis of delirium. Patients were categorized into low, moderate, or high fall risk groups after clinical and functional assessment. Results About 15.9%, 21.1%, and 63.1% of participants were classified into low, moderate, and high fall risk groups, respectively. Twenty-seven falls were recorded in 26 patients. Increased fall probability was associated with age ≥76 years (P<0.001), body mass index (BMI) <23.5 (P=0.007), Mini-Mental State Examination <20 (P=0.004), Barthel Index <65 (P=0.002), hemoglobin <7.69 mmol/L (P=0.017), serum protein <70 g/L (P=0.008), albumin <32 g/L (P=0.001), and calcium level <2.27 mmol/L. Four independent factors associated with fall risk were included in the multivariate logistic regression model: delirium (odds ratio [OR] =7.33; 95% confidence interval [95% CI] =2.76–19.49; P<0.001), history of falls (OR =2.55; 95% CI =1.05–6.19; P=0.039), age (OR =1.14; 95% CI =1.05–1.23; P=0.001), and BMI (OR =0.91; 95% CI =0.83–0.99; P=0.034). Conclusion Delirium, history of falls, and advanced age seem to be the primary risk factors for geriatric falls in the context of a hospital fall prevention program. Higher BMI appears to be associated with protection against inpatient geriatric falls. PMID:27695303

  7. Gentle persuasive approaches: introducing an educational program on an orthopaedic unit for staff caring for patients with dementia and delirium.

    PubMed

    Pizzacalla, Anne; Montemuro, Maureen; Coker, Esther; Martin, Lori Schindel; Gillies, Leslie; Robinson, Karen; Pepper, Heather; Benner, Jeff; Gusciora, Joanna

    2015-01-01

    Gentle Persuasive Approaches in Dementia Care (GPA), a curriculum originally designed for long-term care, was introduced into an acute care setting. This person-centered approach to supporting and responding to persons with behaviors associated with dementia was shown to be applicable for staff on an orthopaedic surgery unit where they had reported significant challenges and care burdens when faced with behaviors such as shouting, explosiveness, and resistance to care. Staff confidence in their ability to care for persons with behaviors increased after attending the 1-day GPA workshop, and they reported being highly satisfied with the curriculum, found it to be applicable to their practice, indicated that it was also useful for patients with delirium, and would recommend it to others. Some of the staff on the orthopaedic unit became certified GPA coaches. The passion of those champions, along with demonstrated success of the program on their unit, contributed to its spread to other units, including rehabilitation and acute medicine.

  8. Post-Injection Delirium/Sedation Syndrome after Olanzapine Long-Acting Intramuscular Injection - Who is at Risk?

    PubMed

    Łukasik-Głębocka, Magdalena; Sommerfeld, Karina; Teżyk, Artur; Panieński, Paweł; Żaba, Czesław; Zielińska-Psuja, Barbara

    2015-09-01

    The post-injection olanzapine delirium/sedation syndrome (PDSS) was observed in a 60-year-old Caucasian, schizophrenic, non-smoker and underweight [body mass index (BMI), 18.2 kg/m(2) ] women after the fourth intramuscular injection of 405 mg olanzapine pamoate. Clinical symptoms of PDSS were similar to those of acute oral olanzapine intoxication. The patient received supportive treatment and recovered fully. High olanzapine concentrations in serum, with maximum level of 698 ng/mL, were confirmed by liquid chromatography with tandem mass spectrometry (LC-MS/MS). The authors wonder whether a low BMI and advanced age may predispose patients to PDSS occurrence.

  9. Systemic Inflammation Impairs Attention and Cognitive Flexibility but Not Associative Learning in Aged Rats: Possible Implications for Delirium

    PubMed Central

    Culley, Deborah J.; Snayd, Mary; Baxter, Mark G.; Xie, Zhongcong; Lee, In Ho; Rudolph, James; Inouye, Sharon K.; Marcantonio, Edward R.; Crosby, Gregory

    2014-01-01

    Delirium is a common and morbid condition in elderly hospitalized patients. Its pathophysiology is poorly understood but inflammation has been implicated based on a clinical association with systemic infection and surgery and preclinical data showing that systemic inflammation adversely affects hippocampus-dependent memory. However, clinical manifestations and imaging studies point to abnormalities not in the hippocampus but in cortical circuits. We therefore tested the hypothesis that systemic inflammation impairs prefrontal cortex function by assessing attention and executive function in aged animals. Aged (24-month-old) Fischer-344 rats received a single intraperitoneal injection of lipopolysaccharide (LPS; 50 μg/kg) or saline and were tested on the attentional set-shifting task (AST), an index of integrity of the prefrontal cortex, on days 1–3 post-injection. Plasma and frontal cortex concentrations of the cytokine TNFα and the chemokine CCL2 were measured by ELISA in separate groups of identically treated, age-matched rats. LPS selectively impaired reversal learning and attentional shifts without affecting discrimination learning in the AST, indicating a deficit in attention and cognitive flexibility but not learning globally. LPS increased plasma TNFα and CCL2 acutely but this resolved within 24–48 h. TNFα in the frontal cortex did not change whereas CCL2 increased nearly threefold 2 h after LPS but normalized by the time behavioral testing started 24 h later. Together, our data indicate that systemic inflammation selectively impairs attention and executive function in aged rodents and that the cognitive deficit is independent of concurrent changes in frontal cortical TNFα and CCL2. Because inattention is a prominent feature of clinical delirium, our data support a role for inflammation in the pathogenesis of this clinical syndrome and suggest this animal model could be useful for studying that relationship further. PMID:24959140

  10. Influence of Granulocyte-Macrophage Colony-Stimulating Factor or Influenza Vaccination on HLA-DR, Infection and Delirium Days in Immunosuppressed Surgical Patients: Double Blind, Randomised Controlled Trial

    PubMed Central

    Lachmann, Gunnar; Renius, Markus; von Haefen, Clarissa; Wernecke, Klaus-Dieter; Bahra, Marcus; Schiemann, Alexander; Paupers, Marco; Meisel, Christian

    2015-01-01

    Purpose Surgical patients are at high risk for developing infectious complications and postoperative delirium. Prolonged infections and delirium result in worse outcome. Granulocyte-macrophage colony-stimulating factor (GM-CSF) and influenza vaccination are known to increase HLA-DR on monocytes and improve immune reactivity. This study aimed to investigate whether GM-CSF or vaccination reverses monocyte deactivation. Secondary aims were whether it decreases infection and delirium days after esophageal or pancreatic resection over time. Methods In this prospective, randomized, placebo-controlled, double-blind, double dummy trial setting on an interdisciplinary ICU of a university hospital 61 patients with immunosuppression (monocytic HLA-DR [mHLA-DR] <10,000 monoclonal antibodies [mAb] per cell) on the first day after esophageal or pancreatic resection were treated with either GM-CSF (250 μg/m2/d), influenza vaccination (Mutagrip 0.5 ml/d) or placebo for a maximum of 3 consecutive days if mHLA-DR remained below 10,000 mAb per cell. HLA-DR on monocytes was measured daily until day 5 after surgery. Infections and delirium were followed up for 9 days after surgery. Primary outcome was HLA-DR on monocytes, and secondary outcomes were duration of infection and delirium. Results mHLA-DR was significantly increased compared to placebo (p < 0.001) and influenza vaccination (p < 0.001) on the second postoperative day. Compared with placebo, GM-CSF-treated patients revealed shorter duration of infection (p < 0.001); the duration of delirium was increased after vaccination (p = 0.003). Conclusion Treatment with GM-CSF in patients with postoperative immune suppression was safe and effective in restoring monocytic immune competence. Furthermore, therapy with GM-CSF reduced duration of infection in immune compromised patients. However, influenza vaccination increased duration of delirium after major surgery. Trial Registration www.controlled-trials.com ISRCTN27114642 PMID

  11. Interstellar Material towards eta UMa

    NASA Astrophysics Data System (ADS)

    Frisch, P. C.; Jenkins, E. B.; Welty, D. E.; Johns-Krull, C.

    1999-05-01

    The star eta UMa (B3 V, vsini=205 km s(-1) , d=31 pc, l=101(o) , b=+65(o) ) samples nearby interstellar gas in a high latitude direction relatively devoid of material. IMAPS, Hubble GHRS Echelle, and ground based optical data are combined to present a comprehensive picture of the interstellar material (ISM) in this direction. Two main components dominate: the blue-shifted component which appears to be ionized, and the dominant, red-shifted, component which exhibits a low electron density ( ~ 0.2 cm(-3) ). However, the Mg(o/Mg^+) ratio and C(+) fine-structure lines yield different ionizations, depending on the adopted temperature, similar to differences found in the diffuse material towards 23 Ori (Welty et al. 1999). The IMAPS and GHRS data give C, N, O, and Fe column densities, which form the basis for calculating the gas-to-dust mass ratio for the main component using a ``missing mass'' calculation combined with an assumed reference abundance (Frisch et al. 1999). Comparing the eta UMa value with other diffuse cloud values then further constrains uncertainties in N(H(o) ) values for this sightline.

  12. Economic Evaluation of a General Hospital Unit for Older People with Delirium and Dementia (TEAM Randomised Controlled Trial)

    PubMed Central

    Tanajewski, Lukasz; Franklin, Matthew; Gkountouras, Georgios; Berdunov, Vladislav; Harwood, Rowan H.; Goldberg, Sarah E.; Bradshaw, Lucy E.; Gladman, John R. F.; Elliott, Rachel A.

    2015-01-01

    Background One in three hospital acute medical admissions is of an older person with cognitive impairment. Their outcomes are poor and the quality of their care in hospital has been criticised. A specialist unit to care for older people with delirium and dementia (the Medical and Mental Health Unit, MMHU) was developed and then tested in a randomised controlled trial where it delivered significantly higher quality of, and satisfaction with, care, but no significant benefits in terms of health status outcomes at three months. Objective To examine the cost-effectiveness of the MMHU for older people with delirium and dementia in general hospitals, compared with standard care. Methods Six hundred participants aged over 65 admitted for acute medical care, identified on admission as cognitively impaired, were randomised to the MMHU or to standard care on acute geriatric or general medical wards. Cost per quality adjusted life year (QALY) gained, at 3-month follow-up, was assessed in trial-based economic evaluation (599/600 participants, intervention: 309). Multiple imputation and complete-case sample analyses were employed to deal with missing QALY data (55%). Results The total adjusted health and social care costs, including direct costs of the intervention, at 3 months was £7714 and £7862 for MMHU and standard care groups, respectively (difference -£149 (95% confidence interval [CI]: -298, 4)). The difference in QALYs gained was 0.001 (95% CI: -0.006, 0.008). The probability that the intervention was dominant was 58%, and the probability that it was cost-saving with QALY loss was 39%. At £20,000/QALY threshold, the probability of cost-effectiveness was 94%, falling to 59% when cost-saving QALY loss cases were excluded. Conclusions The MMHU was strongly cost-effective using usual criteria, although considerably less so when the less acceptable situation with QALY loss and cost savings were excluded. Nevertheless, this model of care is worthy of further evaluation

  13. Use of a Structured Mirrors Intervention Does Not Reduce Delirium Incidence But May Improve Factual Memory Encoding in Cardiac Surgical ICU Patients Aged Over 70 Years: A Pilot Time-Cluster Randomized Controlled Trial

    PubMed Central

    Giraud, Kimberly; Pontin, Megan; Sharples, Linda D.; Fletcher, Paul; Dalgleish, Tim; Eden, Allaina; Jenkins, David P.; Vuylsteke, Alain

    2016-01-01

    Introduction: Post-operative delirium remains a significant problem, particularly in the older surgical patient. Previous evidence suggests that the provision of supplementary visual feedback about ones environment via the use of a mirror may positively impact on mental status and attention (core delirium diagnostic domains). We aimed to explore whether use of an evidence-based mirrors intervention could be effective in reducing delirium and improving post-operative outcomes such as factual memory encoding of the Intensive Care Unit (ICU) environment in older cardiac surgical patients. Methods: This was a pilot time-cluster randomized controlled trial at a 32-bed ICU, enrolling 223 patients aged 70 years and over, admitted to ICU after elective or urgent cardiac surgery from October 29, 2012 to June 23, 2013. The Mirrors Group received a structured mirrors intervention at set times (e.g., following change in mental status). The Usual Care Group received the standard care without mirrors. Primary outcome was ICU delirium incidence; secondary outcomes were ICU delirium days, ICU days with altered mental status or inattention, total length of ICU stay, physical mobilization (balance confidence) at ICU discharge, recall of factual and delusional ICU memories at 12 weeks, Health-Related Quality of Life at 12 weeks, and acceptability of the intervention. Results: The intervention was not associated with a significant reduction in ICU delirium incidence [Mirrors: 20/115 (17%); Usual Care: 17/108 (16%)] or duration [Mirrors: 1 (1–3); Usual Care: 2 (1–8)]. Use of the intervention on ICU was predictive of significantly higher recall of factual (but not delusional) items at 12 weeks after surgery (p = 0.003) and acceptability was high, with clinicians using mirrors at 86% of all recorded hourly observations. The intervention did not significantly impact on other secondary outcomes. Conclusion: Use of a structured mirrors intervention on the post-operative ICU does not

  14. ‘Doc, can I fly to Australia?’ A case report and review of delirium following long-haul flight

    PubMed Central

    McCabe, Thomas

    2017-01-01

    Air travel is now a common feature of most of our elderly population's lives. There is little by way of warnings, rules or recommendations for our patients with psychiatric diagnoses, in particular dementia, who intend to travel by plane, in contrast to other specialties. In this article I highlight an adverse outcome of long-haul air travel as a result of delirium and resulting accelerated decline in overall cognitive function. I review literature related to the topic and suggest ways to minimise precipitating factors for stressors prior to and during flights. This article suggests that more thought should be given to the title question. PMID:28184314

  15. Production of inflammatory cytokines, cortisol, and Aβ1-40 in elderly oral cancer patients with postoperative delirium

    PubMed Central

    Sun, Lulu; Jia, Peiyu; Zhang, Junfeng; Zhang, Xin; Zhang, Yiwei; Jiang, Hong; Jiang, Wei; Guo, Yong

    2016-01-01

    Aim Pathophysiological disorders after surgery might be related to postoperative delirium (POD). This study was designed to elucidate the pathogenesis of POD in elderly oral cancer patients by determining the perioperative kinetics of inflammatory cytokines, cortisol, and amyloid β1-40 (Aβ1-40). Methods A total of 257 elderly oral cancer patients who underwent tumor resection surgery were selected. Venous blood was collected prior to surgery (T0), at the end of surgery (T1), and at 12 hours after surgery (T2). During the first three postoperative days, patients were examined using the confusion assessment method twice a day (8 am and 8 pm). Mini-Mental State Examination scores were recorded at T0 and on postoperative days 1, 3, and 7. Ultimately, 56 patients suffering from POD made up the POD group, and 56 patients randomly selected from a cohort of patients without POD were allocated to the no POD (NPOD) group. Subsequently, interleukin-6, C-reactive protein, procalcitonin, cortisol, and Aβ1-40 in plasma from the two groups were measured. Results The two groups displayed comparable basic characteristics. There were no differences in all tested biomarkers between the two groups at T0. However, after surgery, the biomarker levels displayed distinct patterns between the two groups. The peak levels of all biomarkers were higher in the POD group than in the NPOD group. Conversely, the Mini-Mental State Examination scores after surgery were lower in the POD group than in the no POD group. Conclusion The boost of inflammatory cytokines, cortisol, and Aβ1-40 after surgery might be involved in POD onset among elderly oral cancer patients. POD was accompanied by progressive cognitive deficiency. PMID:27822051

  16. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) – short version

    PubMed Central

    Baron, Ralf; Binder, Andreas; Biniek, Rolf; Braune, Stephan; Buerkle, Hartmut; Dall, Peter; Demirakca, Sueha; Eckardt, Rahel; Eggers, Verena; Eichler, Ingolf; Fietze, Ingo; Freys, Stephan; Fründ, Andreas; Garten, Lars; Gohrbandt, Bernhard; Harth, Irene; Hartl, Wolfgang; Heppner, Hans-Jürgen; Horter, Johannes; Huth, Ralf; Janssens, Uwe; Jungk, Christine; Kaeuper, Kristin Maria; Kessler, Paul; Kleinschmidt, Stefan; Kochanek, Matthias; Kumpf, Matthias; Meiser, Andreas; Mueller, Anika; Orth, Maritta; Putensen, Christian; Roth, Bernd; Schaefer, Michael; Schaefers, Rainhild; Schellongowski, Peter; Schindler, Monika; Schmitt, Reinhard; Scholz, Jens; Schroeder, Stefan; Schwarzmann, Gerhard; Spies, Claudia; Stingele, Robert; Tonner, Peter; Trieschmann, Uwe; Tryba, Michael; Wappler, Frank; Waydhas, Christian; Weiss, Bjoern; Weisshaar, Guido

    2015-01-01

    In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine) and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine), twelve German medical societies published the “Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care”. Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from the American College of Critical Care Medicine (ACCM) in conjunction with Society of Critical Care Medicine (SCCM) and American Society of Health-System Pharmacists (ASHP) from 2013. For this update, a major restructuring and extension of the guidelines were needed in order to cover new aspects of treatment, such as sleep and anxiety management. The literature was systematically searched and evaluated using the criteria of the Oxford Center of Evidence Based Medicine. The body of evidence used to formulate these recommendations was reviewed and approved by representatives of 17 national societies. Three grades of recommendation were used as follows: Grade “A” (strong recommendation), Grade “B” (recommendation) and Grade “0” (open recommendation). The result is a comprehensive, interdisciplinary, evidence and consensus-based set of level 3 guidelines. This publication was designed for all ICU professionals, and takes into account all critically ill patient populations. It represents a guide to symptom-oriented prevention, diagnosis, and treatment of delirium, anxiety, stress, and protocol-based analgesia, sedation, and sleep-management in intensive care medicine. PMID:26609286

  17. A randomised trial of peri-operative positive airway pressure for postoperative delirium in patients at risk for obstructive sleep apnoea after regional anaesthesia with sedation or general anaesthesia for joint arthroplasty.

    PubMed

    Nadler, J W; Evans, J L; Fang, E; Preud'Homme, X A; Daughtry, R L; Chapman, J B; Bolognesi, M P; Attarian, D E; Wellman, S S; Krystal, A D

    2017-03-02

    Previous pilot work has established an association between obstructive sleep apnoea and the development of acute postoperative delirium , but it remains unclear to what extent this risk factor is modifiable in the 'real world' peri-operative setting. In a single-blind randomised controlled trial, 135 elderly surgical patients at risk for obstructive sleep apnoea were randomly assigned to receive peri-operative continuous positive airway pressure (CPAP) or routine care. Of the 114 patients who completed the study, 21 (18.4%) experienced delirium. Delirium was equally common in both groups: 21% (12 of 58 subjects) in the CPAP group and 16% (9 of 56 subjects) in the routine care group (OR = 1.36 [95%CI 0.52-3.54], p = 0.53). Delirious subjects were slightly older - mean (SD) age 68.9 (10.7) vs. 64.9 (8.2), p = 0.07 - but had nearly identical pre-operative STOP-Bang scores (4.19 (1.1) versus 4.27 (1.3), p = 0.79). Subjects in the CPAP group used their devices for a median (IQR [range]) of 3 (0.25-5 [0-12]) nights pre-operatively (2.9 (0.1-4.8 [0.0-12.7]) hours per night) and 1 (0-2 [0-2]) nights postoperatively (1.4 (0.0-5.1 [0.0-11.6]) hours per night). Among the CPAP subjects, the residual pre-operative apnoea-hypopnea index had a significant effect on delirium severity (p = 0.0002). Although we confirm that apnoea is associated with postoperative delirium, we did not find that providing a short-course of auto-titrating CPAP affected its likelihood or severity. Voluntary adherence to CPAP is particularly poor during the initiation of therapy.

  18. Incidence, risk factors, and phenomenological characteristics of postoperative delirium in patients receiving intravenous patient-controlled analgesia: a prospective cohort study

    PubMed Central

    Lin, Yao Tsung; Lan, Kuo Mao; Wang, Li-Kai; Chu, Chin-Chen; Wu, Su-Zhen; Chang, Chia-Yu; Chen, Jen-Yin

    2016-01-01

    Background Intravenous patient-controlled analgesia (IVPCA) is a common method of relieving pain which is a risk factor of postoperative delirium (POD). However, research concerning POD in IVPCA patients is limited. Objective We aimed to determine the incidence, risk factors, and phenomenological characteristics of POD in patients receiving IVPCA. Methods A prospective, cohort study was conducted in post-general anesthesia IVPCA patients aged ≥60 years. POD was measured by the Nursing Delirium Screening Scale (NuDESC; 0–10). Delirium, pain severity at rest and/or on movement, and side effects of IVPCA during 3 postoperative days were examined twice-daily by the acute pain service team. Pain severity is measured by an 11-point verbal numerical rating scale (11-point VNRS) (0–10). An 11-point VNRS >3 was considered inadequate pain relief. If POD (detected by NuDESC ≥1) is suspected, consulting a neurologist or a psychiatrist to confirm suspected POD is required. Results In total, 1,608 patients were included. The incidence rate of POD was 2.2%. Age ≥70 years and American Society of Anesthesiologists physical status >III were the risk factors of POD in IVPCA patients. Approximately three-quarters of all POD cases occurred within the first 2 postoperative days. For pain at rest, patients with inadequate pain relief had significantly greater rates of POD than patients with adequate pain relief (day 1, 8.4% vs 1.5%, P<0.001; day 2, 9.6% vs 2.0%, P=0.028; day 3, 4.1% vs 2.1%, P=0.412). However, the incidence of POD was not associated with movement-evoked pain relief. Most (79.9%) POD cases in IVPCA patients showed either one or two symptoms. The symptoms of POD were ranked from high to low as disorientation (65.7%), illusions/hallucinations (37.1%), inappropriate communication (31.4%), inappropriate behavior (25.7%), and psychomotor retardation (14.2%). Conclusion The incidence rate of POD in IVPCA patients was low. Further research is warranted concerning POD

  19. Rosuvastatin versus placebo for delirium in intensive care and subsequent cognitive impairment in patients with sepsis-associated acute respiratory distress syndrome: an ancillary study to a randomised controlled trial

    PubMed Central

    Needham, Dale M; Colantuoni, Elizabeth; Dinglas, Victor D; Hough, Catherine L; Wozniak, Amy W; Jackson, James C; Morris, Peter E; Mendez-Tellez, Pedro A; Ely, E Wesley; Hopkins, Ramona O

    2016-01-01

    Summary Background Delirium is common in mechanically ventilated patients and is associated with cognitive impairment lasting at least 1 year after hospital discharge. Preclinical and observational studies suggest that the use of statins might reduce delirium in intensive care. We assessed whether the pleiotropic effects of statins can reduce delirium in intensive care and decrease subsequent cognitive impairment in a randomised controlled trial. Methods We did this ancillary study within the SAILS trial, a randomised controlled trial assessing mortality and ventilator-free days for rosuvastatin versus placebo for patients with sepsis-associated acute respiratory distress syndrome. This study was done at 35 hospitals in the USA. Patients were randomly assigned in permuted blocks of eight and stratified by hospital to receive either rosuvastatin (40 mg loading dose and then 20 mg daily until the earliest of 3 days after discharge from intensive care, study day 28, or death) or placebo. Patients and investigators were masked to treatment assignment. Delirium was assessed with the validated Confusion Assessment Method for intensive care. Cognitive function was assessed with tests for executive function, language, verbal reasoning and concept formation, and working, immediate, and delayed memory. We defined cognitive impairment as having one of these domains at least two SDs below population norms or at least two domains at least 1·5 SDs below norms. The primary endpoint was daily delirium status in intensive care up to 28 days in the intention-to-treat population and secondary endpoints were cognitive function at 6 months and 12 months. This trial is registered with ClinicalTrials.gov (NCT00979121 and NCT00719446). Findings 272 patients were assessed for delirium daily in intensive care. The mean proportion of days with delirium was 34% (SD 30%) in the rosuvastatin group versus 31% (29%) in the placebo group; hazard ratio 1·14, 95% CI 0·92–1·41, p=0·22. At 6

  20. Nonpharmacological Interventions Targeted at Delirium Risk Factors, Delivered by Trained Volunteers (Medical and Psychology Students), Reduced Need for Antipsychotic Medications and the Length of Hospital Stay in Aged Patients Admitted to an Acute Internal Medicine Ward: Pilot Study

    PubMed Central

    Piotrowicz, Karolina; Rewiuk, Krzysztof; Halicka, Monika; Kalwak, Weronika; Rybak, Paulina

    2017-01-01

    Purpose. Effectiveness of nonpharmacological multicomponent prevention delivered by trained volunteers (medical and psychology students), targeted at delirium risk factors in geriatric inpatients, was assessed at an internal medicine ward in Poland. Patients and Methods. Participants were recruited to intervention and control groups at the internal medicine ward (inclusion criteria: age ≥ 75, acute medical condition, basic orientation, and logical contact on admission; exclusion criteria: life expectancy < 24 hours, surgical hospitalization, isolation due to infectious disease, and discharge to other medical wards). Every day trained volunteers delivered a multicomponent standardized intervention targeted at risk factors of in-hospital complications to the intervention group. The control group, selected using a retrospective individual matching strategy (1 : 1 ratio, regarding age, gender, and time of hospitalization), received standard care. Outcome Measures. Hospitalization time, deaths, falls, delirium episodes, and antipsychotic prescriptions were assessed retrospectively from medical documentation. Results. 130 patients (38.4% males) participated in the study, with 65 in the intervention group. Antipsychotic medications were initiated less frequently in the intervention group compared to the control group. There was a trend towards a shorter hospitalization time and a not statistically significant decrease in deaths in the intervention group. Conclusion. Nonpharmacological multicomponent intervention targeted at delirium risk factors effectively reduced length of hospitalization and need for initiating antipsychotic treatment in elderly patients at the internal medicine ward. PMID:28164113

  1. Nonpharmacological Interventions Targeted at Delirium Risk Factors, Delivered by Trained Volunteers (Medical and Psychology Students), Reduced Need for Antipsychotic Medications and the Length of Hospital Stay in Aged Patients Admitted to an Acute Internal Medicine Ward: Pilot Study.

    PubMed

    Gorski, Stanislaw; Piotrowicz, Karolina; Rewiuk, Krzysztof; Halicka, Monika; Kalwak, Weronika; Rybak, Paulina; Grodzicki, Tomasz

    2017-01-01

    Purpose. Effectiveness of nonpharmacological multicomponent prevention delivered by trained volunteers (medical and psychology students), targeted at delirium risk factors in geriatric inpatients, was assessed at an internal medicine ward in Poland. Patients and Methods. Participants were recruited to intervention and control groups at the internal medicine ward (inclusion criteria: age ≥ 75, acute medical condition, basic orientation, and logical contact on admission; exclusion criteria: life expectancy < 24 hours, surgical hospitalization, isolation due to infectious disease, and discharge to other medical wards). Every day trained volunteers delivered a multicomponent standardized intervention targeted at risk factors of in-hospital complications to the intervention group. The control group, selected using a retrospective individual matching strategy (1 : 1 ratio, regarding age, gender, and time of hospitalization), received standard care. Outcome Measures. Hospitalization time, deaths, falls, delirium episodes, and antipsychotic prescriptions were assessed retrospectively from medical documentation. Results. 130 patients (38.4% males) participated in the study, with 65 in the intervention group. Antipsychotic medications were initiated less frequently in the intervention group compared to the control group. There was a trend towards a shorter hospitalization time and a not statistically significant decrease in deaths in the intervention group. Conclusion. Nonpharmacological multicomponent intervention targeted at delirium risk factors effectively reduced length of hospitalization and need for initiating antipsychotic treatment in elderly patients at the internal medicine ward.

  2. GHRS Observations of LISM towards eta UMa

    NASA Astrophysics Data System (ADS)

    Frisch, P. C.

    1998-01-01

    The star eta UMa (l=101(deg) , b=+65(deg) , d=31 pc) samples local interstellar matter (LISM) in a high latitude region. The Sun is ``above'' most of the mass of the Local Fluff cloud complex, yielding low total interstellar column densities towards eta UMa. Thus cloud properties can be determined with minimal confusion caused by velocity component blending in this sightline. The physical properties of the cloud surrounding the solar system become the boundary conditions of the solar system. A key property of the surrounding cloud is the proton density, since the Alfven velocity regulates the formation of a bow shock around the heliosphere, and since charge exchange between interstellar p(+) and H(deg) yields a pile-up of H(deg) at the heliopause. As a result, the interstellar electron density in the surrounding cloud is an important parameter in understanding the configuration of the outer heliosphere regions. We present GHRS Echelle A and Echelle B data on C({deg) *}, C(deg) , Mg(deg) and Mg(+) . These data allow us to compare electron densities as estimated from the ratios N(C({deg) *})/N(C(deg) ) versus N(Mg(deg) )/N(Mg(+) ) for a relatively simple sightline. These electron densities are also compared to electron densities determined from optical Ca(+) observations towards eta UMa by Frisch and Welty (in preparation).

  3. Effects of intraoperative dexmedetomidine with intravenous anesthesia on postoperative emergence agitation/delirium in pediatric patients undergoing tonsillectomy with or without adenoidectomy

    PubMed Central

    Cao, Jun-Li; Pei, Yu-Ping; Wei, Jing-Qiu; Zhang, Yue-Ying

    2016-01-01

    Abstract Postoperative emergence agitation/delirium (POED) is a common complication in pediatric surgery patients, which increases the risk of developing postoperative airway obstruction and respiratory depression. This study aims to investigate the safety and efficacy of intraoperative infusion of dexmedetomidine (DEX) and its effects on POED in pediatric patients undergoing tonsillectomy with or without adenoidectomy. Sixty patients scheduled for tonsillectomy with or without adenoidectomy, aged 2 to 8 years, were randomly allocated into 2 groups (n = 30). Pediatric patients in the group DEX received intravenous (IV) DEX 1 μg/kg over 10 minutes, followed by 0.5 μg/kg/h continuous infusion, and the same volume of 0.9% saline was administrated in the group control. Anesthesia was maintained with target-controlled infusion (TCI) of propofol and remifentanyl. Intraoperative heart rate (HR), noninvasive blood pressure (NIBP), blood oxygen saturation (SPO2), recovery time, and extubation time were recorded. Pain level was evaluated using the objective pain score (OPS), pediatric anesthesia emergence delirium (PAED) scale and Cole 5-point scale (CPS) was used to evaluate POED when patients at 0, 5, 15 minutes, and then at intervals of 15 minutes for 60 minutes after parents arrival at postanesthesia care unit (PACU). The results showed that intraoperative HR was significantly lower in group DEX (P <0.05), mean diastolic and systolic NIBP was not statistically different between groups. Time to wake and time to extubation were lengthened in group DEX as compared with group control (P <0.05). OPS and CPS were lower in group DEX at 15, 30, and 45 minutes time points (P <0.05); however, there were no significantly differences in the PAED score at different time points in the PACU. The present data suggested that intraoperative infusion of dexmedetomidine combined with intravenous anesthetics can provide satisfactory intraoperative conditions for pediatric

  4. High speed photometry of AN UMa

    SciTech Connect

    Imamura, J.N.; Steiman-Cameron, T.Y.; Durisen, R.H.

    1985-01-01

    As a class, the AM Her objects exhibit temporal variability on time scales ranging from seconds to years. Most of the variations can be adequately described by ''shot noise'' models (Cordova and Mason 1982). Exceptions to this are the strictly periodic features modulated on the orbital periods of the systems (typically several hours) and the one to two second features which show up as ''excesses'' of power in the time averaged power spectra of AN UMa (Middleditch 1982) and E1405-451 (Mason et al. 1983; Larsson 1985). It has been suggested that the short time scale features are due to an oscillatory ''instability'' of radiative accretion shocks discovered by Langer, Chanmugam, and Shaviv (1981, 1982). This is an interesting suggestion because, if true, it would allow the masses of the accreting white dwarfs to be inferred and would provide other significant constraints on the physics of the accretion flows (see Langer et al. 1981, 1982; Chevalier and Imamura 1982; Imamura, Wolff, and Durisen 1984; Imamura 1985). Unfortunately, a direct physical relationship between the one to two second optical variations and shock oscillations has not yet been demonstrated. Because of the potential importance of such a result further study of these systems is clearly warranted. In this work, we examine the short time scale behavior of AN UMa in more detail and improve on the work of Middleditch (1982) by resolving the feature in time.

  5. Improving Patient Care Through the Prism of Psychology: application of Maslow’s Hierarchy to Sedation, Delirium and Early Mobility in the ICU

    PubMed Central

    Jackson, James C.; Santoro, Michael J.; Ely, Taylor M.; Boehm, Leanne; Kiehl, Amy L; Anderson, Lindsay S.; Ely, E. Wesley

    2016-01-01

    The Intensive Care Unit is not only a place where lives are saved; it is also a site of harm and iatrogenic injury for millions of people treated in this setting globally every year. Increasingly, hospitals admit only the sickest patients, and, while the overall number of hospital beds remains stable in the U.S., the percentage of that total devoted to ICU beds is rising. These two realities engender a demographic imperative to address patient safety in the critical care setting. This manuscript addresses the medical community’s resistance to adopting a culture of safety in critical care with regard to issues surrounding sedation, delirium, and early mobility. Although there is currently much research and quality improvement in this area, most of what we know from these data and published guidelines has not become reality in the day-to-day management of ICU patients. This manuscript is not intended to provide a comprehensive review of the literature, but rather a framework to rethink our currently outdated culture of critical care by employing Maslow’s Hierarchy of Needs, along with a few novel analogies. Application of Maslow’s Hierarchy will help propel healthcare professionals toward comprehensive care of the whole person, not merely for survival, but toward restoration of pre-illness function of mind, body, and spirit. PMID:24636724

  6. Pulsational stability of the SX Phe star AE UMa

    NASA Astrophysics Data System (ADS)

    Pena, J. H.; Renteria, A.; Villarreal, C.; Pina, D. S.; Soni, A. A.; Guillen, J.; Vargas, K.; Trejo, O.

    2016-11-01

    From newly determined times of maxima of the SX Phe star AE UMa and a compilation of previous times of maxima, we were able to determine the nature of this star. With uv photometry we determined its physical parameters.

  7. Doppler Tomography of the Dwarf Nova IY UMa During Quiescence

    NASA Astrophysics Data System (ADS)

    Rolfe, D. J.; Abbott, T. M. C.; Haswell, C. A.

    Quiescent Doppler tomography of the newly discovered deeply-eclipsing SU UMa system IY UMa reveals properties of the region where the accretion stream from the donor impacts the edge of the disc. A very strong bright spot is produced and the Keplerian disc emission in the impact region is disrupted or obscured. The differing properties of Hα, Hβ and He I emission will allow physical parameters of the converging flow region to be studied.

  8. BZ UMa and Var Her 04: Orphan TOADS

    NASA Astrophysics Data System (ADS)

    Price, A.; Howell, S.

    2005-05-01

    Both BZ UMa and Var Her 04 are cataclysmic variable stars without a home. Neither fit easily into current classification systems so may extend the population distribution of two unique CV types: UGWZ dwarf novae and intermediate polars. New outburst photometry and archival X-Ray data shed some new light on BZ UMa's high energy state and new spectral and IR observations from Spitzer of dust around the newly discovered cataclysmic variable Var Her 04 may help find it a home as well.

  9. Delirium: Issues for Older Adults

    MedlinePlus

    ... signs of parkinsonism, and psychiatric disturbances, such as hallucination and behavioral troubles. In addition, patients with this ... full day or longer; general sleepiness, fatigue Insomnia Hallucinations Sudden mood changes, including anxiety, depression, nervousness Extra ...

  10. V4641 Sgr and KV UMa. Two black hole candidates

    NASA Astrophysics Data System (ADS)

    Chuprikov, A.; Guirin, I.

    We have analized the results of processing of the NRAO archive VLA and VLBA data for two star objects titled V4641 Sgr (J1819-2524) and KV UMa (X1118+4802). Some radio images of both sources for some frequency ranges are presented. Data have been processed with the software project titled 'Astro Space Locator' (ASL for Windows). The Multi Frequency Synthesis (MFS) method has been used for reconstruction of radio maps. Images of both sources are presented. Any polarization phenomena are not taken into account. We present results of processing of data of RR polarization for all the observational sessions.

  11. Origin and evolution of contact binaries of W UMa type

    NASA Astrophysics Data System (ADS)

    Rahunen, T.; Vilhu, O.

    Angular momentum loss estimates for single stars are employed to discuss three theories for contact binary evolution. Two of the theories of the metamorphoses of W UMa stars involve the fission of a rapidly rotating star at the end of the pre-main sequence contraction phase, resulting in a constant level of angular momentum and small mass ratios. The second sequence comprises an evolution of the companion from angular momentum loss from a detached or semidetached binary. Chromospheric Ca(+) emission observations are noted to correlate with rotational velocity predicted for the second type of evolution of angular momentum loss rate. The models display cyclic behavior on a time scale of one to ten million years, although the contact never breaks. It is concluded that the constant angular momentum models require a formation process which yield unequal components, while the detached, followed by contact, process is the most natural production mechanism.

  12. The accretion process in AR UMa, an extremely magnetized polar

    NASA Astrophysics Data System (ADS)

    Scipione, Valentina

    2012-10-01

    We propose a triggered observation of the highest magnetized polar, AR UMa. Our target with a magnetic field of about 230 MG gives access to an unexplored parameter regime. It escaped XMM-Newton so far due to extended low states. Utilizing the broad spectral range covered by XMM-Newton including the OM, we will simultaneously determine the energy content of the three cooling channels of the post-shock accretion plasma: cyclotron radiation in the UV, plasma radiation in hard X-rays and re-processed radiation in soft X-rays. We will confront our observations with state-of-art models and study quantitatively the energy balance of the cooling plasma as a function of the accretion rate and the magnetic field strength.

  13. O Universo das Sociedades Numa Perspectiva Relativa: Exercícios de Etnoastronomia

    NASA Astrophysics Data System (ADS)

    Fares, Érika Akel; Pessoa Martins, Karla; Maciel Araujo, Lidiane; Sauma Filho, Michel

    2004-12-01

    This work developed at the Planetarium of Pará employing workshops designed for visitor schools (public, private, specials groups), promotes the popularization of the Ethnoastronomy with the aim of diffusing values based on a cultural diversity tolerance and the need of harmonic interplay between people and environment. Using stories and debates, the relationship between humans and the Cosmos is traced from antiquity until today, with the help of slides as a didactic resource. Thus, many conceptions about the origin of the Universe are shown; as well as some constellations created along the History, ending with the present scientific manner of know and explain the World. We then demonstrate the links between space, time and culture with the Cosmos vision. The need to think the World within a plural context to create respect for other different persons is emphasized. Este trabalho, desenvolvido no Planetário do Pará através de oficinas com escolas visitantes (públicas, privadas e grupos especiais), promove a popularização da Etnoastronomia, com o objetivo de difundir valores pautados na tolerância à diversidade cultural e na necessidade da convivência harmônica entre o ser humano e o meio ambiente. Através da contação de histórias e promoção de debate, é tratada a relação dos humanos com o céu desde a antiguidade até os dias atuais, tendo como apoio didático o uso de slides. Assim, são mostradas diversas concepções de origem do Universo; algumas constelações criadas no decorrer da História; e a atual forma científica de conhecer e explicar o mundo. Demonstrando-se, então, a interligação entre espaço, tempo e cultura com a visão do Cosmo. Enfatiza-se a necessidade de se pensar o mundo numa perspectiva relativa ou plural, de forma a propiciar o respeito ao ser diferente.

  14. VizieR Online Data Catalog: Galaxies in the UMa cluster complex (Karachentsev+, 2013)

    NASA Astrophysics Data System (ADS)

    Karachentsev, I. D.; Nasonova, O. G.; Courtois, H. M.

    2015-04-01

    A nearby friable cloud in Ursa Majoris contains 270 galaxies with radial velocities 500UMa complex. According to Makarov & Karachentsev (2011MNRAS.412.2498M, Cat. J/MNRAS/412/2498), most of the UMa galaxies belong to seven bound groups, which have the following median parameters: velocity dispersion of 58k/s, harmonic projected radius of 300kpc, virial mass of 2x1012M⊙ and virial mass-to-K-band luminosity ratio of 27M⊙/L⊙. Almost a half of the UMa cloud population are gas-rich dwarfs (Ir, Im, BCD) with active star formation seen in the GALEX UV-survey. The UMa groups reside within 15-19Mpc from us, being just at the same distance as the Virgo cluster. The total virial mass of the UMa groups is 4x1013M⊙, yielding the average density of dark matter in the UMa cloud to be Ωm=0.08, i.e. a factor of 3 lower than the cosmic average. This is despite the fact that the UMa cloud resides in a region of the Universe that is an apparent overdensity. A possible explanation for this is that most mass in the Universe lies in the empty space between clusters. Herewith, the mean distances and velocities of the UMa groups follow nearly undisturbed Hubble flow without a sign of the 'Z-wave' effect caused by infall towards a massive attractor. This constrains the total amount of dark matter between the UMa groups within the cloud volume. (1 data file).

  15. New Light Curves and Period Studies of V502 OPH W UMA System

    NASA Astrophysics Data System (ADS)

    Awadalla, Nabil S.

    NEW LIGHT CURVES AND PERIOD STUDIES OF V502 OPH W UMa SYSTEM N.S.Awadalla National Research Institute of Astronomy and Geophysics( NRIAG ) Helwan Cairo EGYPT New BVR photoelectric observations of the W UMa eclipsing binary system V502 Oph have been presented and analyzed. The geometric and physical elements of the system have been obtained and compared to the previous results. The classification of the system concerning the sub-type of the W UMa binary has been studied as well as its evolution stage. Its period variation in a view of the light time effect has been examin

  16. Sequential ultrasound-microwave assisted acid extraction (UMAE) of pectin from pomelo peels.

    PubMed

    Liew, Shan Qin; Ngoh, Gek Cheng; Yusoff, Rozita; Teoh, Wen Hui

    2016-12-01

    This study aims to optimize sequential ultrasound-microwave assisted extraction (UMAE) on pomelo peel using citric acid. The effects of pH, sonication time, microwave power and irradiation time on the yield and the degree of esterification (DE) of pectin were investigated. Under optimized conditions of pH 1.80, 27.52min sonication followed by 6.40min microwave irradiation at 643.44W, the yield and the DE value of pectin obtained was respectively at 38.00% and 56.88%. Based upon optimized UMAE condition, the pectin from microwave-ultrasound assisted extraction (MUAE), ultrasound assisted extraction (UAE) and microwave assisted extraction (MAE) were studied. The yield of pectin adopting the UMAE was higher than all other techniques in the order of UMAE>MUAE>MAE>UAE. The pectin's galacturonic acid content obtained from combined extraction technique is higher than that obtained from sole extraction technique and the pectin gel produced from various techniques exhibited a pseudoplastic behaviour. The morphological structures of pectin extracted from MUAE and MAE closely resemble each other. The extracted pectin from UMAE with smaller and more regular surface differs greatly from that of UAE. This has substantiated the highest pectin yield of 36.33% from UMAE and further signified their compatibility and potentiality in pectin extraction.

  17. A Dynamical Analysis of the 47 UMa Planetary System

    NASA Astrophysics Data System (ADS)

    Laughlin, G.; Chambers, J.; Fischer, D.

    2001-12-01

    Thirteen years of Doppler velocity measurements have revealed the presence of two planets orbiting the star 47 Ursa Majoris on low eccentricity orbits. A 2-Keplerian fit to the radial velocity data suggests that the inner planet has a period Pb = 1089.0 +/- 2.9 d, and a nominal mass msin i = 2.54 MJup, while the outer planet has a period Pc = 2594 +/- 90 d, and a mass m sin i = 0.76 MJup. These mass and period ratios suggest a possible kinship to the Jupiter-Saturn pair in our own solar system. We explore the current dynamical state of this system with numerical integrations, and compare the results with analytic secular theory. We find that the planets in the system are likely participating in a secular resonance in which the arguments of pericenter librate around zero. The system may also currently be in a 7:3 mean-motion resonance. Using a self-consistent fitting procedure in conjunction with numerical integrations, we show that stability considerations restrict the mutual inclination between the two planets to 40 degrees or less, and that this result is relatively insensitive to the total mass of the two planets. We present hydrodynamical simulations which measure the torques exerted on the planets by a hypothesized external protoplanetary disk. We show that planetary migration in response to torques from the disk may have led to capture of the system into a 7:3 mean-motion resonance, although it is unclear how the eccentricities of the planets would have been damped after capture occured. We show that Earth-mass planets can survive for long periods in some regions of the habitable zone of the nominal co-planar system. A set of planetary accretion calculations, however, shows that it is unlikely that large terrestrial planets can form in the 47UMa habitable zone. This work was funded by the NASA Origins Program, and by a NASA Ames Director's Discretionary Fund Award.

  18. Elemental Abundance Analyses with DAO Spectrograms. XXXIX. The Am Stars 2 UMa and 15 Vul

    NASA Astrophysics Data System (ADS)

    Çay, İpek H.; Teker Yelkenci, Aysegul; Adelman, Saul J.

    2016-05-01

    We derived the elemental abundances of the metallic-line stars 2 UMa (=HR 3354; spectral type A2m) and 15 Vul (=HR 7653; spectral type A4 III), using high-dispersion, high signal-to-noise ratio (≥200) optical region spectrograms obtained with CCD detectors at the long Coudé camera of the 1.22 m telescope of the Dominion Astrophysical Observatory (DAO) and Kurucz's ATLAS9 and WIDTH9 programs. The star 2 UMa has not been the subject of a modern detailed elemental abundances analysis. It is relatively sharp-lined and sufficiently hot (T eff = 8050 K) that the continuum placement is not a major problem in the optical region. Comparison of the results of this new study of 15 Vul with the last complete study shows a 0.15 dex mean increase in the derived abundances and a reduction in the standard deviations of the mean values. The abundance anomalies of 2 UMa are usually larger than those of 15 Vul. The greater spectral coverage of 15 Vul compared with 2 UMa results in a larger number of abundances being derived. The abundances of 2 UMa are typical for those of classical Am stars that have similar effective temperatures and surface gravities. 15 Vul, characterized by a similar effective temperature and smaller surface gravity, is a more evolved star.

  19. Sepsis-associated encephalopathy: not just delirium

    PubMed Central

    Zampieri, Fernando Godinho; Park, Marcelo; Machado, Fabio Santana; Azevedo, Luciano Cesar Pontes

    2011-01-01

    Sepsis is a major cause of mortality and morbidity in intensive care units. Organ dysfunction is triggered by inflammatory insults and tissue hypoperfusion. The brain plays a pivotal role in sepsis, acting as both a mediator of the immune response and a target for the pathologic process. The measurement of brain dysfunction is difficult because there are no specific biomarkers of neuronal injury, and bedside evaluation of cognitive performance is difficult in an intensive care unit. Although sepsis-associated encephalopathy was described decades ago, it has only recently been subjected to scientific scrutiny and is not yet completely understood. The pathophysiology of sepsis-associated encephalopathy involves direct cellular damage to the brain, mitochondrial and endothelial dysfunction and disturbances in neurotransmission. This review describes the most recent findings in the pathophysiology, diagnosis, and management of sepsis-associated encephalopathy and focuses on its many presentations. PMID:22012058

  20. MN Dra - a SU UMa-type star during its September 2013 superoutburst

    NASA Astrophysics Data System (ADS)

    Bąkowska, Karolina; Olech, Arkadiusz; Pospieszyński, Remigiusz

    2016-06-01

    We report CCD photometry of the cataclysmic variable star MN Draconis. During the season of August-September 2013, one normal outburst and one superoutburst were detected. In the light curves of MN Dra clear superhumps were present during September 2013 superoutburst. That fact confirms that the star is a member of SU UMa class.

  1. Genome Sequences of Gordonia Bacteriophages Obliviate, UmaThurman, and Guacamole

    PubMed Central

    Akbar, Armaan F.; Ayers, Taylor N.; Belohoubek, Selena G.; Chung, Connie F.; Hartman, Allison C.; Kayiti, Tejus; Kessler, Cecilia M.; Koman, Philipp I.; Kotovskiy, Grigoriy A.; Morgan, Taylor M.; Rohac, Rebecca M.; Silva, Gabriela M.; Willis, Charles E.; Milliken, Katherine A.; Shedlock, Kathleen A.; Stanton, Ann-Catherine J.; Toner, Chelsea L.; Furbee, Emily C.; Grubb, Sarah R.; Warner, Marcie H.; Montgomery, Matthew T.; Garlena, Rebecca A.; Russell, Daniel A.; Jacobs-Sera, Deborah; Hatfull, Graham F.

    2016-01-01

    We describe three newly isolated phages—Obliviate, UmaThurman, and Guacamole—that infect Gordonia terrae 3612. The three genomes are related to one another but are not closely related to other previously sequenced phages or prophages. The three phages are predicted to use integration-dependent immunity systems as described in several mycobacteriophages. PMID:27365348

  2. Absolute and geometric parameters of the W UMa type contact binary V546 And

    NASA Astrophysics Data System (ADS)

    Gürol, Birol; Bradstreet, David H.; Okan, Abdullah

    2015-04-01

    We present the results of our investigation on the geometrical and physical parameters of the W UMa-type binary V546 And from analyzed CCD (BVRI) light curves and radial velocity data. The photometric data were obtained in 2010 and 2011 at Ankara University Observatory (AUO) and the spectroscopic observations were made in 2010 at TUBITAK National Observatory (TUG). Light and radial velocity observations were analyzed simultaneously by using the Wilson-Devinney (2013 revision) code to obtain absolute and geometrical parameters. The system was determined to be a W-type W UMa system. Combining our photometric solution with the spectroscopic data we derived masses and radii of the eclipsing system to be M1 = 0.275M⊙,M2 = 1.083M⊙,R1 = 0.661R⊙ and R2 = 1.229R⊙ . We finally discuss the evolutionary status of the system.

  3. Spectral and photometric behavior of SU UMa during quiescence and outburst states

    NASA Astrophysics Data System (ADS)

    Zead, I.; Saad, S. M.; Sanad, M. R.; Behary, M. M.; Gadallah, K.

    2017-04-01

    We report the results of spectral and photometric observations of SU UMa. Available spectra from International Ultraviolet Explorer (IUE) and CCD photometry of five nights were used. Some profiles revealing the variations of some spectral lines at different times are presented. There is variation with time for photometric observations and the brightness of SU UMa is changed from 12.9 mag. to 15.6 mag in 5 nights with clear display of burst. The ultraviolet luminosity for emitting region is in the range of (6.9*1030 erg s-1). The mass accretion rate is in the range of (9.8*10-13 M⊙yr-1). The line flux modulations at different times can be explained in terms of the mass transfer instability model (Bath 1973).

  4. Increasing Supercycle Lengths of Active SU UMa-type Dwarf Novae

    NASA Astrophysics Data System (ADS)

    Otulakowska-Hypka, M.; Olech, A.

    2014-12-01

    We present observational evidence that supercycle lengths of the most active SU UMa-type stars are increasing during the past decades. We analyzed a large number of photometric measurements from available archives and found that this effect is generic for this class of stars, independently of their evolutionary status. This finding is in agreement with previous predictions and the most recent work of Patterson et al. (2012) on BK Lyn.

  5. UBVRI analysis of the totally eclipsing extreme mass ratio W UMa binary, GSC 3208 1986

    SciTech Connect

    Samec, R. G.; Kring, J. D.; Robb, Russell; Van Hamme, W.; Faulkner, D. R.

    2015-03-01

    GSC 3208 1986 is an NSVS and TYCHO binary, first observed from 1999 to 2000. It is a W UMa binary with a period of 0.405 days. The present observations were taken in 2012 September and are of high precision, averaging a standard deviation of better than 5 mmag. The amplitude of the light curve is very nearly 0.5 mag yet it undergoes total eclipses. Dominion Astrophysical Observatory spectra give an F3V type (T∼6900 K) for the system, the earliest of the extreme mass ratio W UMa binaries. The linear period determination of 0.4045672 days was calculated with the two sets of epochs available. An early NSVS light curve reveals that the period has been smoothly decreasing over its past 12,000 orbits. The binary may be undergoing sinusoidal oscillations due to the presence of a third body, possibly with a period of 23±3 years. The high inclination of 85° results in a long duration secondary total eclipse, lasting some 49.5 minutes. Findings indicate that GSC 3208 1986 is an immaculate extreme mass ratio, q(m{sub 2}/m{sub 1}) = 0.24, A-type W UMa binary.

  6. Curious Variables Experiment (CURVE). Superhump Period Change Pattern in KS UMa and Other Dwarf Novae

    NASA Astrophysics Data System (ADS)

    Olech, A.; Schwarzenberg-Czerny, A.; Kedzierski, P.; Zloczewski, K.; Mularczyk, K.; Wisniewski, M.

    2003-06-01

    We report extensive photometry of the dwarf nova KS UMa throughout its 2003 superoutburst till quiescence. During the superoutburst the star displayed clear superhumps with a mean period of P_sh=0.070092(23) days. In the middle stage of superoutburst the period was increasing with a rate of dot P/P=(21+/-12)*10^-5 and later was decreasing with a rate of dot P/P=-(21+/-8)*10^-5. At the end of superoutburst and during first dozen days of quiescence the star was showing late superhumps with a mean period of P_late=0.06926(2) days. This phenomenon was observed even 30 days after beginning of the superoutburst. In quiescence the star shows quasi-periodic modulations with amplitude reaching 0.5 mag. The most common structure observed during this stage was sinusoidal wave characterized by a period of about 0.1 days. Comparing KS UMa to other SU UMa stars we conclude that this group of dwarf novae shows decreasing superhump periods at the beginning and the end of superoutburst but increasing period in the middle phase.

  7. Cosmoeducação: uma proposta para o ensino de astronomia

    NASA Astrophysics Data System (ADS)

    Medeiros, L. A. L.; Jafelice, L. C.

    2003-08-01

    Entende-se por cosmoeducação o desenvolvimento vivencial da unidade homem-cosmo. Este conceito é norteado pela psicologia transpessoal, que estuda o ser humano em sua totalidade, onde suas relações ecológicas e cósmicas são de grande importância. Constata-se uma necessidade latente no ser humano moderno em resgatar uma relação holística com o Universo. Neste trabalho exploramos meios de cultivar a consciência de que o ser humano constitui parte integrante do cosmo e se relaciona com este com o objetivo de promover em si uma percepção ambiental mais ampla. Nossa hipótese de trabalho inicial foi que o ensino de conteúdos básicos em astronomia realizado através de uma abordagem holística, que incorpore práticas vivenciais correlacionadas àqueles conteúdos, pode despertar no indivíduo sua identidade cósmica. O método que utilizamos é o fenomenológico e o universo desta pesquisa é um grupo de estudantes da disciplina de Astronomia (Curso de Licenciatura em Geografia/UFRN), onde realizamos observação participante, entrevistas, depoimentos e as práticas vivenciais mencionadas. Neste caso estamos desenvolvendo e adaptando exercícios de algumas técnicas terapêuticas de psicologia transpessoal, que um de nós (LALM) tem aplicado no contexto clínico, para trabalhar aspectos cognitivos envolvidos naquele processo de conscientização cósmica. Resultados parciais claramente referendam a hipótese inicial. Um resultado a destacar é fruto de uma dinâmica de representação corporal interiorizada do eclipse lunar, envolvendo um pequeno grupo daqueles estudantes, na qual conteúdos míticos afloraram de maneira espontânea e contundente para todos, sugerindo ressonância, ou pelo menos isomorfismo, entre o macro e o microcosmo. Este e outros resultados são discutidos em detalhe neste trabalho. (PPGECNM/UFRN; PRONEX/FINEP; NUPA/USP; Temáticos/FAPESP).

  8. Optimization and comparison of ultrasound/microwave assisted extraction (UMAE) and ultrasonic assisted extraction (UAE) of lycopene from tomatoes.

    PubMed

    Lianfu, Zhang; Zelong, Liu

    2008-07-01

    The extracting technology including ultrasonic and microwave assisted extraction (UMAE) and ultrasonic assisted extraction (UAE) of lycopene from tomato paste were optimized and compared. The results showed that the optimal conditions for UMAE were 98 W microwave power together with 40 KHz ultrasonic processing, the ratio of solvents to tomato paste was 10.6:1 (V/W) and the extracting time should be 367 s; as for UAE, the extracting temperature was 86.4 degrees C, the ratio of the solvents to tomato paste was 8.0:1 (V/W) and the extracting time should be 29.1 min, while the percentage of lycopene yield was 97.4% and 89.4% for UMAE and UAE, respectively. These results implied that UMAE was far more efficient extracting method than UAE.

  9. The first photometric study of W UMa eclipsing binary OQ Dra

    NASA Astrophysics Data System (ADS)

    Heidarnia, R.; Ebadi, H.; Rooydargard, H.

    2016-11-01

    The present study is an analysis of V-band CCD observations of new W UMa contact binary OQ Dra. To carry out the analysis, Primary and secondary minimum were obtained and new epoch was calculated. The computed period of system was 0.33967 day. Light curve analysis was performed using Binary Maker 3 and PHOEBE that uses the latest Wilson-Devinney code. We obtained photometric mass ratio of qptm = 0.55. O'Connell effect also was seen in the fitted model. Finally, the best model was achieved by introducing 2 spots on each component.

  10. LONG-TERM PHOTOMETRIC ANALYSIS OF THE ACTIVE W UMa-TYPE SYSTEM TU BOOTIS

    SciTech Connect

    Coughlin, Jeffrey L.; Dale, Horace A. III; Williamon, Richard M.

    2008-09-15

    We present multicolor light curves for the W UMa-type eclipsing binary TU Boo for two epochs separated by 22 years. An analysis of the O - C diagram indicates the earlier observations took place right in the middle of a major period change, thus allowing for a unique study on mass transfer and period changes in this W UMa-type system. We compute model fits to our light curves, along with the only other published set, using the Wilson-Devinney program, and find temporally correlated changes in the size of the secondary component with anomalies in the O - C diagram. We investigate the cause of these changes and find support for the existence of rapid, large-scale mass transfer between the components. We postulate that this interaction allows them to maintain nearly equal surface temperatures despite having achieved only marginal contact. We also find support for the evolutionary scenario in which TU Boo has undergone a mass ratio reversal in the past, due to large-scale mass transfer so that what is presently the secondary component of TU Boo is in an advanced evolutionary state, oversized due to a helium-enriched core, with a total system age of {>=}10 Gyr.

  11. BVR photometric study of NSVS 2607629. A high mass-ratio W-type W UMa system

    NASA Astrophysics Data System (ADS)

    Gürol, Birol; Michel, Raul

    2017-02-01

    We present the results of our investigation of the geometrical and physical parameters of the W UMa-type binary system NSVS 2607629 based on CCD BVRc light curves and their analysis with the Wilson-Devinney code. New times of minima and light elements have been determined. We find that, as seen in eccentric systems, secondary minima do not occur at phase 0.5. According to our solution, the system is found to be a high mass-ratio W-type W UMa system. Combining our photometric solution with the emprical relation obtained for W UMa type systems by Dimitrov and Kjurkchieva (2015) we derive the masses and radii of the components of this eclipsing system as M1 = 0.44M⊙ , M2 = 0.73M⊙ , R1 = 0.57R⊙ and R2 = 0.71R⊙ . The evolutionary state of the system is also discussed.

  12. Survey of Period Variations of Superhumps in SU UMa-Type Dwarf Novae. IV. The Fourth Year (2011-2012)

    NASA Astrophysics Data System (ADS)

    Kato, Taichi; Hambsch, Franz-Josef; Maehara, Hiroyuki; Masi, Gianluca; Miller, Ian; Noguchi, Ryo; Akasaka, Chihiro; Aoki, Tomoya; Kobayashi, Hiroshi; Matsumoto, Katsura; Nakagawa, Shinichi; Nakazato, Takuma; Nomoto, Takashi; Ogura, Kazuyuki; Ono, Rikako; Taniuchi, Keisuke; Stein, William; Henden, Arne; de Miguel, Enrique Kiyota, Seiichiro; Dubovsky, Pavol A.; Kudzej, Igor; Imamura, Kazuyoshi; Akazawa, Hidehiko; Takagi, Ryosuke; Wakabayashi, Yuya; Ogi, Minako; Tanabe, Kenji; Ulowetz, Joseph; Morelle, Etienne; Pickard, Roger D.; Ohshima, Tomohito; Kasai, Kiyoshi; Pavlenko, Elena P.; Antonyuk, Oksana I.; Baklanov, Aleksei V.; Antonyuk, Kirill; Samsonov, Denis; Pit, Nikolaj; Sosnovskij, Aleksei; Littlefield, Colin; Sabo, Richard; Ruiz, Javier; Krajci, Thomas; Dvorak, Shawn; Oksanen, Arto; Hirosawa, Kenji; Goff, William N.; Monard, Berto; Shears, Jeremy; Boyd, David; Voloshina, Irina B.; Shugarov, Sergey Yu.; Chochol, Drahomir; Miyashita, Atsushi; Pietz, Jochen; Katysheva, Natalia; Itoh, Hiroshi; Bolt, Greg; Andreev, Maksim V.; Parakhin, Nikolai; Malanushenko, Viktor; Martinelli, Fabio; Denisenko, Denis; Stockdale, Chris; Starr, Peter; Simonsen, Mike; Tristram, Paul J.; Fukui, Akihiko; Tordai, Tamas; Fidrich, Robert; Paxson, Kevin B.; Itagaki, Koh-ichi; Nakashima, Youichirou; Yoshida, Seiichi; Nishimura, Hideo; Kryachko, Timur V.; Samokhvalov, Andrey V.; Korotkiy, Stanislav A.; Satovski, Boris L.; Stubbings, Rod; Poyner, Gary; Muyllaert, Eddy; Gerke, Vladimir; MacDonald, Walter, II; Linnolt, Michael; Maeda, Yutaka; Hautecler, Hubert

    2013-02-01

    Continuing the project described by Kato et al. (2009, PASJ, 61, S395), we collected times of superhump maxima for 86 SU UMa-type dwarf novae, mainly observed during the 2011-2012 season. We confirmed general trends recorded in our previous studies, such as the relation between period derivatives and orbital periods. There are some systems showing positive period derivatives despite the long orbital period. We observed the 2011 outburst of the WZ Sge-type dwarf nova BW Scl, and recorded an O - C diagram similar to those of previously known WZ Sge-type dwarf novae. The WZ Sge-type dwarf nova OT J184228.1+483742 showed an unusual pattern of double outbursts composed of an outburst with early superhumps and one with ordinary superhumps. We propose an interpretation that a very small growth rate of the 3:1 resonance due to an extremely low mass-ratio led to quenching the superoutburst before the ordinary superhump appeared. We systematically studied ER UMa-type dwarf novae, and found that V1159 Ori showed positive superhumps similar to ER UMa in the 1990s. The recently recognized ER UMa-type object BK Lyn dominantly showed negative superhumps, and its behavior was very similar to the present-day state of ER UMa. The pattern of period variations in AM CVn-type objects was very similar to that of short-period hydrogen-rich SU UMa-type dwarf novae, making them a helium analogue of hydrogen-rich SU UMa-type dwarf novae. SBS 1108+574, a peculiar hydrogen-rich dwarf nova below the period minimum, showed a very similar pattern of period variations to those of short-period SU UMa-type dwarf novae. The mass-ratio derived from the detected orbital period suggests that this secondary is a somewhat evolved star whose hydrogen envelope was mostly stripped during the mass-exchange. CC Scl, MASTER OT J072948.66+593824.4, and OT J173516.9+154708 showed only low-amplitude superhumps with complex profiles. These superhumps are likely to be a combination of two closely separated periods.

  13. Multicolour high-speed photometry and Hα spectroscopy of XY UMa

    NASA Astrophysics Data System (ADS)

    Kjurkchieva, D.; Marchev, D.; Ogloza, W.

    2000-02-01

    BVRI photometry and Hα -line spectroscopy of the short-period RS CVn-binary XY UMa are presented. The light curves as a whole as well as the two eclipse minima are asymmetric. The light level after the primary minimum is lower by about 0.04-0.05 mag than that after the secondary one. Two cool spots on the primary with sizes 20degr and 10degr , temperatures 4630 and 4330 K at middle latitudes reproduced well the distortion curve in all colours. The observed Hα profile is quite wide and asymmetric at most the phases out of the eclipses. The radial velocity curve is sinusoidal with semiamplitude K1=120.7+/- 2.9 km/s. The corresponding mass function of the system is 0.082Msun . The phase behaviour of the Hα -profile implies contribution of emission of the chromospheric regions above the photospheric spots.

  14. Buckets of Ash Track Tephra Flux From Halema`uma`u Crater, Hawai`i

    NASA Astrophysics Data System (ADS)

    Swanson, Don; Wooten, Kelly; Orr, Tim

    2009-11-01

    The 2008-2009 eruption at Kīlauea Volcano's summit made news because of its eight small discrete explosive eruptions and noxious volcanic smog (vog) created from outgassing sulfur dioxide. Less appreciated is the ongoing, weak, but continuous output of tephra, primarily ash, from the new open vent in Halema`uma`u Crater. This tephra holds clues to processes causing the eruption and forming the new crater-in-a-crater, and its flux is important to hazard evaluations. The setting of the vent—easily accessible from the Hawaiian Volcano Observatory (HVO)—is unusually favorable for near-daily tracking of tephra mass flux during this small prolonged basaltic eruption. Recognizing this, scientists from HVO are collecting ash and documenting how ejection masses, components, and chemical compositions vary through time.

  15. Sonification of Kepler Field SU UMa Cataclysmic Variable Stars V344 Lyr and V1504 Cyg

    NASA Technical Reports Server (NTRS)

    Tutchton, Roxanne M.; Wood, Matt A.; Still, Martin D.; Howell, Steve B.; Cannizzo, John K.; Smale, Alan P.

    2012-01-01

    Sonification is the conversion of quantitative data into sound. In this work we explain the methods used in the sonification of light curves provided by the Kepler instrument from Q2 through Q6 for the cataclysmic variable systems V344 Lyr and V1504 Cyg . Both systems are SU UMa stars showing dwarf nova outbursts and superoutbursts as well as positive and negative superhumps. Focused sonifications were done from average pulse shapes of each superhump, and separate sonifications of the full, residual light curves were done for both stars. The audio of these data reflected distinct patterns within the evolutions of supercycles and superhumps that matched pervious observations and proved to be effective aids in data analysis.

  16. SU UMa dwarf novae in the period gap showing the negative superhumps

    NASA Astrophysics Data System (ADS)

    Pavlenko, Elena

    2016-07-01

    There are only two known up to date SU UMa dwarf novae in the period gap showing the negative superhumps, namely, MN Dra and 1RXS J003828.7+250920. We present the results of X-ray and spectral investigation for 1RXS J003828.7+250920, multicolor optical investigation for 1RXS J003828.7+250920 and MN Dra at different stages of their activity in 2011-2016 years. We discuss a finding of the accretion disc radius for both dwarf novae, its variation during separated intervals between outbursts for MN Dra as well as high and low temperature regions in quiescent accretion disk for 1RXS J003828.7+250920.

  17. VizieR Online Data Catalog: Search for UMa group companions (Ammler-von Eiff+, 2016)

    NASA Astrophysics Data System (ADS)

    Ammler-von Eiff, M.; Bedalov, A.; Kranhold, C.; Mugrauer, M.; Schmidt, T. O. B.; Neuhaeuser, R.; Errmann, R.

    2016-03-01

    The astrometric and photometric data of companion candidates of members of the Ursa Major (UMa) group are presented. They were identified by coronagraphic observations obtained with the S27 camera of NACO at the ESO VLT, Chile, in 2003-2006. Most of the candidates were observed a second time to assess whether they share the proper motion of the star. For this purpose, the change in position with respect to the star was compared to the stellar parallactic and proper motion known from Hipparcos. This way, all candidates with two epochs of observations were rejected being distant background objects. The layout of the included table deviates from the article version to facilitate automatic reading, i.e. the epoch date and the primary name are added to each row, and the candidate identifier is added to the corresponding data set for each epoch. (2 data files).

  18. Photometric and Period Investigation of the Late F-type Overcontact Binary II UMa

    NASA Astrophysics Data System (ADS)

    Zhou, X.; Qian, S.-B.; Zhang, J.; Zhang, B.; Kreiner, J.

    2016-03-01

    II UMa is a late F-type (F5) contact binary with a close-in tertiary and a distant visual companion. According to the four-color (B V RcIc) light curves’ solutions of II UMa, it is a high fill-out (f = 86.6%) and low-mass ratio (q = 0.172) contact binary system, which indicates that it is at the late evolutionary stage of late-type tidal-locked binary stars. The masses of the primary star and secondary star are calculated to be {M}1=1.99{M}⊙ and {M}2=0.34{M}⊙ . The primary star has evolved from the zero-age main sequence, but it still appeared before the terminal-age main sequence, and the secondary star is even more evolved. Considering the mass ratio ({M}3/{M}1=0.67) obtained by spectroscopic observations, the mass of the close-in tertiary is estimated to be {M}3=1.34{M}⊙ . The period variations of the binary system are investigated for the first time. According to the observed-calculated (O-C) curve analysis, a continuous period increase at a rate of {dP}/{dt}=4.88× {10}-7 {day} {{yr}}-1 is determined. The parabolic variation in the O-C curve may be part of a cyclic period of change, or the combined period of change of a parabolic variation and a cyclic one. More instances of minimum light are needed to confirm this. The presence of the tertiary component may play an important role in the formation and evolution of this binary system by drawing angular momentum from the central system during the pre-contact stage.

  19. Survey of Period Variations of Superhumps in SU UMa-Type Dwarf Novae. II The Second Year (2009-2010)

    NASA Astrophysics Data System (ADS)

    Kato, Taichi; Maehara, Hiroyuki; Uemura, Makoto; Henden, Arne; Miguel, Enrique De; Miller, Ian; Dubovsky, Pavol A.; Kudzej, Igor; Kiyota, Seiichiro; Hambsch, Franz-Josef; Tanabe, Kenji; Imamura, Kazuyoshi; Kunitomi, Nanae; Takagi, Ryosuke; Nose, Mikiha; Akazawa, Hidehiko; Masi, Gianluca; Nakagawa, Shinichi; Iino, Eriko; Noguchi, Ryo; Matsumoto, Katsura; Fujii, Daichi; Kobayashi, Hiroshi; Ogura, Kazuyuki; Ohtomo, Sachi; Yamashita, Kousei; Yanagisawa, Hirofumi; Itoh, Hiroshi; Bolt, Greg; Monard, Berto; Ohshima, Tomohito; Shears, Jeremy; Ruiz, Javier; Imada, Akira; Oksanen, Arto; Nelson, Peter; Gomez, Tomas L.; Staels, Bart; Boyd, David; Voloshina, Irina B.; Krajci, Thomas; Crawford, Tim; Stockdale, Chris; Richmond, Michael; Morelle, Etienne; Novák, Rudolf; Nogami, Daisaku; Ishioka, Ryoko; Brady, Steve; Simonsen, Mike; Pavlenko, Elena P.; Ringwald, Frederick A.; Kuramoto, Tetsuya; Miyashita, Atsushi; Pickard, Roger D.; Hynek, Tomáš; Dvorak, Shawn; Stubbings, Rod; Muyllaert, Eddy

    2010-12-01

    Continued from Kato et al. (2009, PASJ, 61, S395), we collected the times of superhump maxima for 68 SU UMa-type dwarf novae, mainly observed during the 2009-2010 season. The newly obtained data confirmed the basic findings reported in Kato et al. (ibid.): the presence of stages A-C and the predominance of positive period derivatives during stage B in systems with superhump periods shorter than 0.07 d. There was a systematic difference in the period derivatives for the systems with superhump periods longer than 0.075 d between this study and Kato et al. (ibid.). We suggest that this difference was possibly caused by a relative lack of frequently outbursting SU UMa-type dwarf novae in this period regime in the present study. We recorded a strong beat phenomenon during the 2009 superoutburst of IY UMa. A close correlation between the beat period and the superhump period suggests that the changing angular velocity of the apsidal motion of the elliptical disk is responsible for the variation of the superhump periods. We also described three new WZ Sge-type objects with established early superhumps and one with likely early superhumps. We suggest that two systems, VX For and EL UMa, are WZ Sge-type dwarf novae with multiple rebrightenings. The O - C variation in OT J213806.6+261957 suggests that the frequent absence of rebrightenings in very short-Porb objects can be the result of a sustained superoutburst plateau at the epoch when usual SU UMa-type dwarf novae return to quiescence, preceding a rebrightening. We also present a formulation for a variety of Bayesian extensions to traditional period analyses.

  20. The LEECH Exoplanet Imaging Survey: Orbit and Component Masses of the Intermediate-Age, Late-Type Binary NO UMa

    NASA Astrophysics Data System (ADS)

    Schlieder, Joshua E.; Skemer, Andrew J.; Maire, Anne-Lise; Desidera, Silvano; Hinz, Philip; Skrutskie, Michael F.; Leisenring, Jarron; Bailey, Vanessa; Defrère, Denis; Esposito, Simone; Strassmeier, Klaus G.; Weber, Michael; Biller, Beth A.; Bonnefoy, Mickaël; Buenzli, Esther; Close, Laird M.; Crepp, Justin R.; Eisner, Josh A.; Hofmann, Karl-Heinz; Henning, Thomas; Morzinski, Katie M.; Schertl, Dieter; Weigelt, Gerd; Woodward, Charles E.

    2016-02-01

    We present high-resolution Large Binocular Telescope LBTI/LMIRcam images of the spectroscopic and astrometric binary NO UMa obtained as part of the LBT Interferometer Exozodi Exoplanet Common Hunt exoplanet imaging survey. Our H-, Ks-, and L‧-band observations resolve the system at angular separations <0.″09. The components exhibit significant orbital motion over a span of ∼7 months. We combine our imaging data with archival images, published speckle interferometry measurements, and existing spectroscopic velocity data to solve the full orbital solution and estimate component masses. The masses of the K2.0 ± 0.5 primary and K6.5 ± 0.5 secondary are 0.83 ± 0.02 M⊙ and 0.64 ± 0.02 M⊙, respectively. We also derive a system distance of d = 25.87 ± 0.02 pc and revise the Galactic kinematics of NO UMa. Our revised Galactic kinematics confirm NO UMa as a nuclear member of the ∼500 Myr old Ursa Major moving group, and it is thus a mass and age benchmark. We compare the masses of the NO UMa binary components to those predicted by five sets of stellar evolution models at the age of the Ursa Major group. We find excellent agreement between our measured masses and model predictions with little systematic scatter between the models. NO UMa joins the short list of nearby, bright, late-type binaries having known ages and fully characterized orbits. Based on data obtained with the STELLA robotic telescope in Tenerife, an AIP facility jointly operated by AIP and IAC.

  1. THE LEECH EXOPLANET IMAGING SURVEY: ORBIT AND COMPONENT MASSES OF THE INTERMEDIATE-AGE, LATE-TYPE BINARY NO UMa

    SciTech Connect

    Schlieder, Joshua E.; Skemer, Andrew J.; Hinz, Philip; Leisenring, Jarron; Defrère, Denis; Close, Laird M.; Eisner, Josh A.; Maire, Anne-Lise; Desidera, Silvano; Skrutskie, Michael F.; Bailey, Vanessa; Esposito, Simone; Strassmeier, Klaus G.; Weber, Michael; Biller, Beth A.; Bonnefoy, Mickaël; Buenzli, Esther; Henning, Thomas; Crepp, Justin R.; Hofmann, Karl-Heinz; and others

    2016-02-10

    We present high-resolution Large Binocular Telescope LBTI/LMIRcam images of the spectroscopic and astrometric binary NO UMa obtained as part of the LBT Interferometer Exozodi Exoplanet Common Hunt exoplanet imaging survey. Our H-, K{sub s}-, and L′-band observations resolve the system at angular separations <0.″09. The components exhibit significant orbital motion over a span of ∼7 months. We combine our imaging data with archival images, published speckle interferometry measurements, and existing spectroscopic velocity data to solve the full orbital solution and estimate component masses. The masses of the K2.0 ± 0.5 primary and K6.5 ± 0.5 secondary are 0.83 ± 0.02 M{sub ⊙} and 0.64 ± 0.02 M{sub ⊙}, respectively. We also derive a system distance of d = 25.87 ± 0.02 pc and revise the Galactic kinematics of NO UMa. Our revised Galactic kinematics confirm NO UMa as a nuclear member of the ∼500 Myr old Ursa Major moving group, and it is thus a mass and age benchmark. We compare the masses of the NO UMa binary components to those predicted by five sets of stellar evolution models at the age of the Ursa Major group. We find excellent agreement between our measured masses and model predictions with little systematic scatter between the models. NO UMa joins the short list of nearby, bright, late-type binaries having known ages and fully characterized orbits.

  2. Astronomia cultural e meio ambiente segundo uma abordagem holística

    NASA Astrophysics Data System (ADS)

    Jafelice, L. C.

    2003-08-01

    Neste trabalho ampliamos a discussão da abordagem holística para o ensino de astronomia que temos desenvolvido nos últimos anos, analisamos novos resultados e apresentamos exemplos práticos para interessados em experimentá-la. A constatação básica a orientar este enfoque é que cursos introdutórios em astronomia costumam ser excessiva e prematuramente técnicos, além de assumirem uma visão tradicional, muito estreita, do que seja educação científica, herdada da era cartesiana e positivista da ciência. Fundamentamos porque é importante que elementos de astronomia cultural ofereçam o mote e constituam o eixo norteador daqueles cursos e porque é urgente revermos a visão que temos da relação entre astronomia e meio ambiente. Um ponto central nesta abordagem é explorar formas de reativar e atualizar uma relação orgânica com o meio e excitar a consciência de nossa inevitável e profunda interdependência com ele em nível cósmico. Neste trabalho exemplificamos a possibilidade de concretização desta proposta em três diferentes situações: disciplinas de cursos de licenciatura em geografia e em física; escolas de nível fundamental; e, neste caso ainda a ser implementada, comunidades carentes. Estes casos envolvem públicos e espaços diferenciados para educação formal e não-formal. Dos casos já implementados, destacamos os resultados alcançados pelos alunos: enriquecimento cultural, aprendizagem significativa de conteúdos astronômicos tradicionais; mudanças de comportamento, incorporando contato diário com o céu; e freqüentes vivências de sentimentos empáticos que redirecionam a relação com a natureza e a consciência ecológica global. Além disto, para interessados em aplicar esta proposta, também socializamos procedimentos e cuidados para a implementação de ações alternativas consonantes com a mesma. (PPGECNM/UFRN; PRONEX/FINEP; NUPA/USP; Temáticos/FAPESP)

  3. Phenomenological Parameters of the Prototype Eclipsing Binaries Algol, β Lyrae and W UMa

    NASA Astrophysics Data System (ADS)

    Tkachenko, Mariia G.; Andronov, Ivan L.; Chinarova, Lidia L.

    2016-12-01

    The phenomenological parameters of eclipsing binary stars, which are the prototypes of the EA, EB and EW systems are determined using the expert complex of computer programs, which realizes the NAV ("New Algol Variable") algorithm (Andronov 2010, 2012) and its possible modifications are discussed, as well as constrains for estimates of some physical parameters of the systems in a case of photometric observations only, such as the degree of eclipse, ratio of the mean surface brightnesses of the components. The half-duration of the eclipse is 0.0617(7), 0.1092(18) and 0.1015(7) for Algol, β Lyrae and W UMa, respectively. The brightness ratio is 6.8±1.0, 4.9±1.0 and 1.15±0.13. These results show that the eclipses have distinct begin and end not only in EA (as generally assumed), but also in EB and EW - type systems as well. The algorithm may be applied to classification and study of the newly discovered (or poorly studied) eclipsing variables based on own observations or that obtained using photometric surveys.

  4. Curious Variables Experiment (CURVE). RZ LMi - the Most Active SU UMa Star

    NASA Astrophysics Data System (ADS)

    Olech, A.; Wisniewski, M.; Zloczewski, K.; Cook, L. M.; Mularczyk, K.; Kedzierski, P.

    2008-06-01

    We report extensive photometry of the frequently outbursting dwarf nova RZ Leo Minoris. During two seasons of observations we detected 12 superoutbursts and 7 normal outbursts. The V magnitude of the star varied in range from 16.5 mag to 13.9 mag. The superoutbursts occur quite regularly flashing every 19.07(4) days and lasting slightly over 10 days. The average interval between two successive normal outbursts is 4.027(3) days. The mean superhump period observed during the superoutbursts is P_sh=0.059396(4) days (85.530+/-0.006 min). The period of the superhumps was constant except for one superoutburst when it increased with a rate of dot P/P_sh=7.6(1.9)x10^-5. Our observations indicate that RZ LMi enters the stage of permanent superhumps, both in superoutbursts and quiescence. This may indicate that decoupling of thermal and tidal instabilities play important role in ER UMa systems. No periodic light variations which can be connected with orbital period of the binary were seen, thus the mass ratio and evolutionary status of RZ LMi are still unknown.

  5. An Orbital Period Study of the W UMa-Type Binary RZ Comae Berenicis

    NASA Astrophysics Data System (ADS)

    Qian, Sheng-Bang; He, Jia-Jia

    2005-12-01

    New photoelectric and CCD photometry observations of a short-period W UMa-type binary system, RZ Com, are presented. The light curves of Broglia (1960, Contr. Milano-Merate, 165) were symmetric in V band, while the present light curve shows a typical O'Connell effect, with Maximum I brighter than Maximum II by 0.015mag. It is found that the light curve of the binary star has changed from W-subtype to A-subtype according to Binnendijk's classification. This variation may be caused by the activity of dark spot on the primary component. Combining four newly determined times of the light minimum with others published in the literature, the orbital period change of the system was investigated. A small-amplitude oscillation (A = 0.0058 d), with a period of 44.8yr has been discovered to be superimposed on a long-term period increase with a rate of dP/dt = +4.12 × 10-8 d yr-1. The period oscillation can be explained either by the light-time effect via the presence of an unseen third body or by magnetic-activity cycles of the components. The mass ratio of RZ Com is q = 0.43. The secular period variation is in agreement with the conclusions of Qian (2001, MNRAS, 328, 914; 2003, MNRAS, 342, 1260). This indicates that it is on the TRO-controlled stage of the evolutionary scheme proposed by Qian.

  6. Implementation of UMA concept in advanced Internet environments using MPEG-21

    NASA Astrophysics Data System (ADS)

    Rovira, Marc; Freixes, Marc; Lopez, Alejandro; Fernandez, Gabriel

    2005-10-01

    This work presents a partial development within the Internet2 Catalan project called "Integrated Project" which aims to design and build an advanced Internet environment based on Universal Multimedia Access (UMA) concept using MPEG-21 standard tools in order to enable transparent and augmented use of multimedia content across a wide range of networks, devices and by different users. The project is integrated with several modules using Web Service architecture in an interoperable manner to accomplish a complete distributed system. Within this framework, the DI Management & Personalization module provides services such as content recommendation, advanced searches, best content adaptation possibilities and session mobility management. By means of cataloguing tools, user preferences setting and update according to user's habit consumption, it offers content recommendations taking also into account user preferences, terminal capabilities, and network characteristics. Finally, during the consumption process, the Adaptation Decision Engine selects the best adaptation process in each case taking into account network characteristics, terminal capabilities, and state of AV content transcoding servers. The module provides extensive use of MPEG-21 and MPEG-7 standards ensuring interoperability with other similar systems.

  7. VizieR Online Data Catalog: HD 163151: a new W UMa type system (Rodriguez+ 1998)

    NASA Astrophysics Data System (ADS)

    Rodríguez, E.; Claret, A.; García, J. M.; Zerbi, F. M.; Garrido, R.; Martín, S.; Akan, C.; Luedeke, K.; Keskin, V.; Ibanoglu, C.; Evren, S.; Tunca, Z.; Pekunlu, R.; Paparo, M.; Nuspl, J.; Krisciunas, K.; Jiang, S. Y.

    1998-06-01

    Table 2 contains 408 simultaneous measurements collected in each of the four uvby colours of the Stromgren photometric system for the W UMa system HD 163151. The data are magnitude differences (Du, Dv, Db, Dy, D(b-y), Dm1, Dc1) of the variable star minus comparison star in the standard system versus Heliocentric Julian Day. Tables 3, 4 and 5 are the same, but for Hβ (65 points), Johnson B data (212 points) and Johnson V data (355 points). The comparison star is HD 166095. The origin in time is the Julian Day 2449858. The observations were carried out (by E. Rodriguez, A. Claret, J.M. Garcia, F.M. Zerbi, R. Garrido, S. Martin, C. Akan, K. Luedeke, V. Keskin, C. Ibanoglu, S. Evren, Z. Tunca, R. Pekunlu, M. Paparo, J. Nuspl, K. Krisciunas and S.Y. Jiang) in 1995 during the course of a multisite campaign. The following telescopes were used: 90cm telescope of the Sierra Nevada Observatory, Spain (uvby-Hβ photometry); 50cm telescope at the Ege University Observatory, Turkey (BV-uvby); 50cm telescope at Piszkesteto mountain station, Konkoly Observatory, Hungary (BV); 50cm telescope at the Merate Observatory, Italy (V); 30cm telescope at Albuquerque, New Mexico, USA (V) and 15cm telescope at Mauna Kea, Hawaii, USA (V). (4 data files).

  8. Survey of period variations of superhumps in SU UMa-type dwarf novae. V. The fifth year (2012-2013)

    NASA Astrophysics Data System (ADS)

    Kato, Taichi; Hambsch, Franz-Josef; Maehara, Hiroyuki; Masi, Gianluca; Nocentini, Francesca; Dubovsky, Pavol A.; Kudzej, Igor; Imamura, Kazuyoshi; Ogi, Minako; Tanabe, Kenji; Akazawa, Hidehiko; Krajci, Thomas; Miller, Ian; de Miguel, Enrique; Henden, Arne; Noguchi, Ryo; Ishibashi, Takehiro; Ono, Rikako; Kawabata, Miho; Kobayashi, Hiroshi; Sakai, Daisuke; Nishino, Hirochika; Furukawa, Hisami; Masumoto, Kazunari; Matsumoto, Katsura; Littlefield, Colin; Ohshima, Tomohito; Nakata, Chikako; Honda, Satoshi; Kinugasa, Kenzo; Hashimoto, Osamu; Stein, William; Pickard, Roger D.; Kiyota, Seiichiro; Pavlenko, Elena P.; Antonyuk, Oksana I.; Baklanov, Aleksei V.; Antonyuk, Kirill; Samsonov, Denis; Pit, Nikolaj; Sosnovskij, Aleksei; Oksanen, Arto; Harlingten, Caisey; Tyyskä, Jenni; Monard, Berto; Shugarov, Sergey Yu.; Chochol, Drahomir; Kasai, Kiyoshi; Maeda, Yutaka; Hirosawa, Kenji; Itoh, Hiroshi; Sabo, Richard; Ulowetz, Joseph; Morelle, Etienne; Michel, Raúl; Suárez, Genaro; James, Nick; Dvorak, Shawn; Voloshina, Irina B.; Richmond, Michael; Staels, Bart; Boyd, David; Andreev, Maksim V.; Parakhin, Nikolai; Katysheva, Natalia; Miyashita, Atsushi; Nakajima, Kazuhiro; Bolt, Greg; Padovan, Stefano; Nelson, Peter; Starkey, Donn R.; Buczynski, Denis; Starr, Peter; Goff, William N.; Denisenko, Denis; Kochanek, Christopher S.; Shappee, Benjamin; Stanek, Krzysztof Z.; Prieto, José L.; Itagaki, Koh-ichi; Kaneko, Shizuo; Stubbings, Rod; Muyllaert, Eddy; Shears, Jeremy; Schmeer, Patrick; Poyner, Gary; Rodríguez-Marco, Miguel

    2014-04-01

    Continuing the project described in Kato et al. (2009, PASJ, 61, S395), we collected times of superhump maxima for SU UMa-type dwarf novae mainly observed during the 2012-2013 season. We found three objects (V444 Peg, CSS J203937, and MASTER J212624) having strongly positive period derivatives despite the long orbital period (Porb). By using the period of growing stage (stage A) superhumps, we obtained mass ratios for six objects. We characterized nine new WZ Sge-type dwarf novae. We made a pilot survey of the decline rate in the slowly fading parts of SU UMa-type and WZ Sge-type outbursts. The decline time scale was found to generally follow an expected P_orb^{1/4} dependence, and WZ Sge-type outbursts also generally follow this trend. There are some objects which show slower decline rates, and we consider these objects good candidates for period bouncers. We also studied unusual behavior in some objects, including BK Lyn which made a transition from an ER UMa-type state to a novalike (standstill) state in 2013, and unusually frequent occurrences of superoutbursts in NY Ser and CR Boo. We applied the least absolute shrinkage and selection operator (Lasso) power spectral analysis, which has been proven to be very effective in analyzing the Kepler data, to the ground-based photometry of BK Lyn, and detected a dramatic disappearance of the signal of negative superhumps in 2013. We suggested that the mass-transfer rates did not strongly vary between the ER UMa-type state and novalike state in BK Lyn, and this transition was less likely caused by a systematic variation of the mass-transfer rate.

  9. Backyard Research on Cataclysmic Variables by a Consortium of Professional and Amateur Astronomers: DV UMa-A Case Study

    NASA Astrophysics Data System (ADS)

    Vanmunster, T.

    2006-06-01

    The Center for Backyard Astrophysics (CBA) is a multi-longitude network of small photometric telescopes, owned by talented amateurs, who study periodic phenomena in Cataclysmic Variables (CVs). The CBA is among the leading examples of successful partnerships between professional and amateur enthusiasts, producing vast amounts of high-quality variable star data. This poster paper highlights observational CBA results obtained on DV UMa, a most interesting eclipsing UGSU-type dwarf nova, that has been intensively monitored during its April 1997 superoutburst.

  10. First Photometric Investigation of the Newly Discovered W UMa-type Binary Star MR Com

    NASA Astrophysics Data System (ADS)

    Qian, S.-B.; Liu, N.-P.; Liao, W.-P.; He, J.-J.; Liu, L.; Zhu, L.-Y.; Wang, J.-J.; Zhao, E.-G.

    2013-08-01

    By analyzing multi-color light curves of the newly discovered W UMa-type binary, MR Com, we discovered that it is a shallow-contact binary with a degree of contact factor of f = 10.0% ± 2.1%. Photometric solutions reveal that MR Com is a W-type system with a mass ratio of q = 3.9 where the less massive component is about 90 K hotter than the more massive one. By investigating all of the available times of minimum light, we found that the general trend of the Observed-Calculated (O - C) curve shows a downward parabolic variation while it undergoes a cyclic variation with a small amplitude of 0.0031 days and a period of 10.1 yr. The downward parabolic change corresponds to a long-term decrease in the orbital period at a rate of \\dot{P}=-5.3\\times {10^{-7}} days yr-1 that may be caused by a combination of a mass transfer and an angular momentum loss (AML) via magnetic braking. Among the 16 shallow-contact systems with a decreasing orbital period, MR Com has the lowest mass ratio (e.g., 1/q = 0.26). The shallow-contact configuration, the low-mass ratio, and the long-term period decrease all suggest that systems similar to MR Com are on the AML-controlled stage of the evolutionary scheme proposed by Qian. They will oscillate around a critical mass ratio and evolve into a deep contact with a higher mass ratio. The small-amplitude cyclic change in the O - C curve was analyzed for the light-travel time effect via the presence of an extremely cool stellar companion.

  11. BVRI Photometric Study of the Twin, Detached, Near-Contact W UMA Binary, GQ Cancri

    NASA Astrophysics Data System (ADS)

    Caton, Daniel B.; Samec, Ronald G.; Olsen, Amber; Van Hamme, Walter V.; Faulkner, Danny R.

    2017-01-01

    CCD BVRcIc light curves of GQ Cancri were observed in April, 2013 on the SARA North 0.9-m Telescope at Kitt Peak National Observatory in Arizona in remote mode. It is a high amplitude (V~0.9-mag) K0-type eclipsing binary (T1~5250 K) with a photometrically determined mass ratio of M2/M1= 0.99. Its spectral type classifies it as a pre-contact W UMa Binary (PCWB). Binary Maker fits and the Wilson-Devinney Mode 2 solutions show that the binary has a detached binary configuration with fill-outs of 94 and 98% for the primary and secondary component, respectively. As expected, the light curve is asymmetric due to spot activity.Three times of minimum light were calculated, for 2 primary and 1 secondary eclipses from our present observations:HJD I = 2456390.66196±0.00002, 2456406.7056±0.0001HJD II = 2456405.6505±0.0002In total, some 20 times of minimum light covering 17 years of observation were used to determine the following linear ephemeris:JDHelMinI=2456406.70556±0. 00088d + 0. 42220887± 0.00000009 × EAn ephemeris with a weak negative quadratic term with a one probable error significance.It is noted that the solution remained in a detached state for every iteration of the computer runs. The components are truly twins with a computed temperature difference of only 25 K, with the flux of the primary component accounting for 52% of the systems light in B,V,Rc and Ic. A 15 degree equatorial hot spot was iterated on the primary component.

  12. Land use impacts on river health of Uma Oya, Sri Lanka: implications of spatial scales.

    PubMed

    Jayawardana, J M C K; Gunawardana, W D T M; Udayakumara, E P N; Westbrooke, M

    2017-04-01

    Human actions on landscapes are a principal threat to the ecological integrity of river ecosystems worldwide. Tropical landscapes have been poorly investigated in terms of the impact of catchment land cover alteration on water quality and biotic indices in comparison to temperate landscapes. Effects of land cover in the catchment at two spatial scales (catchment and site) on stream physical habitat quality, water quality, macroinvertebrate indices and community composition were evaluated for Uma Oya catchment in the upper Mahaweli watershed, Sri Lanka. The relationship between spatial arrangement of land cover in the catchment and water quality, macroinvertebrate indices and community composition was examined using univariate and multivariate approaches. Results indicate that chemical water quality variables such as conductivity and total dissolved solids are mostly governed by the land cover at broader spatial scales such as catchment scale. Shannon diversity index was also affected by catchment scale forest cover. In stream habitat features, nutrients such as N-NO3(-), macroinvertebrate family richness, %shredders and macroinvertebrate community assemblages were predominantly influenced by the extent of land cover at 200 m site scale suggesting that local riparian forest cover is important in structuring macroinvertebrate communities. Thus, this study emphasizes the importance of services provided by forest cover at catchment and site scale in enhancing resilience of stream ecosystems to natural forces and human actions. Findings suggest that land cover disturbance effects on stream ecosystem health could be predicted when appropriate spatial arrangement of land cover is considered and has widespread application in the management of tropical river catchments.

  13. Infrasonic harmonic tremor and degassing bursts from Halema'uma'u Crater, Kilauea Volcano, Hawaii

    USGS Publications Warehouse

    Fee, David; Garcés, Milton; Patrick, Matt; Chouet, Bernard; Dawson, Phil; Swanson, Donald A.

    2010-01-01

    The formation, evolution, collapse, and subsequent resurrection of a vent within Halema'uma'u Crater, Kilauea Volcano, produced energetic and varied degassing signals recorded by a nearby infrasound array between 2008 and early 2009. After 25 years of quiescence, a vent-clearing explosive burst on 19 March 2008 produced a clear, complex acoustic signal. Near-continuous harmonic infrasonic tremor followed this burst until 4 December 2008, when a period of decreased degassing occurred. The tremor spectra suggest volume oscillation and reverberation of a shallow gas-filled cavity beneath the vent. The dominant tremor peak can be sustained through Helmholtz oscillations of the cavity, while the secondary tremor peak and overtones are interpreted assuming acoustic resonance. The dominant tremor frequency matches the oscillation frequency of the gas emanating from the vent observed by video. Tremor spectra and power are also correlated with cavity geometry and dynamics, with the cavity depth estimated at ~219 m and volume ~3 x 106 m3 in November 2008. Over 21 varied degassing bursts were observed with extended burst durations and frequency content consistent with a transient release of gas exciting the cavity into resonance. Correlation of infrasound with seismicity suggests an open system connecting the atmosphere to the seismic excitation process at depth. Numerous degassing bursts produced very long period (0.03-0.1 Hz) infrasound, the first recorded at Kilauea, indicative of long-duration atmospheric accelerations. Kilauea infrasound appears controlled by the exsolution of gas from the magma, and the interaction of this gas with the conduits and cavities confining it.

  14. V344 Lyrae: A Touchtone SU UMa Cataclysmic Variable in the Kepler Field

    NASA Technical Reports Server (NTRS)

    Smale, Alan P.; Wood, Matt A.; Still, Martin D.; Howell, Steve B.; Cannizzo, John K.

    2012-01-01

    We report on the analysis of the Kepler short-cadence (SC) light curve of V344 Lyr obtained during 2009 June 20 through 2010 Mar 19 (Q2-Q4). The system is an SU UMa star showing dwarf nova outbursts and superoutbursts, and promises to be a touchstone for CV studies for the foreseeable future. The system displays both positive and negative super humps with periods of 2.20 and 2.06-hr, respectively, and we identify an orbital period of 2.11-hr. The positive super humps have a maximum amplitude of approximately 0.025-mag, the negative super humps a maximum amplitude of approximately 0.8 mag, and the orbital period at quiescence has an amplitude of approximately 0.025 mag. The quality of the Kepler data is such that we can test vigorously the models for accretion disk dynamics that have been emerging in the past several years. The SC data for V344 Lyr are consistent with the model that two physical sources yield positive superhumps: early in the superoutburst. the superhump signal is generated by viscous dissipation within the periodically flexing disk. but late in the superoutburst, the signal is generated as the accretion stream bright spot sweeps around the rim of the non-axisymmetric disk. The disk super humps are roughly anti-phased with the stream/late superhumps. The V344 Lyr data also reveal negative super humps arising from accretion onto a tilted disk precessing in the retrograde direction, and suggest that negative superhumps may appear during the decline of DN outbursts. The period of negative superhumps has a positive P(raised dot) in between outbursts.

  15. An extensive analysis of the triple W UMa type binary FI BOO

    SciTech Connect

    Christopoulou, P.-E.; Papageorgiou, A.

    2013-12-01

    We present a detailed analysis of the interesting W UMa binary FI Boo in view of the spectroscopic signature of a third body through photometry, period variation, and a thorough investigation of solution uniqueness. We obtained new BVR{sub c}I{sub c} photometric data that, when combined with spectroscopic data, enable us to analyze the system FI Boo and determine its basic orbital and physical properties through PHOEBE, as well as the period variation by studying the times of the minima. This combined approach allows us to study the long-term period changes in the system for the first time in order to investigate the presence of a third body and to check extensively the solution uniqueness and the uncertainties of derived parameters. Our modeling indicates that FI Boo is a W-type moderate (f = 50.15% ± 8.10%) overcontact binary with component masses of M {sub h} = 0.40 ± 0.05 M {sub ☉} and M {sub c} = 1.07 ± 0.05 M {sub ☉}, temperatures of T {sub h} = 5746 ± 33 K and T {sub c} = 5420 ± 56 K, and a third body, which may play an important role in the formation and evolution. The results were tested by heuristic scanning and parameter kicking to provide the consistent and reliable set of parameters that was used to obtain the initial masses of the progenitors (1.71 ± 0.10 M {sub ☉} and 0.63 ± 0.01 M {sub ☉}, respectively). We also investigated the evolutionary status of massive components with several sets of widely used isochrones.

  16. THE FIRST PHOTOMETRIC INVESTIGATION OF THE NEGLECTED W-UMa-TYPE BINARY STAR UZ CMi

    SciTech Connect

    Qian, S.-B.; Li, K.; Liao, W.-P.; Liu, L.; Zhu, L.-Y.; He, J.-J.; Wang, J.-J.; Zhao, E.-G.

    2013-04-15

    UZ CMi was a W-UMa-type binary star found more than 80 years ago. However, it has been neglected in photometric investigations. Here, the first complete light curves in the B, V, R, and I bands are presented and analyzed using the Wilson and Devinney method. It is discovered that UZ CMi is a contact binary (f = 38.4({+-} 2.3)%) with a mass ratio of 0.45. The derived orbital inclination (i = 87 Degree-Sign ) indicates that it is a total eclipsing binary, which suggests that the determined parameters are reliable. By using 17 new eclipse times together with those collected from the literature, we found that the general trend of the observed-calculated (O - C) curve shows an upward parabolic variation that corresponds to a long-term increase in the orbital period at a rate of P-dot = +4.1 x 10{sup -8} days yr{sup -1}. The continuous increase may be caused by a mass transfer from the less massive component to the more massive one. This suggests that UZ CMi is in the thermal relaxation oscillation controlled stage of the evolutionary scheme proposed by Qian. UZ CMi will oscillate around a critical mass ratio and the contact configuration cannot be broken. After the upward parabolic change was removed, the (O - C){sub 2} curve of the photoelectric and charge-coupled device data revealed a cyclic variation with a small amplitude of 0.0026 days and a period of 21.1 yr. The cyclic change was analyzed for the light-travel time effect via the presence of an extremely cool stellar companion.

  17. Survey of Period Variations of Superhumps in SU UMa-Type Dwarf Novae

    NASA Astrophysics Data System (ADS)

    Kato, Taichi; Imada, Akira; Uemura, Makoto; Nogami, Daisaku; Maehara, Hiroyuki; Ishioka, Ryoko; Baba, Hajime; Matsumoto, Katsura; Iwamatsu, Hidetoshi; Kubota, Kaori; Sugiyasu, Kei; Soejima, Yuichi; Moritani, Yuuki; Ohshima, Tomohito; Ohashi, Hiroyuki; Tanaka, Junpei; Sasada, Mahito; Arai, Akira; Nakajima, Kazuhiro; Kiyota, Seiichiro; Tanabe, Kenji; Imamura, Kazuyoshi; Kunitomi, Nanae; Kunihiro, Kenji; Taguchi, Hiroki; Koizumi, Mitsuo; Yamada, Norimi; Nishi, Yuichi; Kida, Mayumi; Tanaka, Sawa; Ueoka, Rie; Yasui, Hideki; Maruoka, Koichi; Henden, Arne; Oksanen, Arto; Moilanen, Marko; Tikkanen, Petri; Aho, Mika; Monard, Berto; Itoh, Hiroshi; Dubovsky, Pavol A.; Kudzej, Igor; Dancikova, Radka; Vanmunster, Tonny; Pietz, Jochen; Bolt, Greg; Boyd, David; Nelson, Peter; Krajci, Thomas; Cook, Lewis M.; Torii, Ken'ichi; Starkey, Donn R.; Shears, Jeremy; Jensen, Lasse-Teist; Masi, Gianluca; Hynek, Tomáš; Nová; K, Rudolf; Kociá; N, Radek; Krá; L, Lukáš; Kučá; Ková, Hana; Kolasa, Marek; Štastný, Petr; Staels, Bart; Miller, Ian; Sano, Yasuo; de Ponthière, Pierre; Miyashita, Atsushi; Crawford, Tim; Brady, Steve; Santallo, Roland; Richards, Tom; Martin, Brian; Buczynski, Denis; Richmond, Michael; Kern, Jim; Davis, Stacey; Crabtree, Dustin; Beaulieu, Kevin; Davis, Tracy; Aggleton, Matt; Morelle, Etienne; Pavlenko, Elena P.; Andreev, Maksim; Baklanov, Alexander; Koppelman, Michael D.; Billings, Gary; Urbancok, L'ubomír; Ögmen, Yenal; Heathcote, Bernard; Gomez, Tomas L.; Voloshina, Irina; Retter, Alon; Mularczyk, Krzysztof; Zoczewski, Kamil; Olech, Arkadiasz; Kedzierski, Piotr; Pickard, Roger D.; Stockdale, Chris; Virtanen, Jani; Morikawa, Koichi; Hambsch, Franz-Josef; Garradd, Gordon; Gualdoni, Carlo; Geary, Keith; Omodaka, Toshihiro; Sakai, Nobuyuki; Michel, Raul; Cárdenas, A. A.; Gazeas, Kosmas D.; Niarchos, Panos G.; Yushchenko, Alexander V.; Mallia, Franco; Fiaschi, Marco; Good, Gerry A.; Walker, Stan; James, Nick; Douzu, Ken-Ichi; Julian, Wm Mack, II; Butterworth, Neil D.; Shugarov, Sergey Yu.; Volkov, Igor; Chochol, Drahomir; Katysheva, Natalia; Rosenbush, Alexander E.; Khramtsova, Maria; Kehusmaa, Petri; Reszelski, Maciej; Bedient, James; Liller, William; Pojmanski, Grzegorz; Simonsen, Mike; Stubbings, Rod; Schmeer, Patrick; Muyllaert, Eddy; Kinnunen, Timo; Poyner, Gary; Ripero, Jose; Kriebel, Wolfgang

    2009-12-01

    We systematically surveyed period variations of superhumps in SU UMa-type dwarf novae based on newly obtained data and past publications. In many systems, the evolution of the superhump period is found to be composed of three distinct stages: an early evolutionary stage with a longer superhump period, a middle stage with systematically varying periods, and a final stage with a shorter, stable superhump period. During the middle stage, many systems with superhump periods of less than 0.08 d show positive period derivatives. We present observational characteristics of these stages and give greatly improved statistics. Contrary to an earlier claim, we found no clear evidence for a variation of period derivatives among different superoutbursts of the same object. We present an interpretation that the lengthening of the superhump period is a result of the outward propagation of an eccentricity wave, which is limited by the radius near the tidal truncation. We interpret that late-stage superhumps are rejuvenated excitation of a 3:1 resonance when superhumps in the outer disk are effectively quenched. The general behavior of the period variation, particularly in systems with short orbital periods, appears to follow a scenario proposed in Kato, Maehara, and Monard (2008, PASJ, 60, L23). We also present an observational summary of WZ Sge-type dwarf novae. Many of them have shown long-enduring superhumps during a post-superoutburst stage having longer periods than those during the main superoutburst. The period derivatives in WZ Sge-type dwarf novae are found to be strongly correlated with the fractional superhump excess, or consequently with the mass ratio. WZ Sge-type dwarf novae with a long-lasting rebrightening or with multiple rebrightenings tend to have smaller period derivatives, and are excellent candidates for those systems around or after the period minimum of evolution of cataclysmic variables.

  18. Modeling the Radial Velocity Curve of the Water Vapor Maser in VX UMa

    NASA Astrophysics Data System (ADS)

    Salter, D. M.; Benson, P. J.; Strelnitski, V. S.

    1999-12-01

    VX UMa is a unique Mira-type star that demonstrates a triple-peaked spectrum of its 1.35-cm H2O maser emission. We used the high-precision curves of radial velocities of the spectral peaks, obtained by Benson & Little-Marenin from 1988 to 1992, as probes of the kinematics of the masing region. The pronounced periodicity of the radial velocity of the central component, with a period equal to the pulsational period of the optical variations, suggests the involvement of pulsations in the observed excursions of radial velocity. However, the radial velocity of the central spectral component produced by a symmetrical, pulsating spherical layer should be constantly zero. Rotation seems to be the most obvious mechanism to impart a small non-zero component to the central feature. We assume that the bulk of maser radiation originates in the equatorial "belt" around the star and approximate this region as a two-dimensional, rotating and pulsating ring. We found that any combination of rotation and pulsation produces a quadruple peaked, not a triple peaked spectrum. Therefore, some asymmetry in the disk or unequal absorption of the two central peaks by ionized gas (e.g. in the shock responsible for the maser emission) is needed. We demonstrate that one of the central peaks can then undergo periodic changes of its radial velocity with the period of pulsation, as observed. A VLBA experiment that may verify our model is under way. This project was supported by the NSF/REU grant AST-9820555.

  19. FIRST PHOTOMETRIC INVESTIGATION OF THE NEWLY DISCOVERED W UMa-TYPE BINARY STAR MR Com

    SciTech Connect

    Qian, S.-B.; Liu, N.-P.; Liao, W.-P.; He, J.-J.; Liu, L.; Zhu, L.-Y.; Wang, J.-J.; Zhao, E.-G.

    2013-08-01

    By analyzing multi-color light curves of the newly discovered W UMa-type binary, MR Com, we discovered that it is a shallow-contact binary with a degree of contact factor of f = 10.0% {+-} 2.1%. Photometric solutions reveal that MR Com is a W-type system with a mass ratio of q = 3.9 where the less massive component is about 90 K hotter than the more massive one. By investigating all of the available times of minimum light, we found that the general trend of the Observed-Calculated (O - C) curve shows a downward parabolic variation while it undergoes a cyclic variation with a small amplitude of 0.0031 days and a period of 10.1 yr. The downward parabolic change corresponds to a long-term decrease in the orbital period at a rate of P-dot = -5.3 x 10{sup -7} days yr{sup -1} that may be caused by a combination of a mass transfer and an angular momentum loss (AML) via magnetic braking. Among the 16 shallow-contact systems with a decreasing orbital period, MR Com has the lowest mass ratio (e.g., 1/q = 0.26). The shallow-contact configuration, the low-mass ratio, and the long-term period decrease all suggest that systems similar to MR Com are on the AML-controlled stage of the evolutionary scheme proposed by Qian. They will oscillate around a critical mass ratio and evolve into a deep contact with a higher mass ratio. The small-amplitude cyclic change in the O - C curve was analyzed for the light-travel time effect via the presence of an extremely cool stellar companion.

  20. Uma grade de perfis teóricos para estrelas massivas em transição

    NASA Astrophysics Data System (ADS)

    Nascimento, C. M. P.; Machado, M. A.

    2003-08-01

    Na XXVIII Reunião Anual da Sociedade Astronômica Brasileira (2002) apresentamos uma grade de perfis calculados de acordo com os pontos da trajetória evolutiva de metalicidade solar, Z = 0.02 e taxa de perda de massa () padrão, para estrelas com massa inicial de 25, 40, 60, 85 e 120 massas solares. Estes perfis foram calculados com o auxílio de um código numérico adequado para descrever os ventos de objetos massivos, supondo simetria esférica, estacionaridade e homogeneidade. No presente trabalho, apresentamos a complementação da grade com os perfis teóricos relativos às trajetórias de Z = 0.02 com taxa de perda de massa dobrada em relação a padrão (2´), e de metalicidade Z = 0.008. Para cada ponto das três trajetórias obtemos os perfis teóricos de Ha, Hb, Hg e Hd, e como esperado eles se apresentam em pura emissão, pura absorção ou em P-Cygni. Para valores de taxa de perda de massa muito baixos (~10-7) não há formação de linhas, o que é visto nos primeiros pontos em todas as trajetórias. Em geral, para um mesmo ponto a componente de emissão diminui e a absorção aumenta de Ha para Hd. É verificado que as trajetórias com Z = 0.02 e padrão possuem menos circuitos (loops) do que as com metalicidade Z = 0.02 e 2´ padrão, e seus perfis são, em geral, menos intensos. Em relação a trajetória de Z = 0.008, verifica-se menos circuitos e maior variação em luminosidade, e seus perfis mostram-se em, algumas trajetórias, mais intensos. Verificamos também que, pontos distintos em uma mesma trajetória, apresentam perfis diferentes para valores similares de luminosidade e temperatura efetiva. Sendo assim, uma grade de perfis teóricos parece ser útil para fornecer uma informação preliminar sobre o estágio evolutivo de uma estrela massiva.

  1. WZ Cephei: A Dynamically Active W UMa-Type Binary Star

    NASA Astrophysics Data System (ADS)

    Jeong, Jang-Hae; Kim, Chun-Hwey

    2011-09-01

    An intensive analysis of 185 timings of WZ Cep, including our new three timings, was made to understand the dynamical picture of this active W UMa-type binary. It was found that the orbital period of the system has complexly varied in two cyclical components superposed on a secularly downward parabola over about 80y. The downward parabola, corresponding to a secular period decrease of -9.d97 × 10-8 y-1, is most probably produced by the action of both angular momentum loss (AML) due to magnetic braking and mass-transfer from the massive primary component to the secondary. The period decrease rate of -6.d72 × 10-8 y-1 due to AML contributes about 67% to the observed period decrease. The mass flow of about 5.16 × 10-8 M⊙ y-1 from the primary to the secondary results the remaining 33% period decrease. Two cyclical components have an 11.y8 period with amplitude of 0.d0054 and a 41.y3 period with amplitude of 0.d0178. It is very interesting that there seems to be exactly in a commensurable 7:2 relation between their mean motions. As the possible causes, two rival interpretations (i.e., light-time effects (LTE) by additional bodies and the Applegate model) were considered. In the LTE interpretation, the minimum masses of 0.30 M⊙ for the shorter period and 0.49 M⊙ for the longer one were calculated. Their contributions to the total light were at most within 2%, if they were assumed to be main-sequence stars. If the LTE explanation is true for the WZ Cep system, the 7:2 relation found between their mean motions would be interpreted as a stable 7:2 orbit resonance produced by a long-term gravitational interaction between two tertiary bodies. In the Applegate model interpretation, the deduced model parameters indicate that the mechanism could work only in the primary star for both of the two period modulations, but could not in the secondary. However, we couldn't find any meaningful relation between the light variation and the period variability from the historical

  2. Delirium with manic and psychotic features associated with amantadine.

    PubMed

    Neagoe, Adriana D

    2013-01-01

    While clinicians are familiar with psychosis as a complication in the long-term treatment with amantadine, rapid psychiatric complications are of much less concern. In the case presented, severe decompensation in mental status occurred within 48 h of initiation of standard doses of amantadine hydrochloride. Clinicians should be alert not only for delayed complications but also for early-onset mental decompensation in elderly patients with influenza A treated with amantadine.

  3. Delirium as presenting symptom of neuro-Behcet’s disease

    PubMed Central

    Alnasser Alsukhni, Rana; Ghoubari, Mohamed Sourat; Aboras, Yasmin; Almohamad Alkhalifa, Khadija

    2016-01-01

    Objectives: Behcet’s disease is a multisystemic disorder. Most of its clinical manifestations are due to thrombosis or vasculitis. There is a predominance of mucocutaneous and ocular lesions; neurological manifestations are minority. However, this could be the first problem that leads a patient to seek medical help. Methods: We report a 30-year-old female with rapidly progressive headaches and confusion. Brain magnetic resonance imaging showed bilateral thalamic T2 hyperintense lesions and hemorrhage. Directed inquiry revealed recurrent oral ulcers and three miscarriages. During hospitalization, the patient developed a deep venous thrombosis. Results: After exclusion of other differential diagnoses, the diagnosis of Behcet’s disease was established. Conclusion: Behcet’s disease is a protean disease. Hence it should be in mind in patients with otherwise unexplained signs and symptoms, especially in endemic countries, and treatment decision should not be witheld in critical cases if no alternative diagnosis is plausible. PMID:27579169

  4. Hallucinations and delirium in the dental office following triazolam administration.

    PubMed

    Goodchild, Jason H; Donaldson, Mark

    2005-01-01

    A rare and unusual case of hallucinations following triazolam administration is reported. A review of the literature suggests that hallucinations following triazolam are rare; this is the first report of such a reaction when triazolam was used for oral conscious sedation in dentistry. A discussion of dental implications follows with emphasis on complete medical history evaluation before administering oral sedatives. We conclude that the proper selection of oral sedation candidates, coupled with recognition and management of adverse events, is essential.

  5. Survey of period variations of superhumps in SU UMa-type dwarf novae. VII. The seventh year (2014-2015)

    NASA Astrophysics Data System (ADS)

    Kato, Taichi; Hambsch, Franz-Josef; Dubovsky, Pavol A.; Kudzej, Igor; Monard, Berto; Miller, Ian; Itoh, Hiroshi; Kiyota, Seiichiro; Masumoto, Kazunari; Fukushima, Daiki; Kinoshita, Hiroki; Maeda, Kazuki; Mikami, Jyunya; Matsuda, Risa; Kojiguchi, Naoto; Kawabata, Miho; Takenaka, Megumi; Matsumoto, Katsura; de Miguel, Enrique; Maeda, Yutaka; Ohshima, Tomohito; Isogai, Keisuke; Pickard, Roger D.; Henden, Arne; Kafka, Stella; Akazawa, Hidehiko; Otani, Noritoshi; Ishibashi, Sakiko; Ogi, Minako; Tanabe, Kenji; Imamura, Kazuyoshi; Stein, William; Kasai, Kiyoshi; Vanmunster, Tonny; Starr, Peter; Oksanen, Arto; Pavlenko, Elena P.; Antonyuk, Oksana I.; Antonyuk, Kirill A.; Sosnovskij, Aleksei A.; Pit, Nikolaj V.; Babina, Julia V.; Sklyanov, Aleksandr; Novák, Rudolf; Dvorak, Shawn; Michel, Raúl; Masi, Gianluca; Littlefield, Colin; Ulowetz, Joseph; Shugarov, Sergey Yu.; Golysheva, Polina Yu.; Chochol, Drahomir; Krushevska, Viktoriia; Ruiz, Javier; Tordai, Tamás; Morelle, Etienne; Sabo, Richard; Maehara, Hiroyuki; Richmond, Michael; Katysheva, Natalia; Hirosawa, Kenji; Goff, William N.; Dubois, Franky; Logie, Ludwig; Rau, Steve; Voloshina, Irina B.; Andreev, Maksim V.; Shiokawa, Kazuhiko; Neustroev, Vitaly V.; Sjoberg, George; Zharikov, Sergey; James, Nick; Bolt, Greg; Crawford, Tim; Buczynski, Denis; Cook, Lewis M.; Kochanek, Christopher S.; Shappee, Benjamin; Stanek, Krzysztof Z.; Prieto, José L.; Denisenko, Denis; Nishimura, Hideo; Mukai, Masaru; Kaneko, Shizuo; Ueda, Seiji; Stubbings, Rod; Moriyama, Masayuki; Schmeer, Patrick; Muyllaert, Eddy; Shears, Jeremy; Modic, Robert J.; Paxson, Kevin B.

    2015-12-01

    Continuing the project described by Kato et al. (2009, PASJ, 61, S395), we collected times of superhump maxima for 102 SU UMa-type dwarf novae, observed mainly during the 2014-2015 season, and characterized these objects. Our project has greatly improved the statistics of the distribution of orbital periods, which is a good approximation of the distribution of cataclysmic variables at the terminal evolutionary stage, and has confirmed the presence of a period minimum at a period of 0.053 d and a period spike just above this period. The number density monotonically decreased toward the longer period and there was no strong indication of a period gap. We detected possible negative superhumps in Z Cha. It is possible that normal outbursts are also suppressed by the presence of a disk tilt in this system. There was no indication of enhanced orbital humps just preceding the superoutburst, and this result favors the thermal-tidal disk instability as the origin of superoutbursts. We detected superhumps in three AM CVn-type dwarf novae. Our observations and recent other detections suggest that 8% of objects showing dwarf nova-type outbursts are AM CVn-type objects. AM CVn-type objects and EI Psc-type objects may be more abundant than previously recognized. OT J213806, a WZ Sge-type object, exhibited remarkably different features between the 2010 and 2014 superoutbursts. Although the 2014 superoutburst was much fainter, the plateau phase was shorter than the 2010 one, and the course of the rebrightening phase was similar. This object indicates that the O - C diagrams of superhumps can indeed be variable, at least in WZ Sge-type objects. Four deeply eclipsing SU UMa-type dwarf novae (ASASSN-13cx, ASASSN-14ag, ASASSN-15bu, and NSV 4618) were identified. We studied long-term trends in supercycles in MM Hya and CY UMa and found systematic variations of supercycles of ˜20%.

  6. Time sequence spectroscopy of AW UMa. The 518 nm Mg I triplet region analyzed with broadening functions

    SciTech Connect

    Rucinski, Slavek M.

    2015-02-01

    High-resolution spectroscopic observations of AW UMa, obtained on three consecutive nights with a median time resolution of 2.1 minutes, have been analyzed using the broadening function method in the spectral window of 22.75 nm around the 518 nm Mg i triplet region. Doppler images of the system reveal the presence of vigorous mass motions within the binary system; their presence puts into question the solid-body rotation assumption of the contact binary model. AW UMa appears to be a very tight, semi-detached binary; the mass transfer takes place from the more massive to the less massive component. The primary, a fast-rotating star with Vsini=181.4±2.5 km s{sup −1}, is covered with inhomogeneities: very slowly drifting spots and a dense network of ripples more closely participating in its rotation. The spectral lines of the primary show an additional broadening component (called the “pedestal”) that originates either in the equatorial regions, which rotate faster than the rest of the star by about 50 km s{sup −1}, or in an external disk-like structure. The secondary component appears to be smaller than predicted by the contact model. The radial velocity field around the secondary is dominated by accretion of matter transferred from (and possibly partly returned to) the primary component. The parameters of the binary are Asini=2.73±0.11 R{sub ⊙} and M{sub 1}sin{sup 3}i=1.29±0.15 M{sub ⊙}, M{sub 2}sin{sup 3}i=0.128±0.016 M{sub ⊙}. The mass ratio, q{sub sp}=M{sub 2}/M{sub 1}=0.099±0.003, while still the most uncertain among the spectroscopic elements, is substantially different from the previous numerous and mutually consistent photometric investigations which were based on the contact model. It should be studied why photometry and spectroscopy give such discrepant results and whether AW UMa is an unusual object or if only very high-quality spectroscopy can reveal the true nature of W UMa-type binaries.

  7. The 2008-2009 Eruption in Halema`uma`u Crater, Kilauea Volcano

    NASA Astrophysics Data System (ADS)

    Kauahikaua, J. P.; Orr, T. R.; Patrick, M. R.; Swanson, D.; Poland, M. P.; Miklius, A.; Wilson, D.; Sutton, A. J.; Elias, T.; Thornber, C. R.; Wooten, K.

    2009-12-01

    Early in the 26th year of Kilauea volcano’s ongoing east rift zone eruption, a distinct increase in activity was detected at Kilauea summit. By February 2008, the southern part of the summit caldera was bathed in high concentrations of SO2 prompting Hawai`i Volcanoes National Park to close public access. A vigorous fuming area at the base of the east wall of Halema`uma`u Crater was noted on March 12, and the first throat-clearing explosion occurred from that location a week later. This, the first explosive eruption of Kilauea's summit since 1924, was followed by 7 more before the first major vent collapse in early December 2008 buried the lava column beneath rubble, extinguished vent glow, and reduced gas emissions. The vent slowly came back to life in early 2009, exhibiting behavior similar to that in 2008, until another major collapse in mid-2009 reburied the vent and again extinguished glow and reduced gas emissions. As of August 2009, glow had returned and gas emissions had increased, a total of 2,200 tonnes of lithic and juvenile tephra had been erupted, and the dimensions of the vent opening in the crater floor increased to 125 x 133 m. Chemical uniformity of magma erupted from the summit and rift zone vents unambiguously demonstrate their direct connection. The low explosive intensity and location of the 2008-9 explosive activity within the heavily monitored and easily accessible summit have allowed a number of near-vent studies. Near-daily ashfall measurements have revealed temporal variations in tephra production and changes in the proportion of juveniles and lithics. Direct views of the lava surface within the vent allowed cross-correlation with seismic and geodetic signals to suggest new interpretations of tremor, infrasound, and tilt data. Near-source emission measurements allowed uniquely full characterization of gas content and associated hazards. Additional hazards posed by the summit activity include near-vent ballistic impacts and low air quality

  8. Mass Flux of Tephra Sampled Frequently During the Ongoing Halema`uma`u Eruption (Invited)

    NASA Astrophysics Data System (ADS)

    Swanson, D.; Wooten, K.; Orr, T. R.

    2009-12-01

    The ongoing summit eruption of Kilauea provides an unparalleled opportunity to track, almost daily, the production of tephra. The eruption began on 19 March 2008, and tephra has been erupted every day since then to the end of August 2009. Most of the time, tephra is ejected quasi-continuously from the vent accompanied by a light gray to white gas plume, occasionally broken by a more vigorous pulse (“brown plume”) richer in ejecta. In early April 2008, an array of 10 plastic buckets was placed within 400 m of the new vent in Halema`uma`u down the prevailing NE wind direction. The configuration of the array, spanning an area of about 73,000 m2, has not changed since then. Buckets are emptied frequently, initially every day and, since summer 2008, on all weekdays. The contents are dried and weighed, and an “average network accumulation rate” is calculated in g/m2/hour. In addition, componentry analyses are made of the >0.5-mm size fraction from a bucket near the vent, in order to categorize the tephra into juvenile and lithic fractions. To estimate the total mass of tephra ejected from the vent for a given collection, we first drew isomass contours for several daily collections and plotted isomass versus square root of area to obtain the total mass of the deposit. From this, we developed an empirical multiplication factor that allows us to estimate, within ~25 percent, the total ejected mass per day in kilograms from the total collected mass in grams. The tephra is a mix of vitric and lithic pyroclasts, mostly ash in size. The vitric clasts, interpreted as juvenile, include Pele’s hair and tears, hollow spherules, dumbbells, pumice, and bits of coarsely vesicular glass. All these clasts were probably produced by weak spattering at the top of the lava column, which has rarely been seen. Especially since fall 2008, some vitric clasts are partly coated with secondary minerals or rock dust. We interpret such clasts as recycled, first erupted during spattering

  9. Light curve solutions of six eclipsing binaries at the lower limit of periods for W UMa stars

    NASA Astrophysics Data System (ADS)

    Kjurkchieva, Diana P.; Dimitrov, Dinko P.; Ibryamov, Sunay I.

    2015-09-01

    Photometric observations are presented in V and I bands of six eclipsing binaries at the lower limit of the orbital periods for W UMa stars. Three of them are newly discovered eclipsing systems. The light curve solutions reveal that all short-period targets are contact or overcontact binaries and six new binaries are added to the family of short-period systems with estimated parameters. Four binaries have components that are equal in size and a mass ratio near 1. The phase variability shown by the V-I colors of all targets may be explained by lower temperatures on their back surfaces than those on their side surfaces. Five systems exhibit the O'Connell effect that can be modeled by cool spots on the side surfaces of their primary components. The light curves of V1067 Her in 2011 and 2012 are fitted by diametrically opposite spots. Applying the criteria for subdivision of W UMa stars to our targets leads to ambiguous results.

  10. A New Look at the Eclipse Timing Variation Diagram Analysis of Selected 3-body W UMa Systems

    NASA Astrophysics Data System (ADS)

    Christopoulou, P.-E.; Papageorgiou, A.

    2015-07-01

    The light travel effect produced by the presence of tertiary components can reveal much about the origin and evolution of over-contact binaries. Monitoring of W UMa systems over the last decade and/or the use of publicly available photometric surveys (NSVS, ASAS, etc.) has uncovered or suggested the presence of many unseen companions, which calls for an in-depth investigation of the parameters derived from cyclic period variations in order to confirm or reject the assumption of hidden companion(s). Progress in the analysis of eclipse timing variations is summarized here both from the empirical and the theoretical points of view, and a more extensive investigation of the proposed orbital parameters of third bodies is proposed. The code we have developed for this, implemented in Python, is set up to handle heuristic scanning with parameter perturbation in parameter space, and to establish realistic uncertainties from the least squares fitting. A computational example is given for TZ Boo, a W UMa system with a spectroscopically detected third component. Future options to be implemented include MCMC and bootstrapping.

  11. Comparing the precision 2009 and 2012 light curves of the precontact W UMa binary V1001 Cassiopeia

    SciTech Connect

    Samec, R. G.; Koenke, S. S.; Faulkner, D. R.

    2015-01-01

    A 2012 follow up to the analysis of 2009 observations is presented for the very short period (∼0.43 days) precontact W UMa binary (PCWB) V1001 Cassiopeia. Its short period, similar to the majority of W UMa binaries, and its distinct EA light curve make it a very rare and interesting system for continuing photometric investigation. Previous photometric VRI standard magnitudes give a K4 spectral type. Our solutions of light curves separated by some three years give approximately the same physical parameters. However, the spots have radically changed in temperature, area, and position. While only one dark spot was used to model the first curves, two hot spots are now needed. This affects the overall shape of the light curve, especially in the secondary eclipses in B and V. Additional eclipse timings now show that the orbital period is changing. We conclude that spots are very active on this solar-type dwarf system and that it may mimic its larger cousins, the RS CVn binaries. The conclusion is that analysis now needs to be directed at the continuous time evolution of PCWBs.

  12. Observations and light curve solutions of the eclipsing W UMa binaries CSS J071813.2+505000, NSVS 2459652, NSVS 7178717 and NSVS 7377875

    NASA Astrophysics Data System (ADS)

    Kjurkchieva, D. P.; Popov, V. A.; Vasileva, D. L.; Petrov, N. I.

    2017-04-01

    Photometric observations in Sloan g' and i' bands of four eclipsing W UMa binaries are presented. They allowed the improvement of system ephemerides. The light curve solutions led to the following results: (i) CSS J071813.2+505000 is barely an overcontact system, NSVS 2459652 and NSVS 7377875 are overcontact binaries with an intermediate fillout factor, while NSVS 7178717 has a deep-contact configuration; (ii) NSVS 7178717 undergoes total eclipses while the other three targets exhibit partial eclipses; (iii) The components of each target are almost the same in temperature: those of CSS J071813.2+505000 are early G stars while those of the other three targets are of K spectral type; (iv) The targets with late components reveal spot activity; (v) NSVS 2459652 and NSVS 7377875 are W UMa binaries of H subtype; (vi) The relation mass ratio - luminosity ratio of our targets confirms the results from previous statistical analysis of W UMa systems.

  13. BVR{sub c}I{sub c} observations and analyses on V2421 Cygni, a precontact W UMa binary

    SciTech Connect

    Samec, R. G.; Shebs, Travis S.; Faulkner, D. R.; Van Hamme, W.; Mathis, R. F.

    2014-01-01

    We present the first precision BVRI light curves, synthetic light curve solutions, and a period study for the high amplitude solar type binary, V2421 Cygni. The light curves have the appearance of an Algol (EA) type; however, it is made up of dwarf solar type components in a detached mode with a period of only 0.6331 days with an amplitude of about a full magnitude, i.e., it is a precontact W UMa binary. Flare-like disruptions occur in the light curves following the primary and secondary eclipses possibly due to the line-of-sight track of a gas stream. An associated stream spot and splash spot cause bright equatorial spots on the stellar surface of the primary star. The more massive star is the gainer, making this system a classic, albeit dwarf, Algol.

  14. Peculiarities of the SU UMa-Type Dwarf Nova V1504 Cyg Behavior in 1994 - 2012 Years

    NASA Astrophysics Data System (ADS)

    Antonyuk, O. I.; Pavlenko, E. P.

    2013-12-01

    For the SU UMa-type dwarf nova V1504 Cyg on the data base of the CrAO (1998 - 2009), space telescope "Kepler" (2009 - 2011), AAVSO and VSNET (1994 - 2012) we found as follows: 1) the supercycle length varying in average from 100 to 140 d; 2) the normal outbursts show a bimodal cycles lengths distributions with centers 8 - 9 days and 11 days within the range of 5 - 22 days; 3) for the quiescent data JD 2451737-2451745 we have detected the 0.0677-d periodicity that probably connected to the negative superhumps, and for the JD 245497 - 2454974 - these consisting either with simultaneous existing of positive and negative superhumps or with one of these periods.

  15. Survey of period variations of superhumps in SU UMa-type dwarf novae. VIII. The eighth year (2015-2016)

    NASA Astrophysics Data System (ADS)

    Kato, Taichi; Hambsch, Franz-Josef; Monard, Berto; Vanmunster, Tonny; Maeda, Yutaka; Miller, Ian; Itoh, Hiroshi; Kiyota, Seiichiro; Isogai, Keisuke; Kimura, Mariko; Imada, Akira; Tordai, Tamás; Akazawa, Hidehiko; Tanabe, Kenji; Otani, Noritoshi; Ogi, Minako; Ando, Kazuko; Takigawa, Naoki; Dubovsky, Pavol A.; Kudzej, Igor; Shugarov, Sergey Yu.; Katysheva, Natalia; Golysheva, Polina; Gladilina, Natalia; Chochol, Drahomir; Starr, Peter; Kasai, Kiyoshi; Pickard, Roger D.; Miguel, Enrique de; Kojiguchi, Naoto; Sugiura, Yuki; Fukushima, Daiki; Yamada, Eiji; Uto, Yusuke; Kamibetsunawa, Taku; Tatsumi, Taiki; Takeda, Nao; Matsumoto, Katsura; Cook, Lewis M.; Pavlenko, Elena P.; Babina, Julia V.; Pit, Nikolaj V.; Antonyuk, Oksana I.; Antonyuk, Kirill A.; Sosnovskij, Aleksei A.; Baklanov, Aleksei V.; Kafka, Stella; Stein, William; Voloshina, Irina B.; Ruiz, Javier; Sabo, Richard; Dvorak, Shawn; Stone, Geoff; Andreev, Maksim V.; Antipin, Sergey V.; Zubareva, Alexandra M.; Zaostrojnykh, Anna M.; Richmond, Michael; Shears, Jeremy; Dubois, Franky; Logie, Ludwig; Rau, Steve; Vanaverbeke, Siegfried; Simon, Andrei; Oksanen, Arto; Goff, William N.; Bolt, Greg; Dębski, Bartłomiej; Kochanek, Christopher S.; Shappee, Benjamin; Stanek, Krzysztof Z.; Prieto, José L.; Stubbings, Rod; Muyllaert, Eddy; Hiraga, Mitsutaka; Horie, Tsuneo; Schmeer, Patrick; Hirosawa, Kenji

    2016-08-01

    Continuing the project described by Kato et al. (2009, PASJ, 61, S395), we collected times of superhump maxima for 128 SU UMa-type dwarf novae observed mainly during the 2015-2016 season and characterized these objects. The data have improved the distribution of orbital periods, the relation between the orbital period and the variation of superhumps, and the relation between period variations and the rebrightening type in WZ Sge-type objects. Coupled with new measurements of mass ratios using growing stages of superhumps, we now have a clearer and statistically greatly improved evolutionary path near the terminal stage of evolution of cataclysmic variables. Three objects (V452 Cas, KK Tel, and ASASSN-15cl) appear to have slowly growing superhumps, which is proposed to reflect the slow growth of the 3 : 1 resonance near the stability border. ASASSN-15sl, ASASSN-15ux, SDSS J074859.55+312512.6, and CRTS J200331.3-284941 are newly identified eclipsing SU UMa-type (or WZ Sge-type) dwarf novae. ASASSN-15cy has a short (˜0.050 d) superhump period and appears to belong to EI Psc-type objects with compact secondaries having an evolved core. ASASSN-15gn, ASASSN-15hn, ASASSN-15kh, and ASASSN-16bu are candidate period bouncers with superhump periods longer than 0.06 d. We have newly obtained superhump periods for 79 objects and 13 orbital periods, including periods from early superhumps. In order that future observations will be more astrophysically beneficial and rewarding to observers, we propose guidelines on how to organize observations of various superoutbursts.

  16. VizieR Online Data Catalog: TU UMa light curves and maxima, CL Aur minima (Liska+, 2016)

    NASA Astrophysics Data System (ADS)

    Liska, J.; Skarka, M.; Mikulasek, Z.; Zejda, M.; Chrastina, M.

    2016-02-01

    Differential photometry for RR Lyrae star TU UMa in the 1st and 2nd file. The measurements were obtained using 24-inch and 1-inch telescopes, respectively. The observations were performed at the Masaryk University Observatory in Brno (3 nights, 24-inch), and at the private observatory in Brno (16 nights, 1-inch) in the Czech Republic from December 2013 to June 2014. Observing equipments consisted of 24-inch Newtonian telescope (600/2780mm, diameter/focal length) and a Moravian Instruments CCD camera G2-4000 with Stromgren photometric filters vby, and of 1-inch refractor (a photographic lens Sonnar 4/135mm, lens focal ratio/focal length) and ATIK 16IC CCD camera with green photometric filter with similar throughput as the Johnson V filter. Exposures were v - 60s, b - 30s, y - 30s, green - 30s. For the small aperture telescope, five frames were combined to a single image to achieve a better signal-to-noise ratio. The time resolution of a such combined frame is about 170s. CCD images were calibrated in a standard way (dark frame and flat field corrections). The C-Munipack software (Motl 2009) was used for this processing as well as for differential photometry. The comparison star BD+30 2165 was the same for both instruments, but the control stars were BD+30 2164 (for the 24-inch telescope) and HD 99593 (for the 1-inch telescope). The 3rd file contains maxima timings of TU UMa adopted from the GEOS RR Lyr database, from the latest publications, together with maxima timings determined in our study. Times of maxima were calculated from our observations, sky-surveys data (Hipparcos, NSVS, Pi of the Sky, SuperWASP), photographic measurements (project DASCH), and from several published datasets, in which the maxima were omitted or badly determined - Boenigk (1958AcA.....8...13B), Liakos, Niarchos (2011IBVS.6099....1L, 2011IBVS.5990....1L), Liu, Janes (1989ApJS...69..593L), Preston et al. (1961ApJ...133..484P). The 4th file contains minima timings of eclipsing binary CL Aur

  17. Imagens do céu ontem e hoje - um multimídia interativo de astronomia e uma nova exposição no MAST

    NASA Astrophysics Data System (ADS)

    Caretta, C. A.; Lima, F. P.; Requeijo, F.; Vieira, G. G.; Alves, F.; Valente, M. E. A.; de Almeida, R.; de Garcia, G. C.; Quixadá, A. C.

    2003-08-01

    "Imagens do Céu Ontem e Hoje" é o título de uma nova exposição que está sendo inaugurada no Museu de Astronomia e Ciências Afins (MCT), que inclui experimentos interativos, maquetes, réplicas e 8 terminais de computador com um multimídia interativo sobre Astronomia para consulta dos visitantes. O multimídia apresenta um conteúdo bastante extenso, que engloba quase todos os temas em Astronomia, consistindo numa fonte de divulgação e pesquisa para um público que vai das crianças até estudantes universitários. O conteúdo está distribuído em mais de 500 páginas de texto divididas em 4 módulos: "O Universo", "Espectroscopia", "Telescópios" e "Observando o Céu". Cada módulo é subdividido em 5 seções, em média, cada uma iniciada por uma animação que ilustra os temas a serem abordados na seção. Ao final da animação, uma lista de temas é apresentada sob o título "Saiba Mais". Para exemplificar, o módulo "O Universo" contém as seguintes seções: "O Universo visto pelo homem", "Conhecendo o Sistema Solar", "Indo além do Sistema Solar", "Nossa Galáxia, a Via-Láctea" e "Indo mais além, a imensidão do Universo". A seção "Conhecendo o Sistema Solar", por sua vez, tem os seguintes temas: "A origem do Sistema Solar", "O Sol", "Os planetas", "Satélites, asteróides, cometas e outros bichos..." e "O Sistema Solar em números". Cada texto é repleto de imagens, quadros, desenhos, esquemas, etc, além de passatempos ao final de cada seção, incluindo jogos interativos, quadrinhos e curiosidades, que auxiliam o aprendizado de forma divertida. Apresentamos neste trabalho as idéias gerais que permearam a produção da exposição, e uma viagem pelo multimídia para exemplificar sua estrutura e conteúdo. O multimídia será posteriormente disponibilizado para o público externo pela página eletrônica do MAst e/ou por intermédio de uma publicação comercial.

  18. Optimization of Physiochemical Parameters during Bioremediation of Synthetic Dye by Marasmius cladophyllus UMAS MS8 Using Statistical Approach

    PubMed Central

    Shuib, Fatin Nur Sufinas

    2016-01-01

    In many industrial areas such as in food, pharmaceutical, cosmetic, printing, and textile, the use of synthetic dyes has been integral with products such as azo dye, anthrax, and dyestuffs. As such, these industries produce a lot of waste by-products that could contaminate the environment. Bioremediation, therefore, has become an important emerging technology due to its cost-sustainable, effective, natural approach to cleaning up contaminated groundwater and soil via the use of microorganisms. The use of microorganisms in bioremediation requires the optimisation of parameters used in cultivating the organism. Thus the aim of the work was to assess the degradation of Remazol Brilliant Blue R (RBBR) dye on soil using Plackett-Burman design by the basidiomycete, M. cladophyllus UMAS MS8. Biodegradation analyses were carried out on a soil spiked with RBBR and supplemented with rice husk as the fungus growth enhancer. A two-level Plackett-Burman design was used to screen the medium components for the effects on the decolourization of RBBR. For the analysis, eleven variables were selected and from these four parameters, dye concentration, yeast extract concentration, inoculum size, and incubation time, were found to be most effective to degrade RBBR with up to 91% RBBR removal in soil after 15 days. PMID:27803944

  19. First BVR light curves and preliminary results of a recently discovered W UMa-type binary: V1848 Ori

    NASA Astrophysics Data System (ADS)

    Kriwattanawong, W.; Poojon, P.

    2014-04-01

    First complete photometric light curves of a recently discovered contact binary, V1848 Ori, are presented. BVR imaging data were used to derive photometric solutions, using Wilson-Devinney code. We discovered that this system is a weak-contact binary, with a fillout factor of f = 13.14%(±1.44%). Preliminary results showed that V1848 Ori is an A-type W UMa system, with a mass ratio of q = 0.7615. The more massive component was found about 400 K hotter than the other one. This system has varied from W-type to A-type during the last decade. According to the preliminary physical parameters, the weak-contact configuration of this system, with the mass ratio close to unity, and no sign of long-term orbital period change yet, is unlikely to be broken. The contact configuration is expected to be maintained and become deeper or not, depending on effect of the AML mechanism.

  20. Absolute parameter determination in low-mass eclipsing binaries - Radiative parameters for BH Vir, ZZ UMA and CR CAS

    NASA Astrophysics Data System (ADS)

    Clement, R.; Reglero, V.; Garcia, M.; Fabregat, J.; Bravo, A.; Suso, J.

    1993-01-01

    A new uvby and H-beta monitoring program of low mass eclipsing binaries is currently being carried out in the framework of a 5-yr observational program which also involves radial velocity determinations. The scope of this work is to provide very accurate absolute astrophysical parameters: mass, radius, and effective temperatures, for main-sequence late-type stars. One of the main goals is to improve the mass-luminosity relation in the low and intermediate mass range. A second objective is to perform accurate tests of the most recent grids of evolutionary models. This program is complementary to that currently being implemented by the Copenhagen group. In this contribution we present the photometric preliminary results obtained for three of the systems included in our long-term survey: BH Vir, ZZ UMa, and CR Cas for which primary eclipses have been observed. Particular attention is paid to the determination of reddening, distances, and radiative properties. A more detailed study will be carried out when the light curves and radial velocity measurements are completed.

  1. Speciation, population structure, and demographic history of the Mojave Fringe-toed Lizard (Uma scoparia), a species of conservation concern

    PubMed Central

    Gottscho, Andrew D; Marks, Sharyn B; Jennings, W Bryan

    2014-01-01

    The North American deserts were impacted by both Neogene plate tectonics and Quaternary climatic fluctuations, yet it remains unclear how these events influenced speciation in this region. We tested published hypotheses regarding the timing and mode of speciation, population structure, and demographic history of the Mojave Fringe-toed Lizard (Uma scoparia), a sand dune specialist endemic to the Mojave Desert of California and Arizona. We sampled 109 individual lizards representing 22 insular dune localities, obtained DNA sequences for 14 nuclear loci, and found that U. scoparia has low genetic diversity relative to the U. notata species complex, comparable to that of chimpanzees and southern elephant seals. Analyses of genotypes using Bayesian clustering algorithms did not identify discrete populations within U. scoparia. Using isolation-with-migration (IM) models and a novel coalescent-based hypothesis testing approach, we estimated that U. scoparia diverged from U. notata in the Pleistocene epoch. The likelihood ratio test and the Akaike Information Criterion consistently rejected nested speciation models that included parameters for migration and population growth of U. scoparia. We reject the Neogene vicariance hypothesis for the speciation of U. scoparia and define this species as a single evolutionarily significant unit for conservation purposes. PMID:25360285

  2. THE GEOMETRY AND IONIZATION STRUCTURE OF THE WIND IN THE ECLIPSING NOVA-LIKE VARIABLES RW TRI AND UX UMa

    SciTech Connect

    Noebauer, Ulrich M.; Long, Knox S.; Sim, Stuart A.; Knigge, Christian

    2010-08-20

    The UV spectra of nova-like variables are dominated by emission from the accretion disk, modified by scattering in a wind emanating from the disk. Here, we model the spectra of RW Tri and UX UMa, the only two eclipsing nova-like variables which have been observed with the Hubble Space Telescope in the far-ultraviolet, in an attempt to constrain the geometry and the ionization structure of their winds. Using our Monte Carlo radiative transfer code, we computed spectra for simply parameterized axisymmetric biconical outflow models and were able to find plausible models for both systems. These reproduce the primary UV resonance lines-N V, Si IV, and C IV-in the observed spectra in and out of eclipse. The distribution of these ions in the wind models is similar in both cases as is the extent of the primary scattering regions in which these lines are formed. The inferred mass-loss rates are 6%-8% of the mass accretion rates for the systems. We discuss the implication of our point models for our understanding of accretion disk winds in cataclysmic variables.

  3. Teaching and Popularization of Astronomy in Latin America by the Liada Perspective. (Spanish Title: Enseñanza y Divulgación de la Astronomía en la América Latina en la Perspectiva de la Liada.) Ensino e Divulgação da Astronomia na América Latina na Perspectiva da Liada

    NASA Astrophysics Data System (ADS)

    Bretones, Paulo Sergio

    2008-12-01

    disponibilizados en la página de la Sección, faz-se una análisis y discusión sobre la importancia de tales relatos para finalidades educacionales. Es presentada una Hoja de reporte elaborado como sugestión para presentación de relatos por parte de individuos y instituciones ben como discutida la importancia de la sistematización de experiencias visando mayor visibilidad y cambio de informaciones en el área. Concluí con una evaluación de los proyectos, su potencial y limitaciones, ben como sugestiones de proyectos futuros visando mayor interacción entre los países de la América Latina y tornando disponible la Sección para esta finalidad.

    Esse trabalho visa divulgar e analisar as atividades da Seção de Ensino e Divulgação de Astronomia (SEDA) da Liga Iberoamericana de Astronomia (LIADA). Após um histórico da LIADA, são apresentados os diversos projetos da Seção que conta com a colaboração de coordenadores locais na maioria dos países da América Latina. São apresentados os projetos que visam chamar a atenção do público em geral, estudantes e professores para a observação do céu e posterior envio de relatos para colocação na página da Seção na Internet. Mais especificamente são analisados os projetos e relatos relacionados aos eclipses ocorridos desde o ano 2000. Utilizando-se os arquivos disponibilizados na página da Seção, faz-se uma análise e discussão sobre a importância de tais relatos para finalidades educacionais. É apresentado um formulário elaborado como sugestão para apresentação de relatos por parte de indivíduos e instituições bem como discutida a importância da sistematização de experiências visando maior visibilidade e troca de informações na área. Conclui com uma avaliação dos projetos, seu potencial e limitações, bem como sugestões de projetos futuros visando maior interação entre os países da América Latina e tornando disponível a Seção para esta finalidade.

  4. BVRI Photometric Study of the Short Period Solar Type Near-Contact W UMa Binary, FF Vulpeculae

    NASA Astrophysics Data System (ADS)

    Caton, Daniel B.; Samec, Ronald G.; Nyaude, Ropafadzo; Van Hamme, Walter V.

    2016-01-01

    High precision BVRcIc light curves of FF Vul were observed during the Fall, 2015 season at the Dark Sky Observatory 0.81-m reflector of Appalachian State University, and the SARA North 0.91-m reflector at KPNO. It is an eclipsing binary with a period of only 0.444983 (2) d. This is the shortest period of our recently studied Pre Contact W UMa Binary (PCWB's), V2421 Cyg, V1043 Cas, ZZ Eri, V500 Peg, and Mis V1287. Our Binary Maker fits and our Wilson-Devinney solution show that the binary is a near-contact, semidetached binary, i.e., a V1010 Oph type configuration (the more massive component has filled its critical lobe while the secondary component is under-filling). Five times of minimum light were calculated, 3 primary and 2 secondary eclipses from our present observations:HJD I = 2457285.7262 ±0.0002, 2457306.6425 ±0.0002, 2457310.6469 ±0.0002HJD II = 2457279.7222 ±0.0006, 2457280.6124 ±0.0017.The following quadratic ephemerides was determined from all available times of minimum light:JDHelMinI=2457310.6473±0.0007d + 0.4449758±0.0000002 X E -0.00000000006± 0.00000000001 X E2The continuous 20 year period study reveals a period decrease in the orbital period at about the 6 sigma level. Our modeling shows a near-equatorial hot spot on the following side of the secondary component. This is probably due to a matter transfer onto the secondary component. The light curve has a large difference in primary and secondary amplitudes and the light curve solution gives a component temperature difference of more than 1500 K. The solution shows a total secondary eclipse of 23 minutes duration. As expected in binaries of this type, it has a cool spot region on its primary component.

  5. Uma comparação entre técnicas de propagação de erros em astrofísica: Monte Carlo x Bootstrap

    NASA Astrophysics Data System (ADS)

    Waelkens, A. H.; Janot Pacheco, E.

    2003-08-01

    Recentemente Dhillon & Watson (2001) criticaram o procedimento de determinação de erros via simulações de Monte Carlo no caso do imageamento indireto de estrelas, por introduzir ruído nos dados e resultar em erros superestimados. Estes autores propuseram a utilização alternativa do método de Bootstrap como uma técnica superior para a estimativa de erros. Neste trabalho apresentamos os resultados de um estudo comparativo da performance das técnicas de simulação por Monte Carlo e por Bootstrap para a determinação de erros em duas situações de interesse: (i) ajuste de modelos a espectros observados e (ii) imageamento indireto de discos de acréscimo com técnicas de mapeamento por eclipse. No caso (i), os dados de entrada são espectros de emissão simples de hidrogênio aos quais é adicionado ruído gaussiano de amplitude selecionada. No caso (ii), são produzidas curvas de luz do eclipse de uma distribuição de brilho seguindo a lei TµR-3/4 para discos estacionários cuja taxa de acréscimo varia ao longo do eclipse segundo uma distribuição gaussiana de amplitude selecionada, simulando o ruído. A avaliação da performance é feita com o auxílio de um diagrama do erro relativo na grandeza ajustada, conforme obtido por cada método, versus o erro relativo (ruído/sinal) dos dados de entrada. O estudo mostra que as duas técnicas produzem resultados semelhantes nos dois casos, e que a suposta superioridade do método de Bootstrap não se confirma.

  6. Constitutions and Democratic Consolidation: Brazil in Comparative Perspective

    DTIC Science & Technology

    1989-03-31

    Politica. Uma Estrategia para a Democracia," in Fabio W. Reis and Guillermo O’Donnell, eds.,A Democracia no Brasil: Dilemas e Perspectivas (Sao Paulo... Perspectiva dos Anos 80, Dados 24, no. 2, pp. 139-59. 32. Interview with a consultant to lobbies in Brasilia on May 16, 1988. Veja gave coverage to some

  7. Evidence for gas accumulation beneath the surface crust driving cyclic rise and fall of the lava surface at Halema`uma`u, Kilauea Volcano

    NASA Astrophysics Data System (ADS)

    Patrick, M. R.; Orr, T. R.; Wilson, D.; Sutton, A. J.; Elias, T.; Fee, D.; Nadeau, P. A.

    2010-12-01

    The ongoing eruption in Halema`uma`u crater, at the summit of Kilauea Volcano, has surpassed the two-year mark and is characterized by lava lake activity in the vent. As of August 2010, the lava lake is about 70 m in diameter and 180 m below the rim of a narrow vent cavity. Although the explosive events that typified the first year of activity have abated, episodic rise and fall of the lava surface remains common. Cycles of rise and fall range from several minutes to eight hours in duration and are characterized by a quiescent rise phase and violent, gas-charged fall, spanning a height change of 20-30 m. Several models have been proposed to explain the cyclic rise and fall of lava surfaces at basaltic volcanoes, which in some cases is referred to as “gas pistoning”. In one model, episodic rise and fall is driven by the ascent of gas slugs from depth. In another, the cyclic behavior is driven by gas accumulation beneath the surface crust, with each cycle terminated by an abrupt failure of the crust, resulting in gas release. Seismic and infrasound data, as well as gas and webcam monitoring, at Halema`uma`u over the past two years strongly support the gas accumulation model, based on several lines of evidence. First, gas emission rates drop significantly below background levels during the rise phase, and increase dramatically during the fall phase, suggesting a process of gas buildup and release as opposed to slug flow. Second, the rise phases can last several hours, which is longer than reasonable slug ascent times. Third, the rise rate decreases over time, and in many cases plateaus, as the lava reaches its high stand, which is contrary to the exponential increase expected for gas slugs. Fourth, webcam video has captured numerous instances where rockfalls piercing the surface crust initiate gas release and lava level drop, suggestive of gas accumulation at shallow levels. Lastly, FTIR (Fourier Transform Infrared Spectroscopy) data reveal changes in gas

  8. Volatiles in gases and melt inclusions erupted during the 2008-9 Halema`uma`u eruption of Kilauea Volcano, Hawai`i

    NASA Astrophysics Data System (ADS)

    Sawyer, G. M.; Sides, I.; Martin, R.; Mead, I.; Roberts, T. J.; Jones, R.; Tsanev, V. I.; Herd, R.; Sutton, A. J.; Elias, T.; Werner, C. A.; Swanson, D.; Allard, P.; Oppenheimer, C.; Edmonds, M.

    2009-12-01

    Parental magmas ascending beneath Kilauea Volcano degas volatile species in the order of their solubility, with deep degassing (up to a few tens of kilometres depth) dominated by carbon dioxide and shallow degassing (less than 1 km depth), by water and sulphur gases. The 2008-9 Halema`uma`u eruption provides a unique opportunity to measure the composition of primary, unfractionated volcanic gas as part of a young and highly concentrated plume, using new miniature gas sensors. The eruption also offers a chance to test models of volatile fractionation and degassing at Kilauea that were originally proposed a quarter century ago and, in doing so, extend our understanding of magma and degassing pathways at this long-lived and well-studied volcano. In April 2009, the composition of volcanic gas was measured by non-dispersive infra-red spectrometers, electrochemical sensors and FTIR spectroscopy on the Halema`uma`u crater rim. CO2 concentration was measured by two 21 cm-pathlength miniature NDIR spectrometers, deployed side by side. SO2, H2S and CO concentrations were measured simultaneously by an array of electrochemical sensors adjacent to the CO2 sensors. Sampling rates of ~1 Hz were achieved on all sensors. The data sets were cross-correlated with one another and gas ratios derived for the summit gas plume. Open-path active source FTIR measurements carried out close to the sensors yielded independent ratios between the major volatile species. Tephra erupted from the new Halema`uma`u vent in September 2008 was sampled, and olivine-hosted melt inclusions were isolated and exposed for analysis by electron microprobe and SIMS for major elements and volatile species. We present S, Cl, F, H2O and CO2 concentrations in melt inclusions and matrix glasses, as well as major and trace element data, in order to establish degassing and melt evolution trends. We compare the data to those collected previously for East Rift eruptions, for the Summit plume during rift eruptions, for

  9. Uma Visão do Universo Segundo um Grupo de Alunos do Ensino Médio de São Paulo

    NASA Astrophysics Data System (ADS)

    Elias, D. S.; Araújo, M.; Amaral, L. H.; Voelzke, M. R.; Araújo, M.

    2005-08-01

    A astronomia, embora seja uma ciência popular, com inúmeras descobertas de interesse público, ainda é apresentada desconsiderando-se os aspectos históricos e científicos relacionados ao seu desenvolvimento, sendo geralmente veiculada nos meios de comunicação de maneira pouco esclarecedora e não raro com imprecisões. Neste trabalho analisou-se a concepção de um grupo de estudantes de Ensino Médio sobre conceitos de astronomia, visando identificar sua visão de mundo a respeito do Universo, envolvendo idéias sobre espaço e tempo. Para issso, foi aplicado um questionário em três escolas da grande São Paulo em um espaço amostral de 270 alunos. Constatou-se que, embora o ensino de astronomia esteja previsto nos PCNEM, os resultados obtidos na pesquisa mostram que há grande deficiência no conhecimento dos temas investigados. Nesse sentido, verificou-se que apenas 20% dos alunos eram capazes de relacionar a sucessão das semanas com as fases da lua, enquanto 28% associaram as estações do ano à inclinação do eixo de rotação da Terra. Por outro lado, somente 23% dos alunos tinham noções das distâncias entre os objetos celestes próximos da Terra e 56% conseguiram relacionar o Big Bang com a origem do Universo. Finalmente, constatou-se que 37% reconheciam o ano-luz como uma unidade de distância e 60% reconheciam o Sol como sendo uma estrela. Apesar de 60% dos alunos indicarem que a escola é a principal fonte para aquisição dos conhecimentos de astronomia, conclui-se que seus conceitos nessa área ainda são inadequados, havendo necessidade de ampliação e aprimoramento da abordagem desses conteúdos nos ambientes escolares.

  10. Photometric observations and Numerical modeling of SDSS J162520.29+120308.7, an SU UMa in the CV period gap

    NASA Astrophysics Data System (ADS)

    Montgomery, M. M.; Voloshina, I.; Olenick, Richard; Meziere, Kyle; Metlov, Vladimir

    2017-01-01

    We present R-band photometric observations of Cataclysmic Variable dwarf nova SU UMa SDSS J162520.29+120308.7 during the July 2010 superoutburst, from near maximum through decline and into a single rebrightening. We find a maximum superoutburst amplitude of ∼ 6.1 magnitudes and a maximum rebrightening amplitude of ∼4 magnitudes. Near superoutburst maximum, we find 0.09604(3) days for the mean Stage B positive superhump period and a much longer period for the hump shaped modulation during the rebrightening. For the orbital period, we find Porb = 0.09113(30) days. As all periods both agree and disagree with values reported by others, additional observations are needed. Our 2015 observations of this system in quiescence reveal a 0.09080(20) day orbital period. As our 2010 value is within the error bars of a spectroscopically determined value and our 2015 photometrically determined value, we suggest 0.09113(30) days as the orbital period for this system. As for the secondary-to-primary mass ratio, analytical models using observed orbital and Stage B positive superhump periods as input suggest q = 0.221. As a check, we present a 3D SPH simulation of the rise to, and during the plateau stage of, the SU UMa in superoutburst, assuming Porb=0.09113 days. For Stages A and B, we find 0.09717 days and 0.09702 days, respectively, for the average simulated positive superhump periods. Analytical models using these simulated Stages A and B and the simulated orbital period suggest q = 0.1920(4) and q = 0.221, respectively, for this system. Due to the poorly constrained observational data and the similar mass ratio estimates regardless of stage, we can neither confirm nor deny that Stage A is better than Stage B for determining mass ratio in CV dwarf novae SU UMa systems. Additional observations and simulations are needed to further test this recently proposed hypothesis. For now, we suggest an average q = 0.21(1) for this system.

  11. BVR{sub c}I{sub c} OBSERVATIONS AND ANALYSES OF THE DWARF DETACHED BINARY V1043 CASSIOPEIA AND A COMMENT ON PRECONTACT W UMa'S

    SciTech Connect

    Samec, R. G.; Smith, P. M.; Chamberlain, H.; Faulkner, D. R.; Van Hamme, W.

    2013-01-01

    Complete Bessel BVR{sub c}I{sub c} light curves of V1043 Cassiopeia [2MASS J00371195+5301324, Mis V1292, USNO-A2.0 1425-00875743, {alpha}(2000) = 00{sup h}37{sup m}11.{sup s}95, {delta}(2000) = +53 Degree-Sign 01'32.''5] are analyzed. The system is a member of the small group of pre-contact W UMa binaries (PCWBs). Its light curve has the appearance of an Algol (EA) light curve, however it is made up of dwarf solar type components in a detached mode with a period of only 0.6616 days. The analysis includes a period study, an improved ephemeris, a mass ratio search, and a simultaneous BVR{sub c}I{sub c} Wilson-Devinney solution. We document about 20 other PCWBs given in the literature. Several have RS CVn-like properties.

  12. Photometric observations and light curve solutions of the W UMa stars NSVS 2244206, NSVS 908513, CSS J004004.7+385531 and VSX J062624.4+570907

    NASA Astrophysics Data System (ADS)

    Kjurkchieva, Diana Petrova; Popov, Velimir Angelov; Vasileva, Doroteya Lyubenova; Petrov, Nikola Ivanov

    2016-09-01

    Photometric observations in Sloan g‧ and i‧ bands of four W UMa stars, NSVS 2244206, NSVS 908513, CSS J004004.7+385531 and VSX J062624.4+570907, are presented. The light curve solutions reveal that all targets have overcontact configurations with fillout factors within 0.15-0.26. Their components are G-K spectral types and are almost in thermal contact. They are also relatively close in size and luminosity: the radius ratios r2/r1 are within 0.75-0.90 the luminosity ratios l2/l1 are within 0.53-0.63. The results of the light curve solution of CSS J004004.7+385531 imply the weak limb-darkening effect of its primary component and possible presence of additional absorbing features in the system.

  13. Lineage diversification of fringe-toed lizards (Phrynosomatidae: Uma notata complex) in the Colorado Desert: Delimiting species in the presence of gene flow.

    PubMed

    Gottscho, Andrew D; Wood, Dustin A; Vandergast, Amy G; Lemos-Espinal, Julio; Gatesy, John; Reeder, Tod W

    2017-01-01

    Multi-locus nuclear DNA data were used to delimit species of fringe-toed lizards of the Uma notata complex, which are specialized for living in wind-blown sand habitats in the deserts of southwestern North America, and to infer whether Quaternary glacial cycles or Tertiary geological events were important in shaping the historical biogeography of this group. We analyzed ten nuclear loci collected using Sanger sequencing and genome-wide sequence/single-nucleotide polymorphism (SNP) data collected using restriction-associated DNA (RAD) sequencing. A combination of species discovery methods (concatenated phylogenies, parametric and non-parametric clustering algorithms) and species validation approaches (coalescent-based species tree/isolation-with-migration models) were used to delimit species, infer phylogenetic relationships, and to estimate effective population sizes, migration rates, and speciation times. Uma notata, U. inornata, U. cowlesi, and an undescribed species from Mohawk Dunes, Arizona (U. sp.) were supported as distinct in the concatenated analyses and by clustering algorithms, and all operational taxonomic units were decisively supported as distinct species by ranking hierarchical nested speciation models with Bayes factors based on coalescent-based species tree methods. However, significant unidirectional gene flow (2NM>1) from U. cowlesi and U. notata into U. rufopunctata was detected under the isolation-with-migration model. Therefore, we conservatively delimit four species-level lineages within this complex (U. inornata, U. notata, U. cowlesi, and U. sp.), treating U. rufopunctata as a hybrid population (U. notata×cowlesi). Both concatenated and coalescent-based estimates of speciation times support the hypotheses that speciation within the complex occurred during the late Pleistocene, and that the geological evolution of the Colorado River delta during this period was an important process shaping the observed phylogeographic patterns.

  14. Lineage diversification of fringe-toed lizards (Phrynosomatidae: Uma notata complex) in the Colorado Desert: Delimiting species in the presence of gene flow

    USGS Publications Warehouse

    Gottscho, Andrew D.; Wood, Dustin A.; Vandergast, Amy; Lemos Espinal, Julio A.; Gatesy, John; Reeder, Tod

    2017-01-01

    Multi-locus nuclear DNA data were used to delimit species of fringe-toed lizards of theUma notata complex, which are specialized for living in wind-blown sand habitats in the deserts of southwestern North America, and to infer whether Quaternary glacial cycles or Tertiary geological events were important in shaping the historical biogeography of this group. We analyzed ten nuclear loci collected using Sanger sequencing and genome-wide sequence and single-nucleotide polymorphism (SNP) data collected using restriction-associated DNA (RAD) sequencing. A combination of species discovery methods (concatenated phylogenies, parametric and non-parametric clustering algorithms) and species validation approaches (coalescent-based species tree/isolation-with-migration models) were used to delimit species, infer phylogenetic relationships, and to estimate effective population sizes, migration rates, and speciation times. Uma notata, U. inornata, U. cowlesi, and an undescribed species from Mohawk Dunes, Arizona (U. sp.) were supported as distinct in the concatenated analyses and by clustering algorithms, and all operational taxonomic units were decisively supported as distinct species by ranking hierarchical nested speciation models with Bayes factors based on coalescent-based species tree methods. However, significant unidirectional gene flow (2NM >1) from U. cowlesi and U. notata into U. rufopunctata was detected under the isolation-with-migration model. Therefore, we conservatively delimit four species-level lineages within this complex (U. inornata, U. notata, U. cowlesi, and U. sp.), treating U. rufopunctata as a hybrid population (U. notata x cowlesi). Both concatenated and coalescent-based estimates of speciation times support the hypotheses that speciation within the complex occurred during the late Pleistocene, and that the geological evolution of the Colorado River delta during this period was an important process shaping the observed phylogeographic patterns.

  15. Detecção da fase impulsiva de uma explosão solar gigante até 405 GHz

    NASA Astrophysics Data System (ADS)

    Raulin, J.-P.; Makhmutov, V.; Kaufmann, P.; Pacini, A. A.; Luethi, T.; Hudson, H. S.; Gary, D. E.; Yoshimori, M.

    2003-08-01

    A explosão ocorrida no dia 25/08/2001 foi uma das mais intensas do presente ciclo solar em ondas de rádio de altas frequências. Foram medidas em ondas milimétricas e submilimétricas, aproximadamente, 105 e vários milhares de unidades de fluxo solar, respectivamente. Apresentamos um estudo deste evento em múltiplas frequências, desde microondas (1GHz), até ondas submilimétricas (405 GHz) detectadas pelo Telescópio Solar para ondas Submilimétricas (SST). Esta base de dados foi complementada utilizando-se o experimento Yohkoh, incluindo a emissão em raios-X duros e raios-g (até 100 MeV), e imagens em raios-X moles da região ativa envolvida. Enfocamos e discutimos principalmente os seguintes aspectos da fase impulsiva do evento: (i) as implicações deduzidas do espectro eletromagnético, obtido pela primeira vez até 405 GHz; (ii) a dinâmica da região ativa. Os resultados mostram que para explicar o espectro rádio observado, são necessários entre 3.5×1037 e 1.5×1039 elétrons acelerados acima de 20 keV em uma região de campo magnético entre 300 e 800 Gauss. A estimativa do fluxo de fótons que seria produzido por estes elétrons, mostra que grande parte deles não precipitou na baixa atmosfera. A evolução temporal da emissão em raios-X moles revela que a configuração magnética da região ativa foi muito dinâmica durante a fase impulsiva da explosão. Em particular, mostramos que a produção dos elétrons altamente energéticos foi iniciada junto com a aparição, na baixa coroa solar, de um novo sistema compacto de estruturas magnéticas. Este fato sugere que os locais de aceleração estão localizados na baixa atmosfera do Sol, como resultado da interação entre o novo sistema compacto e o campo magnético ambiente da região ativa.

  16. Vesiculation Processes During Transient and Sustained Explosive Activity at Halema'uma'u Crater, Kīlauea in 2008-2013.

    NASA Astrophysics Data System (ADS)

    Houghton, B. F.; Orr, T. R.; Taddeucci, J.; Carey, R.; Del Bello, E.; Scarlato, P.; Patrick, M. R.

    2015-12-01

    The 2008-2015 summit eruption within Halema'uma'u crater, Kilauea has been characterized by alternations of passive degassing with two styles of explosive activity, both frequently triggered by rock falls that perturb the free surface of magma in the vent. In the first, larger rock falls trigger second vesiculation of magma at depths up to 100 m below the free surface ejecting juvenile bomb and lapilli populations of very variable vesicularity. The second, the topic of this presentation, consists of intervals of minutes to tens-of-minutes duration of low fountaining activity often from multiple locations. Vents may migrate with time, first across the free surface to its margins, and then around the margins, in response to convection processes in the underlying melt. Analysis of short sequences of high-speed, high-resolution video footage shows that the sustained fountaining is maintained by not by a continuous discharge but rather by closely spaced bursting of two-to-five meter-wide bubbles. Bubbles accelerate through the free surface at velocities of 10 to 40 m/s disrupting the viscoelastic crust and forming large fall-back, lacework pyroclasts and smaller highly vesicular bombs and lapilli.

  17. Analysis of the southern pre-contact W UMa binary ZZ Eridani: A 34 year period study yields a possible low-mass companion

    SciTech Connect

    Samec, R. G.; Clark, J. D.; Hamme, W. Van; Faulkner, D. R.

    2015-02-01

    Complete Bessel BVRI light curves of ZZ Eridani [2MASS J04130109-1044545, HV 6280, NSVS 14888164 α(2000) = 04{sup h}13{sup m}1{sub ·}{sup s}10, δ(2000) = −10°44′54{sub ·}{sup ″}5 (ICRS), V = 13.9-14.4-15.0] are observed and analyzed. The system is a southern pre-contact W UMa binary. Its light curve has the appearance of an Algol (EA) light curve, however, it is made up of dwarf solar-type components with a period of only 0.4521 days. Our 34 year period study yields a sinusoidal fit or an increasing quadratic fit. The sinusoid may indicate that a third body is orbiting the close binary. The lower-limit mass of the third body is near that of the brown dwarf limit (0.095 M α). Also included is an improved ephemeris, a mass ratio search, and a simultaneous BVRI Wilson–Devinney solution.

  18. Adapting a Common Photographic Camera to Take Pictures of the Sky. (Spanish Title: Adaptando Una Camara Fotografica Comun Para Obtener Fotografias del Cielo.) Adaptando Uma Câmera Fotográfica Manual Simples Para Fotografar o Céu

    NASA Astrophysics Data System (ADS)

    Danhoni Neves, Marcos Cesar; Pereira, Ricardo Francisco

    2007-12-01

    In this paper will be introduced a method of astrophotography using a non-reflex photographic camera (a low-cost method). It will be revised some photographic processes commonly used nowadays for comparison with the aims of this paper. En este trabajo será introducido un método de astrofotografia que utiliza una cámara fotográfica non-reflex (un método de bajo costo). Serán revisados algunos procesos fotográficos comúnmente utilizados actualmente para comparación con los objetivos de este trabajo. O presente artigo procura introduzir um método de astrofotografia utilizando uma câmera fotográfica não reflex, de baixo custo. É feita uma revisão do processo fotográfico comumente empregado para fins de comparação com os objetivos pretendidos no presente trabalho.

  19. Ambient air quality effects of the 2008-2009 Halema`uma`u eruption on the Island of Hawai`i

    NASA Astrophysics Data System (ADS)

    Elias, T.; Sutton, A. J.; Kauahikaua, J. P.; Ray, J. D.; Babb, J. L.

    2009-12-01

    While the Halema`uma`u eruption has enlivened volcanologists with the rare opportunity to observe eruptive processes at Kilauea’s summit, it has also caused significant environmental impact on the Island of Hawai`i. Since the beginning of 2008, the combined SO2 emissions from the east rift zone (ERZ) and summit of Kilauea have increased by ~40% as compared to the 2003-2007 long-term average. However, emissions from Kilauea’s summit have increased ~6-fold, averaging 850 t/d during January 2008-August 2009. Although average emissions from the ERZ during this period have been 1-2 times that of the summit, the relative impact of summit emissions is disproportionately large due to the location of the vent and the plume dispersal pattern to downwind communities. Ambient air quality data show that federal standards have been exceeded frequently in various communities on the south half of the island. Between April 2008 and August 2009, primary health standards for SO2 and PM2.5 were exceeded on 41 and 19 occasions respectively in Pahala, located ~30 km downwind of the Kilauea summit under prevailing trade wind conditions. Pahala, which exceeded the SO2 annual standard for 2008, had not exceeded standards prior to the opening of the Halema`uma`u vent in March 2008. In July 2008, the U.S. Secretary of Agriculture designated Hawai`i County a primary natural disaster area due to agricultural losses from volcanic emissions. Many growers of exotic flower crops in the Ka`u district suffered irrecoverable losses. Coffee and macadamia nut farmers also reported damage to their fields. While some livestock farmers reported eye irritation in cattle, more significant damage was observed in the accelerated deterioration of galvanized fencing, gates, pipelines and other infrastructure. The increase in volcanic pollution has spurred health concerns. A rise in respiratory emergencies for visitors to Kilauea caldera in early 2008 led Hawai`i Volcanoes National Park to close areas

  20. From Delirium to Coherence: Shamanism and Medicine Plants in Silko's "Ceremony"

    ERIC Educational Resources Information Center

    Weso, Thomas F.

    2004-01-01

    A nondescript rock shelter in Texas provides the evidence for shamanism in Leslie Marmon Silko's novel, "Ceremony". There, archaeologists found identifiable images of antlered human figures and entheogenic plant substances, which are medicinal plants, associated with shamanistic practices.

  1. Dissemination Strategies: The Evolution of Learning Resources on the Evaluation of Delirium, Dementia, and Depression

    ERIC Educational Resources Information Center

    Horvath, Kathy J.; Tumosa, Nina; Thielke, Stephen; Moorer, Julie; Huh, Terri; Cooley, Susan; Craft, Suzanne; Burns, Theressa

    2011-01-01

    Clinicians experience great pressures to provide timely, effective, and evidence-based medical care. Educators can aid these clinicians through the development of new tools that can facilitate timely completion of clinical tasks. These tools should summarize evidence-based information in a convenient format that allows easy use. This article…

  2. Delirium Quantum Or, where I will take quantum mechanics if it will let me

    NASA Astrophysics Data System (ADS)

    Fuchs, Christopher A.

    2007-02-01

    Once again, I take advantage of the wonderfully liberal and tolerant mood Andrei Khrennikov sets at his yearly conferences by submitting a nonstandard paper for the proceedings. This pseudo-paper consists of excerpts drawn from two of my samizdats [Quantum States: What the Hell Are They? and Darwinism All the Way Down (and Probabilism All the Way Back Up)] that I think best summarize what I am aiming for on the broadest scale with my quantum foundations program. Section 1 tries to draw a picture of a physical world whose essence is "Darwinism all the way down." Section 2 outlines how quantum theory should be viewed in light of that, i.e., as being an expression of probabilism (in Bruno de Finetti or Richard Jeffrey's sense) all the way back up. Section 3 describes how the idea of "identical" quantum measurement outcomes, though sounding atomistic in character, nonetheless meshes well with a William Jamesian style "radical pluralism." Sections 4 and 5 further detail how quantum theory should not be viewed so much as a "theory of the world," but rather as a theory of decision-making for agents immersed within a quantum world—that is, a world in continual creation. Finally, Sections 6 and 7 attempt to sketch once again the very positive sense in which quantum theory is incomplete, but still just as complete is it can be. In total, I hope these heady speculations convey some of the excitement and potential I see for the malleable world quantum mechanics hints of.

  3. Crack-ing the case: a patient with persistent delirium due to body packing with cocaine.

    PubMed

    Ní Chróinín, D; Gaine, S

    2012-04-01

    A 36-year-old male presented acutely with encephalopathy, following his return to Ireland from a visit to West Africa. Clinical findings included confusion, agitation and tonic-clonic seizures. Difficulties in weaning sedation prompted repeat urine toxicology screening at day 8, which was positive for cocaine. Work-up for a source of continued cocaine exposure led to the discovery of cocaine-containing packages in the gastrointestinal tract. An index of suspicion should be maintained in patients presenting with drug toxicity following cross-border travel.

  4. Delirium due to scopolamine patch in a 4-year-old boy.

    PubMed

    Lin, Yang-Guang; Chen, Po-Hon; Chang, Fang-Yuan; Wu, Li-Te; Liao, Kuo-Yu; Wu, Tzee-Chung

    2011-03-01

    The scopolamine patch is usually used to reduce postoperative nausea and vomiting associated with anesthesia and/or surgery. It is also commonly used for the prevention of motion sickness. Transdermal scopolamine patches have been used for decades and there are few reports in the literature of toxic psychosis associated with the product. Most documented cases of acute psychosis following administration of scopolamine or other anticholinergic agents have been from the adult population. Here we present a 4-year-old boy with deteriorated cognitive function and changed mental status acutely. Besides flushing skin and psychotic behaviors including bizarre actions, hallucinations, aggressive behavior, hyperactivity, and incoherent speech were also noticed. Symptoms and signs were resolved after removal of scopolamine patch and conservative management. This case is possibly one of the youngest patients to exhibit such toxic effects. We hope to relay information about common agents with anticholinergic effects to clinical practitioners and remind that drug-induced psychosis should be considered in children with acute changes in behavior.

  5. Variação temporal do gradiente radial de o/h a partir de uma amostra de nebulosas planetárias

    NASA Astrophysics Data System (ADS)

    Maciel, W. J.; Costa, R. D. D.; Uchida, M. M. M.

    2003-08-01

    Gradientes radiais de abundância são observados no disco de nossa Galáxia e também em outras galáxias espirais. No caso da Galáxia, o principal problema relativo aos gradientes é sua variação temporal, que constitui um dos principais vínculos aos modelos de evolução química da Galáxia. As nebulosas planetárias são particularmente interessantes no estudo dos gradientes e suas variações, tanto espaciais como temporais. São objetos brilhantes, podendo ser observadas a grandes distâncias, e têm abundâncias relativamente precisas de diversos elementos químicos. Além disso, sendo originadas de estrelas com massas entre 0.8 e 8 massas solares na sequência principal, incluem objetos com idades e populações diferentes, o que as torna especialmente interessantes ao estudo da variação temporal dos gradientes. Neste trabalho, apresentamos resultados recentes sobre a variação temporal do gradiente de O/H a partir de uma amostra contendo cerca de 200 nebulosas, para as quais obtivemos distâncias por métodos estatísticos. As abundâncias foram parcialmente obtidas a partir de observações em Itajubá e La Silla, sendo as restantes obtidas da literatura. Os resultados mostram, pela primeira vez, evidências de um achatamento do gradiente de O/H, de -0.11 dex/kpc para -0.06 dex/kpc nos últimos 9 giga-anos ou de -0.08 dex/kpc para -0.06 dex/kpc nos últimos 5 giga-anos. Esses valores apresentam um bom acordo com alguns modelos recentes para a evolução química da Galáxia. (FAPESP/CNPq)

  6. Uso de modelos mecânicos em curso informal de astronomia para deficientes visuais. Resgate de uma experiência

    NASA Astrophysics Data System (ADS)

    Tavares, E. T., Jr.; Klafke, J. C.

    2003-08-01

    O presente trabalho propõe-se a resgatar uma experiência que teve lugar no Planetário de São Paulo nos anos 60. Em 1962, o Sr. Acácio, então com 37 anos, deficiente visual desde os 27, passou a assistir às aulas ministradas pelo Prof. Aristóteles Orsini aos integrantes do corpo de servidores do Planetário. O Sr. Acácio era o único deficiente da turma e, embora possuísse conhecimentos básicos e relativamente avançados de matemática, enfrentava dificuldades na compreensão e acompanhamento da exposição, como também em estudos posteriores. Com o intuito de auxiliá-lo na superação desses problemas, o Prof. Orsini solicitou a construção de modelos mecânicos que, através do sentido do tato, permitissem o acompanhamento das aulas e a transposição do modelo para o "constructo" mental. Essa prática mostrou-se tão eficaz que facilitou sobejamente o aprendizado da matéria pelo sujeito. O Sr. Acácio passou a integrar o corpo de professores do Planetário/Escola Municipal de Astrofísica, tendo ficado responsável pelo curso de "Introdução à Astronomia" por vários anos. Além disso, a experiência foi tão bem sucedida que alguns dos modelos tiveram seus elementos constitutivos pintados diferencialmente para serem utilizados em cursos regulares do Planetário, tornando-se parte integrante do conjunto de recursos didáticos da instituição. É pensando nessa eficácia, tanto em seu objetivo original permitir o aprendizado de um deficiente visual quanto no subsidiário recurso didático sistemático da instituição que decidimos resgatar essa experiência. Estribados nela, acreditamos ser extremamente produtivo, em termos educacionais, o aperfeiçoamento dos modelos originais, agora resgatados e restaurados, e a criação de outros que pudessem ser utilizados no ensino dessa ciência a deficientes visuais.

  7. Percepção astronómica de um grupo de alunos do ensino médio de uma escola da rede estadual de São Paulo

    NASA Astrophysics Data System (ADS)

    de Oliveria, E. F.; Voelzke, M. R.

    2009-03-01

    Sendo a Astronomia uma das cièncias mais antigas da humanidade, e considerando sua importáncia histórica e cultural, é de extrema releváncia que tópicos relacionados a ela sejam tratados nas escolas. Embora os Parámetros Curriculares Nacionais do Ensino Médio (PCN-EM) e as Orientaçiacute;es Complementares aos Parámetros (PCN+) apontem a importáncia de uma abordagem significativa de conceitos relacionados à Astronomia nas aulas de Física, muitos estudantes terminam o Ensino Médio (EM) sem compreender a razão de certos acontecimentos de origem celeste, ainda que estes façam parte de seu cotidiano e sejam alvos da curiosidade natural dos jovens. Da observação dessa curiosidade em alunos de uma escola pública paulista, na cidade de Suzano, surgiu o interesse em investigar os conhecimentos básicos em Astronomia dos alunos do Ensino Médio desta escola, constituindo-se este como principal objetivo desta pesquisa. Para tanto foi elaborado um questionário de múltipla escolha aplicado inicialmente a 34 alunos do primeiro ano e, posteriormente, a mais 310, distribuídos entre as très séries do Ensino Médio dos períodos matutino e noturno. Dessa forma, observou-se que 73,9% dos estudantes identificaram o Sol como sendo uma estrela, 67,1% mostraram compreender a sucessão entre dia e noite e 52,3% relacionaram o Big Bang à origem do Universo. Em contrapartida, apenas 34,5% relacionaram as estaçíes do ano à inclinação do eixo de rotação da Terra, 21,3% indicaram a influència gravitacional simultánea da Lua e do Sol como responsável pelo fenòmeno das marés, 24,5% indicaram corretamente quais são os objetos celestes mais próximos da Terra, 36,1% identificaram ano-luz como uma medida de distáncia e 34,2% reconheceram as estrelas cadentes como meteoros, evidenciando-se assim o pequeno discernimento dos estudantes quanto aos fenòmenos e termos astronòmicos do cotidiano. Além disso, foram comparadas as respostas de alun! os de diferentes s

  8. Multiwavelength optical observations of chromospherically active binary systems. V. FF UMa (2RE J0933+624): a system with orbital period variation

    NASA Astrophysics Data System (ADS)

    Gálvez, M. C.; Montes, D.; Fernández-Figueroa, M. J.; de Castro, E.; Cornide, M.

    2007-09-01

    Context: This is the fifth paper in a series aimed at studying the chromospheres of active binary systems using several optical spectroscopic indicators to obtain or improve orbital solution and fundamental stellar parameters. Aims: We present here the study of FF UMa (2RE J0933+624), a recently discovered, X-ray/EUV selected, active binary with strong Hα emission. The objectives of this work are, to find orbital solutions and define stellar parameters from precise radial velocities and carry out an extensive study of the optical indicators of chromospheric activity. Methods: We obtained high resolution echelle spectroscopic observations during five observing runs from 1998 to 2004. We found radial velocities by cross correlation with radial velocity standard stars to achieve the best orbital solution. We also measured rotational velocity by cross-correlation techniques and have studied the kinematic by galactic space-velocity components (U, V, W) and Eggen criteria. Finally, we have determined the chromospheric contribution in optical spectroscopic indicators, from Ca ii H & K to Ca ii IRT lines, using the spectral subtraction technique. Results: We have found that this system presents an orbital period variation, higher than previously detected in other RS CVn systems. We determined an improved orbital solution, finding a circular orbit with a period of 3.274 days. We derived the stellar parameters, confirming the subgiant nature of the primary component (MP = 1.67 M⊙ and R sin{i}_P=2.17 R⊙) and obtained rotational velocities (v sin{i}), of 33.57 ± 0.45 km s-1 and 32.38 ± 0.75 km s-1 for the primary and secondary components respectively. From our kinematic study, we can deduce its membership to the Castor moving group. Finally, the activity study has given us a better understanding of the possible mechanisms that produce the orbital period variation. Based on observations collected with the 2.2 m telescope at the Centro Astronómico Hispano Alemán (CAHA

  9. Learning Astronomy by Playing in a Park. (Spanish Title: Aprender AstronoMía Jugando en Una Plaza.) Aprender Astronomia Brincando em Uma Praça

    NASA Astrophysics Data System (ADS)

    Camino, Néstor

    2012-12-01

    trabalho alguns jogos de praça, considerados como módulos didáticos para imaginar processos astronômicos, a partir da concepção de que a aprendizagem em Astronomia deve-se desenvolver fortalecendo a relação do próprio corpo com o espaço tridimensional e com o tempo, tal como se vive ao observar o céu, construindo um "diálogo" entre o mundo real e as aprendizagens a construir. Os jogos apresentados (carrosséis e tobogãs) foram desenhados para trabalhar sobre a translação da Terra em torno do Sol, as fases da Lua e a gravidade, e sobre o que um observador percebe dos mesmos. Dá-se a descrição de cada jogo, discutem-se seus fundamentos físicos e astronômicos, e desenvolve-se uma crítica didática dos mesmos. Finalmente, comenta-se o papel que deveriam ter os docentes no apoio aos aprendizes no processo de interação com os jogos apresentados.

  10. Agitation

    MedlinePlus

    ... alertness (altered consciousness) can be a sign of delirium . Delirium has a medical cause and should be checked ... PCP, or opiates) Hospitalization (older adults often have delirium while in the hospital) Overactive thyroid gland ( hyperthyroidism ) ...

  11. Uma análise do fenômeno “alternância de línguas” na fala de bilíngues intermodais (Libras e Português)

    PubMed Central

    de Sousa, Aline Nunes; de Quadros, Ronice Müller

    2013-01-01

    Um interessante fenômeno lingüístico presente nas interações das pessoas bilíngues é a alternância de línguas. Neste trabalho, estamos investigando a alternância entre a língua portuguesa oral e a língua de sinais brasileira – Libras, numa mesma cadeia enunciativa, com o objetivo de identificar e analisar o uso dessa alternância na fala de uma criança e de um adulto (ambos ouvintes, filhos de pais surdos), interagindo em uma situação de bilinguismo intermodal, com interlocutores surdos e ouvintes. A alternância de línguas, nesse caso, ocorre quando se para de falar em português e se alterna para sinalizar. O presente trabalho se caracteriza como um estudo inicial, com análise qualitativa de dados. Fazem parte do nosso corpus nove sessões de interações em Libras e em português oral, gravadas em vídeo, que fazem parte do Projeto Desenvolvimento Bilíngue Bimodal da UFSC. Os dados revelam que as características da alternância de línguas pelo adulto e pela criança parecem ter semelhanças e diferenças. O sujeito adulto parece ter feito um uso da alternância mais preocupado com o curso da interação. A criança, por sua vez, não parece tê-la usado com propósitos pragmáticos específicos. Quanto à extensão das alternâncias, pode-se perceber que tanto a criança quanto o adulto utilizaram enunciados maiores do que uma única palavra isolada. O papel dos interlocutores parece ter sido decisivo nas interações aqui investigadas – especialmente nas do adulto, já que a criança ainda está em processo de tomada de consciência do papel do interlocutor na interação. PMID:24379831

  12. Neuroimagen en la enfermedad de Alzheimer: nuevas perspectivas

    PubMed Central

    Becker, James T.

    2012-01-01

    Introducción y desarrollo En los próximos 50 años vamos a presenciar un incremento significativo de la población mayor de 65 años y por lo tanto va a aumentar, considerablemente, el número de individuos con riesgo de desarrollar demencias neurodegenerativas, especialmente la enfermedad de Alzheimer (EA). Las estrategias actuales de tratamiento farmacológico y no farmacológico se han centrado en las fases sintomáticas de esta enfermedad y, gradualmente, vamos teniendo una mayor comprensión de los posibles factores de riesgo del síndrome clínico. Conclusiones Los estudios de neuroimagen han sido muy útiles para mostrar los cambios estructurales del envejecimiento normal y patológico, así como también los factores de riesgo para la EA. Los tratamientos apropiados de los factores de riesgo y su posible combinación con tratamientos específicos para la EA podrían prolongar el período presintomático de la EA y, por tanto, mejorar la calidad de vida y disminuir la carga para el paciente, la familia y la sociedad. PMID:20517866

  13. School Enrollment Trends: 1981-1985. Perspectivas Publicas. Issue Brief.

    ERIC Educational Resources Information Center

    National Council of La Raza, Washington, DC. Office of Research Advocacy and Legislation.

    Using 1985 school enrollment data for persons 3 to 34 years old, this report discusses increases and decreases in overall enrollments by race and ethnicity. Data on school completion rates are also presented. They reveal that the Hispanic population of 3- to 24-year-olds is growing at a faster rate than either Blacks or Whites, and thus becoming a…

  14. Immigration Reform and Related Issues. Perspectivas Publicas. Issue Update.

    ERIC Educational Resources Information Center

    National Council of La Raza, Washington, DC.

    Asserting that immigration reform and related issues have commanded sustained attention in the opening weeks of the 99th Congress, this paper provides an overview of important developments in this area, and highlights steps taken by the National Council of La Raza to help shape these developments. The developments discussed include: (1) The…

  15. Perspectivas en Chicano Studies I (Perspectives in Chicano Studies I).

    ERIC Educational Resources Information Center

    Macias, Reynaldo Flores, Ed.

    The first of 12 papers, "Colonial Labor and Theories of Inequality: The Case of International Harvestor", reports on the role of minority labor in one of the largest corporations in the U.S. and interprets the patterns of inequality within a framework of colonial theory. "Casimiro Barela: A Case Study of Chicano Political History in…

  16. Una Perspectiva de Mexico: Its People, Places and History.

    ERIC Educational Resources Information Center

    Bianchi, Gary; Bianchi, Maria Eugenia Matute

    Evolving from a general commitment to the goals of cultural pluralism and bicultural education, this portfolio of 24 full color and halftone photographs aims to reinforce those curricular objectives which emphasize a respect for the value and individuality of different cultures and groups, affirm the right of an individual to maintain a bicultural…

  17. Basic Concepts of Astronomy: a Methodological Proposal. (Spanish Title: Conceptos Básicos de Astronomía: Una Propuesta Metodológica.) Conceitos Básicos de Astronomia: Uma Proposta Metodológica

    NASA Astrophysics Data System (ADS)

    Darroz, Luiz Marcelo; Heineck, Renato; Samudio Pérez, Carlos Ariel

    2011-12-01

    obtenidos en diferentes momentos, por los comentarios efectuados por los participantes durante las actividades y por los altos índices de aprobación al final de la etapa, consideramos que la propuesta atingió los objetivos establecidos y puede ser repetida con certeza de éxito. Neste relato, descreve-se o desenvolvimento de uma proposta metodológica que aborda conceitos básicos de astronomia fundamentada pedagogicamente na Aprendizagem Significativa. A proposta, que compreende quatro encontros, foi desenvolvida por professores e acadêmicos do curso de Licenciatura em Física da Universidade de Passo Fundo (UPF), através de um curso de extensão, a um grupo de dez estudantes do ensino médio de uma escola pública da cidade de Passo Fundo, RS. O trabalho centrou-se em conceitos básicos de astronomia. Os indícios da aprendizagem significativa foram obtidos por instrumentos de pesquisa e avaliação aplicados ao término de cada encontro. A avaliação da proposta foi efetuada através de um questionário final respondido pelos participantes ao término do desenvolvimento das atividades. Pelos resultados obtidos nos diferentes instrumentos, pelos comentários efetuados pelos participantes durante as atividades e pelos altos índices de aprovação alcançados no questionário final, consideramos que a proposta atingiu os objetivos estabelecidos e pode ser repetida com convicção de sucesso.

  18. A Proposed Activity for a Meaningful Learning about the Moon Phases. (Breton Title: Uma Proposta de Atividade Para a Aprendizagem Significativa sobre as Fases da Lua.) Una Actividad Propuesta Para EL Aprendizaje Significativo Acerca de Las Fases de la Luna

    NASA Astrophysics Data System (ADS)

    Martins, Bruno Andrade; Langhi, Rodolfo

    2012-12-01

    This paper presents one of the concepts of Astronomy and its consequent failure in teaching this topic in high school, even when the official documents point out the necessity of Astronomy teaching at this school level. Among the spontaneous conceptions in Astronomy that high school students carry with them, even after the end of the school, we emphasized in this research the Moon phases. The development of different strategies in relation to traditional methods, aimed to teaching-learning process on this topic was considered in this study. These strategies were devised based on the reference frame of the Meaningful Learning, as elaborated by Ausubel. The proposals presented here include the active participation of students in experimental activities and other didactic activities, for their continuous evaluation during the process. These activities finished with a Comics elaboration about the Moon phases. Therefore, the objective of this paper is to present a proposal for differentiated teaching activity about Moon phases supported by the theoretical principles of Meaningful Learning at Physics classes. Este texto foca um dos conteúdos de Astronomia e a consequente falha no ensino deste tema no ensino médio, apesar de os documentos oficiais apresentarem a necessidade de se trabalhar a Astronomia neste nível de ensino. Dentre as concepções alternativas em Astronomia que os alunos do ensino médio carregam consigo, mesmo após o término dos estudos, destacamos, nesta pesquisa, o fenômeno das fases da Lua. O desenvolvimento de estratégias diferenciadas em relação ao ensino tradicional, visando o processo de ensino-aprendizagem sobre este tema, foi contemplado neste trabalho como um dos resultados obtidos sob a luz dos referenciais da aprendizagem significativa, fundamentados em Ausubel. Segundo a proposta aqui apresentada, a participação ativa dos alunos na execução de uma atividade experimental e outras atividades didáticas, que visam sua cont

  19. Portuguese and the Computer: "uma bossa nova".

    ERIC Educational Resources Information Center

    Kelly, John R.

    This paper describes the process of preparing a computer study of Brazilian Portuguese literary texts to be used both in teaching and in the preparation of a reference text. Procedural difficulties encountered in the project point out the potential and limitations of computerized research in literary studies. Seven possible areas for computer…

  20. Seniors and Anesthesia

    MedlinePlus

    ... surgery risks particularly in older people are: Postoperative delirium – This temporary condition may not develop until a ... during surgery and decrease your risk of cognitive delirium or dysfunction, plan ahead. Request that a physician ...

  1. Yellow fever

    MedlinePlus

    ... liver, and kidney. Bleeding disorders, seizures, coma, and delirium may also occur. Symptoms may include: Fever, headache, ... tongue Yellow skin and eyes (jaundice) Decreased urination Delirium Irregular heartbeats (arrhythmias) Bleeding (may progress to hemorrhage) ...

  2. 38 CFR 4.126 - Evaluation of disability from mental disorders.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... impairment, but shall not assign an evaluation solely on the basis of social impairment. (c) Delirium...., a head injury) shall be evaluated separately and combined with the evaluation for delirium,...

  3. Gas gangrene

    MedlinePlus

    ... Possible Complications Complications that may result include: Coma Delirium Disfiguring or disabling permanent tissue damage Jaundice with ... Read More Acute kidney failure Alertness - decreased Anaerobic Delirium Necrosis Necrotizing soft tissue infection Shock Stress and ...

  4. Evolution of Wernicke-Korsakoff syndrome in self-neglecting alcoholics: preliminary results of relation with Wernicke-delirium and diabetes mellitus.

    PubMed

    Wijnia, Jan W; van de Wetering, Ben J M; Zwart, Elles; Nieuwenhuis, K Gerrit A; Goossensen, M Anne

    2012-01-01

    We present a descriptive, retrospective study of initial symptoms, comorbidity, and alcohol withdrawal in 73 alcoholic patients with subsequent Korsakoff syndrome. In 25/73 (35%) of the patients the classic triad of Wernicke's encephalopathy with ocular symptoms, ataxia and confusion, was found. In at least 6/35 (17%) of the initial deliria (95% confidence interval: 10-25%) we observed no other underlying causes, thus excluding other somatic causes, medication, (recent) alcohol withdrawal, or intoxication. We suggest that these deliria may have been representing Wernicke's encephalopathy. A high frequency (15%) of diabetics may reflect a contributing factor of diabetes mellitus in the evolution of the Wernicke-Korsakoff syndrome.

  5. Early post-surgical cognitive dysfunction is a risk factor for mortality among hip fracture hospitalized older persons.

    PubMed

    Ruggiero, C; Bonamassa, L; Pelini, L; Prioletta, I; Cianferotti, L; Metozzi, A; Benvenuti, E; Brandi, G; Guazzini, A; Santoro, G C; Mecocci, P; Black, D; Brandi, M L

    2017-02-01

    This study investigates the relationship between cognitive dysfunction or delirium detected in the early post-surgical phase and the 1-year mortality among 514 hip fracture hospitalized older persons. Patients with early cognitive dysfunction or delirium experienced a 2-fold increased mortality risk. Early post-operative cognitive dysfunction and delirium are negative prognostic factors for mortality.

  6. Analysis of the Presence of Content about Astronomy in a Decade of the National High School Examination (1998-2008). (Spanish Title: Análisis de la Presencia de Contenidos de Astronomía em Uma Década del Examen Nacional de Enseñaza Secundária (1998-2008).) Análise da Presença de Conteúdos de Astronomia em Uma DÉcada do Exame Nacional do Ensino Médio (1998-2008)

    NASA Astrophysics Data System (ADS)

    Gomide, Hanny Angeles; Longhini, Marcos Daniel

    2011-07-01

    In this paper we analyzed the presence of contents of Astronomy in the National High School Examination (ENEM) in its first decade (1998-2008). We verified the number of questions addressing this topic that were present over the years, as well as the most recurrent subjects. We discussed the results from what is proposed by the official documents regarding the teaching of Astronomy in the Elementary and Secondary Education and we entertain future expectations about the presence of contents of this science in future official examinations. En este trabajo realizamos un análisis de la presencia de contenidos de Astronomía em las pruebas del Examen Nacional de Enseñanza Secundaria (ENEM) em su primera década de existência (1998-2008). Contabilizamos la cantidad de preguntas incluyendo este tema que estuvieron presentes en el transcurso de los años, así como los temas más recurrentes. Discutimos los resultados a partir de lo propuesto por los documentos oficiales en relación a la enseñanza de Astronomía en la Educación Básica y elaboramos algunos apuntes sobre futuras expectativas em relación a la presencia de contenidos de esta ciencia en examenes oficiales. No presente trabalho fizemos uma análise da presença de conteúdos de Astronomia nas provas do Exame Nacional do Ensino Médio (ENEM), em sua primeira década de existência (1998-2008). Verificamos a quantidade de questões envolvendo essa temática que estiveram presentes no decorrer dos anos, assim como os temas mais recorrentes. Discutimos os resultados a partir do que é proposto pelos documentos oficiais em relação ao ensino de Astronomia na Educação Básica e tecemos alguns apontamentos sobre a expectativa futura quanto à presença de conteúdos dessa ciência nesse exame oficial.

  7. The Universe in a Box: Introduction to the Study of Astronomy in the Initial Formation of Physics Teachers. (Spanish Title: El Universo Representado en Una Caja: Introducción al Estudio de la Astronomía en la Formación Inicial de Profesores de Física.) O Universo Representado em Uma Caixa: Introdução ao Estudo da Astronomia NA Formação Inicial de Professores de Física

    NASA Astrophysics Data System (ADS)

    Longhini, Marcos Daniel

    2009-07-01

    This is a report of an activity of introduction to the study of Astronomy developed with a group of future Physics teachers at a Brazilian public university. Such activity had the goal of giving privileged emphasis to notions of spatiality, alternative conceptions of the participants and the process of interaction among peers, and consisted of the representation, in a three dimensional space, of the models of the universe that the participants had. The results, which were categorized as miscellaneous, geocentric, heliocentric and acentric models of the universe, were qualitatively analyzed. Analyses of the activity in the perspective of the participants are indicated and additional considerations are made regarding its use as a resource for teaching Astronomy and for teacher training. Este es el informe de una actividad para presentar un estudio introductorio de la Astronomía, desarrollado con una clase de futuros profesores de física en una universidad pública brasileña. Esta actividad tuvo como objetivo centrar las nociones de espacialidad, las concepciones alternativas de los participantes y el proceso de interacción entre pares, y consistió en la representación en un espacio tridimensional, de los modelos del universo que los participantes habían. Los resultados, que se clasificaron en universo miscelania, geocéntrico, heliocéntrico y acentrico, se analizaron cualitativamente. Son identificadas análisis de la actividad por los participantes, e hizo observaciones sobre su uso como recurso para la enseñanza de la astronomía y la formación de docentes. Trata-se do relato de uma atividade de introdução ao estudo da Astronomia, desenvolvida com uma turma de futuros professores de Física, em uma universidade pública brasileira. Tal atividade teve como meta privilegiar noções de espacialidade, as concepções alternativas dos participantes e o processo de interação entre pares e constou da representação, em um espaço tridimensional, dos

  8. Nuevas Perspectivas en la Efficiencia del Uso Nirogeno en Vaca Lecheras

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Dairy cows utilize feed crude protein (CP) with greater efficiency than other ruminants, but still excrete about 2 to 3 times more nitrogen (N) in manure than they secrete in milk. This increases milk production costs plus environmental N pollution. Optimizing microbial protein formation in the rume...

  9. MIRADA A LA MENTORÍA EN INVESTIGACIÓN DESDE LA PERSPECTIVA SOCIOCULTURAL DE VYGOTSKY

    PubMed Central

    SANTIAGO, NILDA G. MEDINA; RIVERA, TANIA M. CRUZ; ORTIZ, NATALIA JORDÁN

    2015-01-01

    In this article the authors illustrate the mentoring process through the framework of Vygotsky's sociocultural perspective regarding education and human development. To achieve this goal, they describe their experience as mentor and mentees in a research training mentoring program for undergraduate students. The authors argue that this theoretical and philosophical perspective offers a solid background to mentoring as a real option that contributes to the learning process. They recommend these programs to be encouraged by academic institutions in order for more students and professors to benefit from this process. PMID:27042255

  10. MIRADA A LA MENTORÍA EN INVESTIGACIÓN DESDE LA PERSPECTIVA SOCIOCULTURAL DE VYGOTSKY.

    PubMed

    Santiago, Nilda G Medina; Rivera, Tania M Cruz; Ortiz, Natalia Jordán

    In this article the authors illustrate the mentoring process through the framework of Vygotsky's sociocultural perspective regarding education and human development. To achieve this goal, they describe their experience as mentor and mentees in a research training mentoring program for undergraduate students. The authors argue that this theoretical and philosophical perspective offers a solid background to mentoring as a real option that contributes to the learning process. They recommend these programs to be encouraged by academic institutions in order for more students and professors to benefit from this process.

  11. Undocumented Immigrants in the Labor Market: Recent Research Findings. Perspectivas Publicas: Issue Brief.

    ERIC Educational Resources Information Center

    National Council of La Raza, Washington, DC.

    Most early research on the impact of undocumented workers on the labor market held that it results in the widespread displacement of native workers. More recent and more sophisticated theory argues that immigrants, both legal and illegal, create jobs by consuming goods and services, and by starting new businesses. This latter idea may not be as…

  12. The Proposed Bilingual Education Act Amendments of 1987. Perspectivas Publicas. Issue Brief.

    ERIC Educational Resources Information Center

    National Council of La Raza, Washington, DC. Office of Research Advocacy and Legislation.

    Ten bills have been introduced in Congress in 1987 to amend the Bilingual Education Act. Five of these are similar to legislation introduced in 1985, and they are not expected to be acted upon. The remaining five had been acted upon and are as follows: (1) S.1238 which is designed to increase the proportion of existing funds in the Bilingual…

  13. Perspectiva sobre una Personalidad Senera: Carmen Fischer Ramirez (Perspective on a Singular Personality: Carmen Fischer Ramirez).

    ERIC Educational Resources Information Center

    Quezeda, Dina Alarcon

    1992-01-01

    Traces the career of Carmen Fischer Ramirez, focusing on her work in improving early childhood education in Chile. Reviews her university career, work with the World Organization for Early Childhood Education, and major publications. (AC)

  14. Perspectiva General sobre la Sordo-Ceguera (Overview on Deaf-Blindness). DB-LINK.

    ERIC Educational Resources Information Center

    Miles, Barbara

    This overview provides basic information on the causes of deaf-blindness and the particular challenges faced by individuals who are deaf-blind. Causes of deaf-blindness include various syndromes, multiple congenital anomalies, prematurity, congenital prenatal dysfunction, and various postnatal causes. Differences between people deaf-blind from…

  15. Molecular Hydrogen in the Quiescent Disk of SW UMa

    NASA Technical Reports Server (NTRS)

    Raymond, John C.

    2004-01-01

    The FUSE observation has been reduced and a paper has been submitted to ApJ. The analysis has been slow because of the very noisy quality of the data, but we have derived line profile information for O VI and limits to the continuum brightness which place an interesting limit on the white dwarf temperature. The primary results are that a narrow O VI emission component seems to arise from the accretion flow onto the white dwarf itself, in agreement with cooling flow models for the X-ray spectra of low accretion rate dwarf novae. The broad component of the O VI lines is weaker than the observed C IV emission, suggesting that the UV line emission from the disk comes from photoionized plasma. A secondary result is that there is no H-2 fluorescent emission. The upper limits indicate that if molecular gas is present in the disk, it is shielded from Ly alpha photons by a layer of atomic hydrogen on the disk surface. We also derive an upper limit to the continuum level is below that observed by IUE. The limits are compatible with the lower end of the WD temperature range derived from IUE measurements, and they appear to agree with unpublished analysis of HST spectra. The grant has provided partial support for a data aide (Matt Povich) and a postdoc (Alex Lobel). It purchased a computer for M. Menou.

  16. The Understanding of Astronomy Concepts by Students from Basic Education of a Public School. (Spanish Title: El Entendimiento de Conceptos de Aastronmía Por Los Alumnos de Educación Básica en Una Escuela Pública.) O Entendimento de Conceitos de Astronomia Por Alunos da Educação Básica: O Caso de Uma Escola Pública Brasileira

    NASA Astrophysics Data System (ADS)

    Iria Machado, Daniel; dos Santos, Carlos

    2011-07-01

    movimiento de la Luna, el movimiento aparente del Sol sobre la esfera celeste, los eclipses, las dimensiones y las distancias en el Universo, el brillo de las estrellas y su observación de la Tierra. Si bien ha habido un pequeño progreso en la proporción de respuestas aceptables científicamente cuando se cotejó el octavo grado de la enseñanza primaria con el quinto, y el último año de la enseñanza secundaria con el primero, se observó un predominio de las concepciones alternativas en relación a la mayoría de los temas explorados, que continuó hasta los últimos años de la educación básica. Una comparación con los datos encontrados en investigaciones realizadas en otros contextos socioculturales revelaron, en muchos aspectos, conceptos y dificultades similares expresadas por los estudiantes. Apresentam-se os resultados de uma investigação sobre a compreensão de conceitos astronômicos básicos, da qual participaram 561 estudantes da quinta série do Ensino Fundamental ao terceiro ano do Ensino Médio de uma escola pública da cidade de Foz do Iguaçu. Um teste com 20 questões de múltipla escolha foi aplicado para identificar as concepções mais comuns expressadas pelos alunos. Esse instrumento de coleta de dados foi elaborado com base na literatura sobre concepções alternativas e abordou os seguintes temas: o ciclo dia-noite; os fusos horários; as estações do ano; as fases da Lua; o movimento da Lua; o movimento aparente do Sol na esfera celeste; os eclipses; as dimensões e distâncias no Universo; o brilho das estrelas e sua observação da Terra. Embora se tenha verificado um pequeno progresso na proporção de respostas cientificamente aceitáveis ao se cotejar a oitava série do Ensino Fundamental com a quinta, e a terceira série do Ensino Médio com a primeira, houve o predomínio de concepções alternativas em relação à maior parte dos temas explorados, as quais persistiram até o último ano da Educação Básica. A comparação com

  17. A Diagnostic Assessment for the Teaching of Astronomy. (Spanish Title: Una Evaluación Diagnóstica Para la Enseñanza de la Astronomia.) Uma Avaliação Diagnóstica Para o Ensino da Astronomia

    NASA Astrophysics Data System (ADS)

    Pacifico Ribeiro de Assis Silveira, Felipa; Soares Gomes de Sousa, Célia Maria; Moreira, Antonio

    2011-07-01

    interpretación, lo que nos permite comprender los significados asignados por el estudiante a estos conceptos. Se desprende de la evaluación diagnóstica que la mayoría de los encuestados ha tenido dificultades para exponer los conceptos científicos sobre el Universo y la Tierra, para iniciar el 6 º grado. Sin embargo, se identificaron ideas relevantes y las representaciones que contribuyeron a la re-significación de los conceptos científicos propuestos para la enseñanza del tema en esta serie. Los resultados de la evaluación diagnóstica han servido como referencia para la organización del Programa, facilitando el proceso de aprendizaje, haciendo coincidir la secuencia didáctica a las características de los estudiantes y el contexto del aula. Se espera que el instrumento presentado en este documento también pueda ser utilizado por otros investigadores en investigaciones relacionadas con el tema. Este artigo tem como objetivo apresentar os resultados de uma avaliação diagnóstica, utilizada como instrumento para a coleta de dados sobre o conhecimento prévio de conceitos científicos, necessários à compreensão do tema Terra e Universo, de um grupo composto por 47 estudantes, da 6ª série do Ensino Fundamental. A ação pedagógica de diagnosticar os conhecimentos prévios, do estudante, antes de ensiná-los, tem fundamento na teoria da Aprendizagem Significativa, proposta por David Ausubel. Essa avaliação diagnóstica foi composta por 25 questões, cujas respostas foram analisadas e categorizadas visando sua interpretação, o que permitiu compreender os significados atribuídos pelo estudante a esses conceitos. Conclui-se, a partir da avaliação diagnóstica, que a maioria dos estudantes pesquisados apresentou dificuldades em expor conceitos científicos sobre o tema Terra e Universo ao iniciar a 6ª série. Entretanto, foram identificadas ideias e representações relevantes que contribuíram para a (re)significação dos conceitos científicos propostos

  18. The Long-Term Safety and Efficacy Follow-Up Study of Subjects Who Completed the Phase I Clinical Trial of Neurostem®-AD

    ClinicalTrials.gov

    2012-09-27

    Alzheimer Disease; Dementia; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Tauopathies; Neurodegenerative Diseases; Delirium, Dementia, Amnestic, Cognitive Disorders; Mental Disorders

  19. Genetics Home Reference: cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy

    MedlinePlus

    ... Infarcts and Leukoencephalopathy MalaCards: carasil syndrome Merck Manual Consumer Version: Overview of Delirium and Dementia Merck Manual Consumer Version: Overview of Stroke Orphanet: CARASIL Patient Support ...

  20. Inclusion of Astronomy Themes in an Inovative Approach of Informal Physics Teaching for High School Students. (Spanish Title: Inclusión de Temas Astronómicos en Uma Abordaje Innovadora de la Enseñanza Informal de Física Para Estudiantes de Secumdaria.) Inclusão de Temas Astronômicos Numa Abordagem Inovadora do Ensino Informal de Física Para Estudantes do Ensino Médio

    NASA Astrophysics Data System (ADS)

    Tiara Mota, Aline; de Morais Bonomini, Iracema Ariel; Meloni Martins Rosado, Ricardo

    2009-12-01

    The current work reports on an experience on Astronomy education at the Federal University of Itajubá through an extra-curricular course offered for High School students. This initiative was motivated by the low attention paid to the Astronomy subjects at this stage of the Brazilian Formal Education, in spite that the National Curricular Parameters (PCN and PCN+, in Brazil) point out the importance of their inclusion Este artículo relata una experiencia en la enseñanza de la astronomía efectuada en la Universidad Federal de Itajubá en la forma de un curso de extensión orientado para los estudiantes del colegio secundario. Esta iniciativa surgió de constatar la poca atención dada a la Astronomía en esta etapa de la Educación formal brasileña, a pesar que los Parámetros Curriculares Nacionales (PCN y PCN+, en Brasil) destacan la importancia de su inclusión. Este artigo relata uma experiência em ensino de Astronomia realizada na Universidade Federal de Itajubá na forma de um curso de extensão voltado para alunos do Ensino Médio. Esta iniciativa surgiu da pouca atenção que se dá à Astronomia nesta etapa da Educação embora os Parâmetros Curriculares Nacionais (PCN e PCN+) apontem a importância de sua inclusão.

  1. Espectroscopia infravermelha para a determinacao de carbono do solo: Perspectiva de um metodo economicamente viavel e ambientalmente seguro

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The Kyoto Protocol is an agreement among many of the world’s nations to, among other things, reduce atmospheric carbon dioxide concentrations in order to reduce global warming. One potential method to do so is to sequester carbon in soils. This has had the effect of stimulating the establishment of ...

  2. Perspectiva Historica de la Educacion Bilingue en los Estados Unidos (A Historical Perspective of Bilingual Education in the United States)

    ERIC Educational Resources Information Center

    Zamora, Juan Clemente

    1978-01-01

    This article defines bilingualism and bilingual education and traces the history of bilingual education in the United States, starting with the Spanish missions in the west. (Text is in Spanish.) (NCR)

  3. Ampliacion Interdisciplinar de los Estudios Hispanicos: Temas y Perspectivas (The Expansion of Interdisciplinary Hispanic Studies: Themes and Perspectives)

    ERIC Educational Resources Information Center

    Poyatos, Fernando

    1978-01-01

    States that works concerning hispanic studies traditionally deal with analyses of the Spanish language or with literary works. Emphasis is made on the need for an interdisciplinary approach. (Text is in Spanish.) (NCR)

  4. Ecocardiografía tridimensional. Nuevas perspectivas sobre la caracterización de la válvula mitral

    PubMed Central

    Solis, Jorge; Sitges, Marta; Levine, Robert A.; Hung, Judy

    2010-01-01

    Recent developments in three-dimensional echocardiography have made it possible to obtain images in real time, without the need for off-line reconstruction. These developments have enabled the technique to become an important tool for both research and daily clinical practice. A substantial proportion of the studies carried out using three-dimensional echocardiography have focused on the mitral valve, the pathophysiology of mitral valve disease and, in particular, functional mitral regurgitation. The aims of this article were to review the contribution of three-dimensional echocardiography to understanding of the functional anatomy of the mitral valve and to summarize the resulting clinical applications and therapeutic implications. PMID:19232192

  5. The Meanings of Astronomical Observation: An Analysis on the Basis of Relationship with Knowledge. (Spanish Title: Los Sentidos de la Observación Astronómica: un Análisis sobre la Base de la Relación con el Saber.) Os Sentidos da Observação Astronômica: Uma Análise com Base na Relação com o Saber

    NASA Astrophysics Data System (ADS)

    Klein, Alberto Eduardo; de Mello Arruda, Sergio; Meneghello Passos, Marinez; Vinicius Domenes Zapparoli, Ferdinando

    2010-12-01

    This article presents results of a research which aimed to understand the meanings that people construct for astronomical observation. The subjects, students and school teachers, initially received some instruction on how to view astronomical objects through the telescope. After the observation was realized, they were interviewed. The data analysis allowed the creation of 12 categories, later interpreted on the basis of relationship with knowledge (relation to the world, with himself and with others), as presented by Bernard Charlot. Este artículo presenta los resultados de una investigación que tuvo como objetivo comprender los sentidos que las personas construyen para la observación astronómica. Los sujetos, los estudiantes y maestros de escuela, recibieron inicialmente algunas instrucciones sobre cómo ver los objetos astronómicos a través del telescopio. Al término de la observación, fueron entrevistados. El análisis de datos permitió la creación de 12 categorías que más tarde fueron interpretadas sobre la base de la relación con el conocimiento (relación con el mundo, consigo mismo y con los demás), tal como presentado por Bernard Charlot. Este artigo apresenta resultados de uma pesquisa que objetivou entender quais os sentidos que as pessoas constroem para a observação astronômica. Os sujeitos da pesquisa, estudantes e professores do ensino médio, receberam inicialmente alguma instrução sobre como visualizar os objetos astronômicos através do telescópio. Após a realização da observação, eles foram entrevistados. A análise dos dados permitiu a elaboração de 12 categorias que foram posteriormente interpretadas com base nas relações com o saber (relação com o mundo, consigo mesmo e com o outro), conforme apresentadas por Bernard Charlot.

  6. Learning about the Sky from the Environment: An Experience Working Along One Year with Students of Elementary Education. (Spanish Title: Aprendiendo sobre EL Cielo Desde el Entorno: Una Experiencia Trabajando Durante un Año Junto a Estudiantes del Primario.) Aprendendo sobre o Céu a Partir do Entorno: Uma Experiência de Trabalho ao Longo de um Ano com Alunos de Ensino Fundamental

    NASA Astrophysics Data System (ADS)

    Longhini, Marcos Daniel; Gomide, Hanny Angeles

    2014-12-01

    percepción limitada que los estudiantes tienen de su alrededor la cual, sin embargo, se expandió debido a las actividades llevadas a cabo, sobre todo en relación con la Luna. Trabajar con medidas sistemáticas revela el manejo cuidadoso de los datos para que sean comprensibles para los estudiantes, así como el trabajo con las sombras para que comprendan primero como se forman estas para después trabajarlas en Astronomía. Por último, llegamos a la conclusión de que el proceso desarrollado consistió en una etapa inicial de una obra que debe ser profundizado en los años posteriores de la formación de estos estudiantes. Projeto de pesquisa desenvolvido com 95 alunos do 6º ano do Ensino Fundamental de uma escola pública estadual de Uberlândia, Minas Gerais. Foi um trabalho contínuo, de fevereiro a dezembro de 2013, o qual levou os alunos a participarem de atividades de observação do entorno, dentre ele, o céu, analisando as mudanças ocorridas. Focamos no estudo das variações de temperaturas, chuvas, duração do dia, variações do tamanho das sombras e mudanças nos aspectos da Lua. Nosso foco de análise centrou-se em discutir os conhecimentos que os referidos alunos tinham acerca dos temas indicados no início e ao término da implementação da proposta. Os resultados mostraram a percepção limitada que os estudantes possuem de seu entorno, todavia, ampliada em função das atividades desenvolvidas, principalmente no que se refere à Lua. O trabalho com medidas sistemáticas revela o cuidado no tratamento dos dados para que eles se tornem compreensíveis aos alunos, assim como o trabalho com as sombras sinaliza para que os alunos primeiramente compreendam como as sombras são formadas para depois trabalhar isso em Astronomia. Por fim, concluímos que o processo vivido constituiu-se em uma etapa inicial de um trabalho que deve ser estimulado para os anos subsequentes da formação desses alunos.

  7. Establishing the Empirical Relationship Between Non-Science Majoring Undergraduate Learners' Spatial Thinking Skills and Their Conceptual Astronomy Knowledge. (Spanish Title: Estableciendo Una Relación Empírica Entre el Razonamiento Espacial de los Estudiantes de Graduación de Carreras no Científicas y su Conocimento Conceptual de la Astronomía.) Estabelecendo Uma Relação Empírica Entre o RacioCínio Espacial dos Estudantes de Graduação EM Carreiras Não Científicas e Seu Conhecimento Conceitual da Astronomia

    NASA Astrophysics Data System (ADS)

    Heyer, Inge; Slater, Stephanie J.; Slater, Timothy F.

    2013-12-01

    normalizadas, en el desempeño de los estudiantes en estos dos asuntos foram pequenas, 0.26 e 0.13 respectivamente. El razonamiento espacial de los estudiantes fue medido utilizando un instrumento específico desarrollado para este trabaljo. Las correlaciones entre los resultados de los tests astronómicos y este instrumento específico, antes y después del curso mostraron una relación entre moderada y fuerte, sugiriendo que la relación entre el razonamiento espacial y el conocimiento astronómico puede explicar hasta un 25% de la variación em el desempeño de los estudiantes. A comunidade da educação em astronomia tem suposto de forma implícita que o aprendizado da astronomia consiste em um domínio conceitual fundamentado no raciocínio espacial. Como um primeiro passo para identificar formalmente uma relação empírica entre estas duas coisas, utilizamos como amostra os estudantes de graduação de carreiras não científicas de um curso exploratório em uma universidade norte-americana do meio-oeste de médio porte com programa de Doutorado em andamento, onde estes estudantes foram submetidos a um diagnóstico de raciocino espacial e conceitos astronômicos antes e depois do mesmo. As ferramentas utilizadas foram o Test Of Astronomy Standards (TOAST) e o questionário What do you know? Utilizando somente dados completamente consistentes para esta análise, nossa amostra consistiu de 86 estudantes de graduação. As melhoras, depois de normalizadas, do desempenho dos estudantes nos dois quesitos foram pequenas, 0.26 e 0.13 respectivamente. O raciocínio espacial dos estudantes foi medido utilizando um instrumento específico desenhado para este trabalho. As correlações entre os resultados dos testes astronômicos e este instrumento específico antes e depois do curso mostraram uma relação entre moderada e forte, sugerindo que a relação entre o raciocínio espacial e o conhecimento astronômico pode explicar até um 25% na variação no desempenho dos

  8. An Invited Preface for the Following Book: Astrobiologia, Uma Ciencia Emergente

    NASA Technical Reports Server (NTRS)

    Rothschild, Lynn J.

    2016-01-01

    Since the dawn of civilization, we have beheld at the beauty and wonder of the natural world around us and wondered how it came to be. We have pondered the past, and have been intrigued about the future. For this we are unique. Our ancestors looked to the vastness of space and thought surely there are others out there. We are now at a new time in human history where we can address these age-old questions with a scientific approach and study rigorously the three big questions of astrobiology: Where do we come from? Where are we going? and Are we alone? These fundamental questions of astrobiology correspond to those of humanity, and arguably, what makes us human. And so we cannot help but be drawn to the field. Unlike other scientific disciplines, Astrobiology draws on the latest advances in a multitude of fields, from evolutionary and molecular biology, to prebiotic and interstellar chemistry, from astrophysics to astronomy, with a healthy dose of earth and planetary science. Astrobiology is in reality a "metadiscipline" drawing on useful science wherever it is to be found. From a practical point of view, this endeavor requires the interaction of scientists who might not normally meet each other, much less work on a common research project. And, unlike most other scientific disciplines, Astrobiology has implications for how we see ourselves, and how we interact with the earth and beyond. "Where do we come from" touches on the "why" questions that have intrigued not just scientists but philosophers and theologians. "Where are we going" adds to these an economic and political involvement that is currently being played out with discussions of climate change. "And are we alone" will someday force us to face the fact that we as living creatures are not unique, or perhaps that we are utterly alone in the universe, the result of a chemical history that was so improbable as to result in a sample size of one. Either result will force ethical considerations of either "the other" and their relationship to us, or our solitude and thus responsibility as the only life form in our cosmos. So what is Astrobiology? Let's start with the "Where do we come from?" A biologist will approach this looking at the evolution of life on earth, using such traditional tools as comparative anatomy and paleontology and newer tools such as molecular techniques. But this doesn't address why this happened the way it did without a comprehensive understanding of the environment. What was the temperature at such and such a time? Was the earth in a snowball phase or being bombarded by meteorites -- or even just a single large, well-placed one such as struck off the Yucatan peninsula 65 million years ago. This event could not have been predicted by population genetics alone, yet it had the most profound influence on our evolution as without it, we could still be in a world dominated by dinosaurs with the mammals cowering under cover. But it is not enough to go back to LUCA, the Last Universal Common Ancestor of all extant life. One must go back to the dawn of life. How did life arise? What was the environmental backdrop that allowed it to happen? How did we happen to end up with a habitable planet? Indeed, what is the origin and evolution of our solar system, galaxy, biogenic elements all the way back to the Big Bang. The "Where are we going?" tends to be ignored in many astrobiology programs, but in fact this is of the most immediate importance to us. Whereas the past was dominated by physical and chemical processes, and organismal interactions, the future has a new major player: us. While we probably don't have the power (yet) to stop our galaxy passing through another, or even reset the sun or stop the movement of the moon away from the earth, all of these things will influence the future of life on earth. We are already proving that we have the power to visit other bodies in our solar system, either with humans or our robotic surrogates. We are changing our atmospheric composition and thus our climate. We have the power to render species extinct, including our own. But we also have the power to use these tools for the common good, to extend our lifetimes and reclaim our rivers and forests. Which will it be? And then there is the question where science fiction becomes a reality: "Are we alone?" While many people are anxious to find signs of intelligent life out there, such a creature may not share either our curiosity or values. But what if there was a beneficent alien civilization that could communicate with us, perhaps forging a mutual understanding? More likely in the forseeable future is finding a small life, less evolved, life form. Note I did not use the word "simple" as there is nothing "simple" about life, ever. Which brings us back to the question: what is life? So where does Brazil come in? For nearly a decade there has been interest in a Brazilian astrobiology program, from a small side meeting held by the Brazilian Exobiology Program (BEP) of the Brazilian National Research Council, held in Rio de Janeiro, Brazil, on August 12, 2009, in association with the IAU Assembly to subsequent workshops held in several locations and membership of the Brazilian program in the NASA Astrobiology Institute (NAI). Each time I go to Brazil, I am impressed by the enthusiasm of the community, both scientific and student, the latter an excellent omen for the future of astrobiology in Brazil. Facilities are being built to supplement the natural laboratories that Brazil is blessed to have. In my own lab I have been privileged to have a wonderful Brazilian postdoctoral fellow, Dr. Ivan Paulino-Lima, resulting in a daily reminder of the program. I am honored to have been part of the development of astrobiology in Brazil, and hope that this relationship will continue to flourish. Clearly to advance astrobiology needs new knowledge, a reorganization of that which is known, and space missions. To help the reader join on this quest, what follows is a buffet of topics that will allow the reader to nibble on the richness that is Astrobiology. And, like a fabulous meal, it should make you want more. Welcome to Astrobiology.

  9. Escola versus Televisao: Uma Questao de Linguagem (School versus Television: A Question of Language).

    ERIC Educational Resources Information Center

    Belloni, Maria Luiza

    1995-01-01

    Discusses the increasing presence of technology in social life and its effects on the educational processes. Presents research results about cognitive abilities and the "audiovisual language" typical of the younger generations. Discusses how to adapt the practice of education to these new requirements or necessities of the children who…

  10. Unified Multi-speed analysis (UMA) for the condition monitoring of aero-engines

    NASA Astrophysics Data System (ADS)

    Nembhard, Adrian D.; Sinha, Jyoti K.

    2015-12-01

    For rotating machinery in which speeds and dynamics constantly change, performing vibration-based condition monitoring can be challenging. Thus, an effort is made here to develop a Unified Multi-speed fault diagnosis technique that can exploit useful vibration information available at various speeds from a rotating machine in a single analysis. Commonly applied indicators are computed from data collected from a rig at different speeds for a baseline case and different faults. Four separate analyses are performed: single speed at a single bearing, integrated features from multiple speeds at a single bearing, single speed for integrated features from multiple bearings and the proposed Unified Multi-speed analysis. The Unified Multi-speed approach produces the most conspicuous separation and isolation among the conditions tested. Observations made here suggest integration of more dynamic features available at different speeds improves the learning process of the tool which could prove useful for aero-engine condition monitoring.

  11. First photometric study of the W UMa system GSC 1042-2191

    NASA Astrophysics Data System (ADS)

    Bulut, A.; Bulut, İ.; Demircan, O.

    2016-04-01

    We present new photometric observations covering eight minima times for the eclipsing binary GSC 1042-2191. The light curves in BVRI colors were analyzed by using WD-code for the system parameters. Eight minima times were obtained from the new observations. The system is found a low mass ratio (q = 0.148), A-type over-contact binary with a fill out parameter of f = 65.01 ± 12.18%. The preliminary absolute dimensions (M1= 1.26 ± 0.06 M⊙, M2 = 0.18 ± 0.06 M⊙, R1 = 1.54 ± 0.20 R⊙, R2 = 0.69 ± 0.01 R⊙, L1 =3.30 ± 0.30 L⊙ and L2 = 0.59 ± 0.20 L⊙) indicate the very much oversized and over-luminous secondary component, by assuming the present luminosity of the secondary is its main sequence luminosity, we predict the original mass is about 0.8 M⊙, this means the present secondary could be transferred and/or lost 77% of its original mass and only its core is left.

  12. CCD photometric analysis of the W UMa-type binary V376 Andromeda

    NASA Astrophysics Data System (ADS)

    Çiçek, C.

    2011-01-01

    This study presents the absolute parameters of the contact binary system V376 And. CCD photometric observations were made at the Çanakkale Onsekiz Mart University Observatory in 2004. The instrumental magnitudes of all observed stars were converted into standard magnitudes. New BV light curves of the system were analysed using the Wilson-Devinney method supplemented with a Monte Carlo type algorithm. Since there are large asymmetries between maxima (i.e., O'Connell effect) in these light curves, two different models (one with a cool spot and one with a hot spot) were applied to the photometric data. The best fit, which was obtained with a large hot spot on the secondary component, gives V376 And as an A sub-type contact binary in poor thermal contact and a small value of the filling factor ( f ≈ 0.07). Combining the solutions of our light curves and Rucinski et al. (2001)'s radial velocity curves, the following absolute parameters of the components were determined: M1 = 2.44 ± 0.04 M ⊙, M2 = 0.74 ± 0.03 M ⊙, R1 = 2.60 ± 0.03 R ⊙, R2 = 1.51 ± 0.02 R ⊙, L1 = 40 ± 4 L ⊙ and L2 = 5 ± 1 L ⊙. We also discuss the evolution of the system, which appears to have an age of 1.6 Gyr. The distance to V376 And was calculated as 230 ± 20 pc from this analysis, taking into account interstellar extinction.

  13. Model computations of blue stragglers and W UMa-type stars in globular clusters

    NASA Astrophysics Data System (ADS)

    Stȩpień, K.; Kiraga, M.

    2015-05-01

    Context. It was recently demonstrated that contact binaries occur in globular clusters (GCs) only immediately below turn-off point and in the region of blue straggler stars (BSs). In addition, observations indicate that at least a significant fraction of BSs in these clusters was formed by the binary mass-transfer mechanism. Aims: The aim of our present investigation is to obtain and analyze a set of evolutionary models of cool, close detached binaries with a low metal abundance, which are characteristic of GC. Methods: We computed the evolution of 975 models of initially detached, cool close binaries with different initial parameters. The models include mass exchange between components as well as mass and angular momentum loss due to the magnetized winds for very low-metallicity binaries with Z = 0.001. The models are interpreted in the context of existing data on contact binary and blue straggler members of GCs. The models are based on our recently developed code for evolutionary modeling of cool close and contact binaries. Results: The model parameters agree well with the observed positions of the GC contact binaries in the Hertzsprung-Russell diagram, and we achieve detailed parameters of several individual contact and near-contact binaries. Contact binaries in the lower part of the cluster main sequence are absent because there are no binaries with initial orbital periods shorter than 1.5 d. Contact binaries end their evolution as mergers that appear in the BS region. Binary-formed BSs populate the whole observed BS region in a GC, but a gap is visible between low-mass mergers that are concentrated along the zero-age main sequence and binary BSs occupying the red part of the BS region. Very few binary mergers are expected to rotate rapidly and/or possess chemical peculiarities resulting from the exposure of the layers processed by CNO nuclear reactions. All other binary mergers are indistinguishable from the collisionally formed mergers. The results show that binary-formed BSs may constitute at least a substantial fraction of all BSs in a GC. Tables 2-7 are available in electronic form at http://www.aanda.org

  14. The effect of a complementary e-learning course on implementation of a quality improvement project regarding care for elderly patients: a stepped wedge trial

    PubMed Central

    2012-01-01

    Background Delirium occurs frequently in elderly hospitalised patients and is associated with higher mortality, increased length of hospital stay, functional decline, and admission to long-term care. Healthcare professionals frequently do not recognise delirium, indicating that education can play an important role in improving delirium care for hospitalised elderly. Previous studies have indicated that e-learning can provide an effective way of educating healthcare professionals and improving quality of care, though results are inconsistent. Methods and design This stepped wedge cluster randomised trial will assess the effects of a complementary delirium e-learning course on the implementation of quality improvement initiative, which aims to enhance the recognition and management of delirium in elderly patients. The trial will be conducted in 18 Dutch hospitals and last 11 months. Measurements will be taken in all participating wards using monthly record reviews, in order to monitor delivered care. These measurements will include the percentage of elderly patients who were screened for the risk of developing delirium, use of the Delirium Observation Screening scale, use of nursing or medical interventions, and the percentage of elderly patients who were diagnosed with delirium. Data regarding the e-learning course will be gathered as well. These data will include user characteristics, information regarding use of the course, delirium knowledge before and after using the course, and the attitude and intentions of nurses concerning delirium care. Setting The study will be conducted in internal medicine and surgical wards of eighteen hospitals that are at the beginning stages of implementing the Frail Elderly Project in the Netherlands. Discussion Better recognition of elderly patients at risk for delirium and subsequent care is expected from the introduction of an e-learning course for nurses that is complementary to an existing quality improvement project. This

  15. [Clinico-psychopathologic varieties of the acute Kandinsky-Clerambault syndrome in schizophrenia].

    PubMed

    Dikaia, V I

    1985-01-01

    Acute cases of the Kandinsky-Clerambault syndrome first manifested in adulthood were studied in schizophrenic patients. On the basis of the clinical mechanisms of the development of psychosis and the specific features of acute delirious disturbances in the structure of psychosis 3 clinical variants of the acute syndrome of psychic automatism were identified: developing according to the type of reaction in the structure of acute paranoid (the first variant), according to the regularities of endogenic paroxysm in the picture of acute sensory delirium (the second variant) and according to the mechanism of exacerbation of chronic delirium entering the structure of acute interpretative delirium (the third variant).

  16. The Moon Phases in a Paper Box. (Spanish Title: Las Fases de la Luna en Una Caja de Cartón.) As Fases da Lua Numa Caixa de Papelão

    NASA Astrophysics Data System (ADS)

    de Fátima O. Saraiva, Maria; Amador, Cláudio B.; Kemper, Érico; Goulart, Paulo; Muller, Angela

    2007-12-01

    material didático de baixo custo para demonstração do conceito de fases de um corpo iluminado. O principal objetivo de nosso material é facilitar a compreensão das fases da Lua da perspectiva de um observador na Terra. O material ajuda na visualização de dois efeitos importantes: (1º) mesmo tendo sempre a metade da "Lua" (representada por uma bolinha de isopor ou de ping-pong) iluminada pelo "Sol" (representado por uma fonte de luz natural ou artificial), nós vemos diferentes frações de sua superfície iluminada, dependendo do ângulo pelo qual a olhamos; (2º) a orientação da borda convexa da Lua nas fases Crescente e Minguante também depende da perspectiva pela qual a olhamos da Terra. O uso de uma caixa fechada permite observar o contraste entre as diferentes fases sem necessidade de estar em uma sala escurecida. Apresentamos também um texto explicativo sobre fases da Lua, enfatizando a dependência da aparência da parte iluminada com o ângulo de visada.

  17. Pentobarbital overdose

    MedlinePlus

    Symptoms of a pentobarbital overdose may include: Coma Confusion Decreased energy Delirium (confusion and agitation) Difficulty breathing Headache Large blisters Rash Sleepiness Slowed or stopped breathing Slurred speech Unsteady gait

  18. Successful treatment of Wernicke encephalopathy in terminally ill cancer patients: report of 3 cases and review of the literature.

    PubMed

    Onishi, Hideki; Kawanishi, Chiaki; Onose, Masanari; Yamada, Tomoki; Saito, Hideyuki; Yoshida, Akira; Noda, Kazumasa

    2004-08-01

    Although Wernicke encephalopathy has been reported in the oncological literature, only one terminally ill cancer patient with Wernicke encephalopathy has been reported. Wernicke encephalopathy, a potentially reversible condition, may be unrecognized in terminally ill cancer patients. In this communication, we report three terminally ill cancer patients who developed Wernicke encephalopathy. Early recognition and subsequent treatment resulted in successful palliation of delirium. Two of the three patients did not show the classical triad of Wernicke encephalopathy. Common clinical symptoms were delirium and poor nutritional status. Intravenous thiamine administration dramatically improved the symptoms of delirium in all three patients. In terminally ill cancer patients, clinicians must remain aware of the possibility of Wernicke encephalopathy when patients with a poor nutritional status present with unexplained delirium. Early intervention may correct the symptoms and prevent irreversible brain damage and the quality of life for the patient may improve.

  19. Rabies (image)

    MedlinePlus

    ... messages between the brain and the body. The rabies virus spreads through the nerves, first causing flu- ... to hallucinations, delirium, and insomnia. If left untreated, rabies is nearly always fatal.

  20. Wilson disease

    MedlinePlus

    ... muscle control, muscle tremors, loss of thinking and IQ, loss of memory, and confusion (delirium or dementia) Liver or spleen disorders (including hepatomegaly and splenomegaly ) Lab tests may include: Complete blood count ( CBC ) Serum ceruloplasmin ...

  1. Jimsonweed poisoning

    MedlinePlus

    Angel's trumpet; Devil's weed; Thorn apple; Tolguacha; Jamestown weed; Stinkweed; Datura; Moonflower ... Coma Convulsions Death Delirium Dizziness Hallucinations Headache SKIN Red skin Hot, dry skin WHOLE BODY Fever Thirst

  2. Systematic Assessment and Targeted Improvement of Services Following Yearlong Surgical Outcomes Surveys

    ClinicalTrials.gov

    2015-12-23

    Heart Attack; Cardiac Arrest; Congestive Heart Failure; Atrial Fibrillation; Angina; Deep Vein Thrombosis; Pulmonary Embolism; Respiratory Arrest; Respiratory Failure; Pneumonia; Gastrointestinal Bleed; Stomach Ulcer; Delirium; Stroke; Nerve Injury; Surgical Wound Infection

  3. Treating agitation with dexmedetomidine in the ICU.

    PubMed

    Boyer, Jeanne

    2009-01-01

    Patients in the intensive care unit frequently experience delirium, anxiety, and agitation, with a variety of treatments used. This article discusses the role of an alpha-adrenoceptor agonist, dexmedetomidine, and its clinical relevance and advantages for the agitated patient.

  4. Alcohol withdrawal

    MedlinePlus

    ... Seeing or feeling things that aren't there (hallucinations) Seizures Severe confusion ... alcohol withdrawal. You will be watched closely for hallucinations and other signs of delirium tremens. Treatment may ...

  5. Urinalysis

    MedlinePlus

    ... signs of disease If you have signs of diabetes or kidney disease, or to monitor you if you are being ... Delirium Dementia Dementia due to metabolic causes Diabetes Diabetes and kidney disease Diabetes insipidus - central Distal renal tubular acidosis Epididymitis ...

  6. Intranasal Inhalations of Bioactive Factors Produced by M2 Macrophages in Patients With Organic Brain Syndrome

    ClinicalTrials.gov

    2016-11-04

    Organic Brain Syndrome, Nonpsychotic; Neurocognitive Disorders; Mental Disorder, Organic; Delirium, Dementia, Amnestic, Cognitive Disorders; Nonpsychotic Organic Brain Syndrome; Organic Mental Disorder; Encephalopathy, Post-Traumatic, Chronic; Encephalopathy, Ischemic; Brain Ischemia

  7. Electrocardiogram

    MedlinePlus

    ... 12. Read More Anorexia Aortic dissection Aortic insufficiency Aortic stenosis Arrhythmias Atrial fibrillation or flutter Atrial septal defect (ASD) Cardiac tamponade Chest pain Coarctation of the aorta Coronary artery spasm Delirium tremens Digitalis toxicity Dilated ...

  8. Perspectivas Pedagogicas. Documentos-Ponencias Y Ensayos Proyecto Teacher Corps, Ciclo XII (Pedagogical Perspectives. Documents, Papers and Essays, Teacher Corps Project, Cycle XII).

    ERIC Educational Resources Information Center

    Albino, Isidra, Ed.; Davila, Sonia, Ed.

    The purpose of this book is to stimulate ideas leading to a sharing of approaches, strategies, and methodologies applicable to the education of Puerto Ricans. Following introductory material, 18 papers are presented, the first 10 of which are in Spanish. Titles and authors are: (1) "El maestro que Puerto Rico necesita," Leonides Santos…

  9. Design Principles for Equity and Excellence at Hispanic-Serving Institutions. PERSPECTIVAS: Issues in Higher Education Policy and Practice. Issue No. 4, Spring 2015

    ERIC Educational Resources Information Center

    Malcom-Piqueux, Lindsey E.; Bensimon, Estela Mara

    2015-01-01

    Hispanic-Serving Institutions (HSIs) shoulder unique responsibilities, including the education of post-traditional student populations, while facing distinct resource-related challenges. Any efforts to assess the performance of HSIs must be done with these facts in mind. This brief offers design principles for equity and excellence at HSIs that…

  10. Otra perspectiva sobre lo que los ninos deben estar aprendiendo (Another Look at What Young Children Should Be Learning). ERIC Digest.

    ERIC Educational Resources Information Center

    Katz, Lilian G.

    This Spanish-language ERIC Digest addresses the question of what young children should be learning that will best serve their development and learning in the long term. Two major dimensions of development--normative and dynamic--are explored, and four categories of learning goals are discussed: (1) knowledge; (2) skills; (3) dispositions; and (4)…

  11. Hispanic Youth: Obstacles to Labor Market Success. An Overview of the Job Training Partnership Act and Its Effects on Hispanic Youth. Perspectivas Publicas Issue Brief.

    ERIC Educational Resources Information Center

    Escutia, Marta

    Several independent analyses of the Job Training Partnership Act (JTPA) indicate that it has achieved mixed results and has failed to effectively serve disadvantaged youth and school dropouts. It can only offer short-term, low-cost programs, and has difficulty in attracting youths. The number of dropouts being served is declining. The…

  12. La Observación Sistemática de Vecindarios: El caso de Chile y sus perspectivas para Trabajo Social

    PubMed Central

    Sanhueza, Guillermo E.; Delva, Jorge; Andrade, Fernando H.; Grogan-Kaylor, Andrew; Bares, Cristina; Castillo, Marcela

    2012-01-01

    El estudio acerca de las características de los vecindarios y sus efectos sobre las personas ha llegado a ser un área de creciente atención por parte de investigadores de diversas disciplinas en países desarrollados. Aunque actualmente existen diversas metodologías para estudiar efectos del vecindario, una de las más utilizadas es la Observación Sistemática de Vecindarios –Systematic Social Observation SSO, en inglés—porque permite recolectar información acerca de diversas características del entorno físico, social, ambiental y económico de los vecindarios donde se aplica. El objetivo de este artículo es (i) dar a conocer sumariamente algunas investigaciones influyentes sobre efectos del vecindario en Estados Unidos, ii) describir cómo se diseñó e implementó la Observación Sistemática de Vecindarios en la ciudad de Santiago de Chile, iii) señalar algunos facilitadores y obstaculizadores de la implementación del proyecto y, finalmente iv) enunciar posibles contribuciones y limitaciones que esta metodología ofrecería al trabajo social en Chile. PMID:24791060

  13. Orientaciones Tecnicas para el Mejoramiento de la Administracion Educacional--Necesidades, Posibilidades y Perspectivas (Technical Guidelines on the Improvement of Educational Administration--Needs, Possibilities, and Perspectives).

    ERIC Educational Resources Information Center

    Valle, Victor M.

    The success of development programs in educational systems is dependent, to a large extent, on the quality and relevancy of their management. Many worthwhile, well conceived and planned educational reforms have failed due to poor management. Therefore, both ministries of education and international organizations of technical cooperation have…

  14. H.R. 5 and Hispanic Educational Concerns: An Overview of the School Improvement Act of 1987. Perspectivas Publicas. Issue Brief.

    ERIC Educational Resources Information Center

    National Council of La Raza, Washington, DC. Office of Research Advocacy and Legislation.

    The School Improvement Act of 1987, H.R. 5, has been approved in the House of Representatives. This bill reauthorizes 14 existing federal elementary and secondary programs and creates a new program for gifted and talented children's education. The majority of the programs in H.R. 5 are designed to improve services for educationally disadvantaged…

  15. Opportunity to Teach and Learn Standards: Colombian Teachers' Perspectives (Estándares de oportunidad para la enseñanza y el aprendizaje: perspectivas de profesores colombianos)

    ERIC Educational Resources Information Center

    Cárdenas Ramos, Rosalba; Hernández Gaviria, Fanny

    2012-01-01

    The aim of this article is to present the outcomes of an exploration of in-service teachers' perspectives in relation to an opportunity to teach and learn standards in English. A workshop for English teachers from Cali (Colombia) and the neighboring rural sectors was designed and carried out in order to collect the information. Teachers'…

  16. Mexican Americans' Educational Barriers and Progress: Is the Magic Key within Reach? PERSPECTIVAS: Issues in Higher Education Policy and Practice. Issue No. 5, Spring 2016

    ERIC Educational Resources Information Center

    Zambrana, Ruth Enid; Hurtado, Sylvia

    2016-01-01

    This policy brief is based on the edited book "The Magic Key: The Educational Journey of Mexican Americans from K-12 to College and Beyond" (Zambrana & Hurtado, 2015a), which focuses on the experiences of Mexican Americans in education. Drawing from an interdisciplinary corpus of work, the authors move beyond the rhetoric of progress…

  17. Latino Males: Improving College Access and Degree Completion--A New National Imperative. PERSPECTIVAS: Issues in Higher Education Policy and Practice. Issue No. 1, Spring 2012

    ERIC Educational Resources Information Center

    Sáenz, Victor B.; Ponjuán, Luis

    2012-01-01

    The educational future for Latino male students is in a state of crisis, a trend that has been especially evident at the secondary and postsecondary levels in recent years. The question of why Latino males are struggling to succeed in America's colleges is complex, and this brief explores some key factors that may be perpetuating this trend at…

  18. El uso de las simulaciones educativas en la ensenanza de conceptos de ciencias y su importancia desde la perspectiva de los estudiantes candidatos a maestros

    NASA Astrophysics Data System (ADS)

    Crespo Ramos, Edwin O.

    This research was aimed at establishing the differences, if any, between traditional direct teaching and constructive teaching through the use of computer simulations and their effect on pre-service teachers. It's also intended to gain feedback on the users of these simulations as providers of constructive teaching and learning experiences. The experimental framework used a quantitative method with a descriptive focus. The research was guided by two hypothesis and five inquiries. The data was obtained from a group composed of twenty-nine students from a private Metropolitan University in Puerto Rico and elementary school pre-service teachers. They were divided into two sub-groups: experimental and control. Two means were used to collect data: tests and surveys. Quantitative data was analyzed through test "t" for paired samples and the non-parametric Wilcoxon test. The results of the pre and post tests do not provide enough evidence to conclude that using the simulations as learning tools was more effective than traditional teaching. However, the quantitative results obtained were not enough to reject or dismiss the hypothesis Ho1. On the other hand, an overall positive attitude towards these simulations was obtained from the surveys. The importance of including hands-on activities in daily lesson planning was proven and well recognized among practice teachers. After participating and working with these simulations, the practice teachers expressed being convinced that they would definitely use them as teaching tools in the classroom. Due to these results, hypothesis Ho2 was rejected. Evidence also proved that practice teachers need further professional development to improve their skills in the application of these simulations in the classroom environment. The majority of these practice teachers showed concern about not being instructed on important aspects of the use of simulation as part of their college education curriculum towards becoming teachers.

  19. Closing the Latino/a Transfer Gap: Creating Pathways to the Baccalaureate. PERSPECTIVAS: Issues in Higher Education Policy and Practice. Issue No. 2, Spring 2013

    ERIC Educational Resources Information Center

    Núñez, Anne-Marie; Elizondo, Diane

    2013-01-01

    Latinos are far more likely to begin postsecondary education in community colleges, and in fact roughly 51% are concentrated in this sector. Yet it is well documented that few manage to successfully complete the transition from a two- to a four-year college or university, making transfer the key leakage point in the pathway to the baccalaureate.…

  20. Perspectivas sobre las escuelas charter: Una resena para padres de familia (Perspectives on Charter Schools: A Review for Parents). ERIC Digest.

    ERIC Educational Resources Information Center

    Donahoo, Saran

    Recently, charter schools have gained popularity with parents, students, and others as alternatives to public schools, but what are charter schools and what effects are they having? This Spanish-language Digest defines charter schools and clarifies some of the administrative and legal details surrounding such schools. The Digest also lays out some…

  1. Curriculum Perspectives: Challenges for the Future. Proceedings of a Binational Symnposium = Perspectivas curriculares: Retos para el futuro. Actas del simposio binacional (Austin, Texas, November 9-10, 1994).

    ERIC Educational Resources Information Center

    Southwest Educational Development Lab., Austin, TX.

    This proceedings, in English and Spanish, describes the first U.S./Mexico Curriculum Symposium, held in Austin, Texas, in November 1994. The symposium grew out of an ongoing exchange between educators in the Republic of Mexico and the United States and was attended by over 200 teachers, administrators, staff from state and regional education…

  2. Perspectivas para mejorar la salud sexual de las minorías sexuales y de identidad de género en Guatemala

    PubMed Central

    Alonzo, Jorge; Mann, Lilli; Simán, Florence; Sun, Christina J.; Andrade, Mario; Villatoro, Guillermo; Rhodes, Scott D.

    2016-01-01

    Resumen Las minorías sexuales y de identidad de género en Guatemala son afectadas de manera desproporcionada por el VIH y otras infecciones transmitidas sexualmente (ITS). Sin embargo, poco se sabe de los factores que contribuyen al riesgo de infección en estas minorías. Investigadores de Estados Unidos y Guatemala quisimos informarnos sobre las necesidades de salud sexual e identificar características de programas de prevención de VIH/ITS para estas minorías. Llevamos a cabo 8 grupos focales con hombres gay, bisexuales y personas transgénero y entrevistas en profundidad con líderes comunitarios. Utilizamos el Método Comparativo Constante para analizar las transcripciones. Identificamos 24 factores que influyen en la salud sexual y 16 características de programas para reducir el riesgo de VIH/ITS en estas poblaciones. La identificación de factores de conductas sexuales de riesgo y de características de programas potencialmente efectivos ofrece gran potencial para desarrollar intervenciones que contribuyan a reducir el riesgo de infección por VIH/ITS en estas minorías en Guatemala. PMID:27494000

  3. From Perspectiva Artificialis to Cyberspace: Game-Engine and the Interactive Visualization of Natural Light in the Interior of the Building

    NASA Astrophysics Data System (ADS)

    Christakou, Evangelos Dimitrios; Silva, Neander Furtado; Lima, Ecilamar Maciel

    In order to support the early stages of conceptual design, the architect used throughout the years, mockups - scaled physical models - or perspective drawings that intended to predict architectural ambience before its effective construction. This paper studies the real time interactive visualization, focused on one of the most important aspects inside building space: the natural light. However, the majority of physically-based algorithms currently existing was designed for the synthesis of static images which may not take into account how to rebuild the scene - in real time - when the user is doing experiments to change certain properties of design. In this paper we show a possible solution for this problem.

  4. Biperiden dependence: case report and literature review.

    PubMed

    Espi Martinez, Fernando; Espi Forcen, Fernando; Shapov, Arlenne; Martinez Moya, Amparo

    2012-01-01

    Anticholinergic drugs are frequently used in psychiatry for the prophylaxis and treatment of extrapiramidal symptoms caused by neuroleptics. Abuse of anticholinergic agents has been reported in patients with psychotic disorders, on treatment with neuroleptics, and polysubstance use disorders. We are reporting the case of a patient who presented with hypoactive delirium as a consequence of biperiden dependence. The clinician must pay special attention to detect anticholinergic misuse in patients presenting with delirium of unknown cause.

  5. Biperiden Dependence: Case Report and Literature Review

    PubMed Central

    Espi Martinez, Fernando; Espi Forcen, Fernando; Shapov, Arlenne; Martinez Moya, Amparo

    2012-01-01

    Anticholinergic drugs are frequently used in psychiatry for the prophylaxis and treatment of extrapiramidal symptoms caused by neuroleptics. Abuse of anticholinergic agents has been reported in patients with psychotic disorders, on treatment with neuroleptics, and polysubstance use disorders. We are reporting the case of a patient who presented with hypoactive delirium as a consequence of biperiden dependence. The clinician must pay special attention to detect anticholinergic misuse in patients presenting with delirium of unknown cause. PMID:22937420

  6. The Successful Aging after Elective Surgery (SAGES) Study: Cohort Description and Data Quality Procedures

    PubMed Central

    Jones, Richard N.; Alsop, David C.; Fong, Tamara G.; Metzger, Eran; Cooper, Zara

    2015-01-01

    Background/Objectives Delirium is the most common complication of major elective surgery in older patients. The Successful Aging after Elective Surgery (SAGES) study was designed to examine novel risk factors and long-term outcomes associated with delirium. This report describes the cohort, quality assurance procedures, and results. Design Long-term prospective cohort study. Setting Three academic medical centers. Participants A total of 566 patients age 70 and older without recognized dementia scheduled for elective major surgery. Measurements Participants were assessed preoperatively, daily during hospitalization, and at variable monthly intervals for up to 36 months post-discharge. Delirium was assessed in hospital by trained study staff. Study outcomes included cognitive and physical function. Novel risk factors for delirium were assessed including genetic and plasma biomarkers, neuroimaging markers, and cognitive reserve markers. Interrater reliability (kappa and weighted kappa) was assessed for key variables in 119 of the patient interviews. Results Participants were an average of 77 years old and 58% were female. The majority of patients (81%) were undergoing orthopedic surgery and 24% developed delirium post-operatively. Over 95% of eligible patients were followed for 18 months. There was >99% capture of key study outcomes (cognitive and functional status) at every study interview and interrater reliability was high (weighted kappas for delirium = 0.92 and for overall cognitive and functional outcomes = 0.94 -1.0). Completion rates for plasma biomarkers (4 timepoints) were 95%-99% and for neuroimaging (one year follow-up) was 86%. Conclusion The SAGES study will contribute to the understanding of novel risk factors, pathophysiology and long-term outcomes of delirium. This manuscript describes the cohort and data quality procedures, and will serve as a reference source for future studies based on SAGES. PMID:26662213

  7. VizieR Online Data Catalog: BVRI light curves and RV curves of 65 UMa (Zasche+, 2012)

    NASA Astrophysics Data System (ADS)

    Zasche, P.; Uhlar, R.; Slechta, M.; Wolf, M.; Harmanec, P.; Nemravova, J. A.; Korcakova, D.

    2012-04-01

    We perform a combined analysis of the light and radial velocity curves, as well as the period variation by studying the times of the minima and the interferometric orbit. A disentangling technique is used to perform the spectra decomposition. This combined approach allows us to study the long-term period changes in the system for the first time, identifying the period variation due to the motion on the visual orbit, in addition to some short-term modulation. (4 data files).

  8. Title: BVRI Photometric Study and Spectra of Algol type Pre-contact W UMa Binary, V500 Pegasi

    NASA Astrophysics Data System (ADS)

    Caton, Daniel B.; Samec, Ronald G.; Van Hamme, Walter V.; Robb, Russell M.; Clark, Jeremy; Faulkner, Danny R.

    2015-01-01

    V500 Pegasi is a NSVS and TYCHO variable, fortuitously observed by ASAS-3, 2003-2009. It is an eclipsing binary with a period of 0.57983 d. The light curves have the appearance of a detached binary. Our spectroscopy reveals that it is of F5V-type. A continuous14-year period study reveals a period increase in the orbital period at about the 1 sigma level. This is probably due to weak matter transfer to the primary component. The light curve has a large difference in primary and secondary amplitudes which is typical of detached binaries. The final solution shows a total secondary eclipse. The solution is that of a classical Algol system, but of solar type. As expected in binaries of this type, it has a large cool spot region. The secondary component has a temperature of ~4700 K (K3), which means it is somewhat over-luminous for its mass.

  9. Queda dos homicídios em São Paulo, Brasil: uma análise descritiva

    PubMed Central

    Peres, Maria Fernanda Tourinho; Vicentin, Diego; Nery, Marcelo Batista; de Lima, Renato Sérgio; de Souza, Edinilsa Ramos; Cerda, Magdalena; Cardia, Nancy; Adorno, e Sérgio

    2012-01-01

    Objetivo Descrever a evolução da mortalidade por homicídios no Município de São Paulo segundo tipo de arma, sexo, raça ou cor, idade e áreas de exclusão/inclusão social entre 1996 e 2008. Métodos Estudo ecológico de série temporal. Os dados sobre óbitos ocorridos no Município foram coletados da base de dados do Programa de Aprimoramento das Informações sobre Mortalidade, seguindo a Classificação Internacional de Doenças, Décima Revisão (CID-10). Foram calculadas as taxas de mortalidade por homicídio (TMH) para a população total, por sexo, raça ou cor, faixa etária, tipo de arma e área de exclusão/inclusão social. As TMH foram padronizadas por idade pelo método direto. Foram calculados os percentuais de variação no período estudado. Para as áreas de exclusão/inclusão social foram calculados os riscos relativos de morte por homicídio. Resultados As TMH apresentaram queda de 73,7% entre 2001 e 2008. Foi observada redução da TMH em todos os grupos analisados, mais pronunciada em homens (−74,5%), jovens de 15 a 24 anos (−78,0%) e moradores de áreas de exclusão social extrema (−79,3%). A redução ocorreu, sobretudo, nos homicídios cometidos com armas de fogo (−74,1%). O risco relativo de morte por homicídio nas áreas de exclusão extrema (tendo como referência áreas com algum grau de exclusão social) foi de 2,77 em 1996, 3,9 em 2001 e 2,13 em 2008. Nas áreas de alta exclusão social, o risco relativo foi de 2,07 em 1996 e 1,96 em 2008. Conclusões Para compreender a redução dos homicídios no Município, é importante considerar macrodeterminantes que atingem todo o Município e todos os subgrupos populacionais e microdeterminantes que atuam localmente, influenciando de forma diferenciada os homicídios com armas de fogo e os homicídios na população jovem, no sexo masculino e em residentes em áreas de alta exclusão social. PMID:21390415

  10. A critical review of period analyses and implications for mass exchange in W UMa eclipsing binaries: Part 2

    NASA Astrophysics Data System (ADS)

    Nelson, R. H.; Terrell, D.; Milone, E. F.

    2015-12-01

    This is the second of a series of four papers, the goal of which is to identify the overcontact eclipsing binary star systems for which a solid case can be made for mass exchange. To reach this goal, it is necessary first to identify those systems for which there is a strong case for period change. We have identified 60 candidate systems; in the first paper (Nelson et al., 2014) we discussed 20 individual cases; this paper continues with the next 20. For each system, we present a detailed discussion and evaluation concerning the observational and interpretive material presented in the literature. An eclipse timing (ET) diagram (or diagrams), commonly referred to as an "O-C diagram", that includes the latest available data accompanies each discussion. In paper 4, we will discuss the mechanisms that can effect period change and which of the 60 systems can be reliably concluded to exhibit mass exchange; we will also provide a list of marginal and rejected cases suitable for future work.

  11. A critical review of period analyses and implications for mass exchange in W UMa eclipsing binaries: Paper 3

    NASA Astrophysics Data System (ADS)

    Nelson, R. H.; Terrell, D.; Milone, E. F.

    2016-02-01

    This is the third of a series of four papers, the goal of which is to identify the overcontact eclipsing binary star systems for which a solid case can be made for mass exchange. To reach this goal, it is necessary first to identify those systems for which there is a strong case for period change. We have identified 60 candidate systems; in the first two papers (Nelson et al. 2014, 2016) we discussed 40 individual cases; this paper continues with the last 20. For each system, we present a detailed discussion and evaluation concerning the observational and interpretive material presented in the literature. At least one eclipse timing (ET) diagram, commonly referred to as an "O-C diagram", that includes the latest available data, accompanies each discussion. In paper 4, we will discuss the mechanisms that can cause period change and which of the 60 systems can be reliably concluded to exhibit mass exchange; we will also provide a list of marginal and rejected cases - suitable for future work.

  12. Reducing Iatrogenic Risks

    PubMed Central

    Ely, E. Wesley; Speroff, Theodore; Pun, Brenda T.; Boehm, Leanne; Dittus, Robert S.

    2010-01-01

    ICUs are experiencing an epidemic of patients with acute brain dysfunction (delirium) and weakness, both associated with increased mortality and long-term disability. These conditions are commonly acquired in the ICU and are often initiated or exacerbated by sedation and ventilation decisions and management. Despite > 10 years of evidence revealing the hazards of delirium, the quality chasm between current and ideal processes of care continues to exist. Monitoring of delirium and sedation levels remains inconsistent. In addition, sedation, ventilation, and physical therapy practices proven successful at reducing the frequency and severity of adverse outcomes are not routinely practiced. In this article, we advocate for the adoption and implementation of a standard bundle of ICU measures with great potential to reduce the burden of ICU-acquired delirium and weakness. Individual components of this bundle are evidence based and can help standardize communication, improve interdisciplinary care, reduce mortality, and improve cognitive and functional outcomes. We refer to this as the “ABCDE bundle,” for awakening and breathing coordination, delirium monitoring, and exercise/early mobility. This evidence-based bundle of practices will build a bridge across the current quality chasm from the “front end” to the “back end” of critical care and toward improved cognitive and functional outcomes for ICU survivors. PMID:21051398

  13. Promoting vision and hearing aids use in an intensive care unit

    PubMed Central

    Zhou, Qiaoling; Faure Walker, Nicholas

    2015-01-01

    Vision and hearing impairments have long been recognised as modifiable risk factors for delirium.[1,2,3] Delirium in critically ill patients is a frequent complication (reported as high as 60% to 80% of intensive care patients), and is associated with a three-fold increase in mortality and prolonged hospital stay.[1] Guidelines by the UK Clinical Pharmacy Association recommend minimising risk factors to prevent delirium, rather than to treat it with pharmacological agents which may themselves cause delirium.[4] To address risk factors is a measure of multi-system management, such as sleep-wake cycle correction, orientation and use of vision and hearing aids, etc.[5] We designed an audit to survey the prevalence and availability of vision and hearing aids use in the intensive care unit (ICU) of one university hospital. The baseline data demonstrated a high level of prevalence and low level of availability of vision /hearing aid use. We implemented changes to the ICU Innovian assessment system, which serves to remind nursing staff performing daily checks on delirium reduction measures. This has improved practice in promoting vision and hearing aids use in ICU as shown by re-audit at six month. Further amendments to the Innovian risk assessments have increased the rate of assessment to 100% and vision aid use to near 100%. PMID:26734348

  14. The Psychogeriatric Patient in the Emergency Room: Focus on Management and Disposition

    PubMed Central

    Patel, Priyanka; Grossberg, George T.

    2014-01-01

    Background. The growing geriatric population in the United States (US) has prompted better understanding of treatment of the elderly in the hospital and emergency room (ER) settings. This study examines factors influencing the disposition of psychogeriatric patients after their initial presentation in the ER. Methods. Data was collected on patients 65 years of age or older arriving at the ER of a large urban hospital in the USA (January 2009–December 2010). Results. Of the total subjects (n = 95) included in the study, majority were females (66.3%) with an average age of 75.5 years. The chief complaint for psychogeriatric patients coming to the ER was delirium (61.6%). Caucasians were significantly more likely than African-American patients to get a psychiatric consult (33% versus 9%). Patients with delirium were less likely than patients with other psychiatric complaints to get a psychiatric consult in the ER (1.2% versus 47.2%) and less likely to be referred to a psychiatric inpatient unit compared to patients with other psychiatric complaints (2.4% versus 16.7%). Conclusion. Even though delirium is the most common reason for ER visits among psychogeriatric patients, very few delirium patients got a psychiatric consultation in the ER. A well-equipped geriatric psychiatry unit can manage delirium and associated causes. PMID:24734206

  15. Altered Mental Status in Older Emergency Department Patients

    PubMed Central

    Wilber, Scott T.

    2012-01-01

    Synopsis Altered mental status is a common chief complaint among older emergency department (ED) patients. Acute changes in mental status are more concerning and are usually secondary to delirium, stupor, and coma. These forms of acute brain dysfunction are commonly precipitated by an underlying medical illness that can be potentially life-threatening and are associated with a multitude of adverse outcomes. Though stupor and coma are easily identifiable, the clinical presentation of delirium can be subtle and is often missed without actively screening for it. For patients with acute brain dysfunction, the ED evaluation should focus on searching for the underlying etiology. Infection is one of the most common precipitants of delirium, but multiple etiologies may exist concurrently. PMID:23177603

  16. Mental Status Documentation: Information Quality and Data Processes

    PubMed Central

    Weir, Charlene; Gibson, Bryan; Taft, Teresa; Slager, Stacey; Lewis, Lacey; Staggers, Nancy

    2016-01-01

    Delirium is a fluctuating disturbance of cognition and/or consciousness associated with poor outcomes. Caring for patients with delirium requires integration of disparate information across clinicians, settings and time. The goal of this project was to characterize the information processes involved in nurses’ assessment, documentation, decisionmaking and communication regarding patients’ mental status in the inpatient setting. VA nurse managers of medical wards (n=18) were systematically selected across the US. A semi-structured telephone interview focused on current assessment, documentation, and communication processes, as well as clinical and administrative decision-making was conducted, audio-recorded and transcribed. A thematic analytic approach was used. Five themes emerged: 1) Fuzzy Concepts, 2) Grey Data, 3) Process Variability 4) Context is Critical and 5) Goal Conflict. This project describes the vague and variable information processes related to delirium and mental status that undermine effective risk, prevention, identification, communication and mitigation of harm. PMID:28269919

  17. Chimeric antigen receptor T-cell neuropsychiatric toxicity in acute lymphoblastic leukemia.

    PubMed

    Prudent, Vasthie; Breitbart, William S

    2017-01-04

    Chimeric antigen receptor T cells are used in the treatment of B-cell leukemias. Common chimeric antigen receptor T-cell toxicities can range from mild flu-like symptoms, such as fever and myalgia, to a more striking neuropsychiatric toxicity that can present as discrete neurological symptoms and delirium. We report here two cases of chimeric antigen receptor T-cell neuropsychiatric toxicity, one who presented as a mild delirium and aphasia that resolved without intervention, and one who presented with delirium, seizures, and respiratory insufficiency requiring intensive treatment. The current literature on the treatment and proposed mechanisms of this clinically challenging chimeric antigen receptor T-cell complication is also presented.

  18. Long Term Outcomes of a Geriatric Liaison Intervention in Frail Elderly Cancer Patients

    PubMed Central

    Hempenius, Liesbeth; Slaets, Joris P. J.; van Asselt, Dieneke; de Bock, Truuske H.; Wiggers, Theo; van Leeuwen, Barbara L.

    2016-01-01

    Background The aim of this study was to evaluate the long term effects after discharge of a hospital-based geriatric liaison intervention to prevent postoperative delirium in frail elderly cancer patients treated with an elective surgical procedure for a solid tumour. In addition, the effect of a postoperative delirium on long term outcomes was examined. Methods A three month follow-up was performed in participants of the Liaison Intervention in Frail Elderly study, a multicentre, prospective, randomized, controlled trial. Patients were randomized to standard treatment or a geriatric liaison intervention. The intervention consisted of a preoperative geriatric consultation, an individual treatment plan targeted at risk factors for delirium and daily visits by a geriatric nurse during the hospital stay. The long term outcomes included: mortality, rehospitalisation, Activities of Daily Living (ADL) functioning, return to the independent pre-operative living situation, use of supportive care, cognitive functioning and health related quality of life. Results Data of 260 patients (intervention n = 127, Control n = 133) were analysed. There were no differences between the intervention group and usual-care group for any of the outcomes three months after discharge. The presence of postoperative delirium was associated with: an increased risk of decline in ADL functioning (OR: 2.65, 95% CI: 1.02–6.88), an increased use of supportive assistance (OR: 2.45, 95% CI: 1.02–5.87) and a decreased chance to return to the independent preoperative living situation (OR: 0.18, 95% CI: 0.07–0.49). Conclusions A hospital-based geriatric liaison intervention for the prevention of postoperative delirium in frail elderly cancer patients undergoing elective surgery for a solid tumour did not improve outcomes 3 months after discharge from hospital. The negative effect of a postoperative delirium on late outcome was confirmed. Trial Registration Nederlands Trial Register, Trial ID NTR 823

  19. Readmissions and mortality in delirious versus non-delirious octogenarian patients after aortic valve therapy: a prospective cohort study

    PubMed Central

    Eide, Leslie S P; Ranhoff, Anette H; Fridlund, Bengt; Haaverstad, Rune; Kuiper, Karel K J; Nordrehaug, Jan Erik; Norekvål, Tone M

    2016-01-01

    Objectives To determine whether postoperative delirium predicts first-time readmissions and mortality in octogenarian patients within 180 days after aortic valve therapy with surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI), and to determine the most common diagnoses at readmission. Design Prospective cohort study of patients undergoing elective SAVR or TAVI. Setting Tertiary university hospital that performs all SAVRs and TAVIs in Western Norway. Participants Patients 80+ years scheduled for SAVR or TAVI and willing to participate in the study were eligible. Those unable to speak Norwegian were excluded. Overall, 143 patients were included, and data from 136 are presented. Primary and secondary outcome measures The primary outcome was a composite variable of time from discharge to first all-cause readmission or death. Secondary outcomes were all-cause first readmission alone and mortality within 180 days after discharge, and the primary diagnosis at discharge from first-time readmission. Delirium was assessed with the confusion assessment method. First-time readmissions, diagnoses and mortality were identified in hospital information registries. Results Delirium was identified in 56% of patients. The effect of delirium on readmissions and mortality was greatest during the first 2 months after discharge (adjusted HR 2.9 (95% CI 1.5 to 5.7)). Of 30 first-time readmissions occurring within 30 days, 24 (80%) were patients who experienced delirium. 1 patient (non-delirium group) died within 30 days after therapy. Delirious patients comprised 35 (64%) of 55 first-time readmissions occurring within 180 days. Circulatory system diseases and injuries were common causes of first-time readmissions within 180 days in delirious patients. 8 patients died 180 days after the procedure; 6 (75%) of them experienced delirium. Conclusions Delirium in octogenarians after aortic valve therapy might be a serious risk factor for

  20. Measuring emotional awareness from a cognitive-developmental perspective: Portuguese adaptation studies of the levels of emotional awareness scale.

    PubMed

    Torrado, Marco; Ouakinin, Sílvia; Lane, Richard

    2013-01-01

    Introdução: A Escala de Níveis de Consciência Emocional (LEAS) foi desenvolvida para avaliar o constructo consciência emocional, numa perspectiva cognitivo-desenvolvimentista e influenciada pelas Teorias de Piaget e Werner. É composta por 20 situações ou cenários que evocam emoções e tem sido usada em múltiplas investigações nos domínios da regulação emocional, alexitimia e perturbações psiquiátricas. Trata-se de uma medida bem documentada, validada e precisa. Em virtude da sua extensão, alguns investigadores têm vindo a utilizar uma das formas paralelas que compõe a versão completa, a LEAS-A, sendo contudo notória a vacuidade de estudos que descrevam as qualidades psicométricas desta versão. Face à inexistência de uma medida de caracterização da organização da experiência emocional para a população portuguesa, desenvolveu-se a versão portuguesa da LEAS, caracterizaram-se diversos indicadores de precisão e validade, assim como para a versão reduzida LEAS-A. Materiais e Métodos: Foram desenvolvidos três estudos com estas versões, dois deles com recurso a estudantes universitários e um outro com uma amostra da população em geral. Resultados: A versão portuguesa demonstrou níveis elevados de precisão, mais robustos do que os encontrados em estudos de adaptação da escala noutros países. A LEAS-A apresentou bons níveis de precisão e indicadores de validade discriminante e concorrente. As pontuações obtidas na LEAS-A mostraram-se independentes da presença de afecto negativo e associaram-se significativamente a um estilo cognitivo externalizado, próprio do funcionamento alexitímico. Conclusões: As versões portuguesas da LEAS e da LEAS-A apresentam qualidades psicométricas muito adequadas, o que permite o seu uso científico. São discutidas as implicações da sua utilização nos contextos clínico e de investigação.

  1. Economic analysis of rivaroxaban for the treatment and long-term prevention of venous thromboembolism in Portugal.

    PubMed

    Santos, Isabel Fonseca; Pereira, Sónia; McLeod, Euan; Guillermin, Anne-Laure; Chatzitheofilou, Ismini

    2014-01-01

    Introdução: O tromboembolismo venoso representa uma carga substancial para os sistemas de saúde. O objectivo foi estimar os resultados clínicos e económicos a longo-prazo associados a rivaroxabano relativamente à prática clínica (enoxaparina/varfarina) no tratamento e prevenção secundária de tromboembolismo venoso em Portugal.Material e Métodos: Foi desenvolvido um modelo de Markov baseado nos ensaios clínicos EINSTEIN e dados da literatura para complicações a longo-prazo. Foram avaliados custos e anos de vida ajustados pela qualidade de vida totais e incrementais e rácio custo-efectividade incremental. As indicações trombose venosa profunda e embolismo pulmonar foram analisados separadamente. Adoptou-se a perspectiva da sociedade portuguesa e um horizonte temporal de cinco anos. Aplicou-se uma taxa de actualização de cinco por cento para custos e consequências. Foram desenvolvidas análises de sensibilidade e diversas análises de cenário para avaliação da variação dos resultados em função de determinados pressupostos.Resultados: Rivaroxabano está associado a menores custos na trombose venosa profunda e constitui uma alternativa associada a menores custos e a maior eficácia no tratamento de embolismo pulmonar, relativamente a enoxaparina/varfarina.Discussão: O recurso a um painel de peritos para identificação de alguns recursos e a ausência de utilidades específicas para Portugal constituem as principais limitações.Conclusão: Rivaroxabano constitui uma alternativa eficaz, estando associado a menores custos (para ambas as indicações) e a mais anos de vida ajustados pela qualidade de vida (para embolismo pulmonar) relativamente a enoxaparina/varfarina em Portugal.

  2. Fostering Intercultural Communicative Competence through Reading Authentic Literary Texts in an Advanced Colombian EFL Classroom: A Constructivist Perspective (Desarrollo de la competencia comunicativa intercultural mediante la lectura de textos literarios auténticos: una perspectiva constructivista)

    ERIC Educational Resources Information Center

    Gómez, Luis Fernando R.

    2012-01-01

    This article describes an action research experience carried out in an advanced English as a foreign language classroom of the language program at a university in Bogotá, Colombia, in 2010. The study proposes the inclusion of authentic literary texts in the English as a foreign language classroom through the implementation of four constructivist…

  3. Teacher Collaboration Praxis: Conflicts, Borders, and Ideologies from a Micropolitical Perspective (La práctica colaborativa entre docentes: conflictos, fronteras e ideologías desde una perspectiva micropolítica)

    ERIC Educational Resources Information Center

    Keranen, Nancy; Encinas Prudencio, Fátima

    2014-01-01

    This paper looks at a feature of teacher collaboration within Achinstein's (2002) micropolitics of collaboration but from an intrapersonal perspective. Results discussed feature issues of conflict, borders, and ideologies within each participating teacher rather than between teachers. Unresolved or unacknowledged intrapersonal conflict might lead…

  4. Peer Interaction: A Social Perspective towards the Development of Foreign Language Learning (Interacción entre pares: una perspectiva social hacia el desarrollo del aprendizaje en una lengua extranjera)

    ERIC Educational Resources Information Center

    Gómez Lobatón, July Carolina

    2011-01-01

    This pedagogical innovation aims at discovering new ways of interaction that go beyond the unidirectional relationship that is presented in the classrooms most of the times. The innovation considers peers to be active agents in the construction of knowledge and proposes new ways to arrange groups in the classroom so that the arrangement can…

  5. Examining a Rupture in the Latina/o College Pipeline: Developmental Education in California Community Colleges. PERSPECTIVAS: Issues in Higher Education Policy and Practice. Issue No. 3, Spring 2014

    ERIC Educational Resources Information Center

    Acevedo-Gil, Nancy; Santos, Ryan E.; Solórzano, Daniel G.

    2014-01-01

    This policy brief highlights the trajectories of Latina/o students who test into developmental coursework at California community colleges and brings attention to the obstacles created by these courses. The authors use quantitative data from the Basic Skills Progress Cohort Tracking Tool (Progress Tracker) from the California Community Colleges…

  6. Contributions of a Social Justice Language Teacher Education Perspective to Professional Development Programs in Colombia (Contribuciones de una perspectiva de justicia social para la formación de docentes de lenguas a los programas de desarrollo profesional en Colombia)

    ERIC Educational Resources Information Center

    Sierra Piedrahita, Ana María

    2016-01-01

    In this article, the author discusses the social justice language teacher education perspective and how it can help language teachers to develop a political view of their work and effect change inside and outside their particular school contexts. To do this, she briefly analyzes various professional development programs for teachers of English in…

  7. Protótipo do primeiro interferômetro brasileiro - BDA

    NASA Astrophysics Data System (ADS)

    Cecatto, J. R.; Fernandes, F. C. R.; Neri, J. A. C. F.; Bethi, N.; Felipini, N. S.; Madsen, F. R. H.; Andrade, M. C.; Soares, A. C.; Alonso, E. M. B., Sawant, H. S.

    2004-04-01

    A interferometria é uma poderosa ferramenta usada para investigar estruturas espaciais de fontes astrofísicas fornecendo uma riqueza de detalhes inatingível pelas técnicas convencionais de imageamento. Em particular, a interferometria com ondas de rádio abre o horizonte de conhecimento do Universo nesta ampla banda do espectro eletromagnético, que vai de cerca de 20 kHz até centenas de GHz já próximo ao infravermelho, e que está acessível a partir de instrumentos instalados em solo. Neste trabalho, apresentamos o interferômetro designado por Arranjo Decimétrico Brasileiro (BDA). Trata-se do primeiro interferômetro a ser desenvolvido no Brasil e América Latina que já está em operação na fase de protótipo. Apresentamos o desenvolvimento realizado até o momento, o sítio de instalação do instrumento, o protótipo e os principais resultados dos testes de sua operação, as perspectivas futuras e a ciência a ser desenvolvida com o instrumento nas fases II e III. Neste trabalho é dada ênfase ao desenvolvimento, testes de operação e principais resultados do protótipo. É discutida brevemente a ciência que pode ser feita com o instrumento. Tanto os detalhes técnicos quanto os principais parâmetros estimados para o instrumento nas próximas fases de desenvolvimento e o desempenho do protótipo serão publicados em breve.

  8. 75 FR 73104 - Clinical Development Programs for Sedation Products; Request for Assistance

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-29

    ... purposes and not to treat an anxiety disorder or agitation? Should there be different scales for assessing... not be possible to generalize from them. If active- and placebo-controlled product trial designs are... trials? Are subjective and objective assessments of memory, recall, anxiety, agitation, delirium,...

  9. Mental malfunction and memory maintenance mechanisms.

    PubMed

    Kavanau, J L

    2000-04-01

    Dreams appear to be generated in the process of reinforcing memory circuits of the brain, as circuits are activated by self-generated electrical slow waves, with dream contents reflecting information stored in activated circuits. Illusory dreams and other healthy delirious states appear to occur when activated memory circuits are incompetent, containing synapses whose efficacies deviate from their 'dedicated' values. Organic delirium and some other mental disorders may have their basis in brain pathologies that alter reinforcing slow waves, causing synaptic efficacies to depart from dedicated values. Activation of these incompetent circuits leads to recall of faulty memories--a substrate for delirium. In treatment of organic delirium by electroconvulsive therapy (ECT), the electric shock temporarily suppresses abnormal slow-wave regimes, allowing remedial reinforcement regimes to resume. These restore dedicated synaptic efficacies, temporarily alleviating the delirium. The action of ECT shocks appears to parallel closely that of cardiac defibrillating shocks. Greater than normal amounts of circuit reinforcement protect sensory circuitry in fatal familial insomnia, and cognitive circuitry in encephalitis lethargica.

  10. Understanding cognition in older patients with cancer

    PubMed Central

    Karuturi, Meghan; Wong, Melisa L.; Hsu, Tina; Kimmick, Gretchen G.; Lichtman, Stuart M.; Holmes, Holly M.; Inouye, Sharon K.; Dale, William; Loh, Kah P.; Whitehead, Mary I.; Magnuson, Allison; Hurria, Arti; Janelsins, Michelle C.; Mohile, Supriya

    2016-01-01

    Cancer and neurocognitive disorders, such as dementia and delirium, are common and serious diseases in the elderly that are accompanied by high degree of morbidity and mortality. Furthermore, evidence supports the under-diagnosis of both dementia and delirium in older adults. Complex questions exist regarding the interaction of dementia and delirium with cancer, beginning with guidelines on how best measure disease severity, the optimal screening test for either disorder, the appropriate level of intervention in the setting of abnormal findings, and strategies aimed at preventing the development or progression of either process. Ethical concerns emerge in the research setting, pertaining to the detection of cognitive dysfunction in participants, validity of consent, disclosure of abnormal results if screening is pursued, and recommended level of intervention by investigators. Furthermore, understanding the ways in which comorbid cognitive dysfunction and cancer impact both cancer and non-cancer-related outcomes is essential in guiding treatment decisions. In the following article, we will discuss what is presently known of the interactions of pre-existing cognitive impairment and delirium with cancer. We will also discuss identified deficits in our knowledge base, and propose ways in which innovative research may address these gaps. PMID:27282296

  11. Identification of new molecular alterations in Fatal Familial Insomnia

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Fatal Familial Insomnia (FFI) is a rare disease caused by a D178N mutation in combination with methionine (Met) at codon 129 in the mutated allele of PRNP (D178N-129M haplotype). FFI is manifested by sleep disturbances with insomnia, autonomic disorders, hallucinations, delirium, and spontaneous and...

  12. Visual Auto/biography, Hysteria, and the Pedagogical Performance of the "Real."

    ERIC Educational Resources Information Center

    Hesford, Wendy S.

    2000-01-01

    Discusses Mindy Faber's autobiographical video as an allegory of contradictory interpretations of female hysteria as both a theater of femininity and feminist revolt. Provides an analysis of the resonance between student responses to "Delirium" (her auto/biographical video about her mother's long battle with mental illness) and…

  13. Evaluating Alcoholism and Drug Abuse Knowledge in Medical Education: A Collaborative Project.

    ERIC Educational Resources Information Center

    Griffin, John B., Jr.

    1983-01-01

    Medical students performed less well on examinations about drug abuse problems and patient management than on traditional medical board examinations. The best knowledge was of pharmacology of drug abuse, Alcoholics Anonymous, and treatment of delirium tremens. Students knew less about metabolic and biochemical areas, emergency-room treatment, and…

  14. A Competency-Based Medical Student Curriculum Targeting Key Geriatric Syndromes

    ERIC Educational Resources Information Center

    van Zuilen, Maria H.; Rodriguez, Osvaldo; Mintzer, Michael J.; Paniagua, Miguel A.; Milanez, Marcos N.; Ruiz, Jorge G.; Kaiser, Robert M.; Roos, Bernard A.

    2008-01-01

    The University of Miami Miller School of Medicine (UMMSM) has developed and implemented a competency-based undergraduate medical education (UME) curriculum that targets 61 learning objectives for three geriattic syndromes: dementia, falls, and delirium. This curriculum redesign changed the educational focus from what is taught to what is learned.…

  15. How Nurses Decide to Ambulate Hospitalized Older Adults: Development of a Conceptual Model

    ERIC Educational Resources Information Center

    Doherty-King, Barbara; Bowers, Barbara

    2011-01-01

    Adults over the age of 65 years account for 60% of all hospital admissions and experience consequential negative outcomes directly related to hospitalization. Negative outcomes include falls, delirium, loss in ability to perform basic activities of daily living, and new walking dependence. New walking dependence, defined as the loss in ability to…

  16. Marijuana Revisited.

    ERIC Educational Resources Information Center

    Archer, James, Jr.; Lopata, Ann

    1979-01-01

    This review examines recent research on psychological effects of marijuana. The article contains material on potency, research problems, use patterns in the United States, and expectancy, as well as a review of research on acute effects, including psychosis, toxic delirium, acute anxiety, and brain damage. (Author)

  17. Do You Know the Facts about Reye's Syndrome?

    ERIC Educational Resources Information Center

    PTA Today, 1993

    1993-01-01

    Presents information on Reye's syndrome, which affects all ages, both sexes, and every race, generally following viral illnesses (with or without a fever). Aspirin products increase the risk but are not a necessary element. Symptoms include persistent vomiting, listlessness, disorientation, personality changes, combativeness, and delirium. Early…

  18. 38 CFR Appendix C to Part 4 - Alphabetical Index of Disabilities