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  1. 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 ...

  2. 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 ...

  3. 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. ...

  4. Excited Delirium

    PubMed Central

    Takeuchi, Asia; Ahern, Terence L.; Henderson, Sean O.

    2011-01-01

    Excited (or agitated) delirium is characterized by agitation, aggression, acute distress and sudden death, often in the pre-hospital care setting. It is typically associated with the use of drugs that alter dopamine processing, hyperthermia, and, most notably, sometimes with death of the affected person in the custody of law enforcement. Subjects typically die from cardiopulmonary arrest, although the cause is debated. Unfortunately an adequate treatment plan has yet to be established, in part due to the fact that most patients die before hospital arrival. While there is still much to be discovered about the pathophysiology and treatment, it is hoped that this extensive review will provide both police and medical personnel with the information necessary to recognize and respond appropriately to excited delirium. PMID:21691475

  5. Emergence delirium.

    PubMed

    Munk, Louise; Andersen, Lars Peter Holst; Gögenur, Ismail

    2013-11-01

    Emergence delirium (ED) is a well-known phenomenon in the postoperative period. However, the literature concerning this clinical problem is limited. This review evaluates the literature with respect to epidemiology and risk factors. Treatment strategies are discussed. The review concludes that there is a need for guidelines concerning diagnosis and treatment of ED. Risk factors should be investigated further in the clinical setting in the future. PMID:24312995

  6. [Delirium in the elderly].

    PubMed

    Gogol, Manfred

    2008-12-01

    Delirium is a common, serious medical and often life-threatening condition in elderly in-patients. Delirium can develop primarily or secondarily related to other medical conditions and lead to hospital admission. The pathogenesis is still not fully known and is usually addressed as multifactorial. Alterations in neurotransmitters have a key role in this process. The incidence varies by setting up to 90%. Delirium is associated with increased short- and long-term mortality, iatrogenic complications, functional decline, and future development of cognitive impairment or dementia. Delirium is also associated with longer hospital stays, higher hospital and total health system costs, and an increasing rate of nursing home admissions. A structured diagnostic and therapeutic process is recommended. Delirium should become a quality indicator for hospital medicine; however, many research questions still exist. PMID:19190865

  7. [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.

  8. Delirium and epilepsy

    PubMed Central

    Kaplan, Peter W.

    2003-01-01

    Delirium (a state of usually reversible global brain disfunction due to toxic, metabolic, or infectious causes) and epilepsy (a condition of spontaneous, recurrent paroxysmal electrical excitation or dysfunction) are becoming increasingly better understood, and hence easier to diagnose and treat. The clinical features of delirium predominantly involve subacute changes in cognition, awareness, and activity levels, behavioral disturbance, clouding consciousness, and sleep-wake cycle changes. In contrast, epilepsy involves the acute interruption of brain function, often with convulsive activity, falls, and injury. States that may share the clinical features of both, such as nonconvulsive epileptic states, are also important: the cause of brain derangement is one of excessive and abnormal electrical brain activity. In such conditions, the clinical manifestations may resemble states of delirium and confusion, and the absence of convulsive clinical activity is significant. Electroencephalography remains the diagnostic test of choice: it is essential for differentiating these two conditions, enabling the distinctly different treatments and epilepsy. Ongoing research and investigation are essential to better understand the abnormal brat mechanisms underlying delirium, and to develop better tools for objective diagnosis. PMID:22034394

  9. Delirium: Issues for Older Adults

    MedlinePlus

    ... develop a condition of slowly progressive cognitive or mental decline called dementia. Some of the causes of dementia ... institutions. As a person’s cognitive awareness begins to decline they may be ... delirium. To decrease the risk and chances of delirium, try to ...

  10. Delirium diagnosis, screening and management

    PubMed Central

    Lawlor, Peter G.; Bush, Shirley H.

    2014-01-01

    Purpose of review Our review focuses on recent developments across many settings regarding the diagnosis, screening and management of delirium, so as to inform these aspects in the context of palliative and supportive care. Recent findings Delirium diagnostic criteria have been updated in the long-awaited Diagnostic Statistical Manual of Mental Disorders, fifth edition. Studies suggest that poor recognition of delirium relates to its clinical characteristics, inadequate interprofessional communication and lack of systematic screening. Validation studies are published for cognitive and observational tools to screen for delirium. Formal guidelines for delirium screening and management have been rigorously developed for intensive care, and may serve as a model for other settings. Given that palliative sedation is often required for the management of refractory delirium at the end of life, a version of the Richmond Agitation-Sedation Scale, modified for palliative care, has undergone preliminary validation. Summary Although formal systematic delirium screening with brief but sensitive tools is strongly advocated for patients in palliative and supportive care, it requires critical evaluation in terms of clinical outcomes, including patient comfort. Randomized controlled trials are needed to inform the development of guidelines for the management of delirium in this setting. PMID:25004177

  11. 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'.

  12. Delirium: is sleep important?

    PubMed

    Watson, Paula L; Ceriana, Piero; Fanfulla, Francesco

    2012-09-01

    Delirium and poor sleep quality are common and often co-exist in hospitalised patients. A link between these disorders has been hypothesised but whether this link is a cause-and-effect relationship or simply an association resulting from shared mechanisms is yet to be determined. Potential shared mechanisms include: abnormalities of neurotransmitters, tissue ischaemia, inflammation and sedative exposure. Sedatives, while decreasing sleep latency, often cause a decrease in slow wave sleep and stage rapid eye movement (REM) sleep and therefore may not provide the same restorative properties as natural sleep. Mechanical ventilation, an important cause of sleep disruption in intensive care unit (ICU) patients, may lead to sleep disruption not only from the discomfort of the endotracheal tube but also as a result of ineffective respiratory efforts and by inducing central apnoea events if not properly adjusted for the patient's physiologic needs. When possible, efforts should be made to optimise the patient-ventilator interaction to minimise sleep disruptions.

  13. 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

  14. Altered Mental Status and Delirium.

    PubMed

    Wilber, Scott T; Ondrejka, Jason E

    2016-08-01

    Older patients who present to the emergency department frequently have acute or chronic alterations of their mental status, including their level of consciousness and cognition. Recognizing both acute and chronic changes in cognition are important for emergency physicians. Delirium is an acute change in attention, awareness, and cognition. Numerous life-threatening conditions can cause delirium; therefore, prompt recognition and treatment are critical. The authors discuss an organized approach that can lead to a prompt diagnosis within the time constraints of the emergency department. PMID:27475019

  15. A Practical Guide to Postoperative Delirium.

    PubMed

    Beck, Justin L; Tucker, Phebe

    2015-01-01

    In conclusion, delirium is a common postoperative complication that especially impacts the elderly population. It contributes to a significant increase in morbidity, mortality, length of inpatient stay, and medical costs. Even with preventive efforts, many patients will develop postoperative delirium. While the gold standard treatment is to correct the underlying disorder, many therapies ranging from the use of antipsychotics to patient comfort measures are used to decrease the severity and duration of postoperative delirium. The most practical approach for physicians is continuous vigilance for the emergence of postoperative delirium. Movement toward increased use of multidisciplinary inpatient ward teams, early psychiatric consultation during postoperative delirium, larger clinical trials of prophylactic medications, and future research on delirium's pathogenesis will decrease complications of this common clinical problem. PMID:26638418

  16. Preventing delirium in the intensive care unit.

    PubMed

    Brummel, Nathan E; Girard, Timothy D

    2013-01-01

    Delirium in the intensive care unit (ICU) is exceedingly common, and risk factors for delirium among the critically ill are nearly ubiquitous. Addressing modifiable risk factors including sedation management, deliriogenic medications, immobility, and sleep disruption can help to prevent and reduce the duration of this deadly syndrome. The ABCDE approach to critical care is a bundled approach that clinicians can implement for many patients treated in their ICUs to prevent the adverse outcomes associated with delirium and critical illness.

  17. Neuroblastoma and pediatric delirium: a case series.

    PubMed

    Traube, Chani; Augenstein, Julie; Greenwald, Bruce; LaQuaglia, Michael; Silver, Gabrielle

    2014-06-01

    Delirium occurs frequently in critically ill children, and children with neuroblastoma may be at particular risk. Early diagnosis and treatment may improve short- and long-term outcomes. In this case series, we present four critically ill children with neuroblastoma who were diagnosed with delirium in the post-operative period. In all four patients, the diagnosis of delirium facilitated targeted intervention and improvement. Heightened awareness by pediatric oncologists, surgeons, and intensivists may lead to earlier diagnosis and improvement in clinical outcomes.

  18. [New approach to postoperative delirium treatment].

    PubMed

    Pasechnik, I N; Makhlaĭ, A V; Tepliakova, A N; Gubaĭdullin, R R; Sal'nikov, P S; Borisov, A Iu; Berezenko, M N

    2015-01-01

    The efficiency of different drugs for sedation was studied in 51 patients after large abdominal operations complicated by postoperative delirium. Diagnosis of postoperative delirium was established according to CAM-ICU criteria. Dexmedetomidine has demonstrated significantly decreased duration of delirium and hospital stay in intensive care unit in comparison with haloperidol. Besides, patients which received dexmedetomidine preserved opportunity for verbal contact. Also these patients interacted better with department's stuff. PMID:26031955

  19. Delirium in patients with advanced cancer.

    PubMed

    Lawlor, Peter G; Bruera, Eduardo D

    2002-06-01

    Managing delirium is of major importance in end-of-life care and frequently gives rise to controversies and to clinical and ethical dilemmas. These problems arise from a number of causes, including the sometimes-poor recognition or misdiagnosis of delirium despite its frequent occurrence. Delirium generates major symptomatic of distress for the patient, consequent stress for the patient's family, the potential to misinterpret delirium symptomatology, and behavioral management challenges for health care professionals. Paradoxically, delirium is potentially reversible in some episodes, but in many patients delirium presents a nonreversible terminal episode. Greater educational efforts are required to improve the recognition of delirium and lead to a better understanding of its impact in end-of-life care. Future research might focus on phenomenology, the development of low-burden instruments for assessment, communication strategies, and the family education regarding the manifestations of delirium. Further research is needed among patients with advanced cancer to establish a predictive model for reversibility that recognizes both baseline vulnerability factors and superimposed precipitating factors. Evidence-based guidelines should be developed to assist physicians in more appropriate use of sedation in the symptomatic management of delirium.

  20. 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

  1. 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

  2. Functional interrelationship of brain aging and delirium.

    PubMed

    Rapazzini, Piero

    2016-02-01

    Theories on the development of delirium are complementary rather than competing and they may relate to each other. Here, we highlight that similar alterations in functional brain connectivity underlie both the observed age-related deficits and episodes of delirium. The default mode network (DMN) is a group of brain regions showing a greater level of activity at rest than during attention-based tasks. These regions include the posteromedial-anteromedial cortices and temporoparietal junctions. Evidence suggests that awareness is subserved through higher order neurons associated with the DMN. By using functional MRI disruption of DMN, connectivity and weaker task-induced deactivations of these regions are observed both in age-related cognitive impairment and during episodes of delirium. We can assume that an acute up-regulation of inhibitory tone within the brain acts to further disrupt network connectivity in vulnerable patients, who are predisposed by a reduced baseline connectivity, and triggers the delirium. PMID:25998952

  3. Functional interrelationship of brain aging and delirium.

    PubMed

    Rapazzini, Piero

    2016-02-01

    Theories on the development of delirium are complementary rather than competing and they may relate to each other. Here, we highlight that similar alterations in functional brain connectivity underlie both the observed age-related deficits and episodes of delirium. The default mode network (DMN) is a group of brain regions showing a greater level of activity at rest than during attention-based tasks. These regions include the posteromedial-anteromedial cortices and temporoparietal junctions. Evidence suggests that awareness is subserved through higher order neurons associated with the DMN. By using functional MRI disruption of DMN, connectivity and weaker task-induced deactivations of these regions are observed both in age-related cognitive impairment and during episodes of delirium. We can assume that an acute up-regulation of inhibitory tone within the brain acts to further disrupt network connectivity in vulnerable patients, who are predisposed by a reduced baseline connectivity, and triggers the delirium.

  4. Delirium tremens. Some clinical features. Part I.

    PubMed

    Kramp, P; Hemmingsen, R

    1979-11-01

    Twenty patients with delirium tremens and related states were investigated from the time of admission until the acute state was over. Using strict diagnostic criteria the material was divided into two groups according to the severity of the clinical condition; nine patients had fully developed delirium tremens (grade 3), 11 patients had a less severe clinical state, known as "Predelirium" (grade 2). The material was found to be representative for the condition under discussion. Patients with grade 2 were admitted during the day and the evening, but not during the night; patients with fully developed delirium tremens (grade 3) were admitted during both the day and the night, and this difference is discussed. The two groups had the same pattern of alcohol abuse, but patients with proper delirium tremens had had a drinking bout preceding the acute state; this was not seen among patients with a less severe clinical state. Patients with grade 2 had had symptoms like sleep disturbances and gastro-intestinal disturbances for 12-24 hours before the admission, whereas grade 3 patients had had such symptoms for about 48 hours. Patients with grade 2 stopped drinking when the first symptoms of the acute state appeared, whereas patients with fully developed delirium tremens continued to drink in spite of their condition. These anamnestic were supported by the finding that significantly more patients with proper delirium tremens had alcohol in the blood--several even concentrations about 2 g/l--at the time of admission compared to patients with a less severe clinical state. This lack of "latency period", which previously has been described as a typical feature in the development of delirium tremens, is discussed. It is concluded that due to the methodology used, it has been possible to point out some of the differences between the milder, often harmless, conditions and the potentially serious, fully developed delirium tremens.

  5. Delirium in the Cardiac Surgical Intensive Care Unit

    PubMed Central

    Brown, Charles H

    2014-01-01

    Purpose Evidence is emerging that delirium is associated with both short- and long-term morbidity and mortality. This review highlights the epidemiology, outcomes, prevention and treatment strategies associated with delirium after cardiac surgery. Recent findings The incidence of delirium after cardiac surgery is estimated to be 26-52%, with a significant percentage being hypoactive delirium. It is clear that without an appropriate structured test for delirium, the incidence of delirium will be under-recognized clinically. Delirium after cardiac surgery is associated with poor outcomes including increased long-term mortality, increased risk of stroke, poor functional status, increased hospital readmissions, and substantial cognitive dysfunction for 1-year following surgery. The effectiveness of prophylactic antipsychotics to reduce the risk of delirium is controversial, with data from recent small studies in non-cardiac surgery potentially showing a benefit. Although anti-psychotic medications are often used to treat delirium, the evidence that anti-psychotics in cardiac surgery patients reduce duration of delirium or improve long-term outcomes following delirium is poor. Summary Clinicians in the ICU must recognize the impact of delirium in predicting long-term outcomes for patients. Further research is needed in determining interventions that will be effective in preventing and treating delirium in cardiac surgical setting. PMID:24514034

  6. Delirium

    MedlinePlus

    ... to Pregnancy? Health Highlights: Sept. 13, 2016 Smokers' Perceptions May Play Role in Addiction ALL NEWS > Resources ... delusions (false beliefs usually involving a misinterpretation of perceptions or experiences). Personality and mood may change. Some ...

  7. An Unusual Case of Delirium after Restarting Clozapine.

    PubMed

    Khanra, Sourav; Sethy, Rati Ranjan; Munda, Sanjay Kumar; Khess, Christoday Raja Jayant

    2016-02-29

    Clozapine is a gold standard medication and drug of choice in refractory schizophrenia. Among many of its fatal side effects, delirium is less reported and inconsistently recognized by clinicians. We here present a case of delirium which emerged during retreatment with clozapine in a patient of paranoid schizophrenia. A patient diagnosed with paranoid schizophrenia, was restarted on clozapine after he left medications and became symptomatic. He was delirious on 22nd day after clozapine was restarted. Clozapine was stopped and the patient was managed with standard treatment for delirium. After one week interval, clozapine was restarted. Delirium was not noted till 6 weeks of his hospital stay. Clozapine induced central anticholinergic toxicity or clozapine induced seizure might cause delirium in index case. Limited literature exist delirium with clozapine. Clinicians must have high index of suspicion to detect delirium during clozapine therapy. More researches should focus to explore the association between delirium and clozapine. PMID:26792049

  8. Preventing delirium in dementia: Managing risk factors.

    PubMed

    Ford, Andrew H

    2016-10-01

    Delirium is a common, disabling medical condition that is associated with numerous adverse outcomes. A number of inter-related factors, including pre-existing cognitive impairment, usually contribute to the development of delirium in a particular susceptible individual. Non-pharmacological approaches to prevention typically target multiple risk factors in a systematic manner (multicomponent interventions). There is generally good evidence that multicomponent interventions reduce the incidence of delirium in hospital populations but there are limited data in people with dementia and those living in the community. It is likely that there is a differential effect of specific interventions in those with cognitive impairment (e.g. people with dementia may respond better to simpler, more pragmatic interventions rather than complex procedures) but this cannot be determined from the existing data. Targeted interventions focussed on hydration, medication rationalization and sleep promotion may also be effective in reducing the incidence of delirium, as well as the active involvement of family members in the care of the elderly hospitalized patient. Hospitalization itself is a potential risk factor for delirium and promising data are emerging of the benefits of home-based care as an alternative to hospitalization but this is restricted to specific sub-populations of patients and is reliant on these services being available.

  9. Preventing delirium in dementia: Managing risk factors.

    PubMed

    Ford, Andrew H

    2016-10-01

    Delirium is a common, disabling medical condition that is associated with numerous adverse outcomes. A number of inter-related factors, including pre-existing cognitive impairment, usually contribute to the development of delirium in a particular susceptible individual. Non-pharmacological approaches to prevention typically target multiple risk factors in a systematic manner (multicomponent interventions). There is generally good evidence that multicomponent interventions reduce the incidence of delirium in hospital populations but there are limited data in people with dementia and those living in the community. It is likely that there is a differential effect of specific interventions in those with cognitive impairment (e.g. people with dementia may respond better to simpler, more pragmatic interventions rather than complex procedures) but this cannot be determined from the existing data. Targeted interventions focussed on hydration, medication rationalization and sleep promotion may also be effective in reducing the incidence of delirium, as well as the active involvement of family members in the care of the elderly hospitalized patient. Hospitalization itself is a potential risk factor for delirium and promising data are emerging of the benefits of home-based care as an alternative to hospitalization but this is restricted to specific sub-populations of patients and is reliant on these services being available. PMID:27621236

  10. 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.

  11. Melatonin deficiency hypothesis in delirium: a synthesis of current evidence.

    PubMed

    de Rooij, Sophia E; van Munster, Barbara C

    2013-08-01

    The pineal hormone melatonin plays a major role in circadian sleep-wake rhythm in many mammals, including humans. Patients with acute confusional state or delirium, especially those with underlying cognitive impairment, frequently suffer from sleep disturbances and disturbed circadian rhythm. In this review, an overview is given of delirium and delirium symptoms that correspond with symptoms in dementia, such as sundowning, followed by a presentation of the circadian rhythm disorders in delirium in relation to melatonin deficiency. Finally, this review examines the therapeutic benefit of melatonin treatment in disorders related to delirium and dementia, including the placebo-controlled randomized clinical trials addressing this topic.

  12. The major risk factors for delirium in a clinical setting

    PubMed Central

    Kim, Harin; Chung, Seockhoon; Joo, Yeon Ho; Lee, Jung Sun

    2016-01-01

    Objective We aimed to determine the major risk factors for the development of delirium in patients at a single general hospital by comparison with a control group. Subjects and methods We reviewed the medical records of 260 delirium patients and 77 control patients. We investigated age, sex, and risk factors for delirium in the total delirium group (n=260), the delirium medical subgroup (n=142), and the delirium surgical subgroup (n=118). Logistic regression analysis adjusting for age and sex was performed to identify the odds ratio. Results The mean age and the percentage of males were significantly higher in the delirium group compared with the control group (68.9 vs 54.3 years and 70% vs 41.6%, respectively). Risk factors for the delirium group were lower plasma albumin, hypertension, mechanical ventilation, and antipsychotic drug use. Plasma sodium level and hypertension were important risk factors for the delirium medical subgroup. Stroke history, hypertension, ICU care, and medication were important risk factors for the delirium surgical subgroup. Conclusion Lower plasma albumin, hypertension, mechanical ventilation, and antipsychotic drug use are important risk factors for delirium. PMID:27499625

  13. 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.

  14. Tryptophan Supplementation and Postoperative Delirium – A Randomized Controlled Trial

    PubMed Central

    Robinson, Thomas N.; Dunn, Christina L.; Adams, Jill C.; Hawkins, Carrie L.; Tran, Zung V.; Raeburn, Christopher D.; Moss, Marc

    2014-01-01

    Background/Objectives Tryptophan deficiency has been associated with increased incidence of postoperative delirium. Therefore, we hypothesized that the post-operative administration of tryptophan would be beneficial for elderly surgical patients who are at higher risk of developing post-operative delirium. Design Randomized, double-blind, placebo controlled trial. Setting: Participants A total of 325 individuals aged 60 years and older undergoing major elective operations requiring a postoperative intensive care unit admission. Intervention L-tryptophan, 1 gram orally, three times daily or placebo was started following the operation and continued for up to three days postoperatively. Measurements Delirium and its motor subtypes were measured using the Confusion Assessment Method-ICU and the Richmond Agitation and Sedation Scale. The primary outcome for between groups comparison was the incidence of excitatory (mixed and hyperactive) postoperative delirium. The secondary outcomes for comparison were the incidence and duration of overall postoperative delirium. Results The overall incidence of postoperative delirium was 39% (116) (95% confidence interval 34% to 44%). The percentages of patients with excitatory delirium in the tryptophan and placebo groups were 17% and 9% (p=0.176), and the duration of excitatory delirium was 3.3±1.7 and 3.1±1.9 days (p=0.741). The percentage of patients with overall delirium in the tryptophan and placebo groups was 40% and 37% (p=0.597), and the duration of overall delirium was 2.9±1.8 and 2.4±1.6 days (p=0.167). Conclusion Postoperative tryptophan supplementation in older adults undergoing major elective operations requiring postoperative intensive care unit admission demonstrated no efficacy in reducing the incidence of postoperative excitatory delirium or overall delirium, and the duration of excitatory or overall delirium. PMID:25112175

  15. 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

  16. 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.

  17. 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.

  18. 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. PMID:26911180

  19. Delayed onset and prolonged interictal delirium following electroconvulsive therapy.

    PubMed

    Selvaraj, Arun G; Praharaj, Samir Kumar

    2012-09-01

    Electroconvulsive therapy is safe and effective in the treatment of depression in older individuals. Minor cognitive side effects of electroconvulsive therapy include acute postictal confusion and reversible short-term memory deficits. However, interictal delirium is uncommon in absence of risk factors. Herein, we report the case a depressed male patient without any known risk factors who developed interictal delirium 2 days after his sixth electroconvulsive therapy session. Interictal delirium improved with treatment within 1 week.

  20. 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.

  1. Stabilizing and Managing Patients with Altered Mental Status and Delirium.

    PubMed

    Odiari, Ebelechukwu A; Sekhon, Navdeep; Han, Jin Y; David, Elizabeth H

    2015-11-01

    Present in all patient populations, altered mental status (AMS) is a common, but nonspecific emergency department (ED) presentation that can signify serious underlying pathology. Delirium is a more defined mental status change caused by another medical condition that carries a high morbidity and mortality if missed. However, ED physicians miss the condition in more than 50% of cases. The ED physician should maintain a high index of suspicion for delirium, because if missed in the ED, delirium is more likely to be missed on the floors as well. Management of delirium is directed toward treating the underlying course.

  2. Temperature Variability during Delirium in ICU Patients: An Observational Study

    PubMed Central

    van der Kooi, Arendina W.; Kappen, Teus H.; Raijmakers, Rosa J.; Zaal, Irene J.; Slooter, Arjen J. C.

    2013-01-01

    Introduction Delirium is an acute disturbance of consciousness and cognition. It is a common disorder in the intensive care unit (ICU) and associated with impaired long-term outcome. Despite its frequency and impact, delirium is poorly recognized by ICU-physicians and –nurses using delirium screening tools. A completely new approach to detect delirium is to use monitoring of physiological alterations. Temperature variability, a measure for temperature regulation, could be an interesting component to monitor delirium, but whether temperature regulation is different during ICU delirium has not yet been investigated. The aim of this study was to investigate whether ICU delirium is related to temperature variability. Furthermore, we investigated whether ICU delirium is related to absolute body temperature. Methods We included patients who experienced both delirium and delirium free days during ICU stay, based on the Confusion Assessment method for the ICU conducted by a research- physician or –nurse, in combination with inspection of medical records. We excluded patients with conditions affecting thermal regulation or therapies affecting body temperature. Daily temperature variability was determined by computing the mean absolute second derivative of the temperature signal. Temperature variability (primary outcome) and absolute body temperature (secondary outcome) were compared between delirium- and non-delirium days with a linear mixed model and adjusted for daily mean Richmond Agitation and Sedation Scale scores and daily maximum Sequential Organ Failure Assessment scores. Results Temperature variability was increased during delirium-days compared to days without delirium (βunadjusted=0.007, 95% confidence interval (CI)=0.004 to 0.011, p<0.001). Adjustment for confounders did not alter this result (βadjusted=0.005, 95% CI=0.002 to 0.008, p<0.001). Delirium was not associated with absolute body temperature (βunadjusted=-0.03, 95% CI=-0.17 to 0.10, p=0.61). This

  3. 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…

  4. A relational ethical approach to end-of-life delirium.

    PubMed

    Wright, David Kenneth; Brajtman, Susan; Macdonald, Mary Ellen

    2014-08-01

    Delirium is a condition of acute onset and fluctuating course in which a person's level of consciousness and cognition become disturbed. Delirium is a common and distressing phenomenon in end-of-life care, yet it is underrecognized and undertreated. In this article, we review qualitative descriptions of the delirium experience in end-of-life care, found through a systematic search of academic databases, to generate insight into the intersubjective nature of the delirium experience. Our analysis of retrieved studies advances an understanding of the relational ethical dimensions of this phenomenon, that is, how delirium is lived by patients, families, and health care providers and how it affects the relationships and values at stake. We propose three themes that explain the distressing nature of delirium in palliative care: 1) experiences of relational tension; 2) challenges in recognizing the delirious person; and 3) struggles to interpret the meaning of delirious behaviors. By approaching end-of-life delirium from a perspective of relational ethics, attention is focused on the implications for the therapeutic relationship with patients and families when delirium becomes part of the dying trajectory.

  5. 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)

  6. Indian research on acute organic brain syndrome: Delirium

    PubMed Central

    Pinto, Charles

    2010-01-01

    Delirium, though quite often referred to psychiatrists for management, does not find many takers for analysis, research and publications. Acute in onset, multiplicity of etiology and manifestations, high risk of mortality delirium is very rewarding in proper management and outcome. Delirium has a limited agenda on teaching programs, research protocols and therapeutic strategies. There is a dearth of Indian studies both in international and national scientific literature. This annotation is based on a Medline search for “delirium India” on Pubmed, which resulted in 54 articles. A search in Indian Journal of Psychiatry for “delirium” resulted in 38 published articles, “delirium tremens” showed up only five articles. The articles are primarily from the Indian Journal of Psychiatry with cross reference to articles on Pubmed or Google search on Indian studies and a few international studies PMID:21836671

  7. Pharmacological and nonpharmacological management of delirium in critically ill patients.

    PubMed

    Hipp, Dustin M; Ely, E Wesley

    2012-01-01

    Delirium is a common yet under-diagnosed syndrome of acute brain dysfunction, which is characterized by inattention, fluctuating mental status, altered level of consciousness, or disorganized thinking. Although our recognition of risk factors for delirium has progressed, our understanding of the underlying pathophysiologic mechanisms remains limited. Improvements in monitoring and assessment for delirium (particularly in the intensive care setting) have resulted in validated and reliable tools such as arousal scales and bedside delirium monitoring instruments. Once delirium is recognized and the modifiable risk factors are addressed, the next step in management (if delirium persists) is often pharmacological intervention. The sedatives, analgesics, and hypnotics most often used in the intensive care unit (ICU) to achieve patient comfort are all too frequently deliriogenic, resulting in a longer duration of ICU and hospital stay, and increased costs. Therefore, identification of safe and efficacious agents to reduce the incidence, duration, and severity of ICU delirium is a hot topic in critical care. Recognizing that there are no medications approved by the Food and Drug Administration (FDA) for the prevention or treatment of delirium, we chose anti-psychotics and alpha-2 agonists as the general pharmacological focus of this article because both were subjects of relatively recent data and ongoing clinical trials. Emerging pharmacological strategies for addressing delirium must be combined with nonpharmacological approaches (such as daily spontaneous awakening trials and spontaneous breathing trials) and early mobility (combined with the increasingly popular approach called: Awakening and Breathing Coordination, Delirium Monitoring, Early Mobility, and Exercise [ABCDE] of critical care) to develop evidence-based approaches that will ensure safer and faster recovery of the sickest patients in our healthcare system. PMID:22270810

  8. [Effective Dexmedetomidine Administration for the Prevention of Emergence Agitation and Postoperative Delirium in Patients with a History of Postoperative Delirium].

    PubMed

    Fujisawa, Takanobu; Komasawa, Nobuyasu; Fujiwara, Atsushi; Kido, Haruki; Minami, Toshiaki

    2016-04-01

    We successfully performed intraoperative dexmedetomidine (DEX) administration for the prevention of emergence agitation or postoperative delirium after lung resection in four patients (71.3 ± 5.7 year old, 3 males and 1 female) with a past history of postoperative delirium. DEX was started at 0.35-0.45 μg x kg(-1) x hr(-1) continuously without loading. The average time from DEX initiation to extubation was 141.3 ± 94.4 minutes. No patient had emergence agitation, and DEX administration was continued until the following morning with monitoring in all patients without any symptoms of delirium. Intraoperative DEX administration may be beneficial for the prevention of emergence agitation or postoperative delirium in patients with a past history of postoperative delirium. PMID:27188116

  9. [Effective Dexmedetomidine Administration for the Prevention of Emergence Agitation and Postoperative Delirium in Patients with a History of Postoperative Delirium].

    PubMed

    Fujisawa, Takanobu; Komasawa, Nobuyasu; Fujiwara, Atsushi; Kido, Haruki; Minami, Toshiaki

    2016-04-01

    We successfully performed intraoperative dexmedetomidine (DEX) administration for the prevention of emergence agitation or postoperative delirium after lung resection in four patients (71.3 ± 5.7 year old, 3 males and 1 female) with a past history of postoperative delirium. DEX was started at 0.35-0.45 μg x kg(-1) x hr(-1) continuously without loading. The average time from DEX initiation to extubation was 141.3 ± 94.4 minutes. No patient had emergence agitation, and DEX administration was continued until the following morning with monitoring in all patients without any symptoms of delirium. Intraoperative DEX administration may be beneficial for the prevention of emergence agitation or postoperative delirium in patients with a past history of postoperative delirium.

  10. Management of delirium in palliative care: a review.

    PubMed

    Grassi, Luigi; Caraceni, Augusto; Mitchell, Alex J; Nanni, Maria Giulia; Berardi, Maria Alejandra; Caruso, Rosangela; Riba, Michelle

    2015-03-01

    Delirium is a complex but common disorder in palliative care with a prevalence between 13 and 88 % but a particular frequency at the end of life (terminal delirium). By reviewing the most relevant studies (MEDLINE, EMBASE, PsycLit, PsycInfo, Cochrane Library), a correct assessment to make the diagnosis (e.g., DSM-5, delirium assessment tools), the identification of the possible etiological factors, and the application of multicomponent and integrated interventions were reported as the correct steps to effectively manage delirium in palliative care. In terms of medications, both conventional (e.g., haloperidol) and atypical antipsychotics (e.g., olanzapine, risperidone, quetiapine, aripiprazole) were shown to be equally effective in the treatment of delirium. No recommendation was possible in palliative care regarding the use of other drugs (e.g., α-2 receptors agonists, psychostimulants, cholinesterase inhibitors, melatonergic drugs). Non-pharmacological interventions (e.g., behavioral and educational) were also shown to be important in the management of delirium. More research is necessary to clarify how to more thoroughly manage delirium in palliative care.

  11. Documentation of delirium in elderly patients with hip fracture.

    PubMed

    Milisen, Koen; Foreman, Marquis D; Wouters, Bert; Driesen, Ronny; Godderis, Jan; Abraham, Ivo L; Broos, Paul L O

    2002-11-01

    This study determined the accuracy of diagnosis and documentation of delirium in the medical and nursing records of 55 elderly patients with hip fracture (mean age = 78.4, SD = 8.4). These records were reviewed retrospectively on a patient's discharge for diagnosis of delirium, and for description of clinical indicators or symptoms of delirium. Additionally, all patients were monitored by one of the research members on days 1, 3, 5, 8, and 12 postoperatively for signs of delirium, as measured by the Confusion Assessment Method (CAM). Clinicians were blinded to the purpose of the study. According to the CAM criteria, the incidence of delirium was 14.5% on postoperative Day 1; 9.1% on postoperative Day 3; 10.9% on postoperative Day 5; 7.7% on postoperative Day 8; and 5.6% on postoperative Day 12. For those same days, no formal diagnosis of delirium or a description of clinical indicators was found in the medical records. In the nursing records, a false-positive documentation of 8.5%, 4%, 4.1%, 4.2%, and 5.9%, respectively was noted. False-negative documentation was found in 87.5%, 80%, 66.7%, 75%, and 50% of the cases on the respective days. Documentation of essential symptoms--namely onset and course of the syndrome--and disturbances in consciousness, attention, and cognition, were seldom or never found in the nursing records. However, behaviors of the hyperactive variant of delirium and which are known to interfere with nursing care were documented more often (e.g., 13.4% restless, 10.3% fidget with materials, 7.2% annoying behavior). Both medical and nursing records showed poor documentation and under-diagnosis of delirium. However, a correct diagnosis and early recognition of delirium may enhance the management of this syndrome.

  12. [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.

  13. Delirium Common in Cancer Patients Seen in ER

    MedlinePlus

    ... often missed, in advanced cancer patients who visit emergency departments, a new study says. Delirium is a serious ... in 243 advanced cancer patients seen at an emergency department. The patients were between the ages of 19 ...

  14. Delirium Research | NIH MedlinePlus the Magazine

    MedlinePlus

    ... dementia almost immediately switched to delirium. He was agitated, wandered the halls, and alternated between believing he ... night after surgery, a highly anxious state of agitated non-stop yelling and confusion started. It was ...

  15. 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

  16. [Subsyndromal delirium -- experience in psychiatry -- expectations for postoperative management].

    PubMed

    Brinkers, Michael; Pfau, Giselher; Gerth, Nico; Hachenberg, Thomas

    2014-07-01

    The phenomenon of delirium is well known since over 100 years. The anesthesiology has recognized that early detection and therapy results in significant improvement of postoperative clinical state of health of the patients. In the following article it will be discussed that it could be profitable to make a further step: threatening the subsyndromal delirium. Because there are only few experiences in anesthesiology, this thesis will be substantiated by datas from psychiatry.

  17. 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

  18. Symptoms of Posttraumatic Stress after Intensive Care Delirium

    PubMed Central

    Svenningsen, Helle; Egerod, Ingrid; Christensen, Doris; Tønnesen, Else Kirstine; Frydenberg, Morten; Videbech, Poul

    2015-01-01

    Introduction. Long-term psychological consequences of critical illness are receiving more attention in recent years. The aim of our study was to assess the correlation of ICU-delirium and symptoms of posttraumatic stress disorder (PTSD) anxiety and depression after ICU-discharge in a Danish cohort. Methods. A prospective observational cohort study assessing the incidence of delirium in the ICU. Psychometrics were screened by validated tools in structured telephone interviews after 2 months (n = 297) and 6 months (n = 248) after ICU-discharge. Results. Delirium was detected in 54% of patients in the ICU and symptoms of PTSD in 8% (2 months) and 6% (6 months) after ICU-discharge. Recall of ICU stay was present in 93%. Associations between ICU-delirium and post-discharge PTSD-symptoms were weak and insignificant. Memories of delusions were significantly associated with anxiety after two months. Remaining associations between types of ICU-memories and prevalence of post-discharge symptoms of PTSD, anxiety, and depression were insignificant after adjusting for age. Incidence of ICU-delirium was unaffected by preadmission use of psychotropic drugs. Prevalence of PTSD-symptoms was unaffected by use of antipsychotics and sedation in the ICU. Conclusion. ICU-delirium did not increase the risk of PTSD-symptoms at 2 and 6 months after ICU discharge. PMID:26557708

  19. Biomarkers of postoperative delirium and cognitive dysfunction

    PubMed Central

    Androsova, Ganna; Krause, Roland; Winterer, Georg; Schneider, Reinhard

    2015-01-01

    Elderly surgical patients frequently experience postoperative delirium (POD) and the subsequent development of postoperative cognitive dysfunction (POCD). Clinical features include deterioration in cognition, disturbance in attention and reduced awareness of the environment and result in higher morbidity, mortality and greater utilization of social financial assistance. The aging Western societies can expect an increase in the incidence of POD and POCD. The underlying pathophysiological mechanisms have been studied on the molecular level albeit with unsatisfying small research efforts given their societal burden. Here, we review the known physiological and immunological changes and genetic risk factors, identify candidates for further studies and integrate the information into a draft network for exploration on a systems level. The pathogenesis of these postoperative cognitive impairments is multifactorial; application of integrated systems biology has the potential to reconstruct the underlying network of molecular mechanisms and help in the identification of prognostic and diagnostic biomarkers. PMID:26106326

  20. A new delirium phenotype with rapid high amplitude onset and nearly as rapid reversal: Central Coast Australia Delirium Intervention Study

    PubMed Central

    Regal, Paul J

    2015-01-01

    Background Traditional models for delirium based on the Diagnostic and Statistical Manual for Mental Disorders and its 1990 offspring, the Confusion Assessment Method (CAM), were not designed to distinguish behavioral and psychological symptoms of dementia from rapid cognitive decline. We examined a new diagnostic criterion for delirium plus exclusion of behavioral and psychological symptoms of dementia and recent inattention with a 25% decline in digit span forward (DSF). Methods This was a prospective, randomized controlled trial comparing management of prevalent delirium in general medical with that in geriatric medical wards in a 370-bed hospital north of Sydney. Inclusion criteria were age ≥65 years and prevalent delirium in the emergency department based on: CAM; proof that CAM elements were not better explained by behavioral and psychological symptoms of dementia; proof of recent inattention on DSF; evidence of cognitive decline not due to sedatives or antipsychotics in the emergency department. Measurements included the Instrumental Activities of Daily Living (IADL, 22-item), Selective IADL (8-item), Mini-Mental State Examination, DSF daily, Delirium Index daily, and Apathy Evaluation Scale. Pre-delirium scores from past cognitive tests and best scores were imputed after admission. Relative change (RC) was calculated as absolute change/test range and RC/MPC ratio was calculated as RC after admission/maximal possible change. Results A total of 130 subjects were recruited but 14 with subsyndromal delirium were excluded, leaving 116 subjects (mean age 83.6 years). Forty-eight percent had prior dementia. RC from pre-delirium to admission was 42% for the Mini-Mental State Examination, 41% for Selective IADL, 34% for 5-DSF, 54% for 6-DSF, and 37% for the Apathy Evaluation Scale. Improvements after admission (RC and RC/MPC ratios) were 32%/98% for 5-DSF, 54%/82% for 6-DSF, and 45%/80% for the Delirium Index. General medicine and geriatric medicine groups had

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

    MedlinePlus

    ... delirium experience its effects for weeks after the first occurrence. Why is this? That's part of the mystery of the syndrome. We don't fully understand what's happening in the basic neuroscience of delirium. It's part of what our scientists are interested in figuring out. Delirium often affects ...

  2. A clinical perspective of sepsis-associated delirium.

    PubMed

    Tsuruta, Ryosuke; Oda, Yasutaka

    2016-01-01

    The term sepsis-associated encephalopathy (SAE) has been applied to animal models, postmortem studies in patients, and severe cases of sepsis. SAE is considered to include all types of brain dysfunction, including delirium, coma, seizure, and focal neurological signs. Clinical data for sepsis-associated delirium (SAD) have been accumulating since the establishment of definitions of coma or delirium and the introduction of validated screening tools. Some preliminary studies have examined the etiology of SAD. Neuroinflammation, abnormal cerebral perfusion, and neurotransmitter imbalances are the main mechanisms underlying the development of SAD. However, there are still no specific diagnostic blood, electrophysiological, or imaging tests or treatments specific for SAD. The duration of delirium in intensive care patients is associated with long-term functional disability and cognitive impairment, although this syndrome usually reverses after the successful treatment of sepsis. Once the respiratory and hemodynamic states are stabilized, patients with severe sepsis or septic shock should receive rehabilitation as soon as possible because early initiation of rehabilitation can reduce the duration of delirium. We expect to see further pathophysiological data and the development of novel treatments for SAD now that reliable and consistent definitions of SAD have been established. PMID:27011789

  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. Delirium in the elderly: current problems with increasing geriatric age

    PubMed Central

    Kukreja, Deepti; Günther, Ulf; Popp, Julius

    2015-01-01

    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, multfactorial, 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. PMID:26831414

  5. 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

  6. [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. PMID:26817653

  7. 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

  8. 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.

  9. Confirmatory Factor Analysis of the Delirium Rating Scale Revised-98 (DRS-R98).

    PubMed

    Thurber, Steven; Kishi, Yasuhiro; Trzepacz, Paula T; Franco, Jose G; Meagher, David J; Lee, Yanghyun; Kim, Jeong-Lan; Furlanetto, Leticia M; Negreiros, Daniel; Huang, Ming-Chyi; Chen, Chun-Hsin; Kean, Jacob; Leonard, Maeve

    2015-01-01

    Principal components analysis applied to the Delirium Rating Scale-Revised-98 contributes to understanding the delirium construct. Using a multisite pooled international delirium database, the authors applied confirmatory factor analysis to Delirium Rating Scale-Revised-98 scores from 859 adult patients evaluated by delirium experts (delirium, N=516; nondelirium, N=343). Confirmatory factor analysis found all diagnostic features and core symptoms (cognitive, language, thought process, sleep-wake cycle, motor retardation), except motor agitation, loaded onto factor 1. Motor agitation loaded onto factor 2 with noncore symptoms (delusions, affective lability, and perceptual disturbances). Factor 1 loading supports delirium as a single construct, but when accompanied by psychosis, motor agitation's role may not be solely as a circadian activity indicator. PMID:25923855

  10. Preoperative anxiety management, emergence delirium, and postoperative behavior.

    PubMed

    Banchs, Richard J; Lerman, Jerrold

    2014-03-01

    Preoperative anxiolysis is important for children scheduled for surgery. The nature of the anxiety depends on several factors, including age, temperament, past hospitalizations, and socioeconomic and ethnic backgrounds. A panoply of interventions effect anxiolysis, including parental presence, distraction, and premedication, although no single strategy is effective for all ages. Emergence delirium (ED) occurs after the use of sevoflurane and desflurane in preschool-aged children in the recovery room. Symptoms usually last approximately 15 minutes and resolve spontaneously. The Pediatric Anesthesia Emergence Delirium scale is used to diagnose ED and evaluate therapeutic interventions for ED such as propofol and opioids. PMID:24491647

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

    PubMed Central

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

    2016-01-01

    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. PMID:27182528

  12. 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. PMID:27182528

  13. 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

  14. 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

  15. Delirium in Older Emergency Department Patients: Recognition, Risk Factors, and Psychomotor Subtypes

    PubMed Central

    Han, Jin H.; Zimmerman, Eli E.; Cutler, Nathan; Schnelle, John; Morandi, Alessandro; Dittus, Robert S.; Storrow, Alan B.; Ely, E. Wesley

    2016-01-01

    Objectives Missing delirium in the emergency department (ED) has been described as a medical error, yet this diagnosis is frequently unrecognized by emergency physicians. Identifying a subset of patients at high risk for delirium may improve delirium screening compliance by emergency physicians. We sought 1) to determine how often delirium is missed in the ED and how often these missed cases are detected by admitting hospital physicians at the time of admission, 2) to identify delirium risk factors in older ED patients, and 3) to characterize delirium by psychomotor subtypes in the ED setting. Methods This cross-sectional study was a convenience sample of patients conducted at a tertiary care, academic ED. English speaking patients who were 65 years and older and present in the ED for less than 12 hours at the time of enrollment were included. Patients were excluded if they refused consent, were previously enrolled, had severe dementia, were unarousable to verbal stimuli for all delirium assessments, or had incomplete data. Delirium status was determined by using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) administered by trained research assistants. Recognition of delirium by emergency and hospital physicians was determined from the medical record, blinded to CAM-ICU status. Multivariable logistic regression was used to identify independent delirium risk factors. The Richmond Agitation and Sedation Scale was used to classify delirium by its psychomotor subtypes. Results Inclusion and exclusion criteria were met in 303 patients and 25 (8.3%) presented to the ED with delirium. The vast majority (92.0%, 95%CI: 74.0% - 99.0%) of delirious patients had the hypoactive psychomotor subtype. Of the 25 patients with delirium, 19 (76.0%, 95%CI: 54.9% - 90.6%) were not recognized to be delirious by the emergency physician. Of the 16 admitted delirious patients who were undiagnosed by the emergency physicians, 15 (93.8%, 95%CI: 69.8% - 99.8%) remained

  16. 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)

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

    PubMed Central

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

    2015-01-01

    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. PMID:26165565

  18. [Emergence delirium in children - prophylaxis and treatment].

    PubMed

    Wermelt, Julius Z; Ellerkmann, Richard K

    2016-07-01

    Emergence Delirium in children after general anesthesia is a common and self limitating event. Although it might be seen as being harmless it can cause other serious complications and might leave both parents and other caregivers with a negative impression behind. Although the cause may still not be clear, potential predictors can be named: preschool age, the use of fast acting volatile anesthestics, higher preoperative anxiety levels and postoperative pain.A child-focused approach to reduce preoperative anxiety focusing on distraction methods rather than pharmacological sedation may be the key as well as sufficient postoperative pain control and the use of total intravenous anesthesia. Parenteal presence during induction of anaesthesia (PPIA) may be beneficial to reduce preoperative anxiety levels, but has failed to prove a better outcome regarding ED.The use of age adopted scores/scales to diagnose ED and Pain are mandatory.In the case of an ED event it is most important to protect the child from self injury and the loss of the iv-line. Postoperative pian needs to be ruled out before treating ED. Most cases can be treated by interrupting the situation and putting the child "back to sleep". Short acting drugs as Propofol have been used successfully due to its pharmacodynamics and short acting profile. Alternatively alpha-agonists or ketamin may be preferred by other authors. If potential predictors and a positive history are present, prophylactic treatment should be considered. A TIVA or the use of alpha-2-agonists have proven to be successful in reducing the risk of an ED. Midazolam may reduce preoperative anxiety but not the incidence of ED and should therefore be used carefully and is not a good choice in PACU for the treatment of ED.Parents who witnessed ED in their children should be guided and followed up. Explaining this phenomenon to parents beforehand should be part of the pre anaesthesia clinic talk and written consent.Standard protocols should be in

  19. [Emergence delirium in children - prophylaxis and treatment].

    PubMed

    Wermelt, Julius Z; Ellerkmann, Richard K

    2016-07-01

    Emergence Delirium in children after general anesthesia is a common and self limitating event. Although it might be seen as being harmless it can cause other serious complications and might leave both parents and other caregivers with a negative impression behind. Although the cause may still not be clear, potential predictors can be named: preschool age, the use of fast acting volatile anesthestics, higher preoperative anxiety levels and postoperative pain.A child-focused approach to reduce preoperative anxiety focusing on distraction methods rather than pharmacological sedation may be the key as well as sufficient postoperative pain control and the use of total intravenous anesthesia. Parenteal presence during induction of anaesthesia (PPIA) may be beneficial to reduce preoperative anxiety levels, but has failed to prove a better outcome regarding ED.The use of age adopted scores/scales to diagnose ED and Pain are mandatory.In the case of an ED event it is most important to protect the child from self injury and the loss of the iv-line. Postoperative pian needs to be ruled out before treating ED. Most cases can be treated by interrupting the situation and putting the child "back to sleep". Short acting drugs as Propofol have been used successfully due to its pharmacodynamics and short acting profile. Alternatively alpha-agonists or ketamin may be preferred by other authors. If potential predictors and a positive history are present, prophylactic treatment should be considered. A TIVA or the use of alpha-2-agonists have proven to be successful in reducing the risk of an ED. Midazolam may reduce preoperative anxiety but not the incidence of ED and should therefore be used carefully and is not a good choice in PACU for the treatment of ED.Parents who witnessed ED in their children should be guided and followed up. Explaining this phenomenon to parents beforehand should be part of the pre anaesthesia clinic talk and written consent.Standard protocols should be in

  20. 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

  1. Ondasetron versus haloperidol for the treatment of postcardiotomy delirium: a prospective, randomized, double-blinded study

    PubMed Central

    2012-01-01

    Background To investigate the controlling efficacy of ondasetron and haloperidol in regard to the postcardiotomy delirium. Methods We included in this prospective, randomized, double-blinded study 80 patients who developed delirium after heart surgery with the application of heart lung-machine. The patients were divided into two, equally-sized groups, which on detection of delirium received ondasetron 8 mg iv or haloperidol 5 mg iv respectively. The statistical analysis compared the baseline and demographic characteristics of the two groups (age, gender, comorbidities, years of education, type of surgery etc.). Results Both ondasetron and haloperidol had very good delirium controlling effects, without statistically significant differences. Discussion-Conclusions Ondasetron and haloperidol are efficient agents as far as the treatment of postcardiotomy delirium is concerned. As, in addition, ondasetron bares milder side-effects, we believe this could be the agent of choice in patients developing postcardiotomy delirium in the future. PMID:22436170

  2. Study protocol—investigation of the Delirium Observation Screening Scale (DOSS) for the routine detection of delirium in the care home setting: a prospective cohort study

    PubMed Central

    Teale, Elizabeth; Young, John; Siddiqi, Najma; Munyombwe, Theresa; Harrison, Jennifer; Schuurmanns, Marieke

    2016-01-01

    Introduction Delirium is a common and distressing condition associated with frailty, dementia and comorbidity. These are common in long-term care settings. Residents in care homes are therefore at particular risk of delirium. Despite this, methods to detect delirium in care homes are lacking, with existing diagnostic tools taking too long, or requiring specific training to deliver. This limits their feasibility for use for the routine detection of delirium by care home staff. Routine screening for delirium in care homes would allow timely attention to exacerbating factors to attenuate the episode, and facilitate future research into delirium in the care home environment. Methods Residents from 4 large care homes will be asked to consent (or their consultees asked to provide a declaration of agreement) to participate in the study. Care home staff will administer the 25-item Delirium Observation Screening Scale (DOSS)—a delirium screening tool based on observed behaviours—and this will be tested against the research standard Confusion Assessment Method (CAM) administered by trained research assistants performed two times per week for all participating residents. Analysis Sensitivity, specificity, positive and negative predictive values, likelihood ratios and a diagnostic OR will be calculated for the detection of delirium with the 25-item DOSS. The feasibility of routine delirium screening and the scaling properties of the 25-item DOSS will also be explored. Ethics and Dissemination For residents lacking capacity to participate, a consultee will be approached for a declaration of agreement for inclusion in the study. Results will be published in peer-reviewed journals and disseminated in written format to clinical commissioning groups, general practitioners and relevant third parties. Trial registration number ISRCTN14608554. PMID:27324706

  3. Impact of surgical approach on postoperative delirium in elderly patients undergoing gastrectomy: laparoscopic versus open approaches

    PubMed Central

    Shin, Young-Hee; Jeong, Hee-Joon

    2015-01-01

    Background Postoperative delirium is a frequent complication in elderly patients undergoing major abdominal surgery and is associated with a poor outcome. We compared postoperative delirium in elderly patients following laparoscopic gastrectomy (LG) versus open gastrectomy (OG). Methods In total, 130 patients aged ≥ 65 years with gastric cancer undergoing LG and OG were enrolled prospectively. Postoperative delirium and cognitive status were assessed daily using the Confusion Assessment Method (CAM) and Mini-Mental Status Examination (MMSE), respectively, for 3 days postoperatively. For CAM-positive patients, delirium severity was then assessed using the Delirium Index (DI). Results In total, 123 subjects (LG, n = 60; OG, n = 63) were included in the analysis. In both groups, the overall incidences of postoperative delirium were similar: 31.6% (19/60) in the LG group and 41.2% (26/63) in the OG group. When considering only those with delirium, the severity, expressed as the highest DI score, was similar between the groups. A decline in cognitive function (reduction in MMSE ≥ 2 points from baseline) during 3 days postoperatively was observed in 23 patients in the LG group (38.3%) and 27 patients in the OG group (42.9%) (P = 0.744). In both groups, postoperative cognitive decline was significantly associated with postoperative delirium (P < 0.001). Conclusions We found that, compared with traditional open gastrectomy, laparoscopic gastrectomy did not reduce either postoperative delirium or cognitive decline in elderly patients with gastric cancer. PMID:26257851

  4. 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.

  5. Pharmacological management of anticholinergic delirium - theory, evidence and practice.

    PubMed

    Dawson, Andrew H; Buckley, Nicholas A

    2016-03-01

    The spectrum of anticholinergic delirium is a common complication following drug overdose. Patients with severe toxicity can have significant distress and behavioural problems that often require pharmacological management. Cholinesterase inhibitors, such as physostigmine, are effective but widespread use has been limited by concerns about safety, optimal dosing and variable supply. Case series support efficacy in reversal of anticholinergic delirium. However doses vary widely and higher doses commonly lead to cholinergic toxicity. Seizures are reported in up to 2.5% of patients and occasional cardiotoxic effects are also recorded. This article reviews the serendipitous path whereby physostigmine evolved into the preferred anticholinesterase antidote largely without any research to indicate the optimal dosing strategy. Adverse events observed in case series should be considered in the context of pharmacokinetic/pharmacodynamic studies of physostigmine which suggest a much longer latency before the maximal increase in brain acetylcholine than had been previously assumed. This would favour protocols that use lower doses and longer re-dosing intervals. We propose based on the evidence reviewed that the use of cholinesterase inhibitors should be considered in anticholinergic delirium that has not responded to non-pharmacological delirium management. The optimal risk/benefit would be with a titrated dose of 0.5 to 1 mg physostigmine (0.01-0.02 mg kg(-1) in children) with a minimum delay of 10-15 min before re-dosing. Slower onset and longer acting agents such as rivastigmine would also be logical but more research is needed to guide the appropriate dose in this setting.

  6. Delirium transitions in the medical ICU: exploring the role of sleep quality and other factors

    PubMed Central

    Colantuoni, Elizabeth; King, Lauren M.; Neufeld, Karin J.; Bienvenu, O. Joseph; Rowden, Annette M.; Collop, Nancy A.; Needham, Dale M.

    2014-01-01

    Objective Disrupted sleep is a common and potentially modifiable risk factor for delirium in the intensive care unit (ICU). As part of a quality improvement (QI) project to promote sleep in the ICU, we examined the association of perceived sleep quality ratings and other patient and ICU risk factors with daily transition to delirium. Design Secondary analysis of prospective observational study. Setting Medical ICU (MICU) over a 201-day period. Patients 223 patients with ≥1 night in the MICU in between two consecutive days of delirium assessment. Interventions None Measurements Daily perceived sleep quality ratings were measured using the Richards Campbell Sleep Questionnaire (RCSQ). Delirium was measured twice-daily using the Confusion Assessment Method for the ICU (CAM-ICU). Other covariates evaluated included: age, sex, race, ICU admission diagnosis, nighttime mechanical ventilation status, prior day’s delirium status, and daily sedation using benzodiazepines and opioids, via both bolus and continuous infusion. Main Results Perceived sleep quality was similar in patients who were ever versus never delirious in the ICU (median [IQR] ratings 58 [35-76] vs. 57 [33-78], respectively p=0.71), and perceived sleep quality was unrelated to delirium transition (adjusted OR 1.00, 95% CI 0.99-1.00). In mechanically ventilated patients, receipt of a continuous benzodiazepine and/or opioid infusion was associated with delirium transition (adjusted OR 4.02, 95% CI 2.19-7.38, p<0.001) and patients reporting use of pharmacological sleep aids at home were less likely to transition to delirium (adjusted OR 0.40, 95% CI 0.20-0.80, p=0.01). Conclusions We found no association between daily perceived sleep quality ratings and transition to delirium. Infusion of benzodiazepine and/or opioid medications was strongly associated with transition to delirium in the ICU in mechanically ventilated patients and is an important, modifiable risk factor for delirium in critically ill

  7. 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.

  8. Pilot trial of Stop Delirium! (PiTStop) - a complex intervention to prevent delirium in care homes for older people: study protocol for a cluster randomised controlled trial

    PubMed Central

    2014-01-01

    Background Delirium (or acute confusion) is a serious illness common in older people, in which a person’s thinking and perceptions may be affected. Reducing delirium is important because of the considerable distress it causes, and the poor outcomes associated with it, such as increased admissions to hospital, falls, mortality and costs to the National Health Service (NHS). Preventing delirium is possible using multicomponent interventions; successful interventions in hospitals have reduced it by one-third. However, there is little research to guide practice in care homes, where it is common because of the clustering of known risk factors (older age, frailty, and dementia). In previous work we developed a multicomponent intervention to prevent delirium in care homes, called Stop Delirium! The intervention was based upon evidence from the research literature relating to the prevention of delirium and on strategies to change professional practice. Before starting a large costly trial of Stop Delirium!, this pilot study will test and help improve the design and feasibility of the trial protocol. Methods/Design We plan to conduct a cluster randomised pilot trial in 14 care homes (independent residential and nursing). Following recruitment of residents (over 60 years, consenting or with consultee agreement, able to communicate in English, and not in palliative care) participating homes will be randomised, stratified by size of home and proportion of residents with dementia. Stop Delirium! will be delivered to intervention homes over 16 months, with controls receiving usual care. The primary outcome measure will be the presence of delirium on any day during a one-month post-intervention period. We will collect data to determine 1) recruitment and attrition rates, 2) feasibility of various outcomes measurements, and 3) feasibility of capturing health resource use (resident diaries and by examining health records). We will estimate the between-cluster variation for the

  9. Excited delirium syndrome (ExDS): treatment options and considerations.

    PubMed

    Vilke, Gary M; Bozeman, William P; Dawes, Donald M; Demers, Gerard; Wilson, Michael P

    2012-04-01

    The term Excited Delirium Syndrome (ExDS) has traditionally been used in the forensic literature to describe findings in a subgroup of patients with delirium who suffered lethal consequences from their untreated severe agitation.(1-5) Excited delirium syndrome, also known as agitated delirium, is generally defined as altered mental status and combativeness or aggressiveness. Although the exact signs and symptoms are difficult to define precisely, clinical findings often include many of the following: tolerance to significant pain, rapid breathing, sweating, severe agitation, elevated temperature, delirium, non-compliance or poor awareness to direction from police or medical personnel, lack of fatiguing, unusual or superhuman strength, and inappropriate clothing for the current environment. It has become increasingly recognized that individuals displaying ExDS are at high risk for sudden death, and ExDS therefore represents a true medical emergency. Recently the American College of Emergency Physicians (ACEP) published the findings of a white paper on the topic of ExDS to better find consensus on the issues of definition, diagnosis, and treatment.(6) In so doing, ACEP joined the National Association of Medical Examiners (NAME) in recognizing ExDS as a medical condition. For both paramedics and physicians, the difficulty in diagnosing the underlying cause of ExDS in an individual patient is that the presenting clinical signs and symptoms of ExDS can be produced by a wide variety of clinical disease processes. For example, agitation, combativeness, and altered mental status can be produced by hypoglycemia, thyroid storm, certain kinds of seizures, and these conditions can be difficult to distinguish from those produced by cocaine or methamphetamine intoxication.(7) Prehospital personnel are generally not expected to differentiate between the multiple possible causes of the patient's presentation, but rather simply to recognize that the patient has a medical emergency

  10. 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

  11. 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…

  12. 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,…

  13. 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…

  14. MMSE items that predict incident delirium and hypoactive subtype in older medical inpatients.

    PubMed

    Gabriel Franco, José; Santesteban, Olga; Trzepacz, Paula; Bernal, Carolina; Valencia, Camila; Ocampo, María Victoria; Pablo, Joan de; Gaviria, Ana Milena; Vilella, Elisabet

    2014-12-30

    Because hypoactive delirium is especially under-recognized, we analyzed which Mini-Mental State Examination (MMSE) items predicted incident delirium and its hypoactive motor presentation. Over a 1-year period, older medical inpatients (n=291) were consecutively screened on admission with the Confusion Assessment Method-Spanish (CAM-S) to exclude prevalent delirium. Nondelirious patients were evaluated the same day with the MMSE, followed by daily ratings with the CAM-S. Those who became CAM-S positive were rated using the Delirium Rating Scale-Revised-98 to assess severity and motor subtype. Disorientation to time (OR 4.4, 95% CI 1.7-11.1) and place (OR 3.8, 95% CI 1.7-8.2) at admission were risk factors for delirium at follow-up and together correctly classified 88.3% of subjects as to delirium status. Disorientation to time and place, and visuoconstructional impairment were each associated with either hypoactive or mixed subtype (p<0.05 χ(2) test). Simple bedside evaluation of cognitive function in nondelirious patients revealed deficits that detected patients at risk for developing incident delirium at follow-up (especially hypoactive or mixed). We recommend patients with orientation deficits be monitored closely for emergence of delirium. A separate evaluation for possible dementia or other causes of cognitive impairment at admission should be considered too. PMID:25307690

  15. Selecting optimal screening items for delirium: an application of item response theory

    PubMed Central

    2013-01-01

    Background Delirium (acute confusion), is a common, morbid, and costly complication of acute illness in older adults. Yet, researchers and clinicians lack short, efficient, and sensitive case identification tools for delirium. Though the Confusion Assessment Method (CAM) is the most widely used algorithm for delirium, the existing assessments that operationalize the CAM algorithm may be too long or complicated for routine clinical use. Item response theory (IRT) models help facilitate the development of short screening tools for use in clinical applications or research studies. This study utilizes IRT to identify a reduced set of optimally performing screening indicators for the four CAM features of delirium. Methods Older adults were screened for enrollment in a large scale delirium study conducted in Boston-area post-acute facilities (n = 4,598). Trained interviewers conducted a structured delirium assessment that culminated in rating the presence or absence of four features of delirium based on the CAM. A pool of 135 indicators from established cognitive testing and delirium assessment tools were assigned by an expert panel into two indicator sets per CAM feature representing (a) direct interview questions, including cognitive testing, and (b) interviewer observations. We used IRT models to identify the best items to screen for each feature of delirium. Results We identified 10 dimensions and chose up to five indicators per dimension. Preference was given to items with peak psychometric information in the latent trait region relevant for screening for delirium. The final set of 48 indicators, derived from 39 items, maintains fidelity to clinical constructs of delirium and maximizes psychometric information relevant for screening. Conclusions We identified optimal indicators from a large item pool to screen for delirium. The selected indicators maintain fidelity to clinical constructs of delirium while maximizing psychometric information important for

  16. Moving Beyond Metabolic Encephalopathy: An Update on Delirium Prevention, Workup, and Management.

    PubMed

    Brown, Ethan G; Douglas, Vanja C

    2015-12-01

    Delirium is a condition that frequently complicates hospitalization and consists of an acute decline in orientation and attention, often accompanied by other cognitive changes. Delirium is tied to multiple detrimental outcomes both in the short and long term, including cognitive and functional decline, inpatient complications, and mortality. Postoperative, elderly medical, and critical care patients have been identified as populations at particular risk. In this review, the authors discuss current theories on pathophysiology, recommended workup, and evidence-based prevention and management of inpatient delirium. In general, instituting a system of active screening of at-risk populations and nonpharmacologic interventions for prevention and treatment seems to be the most effective method of addressing delirium. More research is needed to clarify the etiology of delirium and develop safe therapeutic options that address the underlying pathophysiology.

  17. Phenomenological and neuropsychological profile across motor variants of delirium in a palliative-care unit.

    PubMed

    Leonard, Maeve; Donnelly, Sinead; Conroy, Marion; Trzepacz, Paula; Meagher, David J

    2011-01-01

    Studies using composite measurement of cognition suggest that cognitive performance is similar across motor variants of delirium. The authors assessed neuropsychological and symptom profiles in 100 consecutive cases of DSM-IV delirium allocated to motor subtypes in a palliative-care unit: Hypoactive (N=33), Hyperactive (N=18), Mixed (N=26), and No-Alteration motor groups (N=23). The Mixed group had more severe delirium, with highest scores for DRS-R-98 sleep-wake cycle disturbance, hallucinations, delusions, and language abnormalities. Neither the total Cognitive Test for Delirium nor its five neuropsychological domains differed across Hyperactive, Mixed, and Hypoactive motor groups. Most patients (70%) with no motor alteration had DRS-R-98 scores in the mild or subsyndromal range even though they met DSM-IV criteria. Motor variants in delirium have similar cognitive profiles, but mixed cases differ in expression of several noncognitive features.

  18. Detection and Management of Delirium in the Neonatal Unit: A Case Series.

    PubMed

    Groves, Alan; Traube, Chani; Silver, Gabrielle

    2016-03-01

    Delirium is increasingly recognized as a common syndrome in critically ill children, but in our experience, it is rarely considered in the NICU. Delirium is independently associated with prolonged length of stay and adverse long-term outcomes in children. We report the cases of 3 infants cared for in our NICU at corrected gestational ages of 4, 11, and 17 weeks who presented with classic symptoms of delirium. All 3 children had complex medical problems and were receiving multiple analgesic and sedative medications. All 3 children exhibited agitation that was unresponsive to increasing doses of medications, and they all appeared to improve after treatment with quetiapine, allowing weaning of other medications. It is possible that with increased vigilance, delirium will be increasingly recognized in newborns, thus allowing tailored intervention. Further research is needed to investigate the prevalence and associated risk factors for developing delirium in the NICU and to explore possible treatment options.

  19. Delirium and dementia with Lewy bodies: distinct diagnoses or part of the same spectrum?

    PubMed

    Gore, Rachel L; Vardy, Emma R L C; O'Brien, John T

    2015-01-01

    Dementia with Lewy bodies (DLB) is recognised as the second most common form of dementia in older people. Delirium is a condition of acute brain dysfunction for which a pre-existing diagnosis of dementia is a risk factor. Conversely delirium is associated with an increased risk of developing dementia. The reasons for this bidirectional relationship are not well understood. Our aim was to review possible similarities in the clinical presentation and pathophysiology between delirium and DLB, and explore possible links between these diagnoses. A systematic search using Medline, Embase and Psychinfo was performed. References were scanned for relevant articles, supplemented by articles identified from reference lists and those known to the authors. 94 articles were selected for inclusion in the review. Delirium and DLB share a number of clinical similarities, including global impairment of cognition, fluctuations in attention and perceptual abnormalities. Delirium is a frequent presenting feature of DLB. In terms of pathophysiological mechanisms, cholinergic dysfunction and genetics may provide a common link. Neuroimaging studies suggest a brain vulnerability in delirium which may also occur in dementia. The basal ganglia, which play a key role in DLB, have also been implicated in delirium. The role of Cerebrospinal fluid (CSF) and serum biomarkers for both diagnoses is an interesting area although some results are conflicting and further work in this area is needed. Delirium and DLB share a number of features and we hypothesise that delirium may, in some cases, represent early or 'prodromal' DLB. Further research is needed to test the novel hypothesis that delirium may be an early marker for future DLB, which would aid early diagnosis of DLB and identify those at high risk.

  20. 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.

  1. 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

  2. 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

  3. The development of an automated ward independent delirium risk prediction model.

    PubMed

    de Wit, Hugo A J M; Winkens, Bjorn; Mestres Gonzalvo, Carlota; Hurkens, Kim P G M; Mulder, Wubbo J; Janknegt, Rob; Verhey, Frans R; van der Kuy, Paul-Hugo M; Schols, Jos M G A

    2016-08-01

    Background A delirium is common in hospital settings resulting in increased mortality and costs. Prevention of a delirium is clearly preferred over treatment. A delirium risk prediction model can be helpful to identify patients at risk of a delirium, allowing the start of preventive treatment. Current risk prediction models rely on manual calculation of the individual patient risk. Objective The aim of this study was to develop an automated ward independent delirium riskprediction model. To show that such a model can be constructed exclusively from electronically available risk factors and thereby implemented into a clinical decision support system (CDSS) to optimally support the physician to initiate preventive treatment. Setting A Dutch teaching hospital. Methods A retrospective cohort study in which patients, 60 years or older, were selected when admitted to the hospital, with no delirium diagnosis when presenting, or during the first day of admission. We used logistic regression analysis to develop a delirium predictive model out of the electronically available predictive variables. Main outcome measure A delirium risk prediction model. Results A delirium risk prediction model was developed using predictive variables that were significant in the univariable regression analyses. The area under the receiver operating characteristics curve of the "medication model" model was 0.76 after internal validation. Conclusions CDSSs can be used to automatically predict the risk of a delirium in individual hospitalised patients' by exclusively using electronically available predictive variables. To increase the use and improve the quality of predictive models, clinical risk factors should be documented ready for automated use. PMID:27177868

  4. Application of Clinical Practice Guidelines for Pain, Agitation, and Delirium.

    PubMed

    Krupp, Anna; Balas, Michele C

    2016-06-01

    Critically ill patients experience several severe, distressing, and often life-altering symptoms during their intensive care unit stay. A clinical practice guideline released by the American College of Critical Care Medicine provides a template for improving the care and outcomes of the critically ill through evidence-based pain, agitation, and delirium assessment, prevention, and management. Key strategies include the use of valid and reliable assessment tools, setting a desired sedation level target, a focus on light sedation, choosing appropriate sedative medications, the use of nonpharmacologic symptom management strategies, and engaging and empowering patients and their family to play an active role in their intensive care unit care.

  5. Defining the Role of Dexmedetomidine in the Prevention of Delirium in the Intensive Care Unit

    PubMed Central

    Nelson, S.; Muzyk, A. J.; Bucklin, M. H.; Brudney, S.; Gagliardi, J. P.

    2015-01-01

    Dexmedetomidine is a highly selective α2 agonist used as a sedative agent. It also provides anxiolysis and sympatholysis without significant respiratory compromise or delirium. We conducted a systematic review to examine whether sedation of patients in the intensive care unit (ICU) with dexmedetomidine was associated with a lower incidence of delirium as compared to other nondexmedetomidine sedation strategies. A search of PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews yielded only three trials from 1966 through April 2015 that met our predefined inclusion criteria and assessed dexmedetomidine and outcomes of delirium as their primary endpoint. The studies varied in regard to population, comparator sedation regimen, delirium outcome measure, and dexmedetomidine dosing. All trials are limited by design issues that limit our ability definitively to conclude that dexmedetomidine prevents delirium. Evidence does suggest that dexmedetomidine may allow for avoidance of deep sedation and use of benzodiazepines, factors both observed to increase the risk for developing delirium. Our assessment of currently published literature highlights the need for ongoing research to better delineate the role of dexmedetomidine for delirium prevention. PMID:26576429

  6. 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. PMID:24674794

  7. Association between frailty and delirium in older adult patients discharged from hospital

    PubMed Central

    Verloo, Henk; Goulet, Céline; Morin, Diane; von Gunten, Armin

    2016-01-01

    Background Delirium and frailty – both potentially reversible geriatric syndromes – are seldom studied together, although they often occur jointly in older patients discharged from hospitals. This study aimed to explore the relationship between delirium and frailty in older adults discharged from hospitals. Methods Of the 221 patients aged >65 years, who were invited to participate, only 114 gave their consent to participate in this study. Delirium was assessed using the confusion assessment method, in which patients were classified dichotomously as delirious or nondelirious according to its algorithm. Frailty was assessed using the Edmonton Frailty Scale, which classifies patients dichotomously as frail or nonfrail. In addition to the sociodemographic characteristics, covariates such as scores from the Mini-Mental State Examination, Instrumental Activities of Daily Living scale, and Cumulative Illness Rating Scale for Geriatrics and details regarding polymedication were collected. A multidimensional linear regression model was used for analysis. Results Almost 20% of participants had delirium (n=22), and 76.3% were classified as frail (n=87); 31.5% of the variance in the delirium score was explained by frailty (R2=0.315). Age; polymedication; scores of the Confusion Assessment Method (CAM), instrumental activities of daily living, and Cumulative Illness Rating Scale for Geriatrics; and frailty increased the predictability of the variance of delirium by 32% to 64% (R2=0.64). Conclusion Frailty is strongly related to delirium in older patients after discharge from the hospital. PMID:26848261

  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. 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

  10. Emergence Delirium with Transient Associative Agnosia and Expressive Aphasia Reversed by Flumazenil in a Pediatric Patient

    PubMed Central

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

    2014-01-01

    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. PMID:26035220

  11. 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

  12. Remission of Methamphetamine-Induced Withdrawal Delirium and Craving After Electroconvulsive Therapy

    PubMed Central

    Ahmadi, Jamshid; Ekramzadeh, Sara; Pridmore, Saxby

    2015-01-01

    Introduction: The aim of this study is to describe the use of electroconvulsive therapy (ECT) in the treatment of methamphetamine-induced withdrawal delirium and craving in a single case. Case Presentation: A 44-year-old male presented to the hospital in Fars province, Iran, with Methamphetamine-Induced Withdrawal Delirium who responded to ECT. Conclusions: The electroconvulsive therapy can be a suitable option for the treatment of methamphetamine withdrawal delirium and craving. Also, it can be usefully employed in these very serious conditions which may represent a risk to life. PMID:26834801

  13. 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. PMID:26035220

  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. 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

  16. 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

  17. 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

    2016-01-01

    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

  18. 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.

  19. 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

  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. 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…

  2. Delirium as a contributing factor to "crescendo" pain: three case reports.

    PubMed

    Coyle, N; Breitbart, W; Weaver, S; Portenoy, R

    1994-01-01

    Cancer patients occasionally experience periods of rapidly escalating pain--"crescendo" pain--that may present a challenge in assessment and management. Although these episodes are often associated with progressive neoplasm, any of a variety of other processes may be involved. Delirium is a potentially treatable and frequently unrecognized factor. We present three patients who illustrate this relationship between delirium and a crescendo pattern of cancer pain.

  3. Neuropathogenesis of delirium: review of current etiologic theories and common pathways.

    PubMed

    Maldonado, José R

    2013-12-01

    Delirium is a neurobehavioral syndrome caused by dysregulation of neuronal activity secondary to systemic disturbances. Over time, a number of theories have been proposed in an attempt to explain the processes leading to the development of delirium. Each proposed theory has focused on a specific mechanism or pathologic process (e.g., dopamine excess or acetylcholine deficiency theories), observational and experiential evidence (e.g., sleep deprivation, aging), or empirical data (e.g., specific pharmacologic agents' association with postoperative delirium, intraoperative hypoxia). This article represents a review of published literature and summarizes the top seven proposed theories and their interrelation. This review includes the "neuroinflammatory," "neuronal aging," "oxidative stress," "neurotransmitter deficiency," "neuroendocrine," "diurnal dysregulation," and "network disconnectivity" hypotheses. Most of these theories are complementary, rather than competing, with many areas of intersection and reciprocal influence. The literature suggests that many factors or mechanisms included in these theories lead to a final common outcome associated with an alteration in neurotransmitter synthesis, function, and/or availability that mediates the complex behavioral and cognitive changes observed in delirium. In general, the most commonly described neurotransmitter changes associated with delirium include deficiencies in acetylcholine and/or melatonin availability; excess in dopamine, norepinephrine, and/or glutamate release; and variable alterations (e.g., either a decreased or increased activity, depending on delirium presentation and cause) in serotonin, histamine, and/or γ-aminobutyric acid. In the end, it is unlikely that any one of these theories is fully capable of explaining the etiology or phenomenologic manifestations of delirium but rather that two or more of these, if not all, act together to lead to the biochemical derangement and, ultimately, to the

  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. Antipsychotics for delirium in the general hospital setting in consecutive 2453 inpatients: a prospective observational study

    PubMed Central

    Hatta, Kotaro; Kishi, Yasuhiro; Wada, Ken; Odawara, Toshinari; Takeuchi, Takashi; Shiganami, Takafumi; Tsuchida, Kazuo; Oshima, Yoshio; Uchimura, Naohisa; Akaho, Rie; Watanabe, Akira; Taira, Toshihiro; Nishimura, Katsuji; Hashimoto, Naoko; Usui, Chie; Nakamura, Hiroyuki

    2014-01-01

    Objective Attention to risk of antipsychotics for older patients with delirium has been paid. A clinical question was whether risk of antipsychotics for older patients with delirium would exceed efficacy of those even in the general hospital setting. Methods A prospective observational study proceeded over a 1-year period at 33 general hospitals, where at least one psychiatrist worked full time. Subjects were patients who developed delirium during their admission due to acute somatic diseases or surgery, and who received antipsychotics for delirium. The primary outcome was rates and kinds of serious adverse events. Results Among 2834 patients who developed delirium, 2453 patients received antipsychotics, such as risperidone (34%), quetiapine (32%), and parenteral haloperidol (20%), for delirium. Out of 2453 patients, 22 serious adverse events (0.9%) were reported. Aspiration pneumonia was the most frequent (17 patients, 0.7%), followed by cardiovascular events (4 patients, 0.2%) and venous thromboembolism (1 patient, 0.0%). There was no patient with a fracture or intracranial injury due to a fall. No one died because of antipsychotic side effects. The mean Clinical Global Impressions—Improvement Scale score was 2.02 (SD 1.09). Delirium was resolved within 1 week in more than half of the patients (54%). Conclusions In the general hospital setting under management including fine dosage adjustment and early detection of side effects, risk of antipsychotics for older patients with delirium might be low, in contrast to antipsychotics for dementia in the nursing home or outpatient settings. A point may be not how to avoid using antipsychotics but how to monitor their risk. PMID:23801358

  6. Preliminary Development of an Ultrabrief Two-Item Bedside Test for Delirium

    PubMed Central

    Fick, Donna M.; Inouye, Sharon K.; Guess, Jamey; Ngo, Long H.; Jones, Richard N.; Saczynski, Jane S.; Marcantonio, Edward R.

    2015-01-01

    Background Delirium is common, morbid, and costly, yet is greatly under-recognized among hospitalized older adults. Objective To identify the best single and pair of mental status test items that predict the presence of delirium. Design, Setting Diagnostic test evaluation study that enrolled medicine inpatients aged 75 years or older at an academic medical center. Methods Patients underwent a clinical reference standard assessment involving a patient interview, medical record review, and interviews with family members and nurses to determine the presence or absence of Diagnostic and Statistical Manual of Mental Disorders, 4th Edition defined delirium. Participants also underwent the three-dimensional Confusion Assessment Method (3D-CAM), a brief, validated assessment for delirium. Individual items and pairs of items from the 3D-CAM were evaluated to determine sensitivity and specificity relative to the reference standard delirium diagnosis. Results Of the 201 participants (mean age 84 years, 62% female), 42 (21%) had delirium based on the clinical reference standard. The single item with the best test characteristics was “months of the year backwards” with a sensitivity of 83% (95% confidence interval [CI]: 69%-93%) and specificity of 69% (95% CI: 61%-76%). The best 2-item screen was the combination of “months of the year backwards” and “what is the day of the week?” with a sensitivity of 93% (95% CI: 81%-99%) and specificity of 64% (95% CI: 56%-70%). Conclusions We identified a single item with >80% and pair of items with >90% sensitivity for delirium. If validated prospectively, these items will serve as an initial innovative screening step for delirium identification in hospitalized older adults. PMID:26369992

  7. Factors Associated with Post-Surgical Delirium in Patients Undergoing Open Heart Surgery

    PubMed Central

    Jannati, Yadollah; Bagheri-Nesami, Masoumeh; Sohrabi, Maryam; Yazdani-Cherati, Jamshid; Mazdarani, Shahrzad

    2014-01-01

    Objective The objective of the present study is to determine the incidence of delirium and the associated factors in patients undergoing open heart surgery. Method This is an Analytic-descriptive study conducted on 404 patients undergoing elective open heart surgery in Fatemeh Zahra Heart Center, Sari, over the period of 6 months from July to December 2011. Sampling was achieved in a nonrandomized targeted manner and delirium was assessed using NeeCham questionnaire. A trained nurse evaluated the patients for delirium and completed the risk factor checklist on days 1 to 5 after surgery. Data analyses were accomplished using survival analysis (Kaplan-Meier and Cox regression) on SPSS software version 15. Results We found that variables, including ventilation time, increased drainage during the first 24 hours, the need for re-operation in the first 24 hours, dysrhythmias, use of inotropic agents, increased use of analgesics, increased arterial carbon dioxide, lack of visitors, and use of physical restrainers were associated with the development of delirium. In addition, we found a delirium incidence of 29%. Conclusion Diagnosis of cognitive disorders is of utmost value; therefore, further studies are required to clarify the risk factors because controlling them will help prevent delirium. PMID:25337310

  8. Delirium in adult patients receiving palliative care: a systematic review of the literature.

    PubMed

    Sánchez-Román, Sofía; Beltrán Zavala, Cristina; Lara Solares, Argelia; Chiquete, Erwin

    2014-01-01

    Delirium in palliative care patients is common and its diagnosis and treatment is a major challenge. Our objective was to perform a literature analysis in two phases on the recent scientific evidence (2007-2012) on the diagnosis and treatment of delirium in adults receiving palliative care. In phase 1 (descriptive studies and narrative reviews) 133 relevant articles were identified: 73 addressed the issue of delirium secondarily, and 60 articles as the main topic. However, only 4 prospective observational studies in which delirium was central were identified. Of 135 articles analysed in phase 2 (clinical trials or descriptive studies on treatment of delirium in palliative care patients), only 3 were about prevention or treatment: 2 retrospective studies and one clinical trial on multicomponent prevention in cancer patients. Much of the recent literature is related to reviews on studies conducted more than a decade ago and on patients different to those receiving palliative care. In conclusion, recent scientific evidence on delirium in palliative care is limited and suboptimal. Prospective studies are urgently needed that focus specifically on this highly vulnerable population.

  9. Different MMSE Score Is Associated with Postoperative Delirium in Young-Old and Old-Old Adults

    PubMed Central

    Wang, Meijuan; Zhu, Yingbo; Li, Cheng; Li, Guodong; Marcantonio, Edward R.; Xie, Zhongcong; Shen, Yuan

    2015-01-01

    Background Postoperative delirium is one of the most common postoperative complications in geriatric patients. Mini-mental state examination (MMSE) assesses cognitive function in patients and is associated with postoperative delirium. However, whether there is an age-dependent relationship between preoperative MMSE score and postoperative delirium remains unknown. Methods We therefore set out to investigate the association between preoperative MMSE score and postoperative delirium in young-old (≤80 year-old, 75.46±4.69 years, 27.0% male, n = 63) and old-old (>80 year-old, 84.51±3.46 years, 20.9% male, n = 67) participants, who had repairs of hip fractures under general anesthesia. The Confusion Assessment Method and Memorial Delirium Assessment Scale were administrated before surgery, and on the first, second and fourth days after surgery, to assess the incidence and severity of the delirium, respectively. A receiver operating characteristic curve analysis was used to calculate the optimal cutoff score of MMSE in predicting postoperative delirium. Results Thirty-four (26.2%) of 130 patients (80.12±6.12 years, 23.8% male) developed postoperative delirium. Preoperative MMSE scores were negatively associated with higher incidences and greater severity of postoperative delirium. The optimal cutoff scores of MMSE associated with postoperative delirium for young-old and old-old participants were 18.4 and 21.4, with a sensitivity of 60% and 83.8%, and a specificity of 92.5% and 62.8%, respectively. Conclusion The data demonstrated the optimal cutoff score of MMSE associated with postoperative delirium in young-old adults might be lower than that in old-old adults. Pending further investigation, these findings suggest that the association between preoperative MMSE score and postoperative delirium is age-dependent. PMID:26460750

  10. Postinjection Delirium/Sedation Syndrome with Olanzapine Depot Injection

    PubMed Central

    Sarangula, Sadhvi Mythili; Mythri, Starlin Vijay; Sanjay, Y.; Reddy, M. S.

    2016-01-01

    After 1 year of introduction of olanzapine long-acting injectable (LAI) in India, many psychiatrists believe that it is a very affordable, well-tolerated, and effective second generation long-acting antipsychotic depot compared to not well tolerated but cheap first generation antipsychotic depots and to other second generation depots which are costly. However, reports of its possible adverse events in clinical settings are not yet published. We report what probably might be the first case of postinjection delirium/sedation syndrome (PDSS) in India. Although the occurrence is uncommon, incorrect understanding of this event may hinder the future use of the potentially useful olanzapine LAI. We review the available literature on the proposed diagnostic guidelines, mechanism of this event, precautions, and management of PDSS. PMID:27570354

  11. Postinjection Delirium/Sedation Syndrome with Olanzapine Depot Injection.

    PubMed

    Sarangula, Sadhvi Mythili; Mythri, Starlin Vijay; Sanjay, Y; Reddy, M S

    2016-01-01

    After 1 year of introduction of olanzapine long-acting injectable (LAI) in India, many psychiatrists believe that it is a very affordable, well-tolerated, and effective second generation long-acting antipsychotic depot compared to not well tolerated but cheap first generation antipsychotic depots and to other second generation depots which are costly. However, reports of its possible adverse events in clinical settings are not yet published. We report what probably might be the first case of postinjection delirium/sedation syndrome (PDSS) in India. Although the occurrence is uncommon, incorrect understanding of this event may hinder the future use of the potentially useful olanzapine LAI. We review the available literature on the proposed diagnostic guidelines, mechanism of this event, precautions, and management of PDSS. PMID:27570354

  12. Delirium superimposed on Charles Bonnet syndrome: a case study.

    PubMed

    Yeager, Jennifer J

    2013-01-01

    Older adults with visual impairment may experience visual hallucinations in the setting of normal cognition and absence of psychiatric illness. This phenomenon is referred to as Charles Bonnet syndrome. Information concerning Charles Bonnet syndrome predominantly comes from case studies. Reassuring the person experiencing the hallucinations they are not suffering from psychosis constitutes the mainstay of treatment. What follows is the case of a vision impaired, older adult male with known Charles Bonnet syndrome, who, following emergency surgery and associated delirium while in the intensive care unit, experiences an aggressive change in hallucinations. Nurses need to understand the pathology and characteristics of Charles Bonnet syndrome in order to distinguish it from other pathologies underlying hallucinations. This knowledge is necessary to provide safe, patient-centered care for older adults.

  13. Gaps in patient care practices to prevent hospital-acquired delirium

    PubMed Central

    Alagiakrishnan, Kannayiram; Marrie, Thomas; Rolfson, Darryl; Coke, William; Camicioli, Richard; Duggan, D’Arcy; Launhardt, Bonnie; Fisher, Bruce; Gordon, Debbie; Hervas-Malo, Marilou; Magee, Bernice; Wiens, Cheryl

    2009-01-01

    ABSTRACT OBJECTIVE To evaluate the current patient care practices that address the predisposing and precipitating factors contributing to the prevention of hospital-acquired delirium in the elderly. DESIGN Prospective cohort (observational) study. PARTICIPANTS Patients 65 years of age and older who were admitted to medical teaching units at the University of Alberta Hospital in Edmonton over a period of 7 months and who were at risk of delirium. SETTING Medical teaching units at the University of Alberta. MAIN OUTCOME MEASURES Demographic data and information on predisposing factors for hospital-acquired delirium were obtained for all patients. Documented clinical practices that likely prevent common precipitants of delirium were also recorded. RESULTS Of the 132 patients enrolled, 20 (15.2%) developed hospital-acquired delirium. At the time of admission several predisposing factors were not documented (eg, possible cognitive impairment 16 [12%], visual impairment 52 [39.4%], and functional status of activities of daily living 99 [75.0%]). Recorded precipitating factors included catheter use, screening for dehydration, and medications. Catheters were used in 35 (26.5%) patients, and fluid intake-and-output charting assessed dehydration in 57 (43.2%) patients. At the time of admission there was no documentation of hearing status in 69 (52.3%) patients and aspiration risk in 104 (78.8%) patients. After admission, reorientation measures were documented in only 16 (12.1%) patients. Although all patients had brief mental status evaluations performed once daily, this was not noted to occur twice daily (which would provide important information about fluctuation of mental status) and there was no formal attention span testing. In this study, hospital-acquired delirium was also associated with increased mortality (P < .004), increased length of stay (P < .007), and increased institutionalization (P < .027). CONCLUSION Gaps were noted in patient care practices that might

  14. Association between Contact Precautions and Delirium at a Tertiary Care Center

    PubMed Central

    Day, Hannah R.; Perencevich, Eli N.; Harris, Anthony D.; Gruber-Baldini, Ann L.; Himelhoch, Seth S.; Brown, Clayton H.; Dotter, Emily; Morgan, Daniel J.

    2012-01-01

    OBJECTIVE To investigate the relationship between contact precautions and delirium among inpatients, adjusting for other factors. DESIGN Retrospective cohort study. SETTING A 662-bed tertiary care center. PATIENTS All nonpyschiatric adult patients admitted to a tertiary care center from 2007 through 2009. METHODS Generalized estimating equations were used to estimate the association between contact precautions and delirium in a retrospective cohort of 2 years of admissions to a tertiary care center. RESULTS During the 2-year period, 60,151 admissions occurred in 45,266 unique nonpsychiatric patients. After adjusting for comorbid conditions, age, sex, intensive care unit status, and length of hospitalization, contact precautions were significantly associated with delirium (as defined by International Classification of Diseases, Ninth Revision), medication, or restraint exposure (adjusted odds ratio [OR], 1.40 [95% confidence interval {CI}, 1.24–1.51]). The association between contact precautions and delirium was seen only in patients who were newly placed under contact precautions during the course of their stay (adjusted OR, 1.75 [95% CI, 1.60–1.92]; P < .01) and was not seen in patients who were already under contact precautions at admission (adjusted OR, 0.97 [95% CI, 0.86–1.09]; P=.60). CONCLUSIONS Although delirium was more common in patients who were newly placed under contact precautions during the course of their hospital admission, delirium was not associated with contact precautions started at hospital admission. Patients newly placed under contact precautions after admission but during hospitalization appear to be at a higher risk and may benefit from proven delirium-prevention strategies. PMID:22173520

  15. 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

  16. Clinical deterioration in older adults with delirium during early hospitalisation: a prospective cohort study

    PubMed Central

    Hsieh, S Jean; Madahar, Purnema; Hope, Aluko A; Zapata, Jennifer; Gong, Michelle N

    2015-01-01

    Objectives To measure the prevalence and incidence of delirium in older adults as they transition from the emergency department (ED) to the inpatient ward, and to determine the association between delirium during early hospitalisation and subsequent clinical deterioration. Design Prospective cohort study. Setting Urban tertiary care hospital in Bronx, New York. Participants Adults aged 65 years or older admitted to the inpatient ward from the ED (n=260). Measurements Beginning in the ED, delirium was assessed daily for 3 days, using the Confusion Assessment Method for the Intensive Care Unit. Outcomes (1) Clinical deterioration, defined as unanticipated intensive care unit (ICU) admission or in-hospital death (primary outcome); (2) decline in discharge status, defined as discharge to higher level of care, hospice or in-hospital death. Results 38 of 260 participants (15%) were delirious at least once during the first 3 days of hospitalisation. Of the 29 (11%) patients with delirium in the ED (ie, hospital day 1), delirium persisted into hospital day 2 in 72% (n=21), and persisted for all 3 days in 52% (n=15). In multivariate analyses, as little as 1 episode of delirium during the first 3 days was associated with increased odds of unanticipated ICU admission or in-hospital death (adjusted OR 8.07 (95% CI 1.91 to 34.14); p=0.005). Delirium that persisted for all 3 days was associated with a decline in discharge status, even after adjusting for factors such as severity of illness and baseline cognitive impairment (adjusted OR 4.70 (95% CI 1.41 to 15.63); p=0.012). Conclusions Delirium during the first few days of hospitalisation was associated with poor outcomes in older adults admitted from the ED to the inpatient ward. These findings suggest the need for serial delirium monitoring that begins in the ED to identify a high-risk population that may benefit from closer follow-up and intervention. PMID:26353866

  17. Does Haloperidol Prophylaxis Reduce Ketamine-Induced Emergence Delirium in Children?

    PubMed Central

    Amr, Mostafa A. M.; Shams, Tarek; Al-Wadani, Hamid

    2013-01-01

    Objectives: Ketamine is a non-barbiturate agent with rapid action onset that induces profound sedation; however, some emergency physicians tend not to use ketamine because of the risk of emergence delirium (ED). This study aimed to evaluate the effectiveness of haloperidol prophylaxis in postoperative ketamine delirium in children. Methods: Prospective data relating to any emergence dreams, delirium, hallucinations, agitation, crying, altered perceptions, and necessary interventions were recorded in consecutive cases of ketamine delirium in patients attending Mansoura University Hospital, Egypt, from June 2010 to May 2011. Results: A total of 537 records were available for analysis. Of those, 267 received prophylactic haloperidol (49.7%). There were significant differences between the two groups regarding post-anaesthetic care unit behaviour. The ketamine-haloperidol groups included more patients who were sleepy, calm (P ≤0.01) and less irritable (P ≤0.01), with a lower incidence of crying (P ≤0.01) and disorientation (P ≤0.01). Conclusion: We found that preoperative administration of haloperidol decreases the incidence of postoperative delirium in a sample of Egyptian children undergoing minor surgery. This is congruent with earlier work conducted in adults. This work carries great hope to decrease and even prevent ED in hospitalised, non-surgical patients. PMID:23862031

  18. 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.

  19. Sudden Death Due To Acute Cocaine Toxicity-Excited Delirium in a Body Packer.

    PubMed

    Shields, Lisa B E; Rolf, Cristin M; Hunsaker, John C

    2015-11-01

    Excited delirium denotes a life-threatening medical condition characterized by the acute onset of agitated and violent behavior that often results in a sudden and unexplained death. Cocaine-induced excited delirium refers to fatal cocaine intoxication with the following symptoms occurring sequentially: hyperthermia, delirium with agitation, respiratory arrest, and death. We present a case of cocaine-induced excited delirium in a cocaine "body packer" or a "mule", specifically an individual who attempts to smuggle cocaine within the body. Investigators at the scene initially suspected homicide due to the victim's sharp and blunt force injuries. Three rubber packets containing cocaine were removed from the victim's rectum. Blood toxicological analysis revealed an alcohol concentration of 0.016 g/100 and cocaine >1 mg/L. The forensic pathologist should consider cocaine-induced excited delirium when an individual exhibits aggressive behavior, unexpected strength, and resistance to pain who dies suddenly. Further analysis should be performed during the scene investigation and autopsy for evidence of body packing.

  20. Managing verbal agitation in people with dementia and delirium.

    PubMed

    Inkley, Francesca; Goldberg, Sarah

    2016-03-01

    Patients with dementia and delirium in acute hospitals can exhibit verbal agitation, but there is no research on rate of occurrence or how ward staff manage such behaviour. This service evaluation aimed to measure rate of occurrence of verbal agitation in confused older inpatients and understand the management strategies used by staff. An agitation inventory was completed daily by the nursing team for all verbally agitated patients on eight older person wards over two weeks. Six semi-structured interviews were conducted with staff and three hours of non-participant observations were undertaken. A mean 6% (13/223) of patients were verbally agitated each day. Management strategies included trial and error, distraction and engagement, reassurance, communication and familiarity. Staff did not adopt a systematic approach to care planning due to lack of training and support on the ward, as well as scarce resources in terms of staff, space and activities. Research is needed to develop and evaluate interventions that support staff to care for these patients.

  1. Management of pain, agitation, and delirium in critically ill patients.

    PubMed

    Pandharipande, Pratik P; Patel, Mayur B; Barr, Juliana

    2014-01-01

    Pain, agitation, and delirium (PAD) are common in critically ill patients. Consequently, analgesic and sedative medications are frequently administered to critically ill patients to treat PAD, to improve synchrony with mechanical ventilation, and to decrease the physiological stress response. However, prolonged, continuous deep sedation of intensive care unit (ICU) patients is associated with numerous adverse outcomes, including longer durations of mechanical ventilation, prolonged ICU stays, acute brain dysfunction, and an increased risk of death. The 2013 ICU PAD Guidelines were developed to provide a clear, evidence-based road map for clinicians to better manage PAD in critically ill patients. Significant knowledge gaps in these areas still remain, but if widely adopted, the PAD Guidelines can help bridge these gaps and will be transformative in terms of their impact on ICU care. Strong evidence indicates that linking PAD management strategies with ventilator weaning, early mobility, and sleep hygiene in ICU patients will result in significant synergistic benefits to patient care and reductions in costs. An interdisciplinary team-based approach, using proven process improvement strategies, and ICU patient and family activation and engagement, will help ensure successful implementation of the ICU PAD Care Bundle in ICUs. This paper highlights the major recommendations of the 2013 ICU PAD Guidelines. We hope this review will help ICU physicians and other health care providers advance the management of PAD in critically ill patients, and improve patients' clinical outcomes.

  2. Comparative Study of Delirium in Emergency and Consultation Liaison- A Tertiary Care Hospital Based Study in Northern India

    PubMed Central

    Prinka

    2016-01-01

    Introduction Delirium is an acute and often fluctuating disturbance in level of consciousness and thought process (cognition) that develops over a short period of time and is a significant change from previous level of functioning. Its prevalence increases with age, complexity of medical co- morbidities and number of medications prescribed. Aim To compare the cause and severity of delirium in patients in emergency and consultation liaison psychiatry group. Materials and Methods A cross-sectional, tertiary care hospital based study was conducted on the patients who presented with delirium from emergency department (50) and consultation-liaison psychiatry groups (50), over a period of one year. The diagnosis was made on the basis of DSM- 5 criteria. The Delirium Rating Scale (DRS-R-98) was applied to know the severity of delirium, cognitive and non-cognitive symptoms of delirium in patients. The results were subjected to appropriate statistical analysis. Results In emergency group, 42% patients had metabolic abnormalities, while in consultation-liaison, 38% patients had hyponatremia and hypokalemia and the difference was found to be statistically non-significant (p>0.05). In emergency group, 21(42%) patients were diagnosed as delirium due to other medical condition, followed by 13 (26%) and 8(16%) patients, who were diagnosed as delirium due to multiple aetiologies and substance intoxication each respectively. In only 33(66%) cases in consultation liaison group patients had delirium secondary to other medical conditions. As per DRS-R98 Scale, mean severity score was found to be statistically significant (p<0.05) in consultation liaison group as compared to emergency department group (p> 0.05). Conclusion Delirium is multifactorial aetiological disease, with variable but preventable outcome. Approach should be aimed at finding the treatable causes to reduce morbidity and mortality. PMID:27656535

  3. 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

  4. Preoperative discussion with patients about delirium risk: are we doing enough?

    PubMed

    Tomlinson, Judith H; Partridge, Judith S L

    2016-01-01

    Postoperative delirium is a common complication in the older surgical population, occurring in 10-50 % of cases. It is thought to be more common if an individual is identified as frail. Postoperative delirium is associated with poor outcome including higher mortality rates, prolonged length of hospital stay, increased care needs on discharge and longer term post-traumatic stress disorder. Guidelines from the American Geriatric Society and the National Institute for Health and Care Excellence highlight the importance of risk assessment at the time of the preoperative visit. This enables the perioperative team to plan a care pathway that minimises the risk of delirium occurring postoperatively. Risk assessment also informs a discussion with patient and family regarding their risk, as part of a process of informed patient consent. This is an essential step in conforming to current legal and General Medical Council guidance on the process of consent. PMID:27594990

  5. 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

  6. Impaired Olfaction and Risk for Delirium or Cognitive Decline After Cardiac Surgery

    PubMed Central

    Brown, Charles H.; Morrissey, Candice; Ono, Masahiro; Yenokyan, Gayane; Selnes, Ola A.; Walston, Jeremy; Max, Laura; LaFlam, Andrew; Neufeld, Karin; Gottesman, Rebecca F.; Hogue, Charles W.

    2014-01-01

    Summary Statement Impaired olfaction, identified in 33% of patients undergoing cardiac surgery, was associated with the adjusted risk for postoperative delirium but not cognitive decline. Objectives The prevalence and significance of impaired olfaction is not well characterized in patients undergoing cardiac surgery. Because impaired olfaction has been associated with underlying neurologic disease, impaired olfaction may identify patients who are vulnerable to poor neurological outcomes in the perioperative period. The objective of this study was to determine the prevalence of impaired olfaction among patients presenting for cardiac surgery and the independent association of impaired olfaction with postoperative delirium and cognitive decline. Design Nested prospective cohort study Setting Academic hospital Participants 165 patients undergoing coronary artery bypass and/or valve surgery Measurements Olfaction was measured using the Brief Smell Identification Test, with impaired olfaction defined as an olfactory score < 5th percentile of normative data. Delirium was assessed using a validated chart-review method. Cognitive performance was assessed using a neuropsychological testing battery at baseline and 4–6 weeks after surgery. Results Impaired olfaction was identified in 54 of 165 patients (33%) prior to surgery. Impaired olfaction was associated with increased adjusted risk for postoperative delirium (relative risk [RR] 1.90, 95% CI 1.17–3.09; P=0.009). There was no association between impaired olfaction and change in composite cognitive score in the overall study population. Conclusion Impaired olfaction is prevalent in patients undergoing cardiac surgery and is associated with increased adjusted risk for postoperative delirium, but not cognitive decline. Impaired olfaction may identify unrecognized vulnerability for postoperative delirium among patients undergoing cardiac surgery. PMID:25597555

  7. 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

  8. Pain, agitation, and delirium guidelines: nurses' involvement in development and implementation.

    PubMed

    Davidson, Judy E; Winkelman, Chris; Gélinas, Céline; Dermenchyan, Anna

    2015-06-01

    The 2013 American College of Critical Care Medicine/Society of Critical Care Medicine clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit serves as a living example of nurses' involvement in the development and implementation of professional guidelines. Nurses who served on this guideline-writing panel describe their experiences. Specific examples from the pain, agitation, and delirium guidelines for care are used to explore the roles of the nurse leader, nurse informaticist, staff nurse, and nurse researcher in relationship to guideline implementation. PMID:26033098

  9. "Excited delirium syndrome": is it a cause of death?

    PubMed

    Kodikara, Sarathchandra; Cunningham, Kristopher; Pollanen, Michael S

    2012-09-01

    Excited delirium syndrome (EDS) has become a controversial and vexing forensic issue due to its association with restraint and sudden unexpected death. Although some authorities and jurisdictions recognised EDS as a cause of death there is no consensus among the medical community in this regard. The overlapping nature of the spectrum of antemortem behaviours and signs with many natural disease processes complicates this issue further. We describe two deaths which initially presented as EDS-like behaviour during restraint. In the first case, the deceased was travelling on a long distance flight when he died while in the custody of air cabin crew. The autopsy revealed the cause of death as air travel-related pulmonary thromboembolism. Acute alcoholic intoxication, nicotine withdrawal, hypoxia due to acute pulmonary thromboembolism, and hypobaric environment in the air plane cabin appeared as the potential reasons for EDS-like behaviour. In the second case, the deceased died while in the custody of immigration officials. At autopsy the cause of death turned out to be tense pericardial effusion due to fibrinous pericarditis. In this case, hypoperfusion of the brain following systemic hypotension as a result of cardiac tamponade associated with pericardial effusion likely led to the EDS-like behaviour. Clinicopathologic correlation in these two cases would strongly suggest EDS as the cause of death, had the decedents not had fatal anatomical causes of death. This alerts the forensic pathologist that not all the individuals dying with signs and symptoms of EDS during restraint are accounted for EDS as the immediate cause of death. PMID:22622258

  10. Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after non-cardiac surgery†‡

    PubMed Central

    Hirsch, J.; DePalma, G.; Tsai, T. T.; Sands, L. P.; Leung, J. M.

    2015-01-01

    Introduction Postoperative delirium is common in older patients. Despite its prognostic significance, the pathophysiology is incompletely understood. Although many risk factors have been identified, no reversible factors, particularly ones potentially modifiable by anaesthetic management, have been identified. The goal of this prospective cohort study was to investigate whether intraoperative hypotension was associated with postoperative delirium in older patients undergoing major non-cardiac surgery. Methods Study subjects were patients >65 years of age, undergoing major non-cardiac surgery, who were enrolled in an ongoing prospective observational study of the pathophysiology of postoperative delirium. Intraoperative blood pressure was measured and predefined criteria were used to define hypotension. Delirium was measured by the Confusion Assessment Method on the first two postoperative days. Data were analysed using t-tests, two-sample proportion tests and ordered logistic regression multivariable models, including correction for multiple comparisons. Results Data from 594 patients with a mean age of 73.6 years (sd 6.2) were studied. Of these 178 (30%) developed delirium on day 1 and 176 (30%) on day 2. Patients developing delirium were older, more often female, had lower preoperative cognitive scores, and underwent longer operations. Relative hypotension (decreases by 20, 30, or 40%) or absolute hypotension [mean arterial pressure (MAP)<50 mm Hg] were not significantly associated with postoperative delirium, nor was the duration of hypotension (MAP<50 mm Hg). Conversely, intraoperative blood pressure variance was significantly associated with postoperative delirium. Discussion These results showed that increased blood pressure fluctuation, not absolute or relative hypotension, was predictive of postoperative delirium. PMID:25616677

  11. Delirium after transcatheter aortic valve implantation via the femoral or apical route.

    PubMed

    Sharma, V; Katznelson, R; Horlick, E; Osten, M; Styra, R; Cusimano, R J; Carroll, J; Djaiani, G

    2016-08-01

    We thought that delirium might be less frequent after transcatheter aortic valve implantation via the femoral artery compared with via the cardiac apex. We reviewed 210 patients who underwent transcatheter aortic valve implantation between January 2009 and October 2014. The proportion (95% CI) of patients who suffered delirium in the 3 days after valve implantation were: 10 (3-16%) in 105 patients who had transfemoral implantation; and 35 (25-45%) in 105 patients who had transapical implantation, p = 0.0001. The variables that independently associated with postoperative delirium were age, male sex and the transapical approach. The median (IQR [range]) hospital stay was 7 (5-13 [2-41]) days and 10 (7-15 [2-64]) days, respectively, p = 0.004. Future trials should focus on different peri-operative management strategies to reduce delirium rates after transcatheter aortic valve implantation, particularly in older men having implantations via the cardiac apex.

  12. 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…

  13. 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.

  14. 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…

  15. Syndrome of agitated delirium and visual impairment: a manifestation of medial temporo-occipital infarction.

    PubMed

    Medina, J L; Chokroverty, S; Rubino, F A

    1977-09-01

    Three patients presented with sudden visual impairment followed by agitated delirium one to three days later. Examination revealed marked agitation, dementia, and loss of vision. Computerised axial tomography demonstrated temporo-occipital infarctions. All recovered from the agitated state in four days to two months, but their visual impairment and dementia persisted one to four years later.

  16. 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

  17. A continuous wavelet transform and classification method for delirium motoric subtyping.

    PubMed

    Godfrey, Alan; Conway, Richard; Leonard, Maeve; Meagher, David; Olaighin, Gearóid M

    2009-06-01

    The usefulness of motor subtypes of delirium is unclear due to inconsistency in subtyping methods and a lack of validation with objective measures of activity. The activity of 40 patients was measured over 24 h with a discrete accelerometer-based activity monitor. The continuous wavelet transform (CWT) with various mother wavelets were applied to accelerometry data from three randomly selected patients with DSM-IV delirium that were readily divided into hyperactive, hypoactive, and mixed motor subtypes. A classification tree used the periods of overall movement as measured by the discrete accelerometer-based monitor as determining factors for which to classify these delirious patients. This data used to create the classification tree were based upon the minimum, maximum, standard deviation, and number of coefficient values, generated over a range of scales by the CWT. The classification tree was subsequently used to define the remaining motoric subtypes. The use of a classification system shows how delirium subtypes can be categorized in relation to overall motoric behavior. The classification system was also implemented to successfully define other patient motoric subtypes. Motor subtypes of delirium defined by observed ward behavior differ in electronically measured activity levels. PMID:19497833

  18. The Development and Evaluation of Delirium Assessment and Nursing Care Decision-Making Assistant Mobile Application for Intensive Care Unit.

    PubMed

    Yang, Fangyu; Ji, Meihua; Ding, Shu; Wu, Ying; Chang, Polun; Lin, Chiawei; Yang, Xin

    2016-01-01

    Delirium is a common complication among patients in ICU settings. Although it has been repeatedly confirmed that Confusion Assessment Model for Intensive Care Unit (CAM-ICU), one of the most commonly used ICU delirium assessment tool, is highly accurate in validation studies, it's sensitivity and specificity is relatively low during routine practice among bedside nurses. The aim of this study is to develop a mobile application (app) to detect delirium and to test its reliability and validity both by research nurses and among ICU bedside nurses. The app was programmed with Java and installed on a mobile device with Android system. After completion of reliability and validity testing, the app will be integrated into the existing Hospital Information System in order to automatically retrieve essential information for risk factor identification and formulation of care plan accordingly to prevent or manage ICU delirium. PMID:27332299

  19. Caring for dying patients in the intensive care unit: managing pain, dyspnea, anxiety, delirium, and death rattle.

    PubMed

    Campbell, Margaret L

    2015-01-01

    Critically ill patients receiving palliative care at the end of life are at high risk for experiencing pain, dyspnea, and death rattle. Nearly all these patients are at risk for the development of delirium. Patients who are alert may experience anxiety. Advanced practice nurses and staff nurses are integral to detecting and treating these symptoms. Pain, dyspnea, and anxiety should be routinely assessed by patient self-report when possible. Routine behavioral screening for delirium is recommended. Behavioral observation tools to detect pain and dyspnea and proxy assessments guide symptom identification when the patient cannot provide a self-report. Evidence-based interventions are offered for both prevention and treatment of pain, dyspnea, anxiety, and delirium. Death rattle does not produce patient distress, and current pharmacological treatment lacks an evidence base. Pain management has a robust evidence base compared to management of dyspnea, anxiety, and delirium among this population; well-designed, adequately powered studies are needed.

  20. 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

  1. 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.

  2. 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

  3. 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. PMID:19252697

  4. Managing the Care of the Older Patient with Delirium and Dementia.

    PubMed

    Seeganna, Carolyn; Antai-Otong, Deborah

    2016-06-01

    As the population ages, nurses in various clinical settings must identify high-risk groups that are vulnerable to delirium and dementia. They also must be able to provide psychosocial and pharmacologic interventions that promote comfort and safety for patients and their families experiencing these distressful medical conditions. Efforts to facilitate health resolution and restore the patient and caregivers to an optimal level of functioning must be priorities. PMID:27229280

  5. Prolonged Delirium With Catatonia Following Orthotopic Liver Transplant Responsive to Memantine.

    PubMed

    Brown, Gregory D; Muzyk, Andrew J; Preud'homme, Xavier A

    2016-03-01

    A 59-year-old man with nonalcoholic steatohepatitis cirrhosis underwent an orthotopic liver transplant and experienced a complicated postoperative course, including a prolonged delirium. After discharge to rehabilitation, he had 2 subsequent admissions for delirium. On the first readmission, the transplant team started the patient on risperidone and resumed treatment with sertraline. On his second readmission, neurology and psychiatry were consulted. On evaluation, the patient demonstrated signs of catatonia. On the basis of recommendations from psychiatry, the risperidone and sertraline were stopped, and the patient was started on mirtazapine. He failed to demonstrate improvement within the next 48 hours. Extensive work-up demonstrated a multifactorial etiology for his delirium, including calcineurin-related neuropsychiatric toxicity from tacrolimus leading to possible posterior reversible encephalopathy syndrome. However, after the initiation of memantine on hospital day 3-before the cessation of tacrolimus-the patient demonstrated marked improvement in mental status and motor symptoms. His magnetic resonance imaging, in addition to findings that raised concerns about posterior reversible encephalopathy syndrome, had demonstrated bilateral basal ganglia abnormalities on T1 imaging of uncertain origin. It is postulated that these findings served as predisposing factors for the patient's catatonic symptoms. Although it has been described in case reports following liver transplant, catatonia remains an underrecognized neuropsychiatric complication following liver transplant. This case demonstrates the effectiveness of memantine, an N-methyl-D-aspartic acid antagonist that decreases glutamine excitotoxicity, as a potential treatment for catatonia in postliver transplant patients. PMID:27138082

  6. Reflexivity and exploring the meaning of delirium through media depictions: Methodological insights from a phenomenological study.

    PubMed

    Day, Jenny; Higgins, Isabel

    2016-03-01

    In the course of a phenomenological study that explored the experiences of family members during their older loved one's delirium, a range of delirium experiences depicted in artistic, creative, and linguistic media were reviewed. The search for, and compilation of, media sources for reflection during data analysis is described in this paper. In doing so, the researcher reveals how attentiveness and openness to varied depictions of lived experiences, as well as a valuing attitude toward challenging subjective perspectives, can enhance researcher reflexivity and appreciation of interpretive meanings. Turning to media depictions of delirium offered alternative perspectives on the experience. It challenged the researcher's assumptions, enhanced phenomenological reflection, promoted critique of evolving interpretations, and suggested meanings that might not have otherwise been realized. The approach used is a potent, although often overlooked, way to differentiate the nature of phenomena shared through lived experience data. Media-based methods and their use in phenomenology continue to be explored. Illustrations of how to integrate media sources, as well as discussion about the benefits and alternatives to more common uses, are needed.

  7. Prevalence of Delirium and Coma In Mechanically Ventilated Patients Sedated With Dexmedetomidine or Propofol

    PubMed Central

    Jiang, Yi Kai (Johnny); Wang, Shan; Lam, Timothy S.; Hanna, Adel; DeMuro, Jonas P.; Calixte, Rose; Brathwaite, Collin E.M.

    2016-01-01

    Objective: To assess the prevalence of delirium and coma in mechanically ventilated patients sedated with dexmedetomidine or propofol alone; to evaluate the hospital length of stay for both treatment groups; and to evaluate the level of sedation, adverse effects, and hospital outcomes. Methods: Medical records were reviewed retrospectively for patients who were admitted to the medical or surgical intensive care units (ICUs) in a 591-bed teaching hospital and who received either dexmedetomidine or propofol alone for 24 hours or more for sedation. Results: A total of 111 patients were included in the study, with 56 patients in the dexmedetomidine group and 55 patients in the propofol group. Results of the analysis showed that the propofol group had a higher prevalence of coma (43.6% versus 12.5%; P < 0.001). Dexmedetomidine patients had a longer median hospital length of stay of 23.5 days (interquartile range [IQR], 11.5–39.5 days) versus 15.0 days (IQR, 7.0–24.0 days; P = 0.01). The rates of delirium were similar in both groups, with 16% in dexmedetomidine-treated patients versus 20% in propofol-treated patients (P = 0.63). Conclusion: No difference in the prevalence of delirium was found when comparing the dexmedetomidine- and propofol-treated groups. Propofol was associated with more coma and oversedation; dexmedetomidine was associated with longer time to extubation, longer length of stay in the ICU, and longer hospital length of stay. PMID:27408521

  8. 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

  9. Delirium, sedation and analgesia in the intensive care unit: a multinational, two-part survey among intensivists.

    PubMed

    Luetz, Alawi; Balzer, Felix; Radtke, Finn M; Jones, Christina; Citerio, Giuseppe; Walder, Bernhard; Weiss, Bjoern; Wernecke, Klaus-Dieter; Spies, Claudia

    2014-01-01

    Analgesia, sedation and delirium management are important parts of intensive care treatment as they are relevant for patients' clinical and functional long-term outcome. Previous surveys showed that despite this fact implementation rates are still low. The primary aim of the prospective, observational multicenter study was to investigate the implementation rate of delirium monitoring among intensivists. Secondly, current practice concerning analgesia and sedation monitoring as well as treatment strategies for patients with delirium were assesed. In addition, this study compares perceived and actual practice regarding delirium, sedation and analgesia management. Data were obtained with a two-part, anonymous survey, containing general data from intensive care units in a first part and data referring to individual patients in a second part. Questionnaires from 101 hospitals (part 1) and 868 patients (part 2) were included in data analysis. Fifty-six percent of the intensive care units reported to monitor for delirium in clinical routine. Fourty-four percent reported the use of a validated delirium score. In this respect, the survey suggests an increasing use of delirium assessment tools compared to previous surveys. Nevertheless, part two of the survey revealed that in actual practice 73% of included patients were not monitored with a validated score. Furthermore, we observed a trend towards moderate or deep sedation which is contradicting to guideline-recommendations. Every fifth patient was suffering from pain. The implementation rate of adequate pain-assessment tools for mechanically ventilated and sedated patients was low (30%). In conclusion, further efforts are necessary to implement guideline recommendations into clinical practice. The study was registered (ClinicalTrials.gov identifier: NCT01278524) and approved by the ethical committee.

  10. Unexpected death related to restraint for excited delirium: a retrospective study of deaths in police custody and in the community

    PubMed Central

    Pollanen, M S; Chiasson, D A; Cairns, J T; Young, J G

    1998-01-01

    BACKGROUND: Some people in states of excited delirium die while in police custody. Emerging evidence suggests that physical restraint in certain positions may contribute to such deaths. In this study the authors determined the frequency of physical restraint among people in a state of excited delirium who died unexpectedly. METHODS: The authors reviewed the records of 21 cases of unexpected death in people with excited delirium, which were investigated by the Office of the Chief Coroner for Ontario between 1988 and 1995. Eyewitness testimony, findings during postmortem examinations, clinical history, toxicological data and other official documents describing the events surrounding the deaths were analyzed. Specific reference was made to documented eyewitness testimony of restraint method, body position and use of capsicum oleoresin (pepper) spray. Because cocaine was detected in the blood of some of these people during the postmortem examination, the role of cocaine in excited delirium was examined by comparing the cocaine levels in these cases with levels in 2 control groups: 19 people who died from acute cocaine intoxication and 21 people who had used cocaine shortly before they died but who had died from other causes. RESULTS: In all 21 cases of unexpected death associated with excited delirium, the deaths were associated with restraint (for violent agitation and hyperactivity), with the person either in a prone position (18 people [86%]) or subjected to pressure on the neck (3 [14%]). All of those who died had suddenly lapsed into tranquillity shortly after being restrained. The excited delirium was caused by a psychiatric disorder in 12 people (57%) and by cocaine-induced psychosis in 8 (38%). Eighteen people (86%) were in police custody when they died. Four (19%) had been sprayed with capsicum oleoresin, and heart disease was found in another 4 at autopsy. The blood level of cocaine in those whose excited delirium was cocaine induced was similar to levels

  11. 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%.

  12. 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%. PMID:25311146

  13. 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. PMID:26444149

  14. Can an e-learning course improve nursing care for older people at risk of delirium: a stepped wedge cluster randomised trial

    PubMed Central

    2014-01-01

    Background Delirium occurs frequently in older hospitalised patients and is associated with several adverse outcomes. Ignorance among healthcare professionals and a failure to recognise patients suffering from delirium have been identified as the possible causes of poor care. The objective of the study was to determine whether e-learning can be an effective means of improving implementation of a quality improvement project in delirium care. This project aims primarily at improving the early recognition of older patients who are at risk of delirium. Methods In a stepped wedge cluster randomised trial an e-learning course on delirium was introduced, aimed at nursing staff. The trial was conducted on general medical and surgical wards from 18 Dutch hospitals. The primary outcome measure was the delirium risk screening conducted by nursing staff, measured through monthly patient record reviews. Patient records from patients aged 70 and over admitted onto wards participating in the study were used for data collection. Data was also collected on the level of delirium knowledge of these wards’ nursing staff. Results Records from 1,862 older patients were included during the control phase and from 1,411 patients during the intervention phase. The e-learning course on delirium had a significant positive effect on the risk screening of older patients by nursing staff (OR 1.8, p-value <0.01), as well as on other aspects of delirium care. The number of patients diagnosed with delirium was reduced from 11.2% in the control phase to 8.7% in the intervention phase (p = 0.04). The e-learning course also showed a significant positive effect on nurses’ knowledge of delirium. Conclusions Nurses who undertook a delirium e-learning course showed a greater adherence to the quality improvement project in delirium care. This improved the recognition of patients at risk and demonstrated that e-learning can be a valuable instrument for hospitals when implementing improvements in

  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. Managing hyperactive delirium and spinal immobilisation in the intensive care setting: a case study and reflective discussion of the literature.

    PubMed

    Hyde-Wyatt, Jaime P

    2014-06-01

    The management of ventilated patients on intensive care has, at its core, a care bundle; an evidence based group of actions designed to reduce the risk of ventilator-associated pneumonia. One of these is the daily cessation of sedation medication to expedite weaning from ventilatory support. A reflection-on-action exercise was carried out when a spinally injured patient became physically active during a sedation hold. This was attributed to hyperactive delirium. The concern was the conflict between providing evidence based Intensive Care Unit (ICU) therapy care and maintaining spinal immobility. Reflection on this incident led to a literature search for guidance on the likelihood of delirium causing secondary spinal injury in patients with unstable fractures. There was plentiful research on delirium and its consequences but very little examining the link between spinal injury and delirium. In order to be able to provide evidence-based care to future trauma patients the research supporting spinal immobilisation was also examined. The research showed that compliance with ventilator care bundles reduced the risks of acquiring ventilator-associated pneumonia. Research surrounding spinal immobilisation was conflicting and there were no studies linking the consequences of immobilised patients experiencing hyperactive delirium. Through a case study approach the research was reviewed in relation to a particular patient and although literature was lacking some implications for practice could be identified to promote the best possible outcomes. Sedation cessation episodes are an essential part of patient care on intensive care. For spinally injured patients' these may need to be modified to sedation reductions to prevent sudden wakening and uncontrolled movement should the patient be experiencing hyperactive delirium. This case study clearly highlights the need for further research in this area as the consequences of both ventilator associated pneumonia and extending spinal

  17. 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

  18. 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

  19. 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

  20. Prevention of delirium in trauma patients: Are we giving thiamine prophylaxis a fair chance?

    PubMed Central

    Blackmore, Christopher; Ouellet, Jean-Francois; Niven, Daniel; Kirkpatrick, Andrew W.; Ball, Chad G.

    2014-01-01

    Background Delirium is associated with increased morbidity and mortality in injured patients. Wernicke encephalopathy (WE) is delirium linked to malnutrition and chronic alcoholism. It is prevented with administration of thiamine. Our primary goal was to evaluate current blood alcohol level (BAL) testing and thiamine prophylaxis in severely injured patients. Methods We retrospectively reviewed the cases of 1000 consecutive severely injured patients admitted to hospital between Mar. 1, 2009, and Dec. 31, 2009. We used the patients’ medical records and the Alberta Trauma Registry. Results Among 1000 patients (mean age 48 yr, male sex 70%, mean injury severity score 23, mortality 10%), 627 underwent BAL testing at admission; 221 (35%) had a BAL greater than 0 mmol/L, and 189 (30%) had a BAL above the legal limit of 17.4 mmol/L. The mean positive BAL was 41.9 mmol/L. More than 4% had a known history of alcohol abuse. More patients were assaulted (20% v. 9%) or hit by motor vehicles (10% v. 6%) when intoxicated (both p < 0.05). Most injuries occurred after falls (37%) and motor vehicle collisions (33%). Overall, 17% of patients received thiamine prophylaxis. Of the 221 patients with elevated BAL, 44% received thiamine prophylaxis. Of those with a history of alcohol abuse, 77% received thiamine prophylaxis. Conclusion Despite the strong link between alcohol abuse, trauma and WE, more than one-third of patients were not screened for alcohol use. Furthermore, a minority of intoxicated patients received adequate prophylaxis against WE. Given the low risk and cost of BAL testing and thiamine prophylaxis and the high cost of delirium, standard protocols for prophylaxis are essential. PMID:24666443

  1. 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.

  2. 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.

  3. High Yield Research Opportunities in Geriatric Emergency Medicine: Prehospital Care, Delirium, Adverse Drug Events, and Falls

    PubMed Central

    Carpenter, Christopher R.; Shah, Manish N.; Hustey, Fredric M.; Heard, Kennon; Gerson, Lowell W.

    2011-01-01

    Emergency services constitute crucial and frequently used safety nets for older persons, an emergency visit by a senior very often indicates high vulnerability for functional decline and death, and interventions via the emergency system have significant opportunities to change the clinical course of older patients who require its services. However, the evidence base for widespread employment of emergency system-based interventions is lacking. In this article, we review the evidence and offer crucial research questions to capitalize on the opportunity to optimize health trajectories of older persons seeking emergency care in four areas: prehospital care, delirium, adverse drug events, and falls. PMID:21498881

  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. PMID:25570415

  5. Delirium and dementia in acute hospitals: assessing the impact of RMN input.

    PubMed

    Law, Emma

    2008-11-01

    There is evidence that provision for the mental health needs of older people in acute hospitals is generally poor. This article describes a study undertaken over a nine-month period at Perth Royal Infirmary, a 317-bed district general hospital. The study sought to measure the impact of input from an RMN in an acute hospital setting and within a multidisciplinary liaison model. The article examines the implications, preparation, implementation and evaluation of RMN input, and the baseline knowledge and expectations of acute hospital staff when caring for patients with dementia and delirium.

  6. Early postoperative cognitive dysfunction and postoperative delirium after anaesthesia with various hypnotics: study protocol for a randomised controlled trial - The PINOCCHIO trial

    PubMed Central

    2011-01-01

    Background Postoperative delirium can result in increased postoperative morbidity and mortality, major demand for postoperative care and higher hospital costs. Hypnotics serve to induce and maintain anaesthesia and to abolish patients' consciousness. Their persisting clinical action can delay postoperative cognitive recovery and favour postoperative delirium. Some evidence suggests that these unwanted effects vary according to each hypnotic's specific pharmacodynamic and pharmacokinetic characteristics and its interaction with the individual patient. We designed this study to evaluate postoperative delirium rate after general anaesthesia with various hypnotics in patients undergoing surgical procedures other than cardiac or brain surgery. We also aimed to test whether delayed postoperative cognitive recovery increases the risk of postoperative delirium. Methods/Design After local ethics committee approval, enrolled patients will be randomly assigned to one of three treatment groups. In all patients anaesthesia will be induced with propofol and fentanyl, and maintained with the anaesthetics desflurane, or sevoflurane, or propofol and the analgesic opioid fentanyl. The onset of postoperative delirium will be monitored with the Nursing Delirium Scale every three hours up to 72 hours post anaesthesia. Cognitive function will be evaluated with two cognitive test batteries (the Short Memory Orientation Memory Concentration Test and the Rancho Los Amigos Scale) preoperatively, at baseline, and postoperatively at 20, 40 and 60 min after extubation. Statistical analysis will investigate differences in the hypnotics used to maintain anaesthesia and the odds ratios for postoperative delirium, the relation of early postoperative cognitive recovery and postoperative delirium rate. A subgroup analysis will be used to categorize patients according to demographic variables relevant to the risk of postoperative delirium (age, sex, body weight) and to the preoperative score index

  7. 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.

  8. A Review of the Role of Anticholinergic Activity in Lewy Body Disease and Delirium.

    PubMed

    Kitajima, Yuka; Hori, Koji; Konishi, Kimiko; Tani, Masayuki; Tomioka, Hiroi; Akashi, Norihisa; Hosoi, Misa; Inamoto, Atsuko; Hasegawa, Sayaka; Kikuchi, Nodoka; Takahashi, Akari; Hachisu, Mitsugu

    2015-01-01

    We have previously proposed a hypothesis in which we argue that anticholinergic activity (AA) appears endogenously in Alzheimer's disease (AD). Acetylcholine (ACh) controls both cognitive function and inflammation. Consequently, when the downregulation of ACh reaches critical levels, the inflammatory system is upregulated and proinflammatory cytokines with AA appear. However, factors other than downregulation of ACh can produce AA; even if ACh downregulation does not reach critical levels, AA can still appear if one of these other AA-producing factors is added. These factors can include neurocognitive disorders other than AD, such as delirium and Lewy body disease (LBD). In delirium, ACh downregulation fails to reach critical levels, but AA appears due to the use of medicines, physical illnesses or mental stress (termed 'AA inserts'). In LBD, we speculate that AA appears endogenously, even in the absence of severe cognitive dysfunction, for 2 reasons. One reason is that patterns of ACh deterioration are different in LBD from those in AD, with synergistic actions between amyloid and α-synuclein thought to cause additional or severe symptoms that accelerate the disease course. The second reason is that AA occurs through disinhibition by reduced cortisol levels that result from severe autonomic parasympathetic dysfunction in LBD.

  9. Perceptions and practices regarding delirium, sedation and analgesia in critically ill patients: a narrative review.

    PubMed

    Shinotsuka, Cassia Righy; Salluh, Jorge Ibrain Figueira

    2013-01-01

    A significant number of landmark studies have been published in the last decade that increase the current knowledge on sedation for critically ill patients. Therefore, many practices that were considered standard of care are now outdated. Oversedation has been shown to be hazardous, and light sedation and no-sedation protocols are associated with better patient outcomes. Delirium is increasingly recognized as a major form of acute brain dysfunction that is associated with higher mortality, longer duration of mechanical ventilation and longer lengths of stay in the intensive care unit and hospital. Despite all the available evidence, translating research into bedside care is a daunting task. International surveys have shown that practices such as sedation interruption and titration are performed only in the minority of cases. Implementing best practices is a major challenge that must also be addressed in the new guidelines. In this review, we summarize the findings of sedation and delirium research over the last years. We also discuss the gap between evidence and clinical practice and highlight ways to implement best practices at the bedside. PMID:23917981

  10. 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. PMID:26455008

  11. Incidence and risk factors of postoperative delirium in elderly patients undergoing transurethral resection of prostate: a prospective cohort study

    PubMed Central

    Xue, Peng; Wu, Ziyu; Wang, Kunpeng; Tu, Chuanquan; Wang, Xiangbo

    2016-01-01

    Aim The aim of the present study was to investigate the occurrence of postoperative delirium (POD) in elderly patients undergoing transurethral resection of prostate (TURP) and to identify those factors associated with delirium. Methods From July 2010 to February 2015, 358 patients, aged ≥65 years and undergoing TURP were prospectively enrolled. Personal, medical and cognitive data, laboratory assessments, pain intensity, preoperative medications, and details of hemodynamic control were collected as predictors of delirium. POD was assessed using the Confusion Assessment Method. Results In the present study, POD occurred in 28 out of 358 cases (7.8%) after TURP, with duration of 1–4 days. The multivariate analysis showed that old age and visual analog scale pain scores were associated with POD. Marital status, body mass index, education, alcohol consumption, smoking history, preoperative psychotropic medication usage, activities of daily living scores, preoperative Mini-Mental Status Examination score, anesthesia type, American Society of Anesthesiologists classification, or hypotensive episodes during surgery did not significantly correlate with the occurrence of POD. Conclusion Old age and pain intensity after surgery were found as the risk factors for the development of delirium in elderly patients undergoing TURP. These findings might help develop preventive strategies to decrease POD through targeted evaluation. PMID:26834475

  12. Case discussion: large volume blood loss and delirium in a patient with subtrochanteric fracture, dementia, and multiple comorbidities.

    PubMed

    Christmas, Colleen; Mears, Simon C; Sieber, Frederick E; Votsis, Julie; Wood, Ronald C; Friedman, Susan M

    2011-09-01

    This case presents a discussion of a 92-year-old man with multiple comorbidities, who presents with a subtrochanteric fracture. His course is complicated by large volume blood loss intraoperatively, requiring intensive care unit (ICU) monitoring postoperatively. His course is also complicated by delirium.

  13. Delirium with anticholinergic symptoms after a combination of paliperidone and olanzapine pamoate in a patient known to smoke cannabis: an unfortunate coincidence.

    PubMed

    Kokalj, Anja; Rijavec, Nikolina; Tavčar, Rok

    2016-01-01

    We report a case of delirium with anticholinergic symptoms in a 19-year-old female patient with schizophrenia. On the day the symptoms emerged, the patient received olanzapine long-acting injection and a higher dose of paliperidone. We observed symptoms ranging from confusion to delirium as well as some anticholinergic symptoms. The delirium lasted 24 hours and was managed by intravenous fluid substitution and oral benzodiazepines. Olanzapine pamoate, paliperidone and cannabis are central nervous system (CNS) depressants, and their combination can increase the risks of CNS depression. In this case report, we review the symptoms of delirium in a case of antipsychotic overdose and provide general guidelines for managing these symptoms. We also review possible complications in combined use of cannabis, olanzapine and paliperidone. PMID:27335358

  14. Efficacy of Intravenous Haloperidol on the duration of Delirium and Coma in Critically Ill Patients (Hope-ICU): a Randomised, Placebo-Controlled Trial

    PubMed Central

    Page, Valerie J; Ely, E Wesley; Gates, Simon; Zhao, Xiao Bei; Alce, Timothy; Shintani, Ayumi; Jackson, Jim; Perkins, Gavin D; McAuley, Daniel F

    2016-01-01

    Background Delirium is frequently diagnosed in critically ill patients and is associated with poor clinical outcomes. Haloperidol is the most commonly used drug for delirium despite little evidence of its effectiveness. The aim of this study was to establish whether early treatment with haloperidol would decrease the time that survivors of critical illness spent in delirium or in coma. Methods We did this double-blind, placebo-controlled randomised trial in a general adult intensive care unit (ICU). Critically ill patients (≥18 years) needing mechanical ventilation within 72 of admission were enrolled. Patients were randomised (by an independent nurse, in 1:1 ratio, with permuted block size of four and six, using a centralised, secure web-based randomisation service) to receive haloperidol 2·5mgs or 0·9% saline placebo intravenously every 8 h irrespective of coma or delirium status. Study drug was discontinued on ICU discharge, once delirium-free and coma-free for 2 consecutive days, or after a maximum of 14 days treatment, which ever came first. Delirium was assessed using the confusion assessment method - for the ICU (CAM-ICU). The primary outcome was delirium-free and coma-free days, defined as the number of days in the first 14 days after randomisation during which the patient was alive without delirium and not in coma from any cause. Patients who died within the 14-day study period were recorded as having 0 days free of delirium and coma. ICU clinical and research staff and patients were masked to treatment throughout the study. Analyses were by intention to treat. This trial is registered with the International Standard Randomised Controlled Trial Registry, number ISRCTN83567338. Findings 142 patients were randomised, 141 were included in the final analysis (71 haloperidol, 70 placebo). Patients in the haloperidol group spent about the same number of days alive, without delirium, and without coma as did patients in the placebo group (median 5 days [IQR 0

  15. A pragmatic study exploring the prevention of delirium among hospitalized older hip fracture patients: Applying evidence to routine clinical practice using clinical decision support.

    PubMed

    Holroyd-Leduc, Jayna M; Abelseth, Greg A; Khandwala, Farah; Silvius, James L; Hogan, David B; Schmaltz, Heidi N; Frank, Cyril B; Straus, Sharon E

    2010-10-22

    Delirium occurs in up to 65% of older hip fracture patients. Developing delirium in hospital has been associated with a variety of adverse outcomes. Trials have shown that multi-component preventive interventions can lower delirium rates. The objective of this study was to implement and evaluate the effectiveness of an evidence-based electronic care pathway, which incorporates multi-component delirium strategies, among older hip fracture patients. We conducted a pragmatic study using an interrupted time series design in order to evaluate the use and impact of the intervention. The target population was all consenting patients aged 65 years or older admitted with an acute hip fracture to the orthopedic units at two Calgary, Alberta hospitals. The primary outcome was delirium rates. Secondary outcomes included length of hospital stay, in-hospital falls, in-hospital mortality, new discharges to long-term care, and readmissions. A Durbin Watson test was conducted to test for serial correlation and, because no correlation was found, Chi-square statistics, Wilcoxon test and logistic regression analyses were conducted as appropriate. At study completion, focus groups were conducted at each hospital to explore issues around the use of the order set. During the 40-week study period, 134 patients were enrolled. The intervention had no effect on the overall delirium rate (33% pre versus 31% post; p = 0.84). However, there was a significant interaction between study phase and hospital (p = 0.03). Although one hospital did not experience a decline in delirium rate, the delirium rate at the other hospital declined from 42% to 19% (p = 0.08). This difference by hospital was mirrored in focus group feedback. The hospital that experienced a decline in delirium rates was more supportive of the intervention. Overall, post-intervention there were no significant differences in mean length of stay (12 days post versus 14 days pre; p = 0.74), falls (6% post versus 10% pre; p = 0.43) or

  16. 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

  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. Effect Estimation of an Innovative Nursing Intervention to Improve Delirium among Home-Dwelling Older Adults: A Randomized Controlled Pilot Trial

    PubMed Central

    Verloo, Henk; Goulet, Céline; Morin, Diane; von Gunten, Armin

    2015-01-01

    Aims Estimating the effect of a nursing intervention in home-dwelling older adults on the occurrence and course of delirium and concomitant cognitive and functional impairment. Methods A randomized clinical pilot trial using a before/after design was conducted with older patients discharged from hospital who had a medical prescription to receive home care. A total of 51 patients were randomized into the experimental group (EG) and 52 patients into the control group (CG). Besides usual home care, nursing interventions were offered by a geriatric nurse specialist to the EG at 48 h, 72 h, 7 days, 14 days, and 21 days after discharge. All patients were monitored for symptoms of delirium using the Confusion Assessment Method. Cognitive and functional statuses were measured with the Mini-Mental State Examination and the Katz and Lawton Index. Results No statistical differences with regard to symptoms of delirium (p = 0.085), cognitive impairment (p = 0.151), and functional status (p = 0.235) were found between the EG and CG at study entry and at 1 month. After adjustment, statistical differences were found in favor of the EG for symptoms of delirium (p = 0.046), cognitive impairment (p = 0.015), and functional status (p = 0.033). Conclusion Nursing interventions to detect delirium at home are feasible and accepted. The nursing interventions produced a promising effect to improve delirium. PMID:26034489

  19. A volunteer-based Hospital Elder Life Program to reduce delirium.

    PubMed

    Sandhaus, Sonia; Zalon, Margarete L; Valenti, Donna; Dzielak, Edward; Smego, Raymond A; Arzamasova, Ulyana

    2010-01-01

    A community hospital with nearly 50% of its admitted patients 70 years or older adapted the well-established Hospital Elder Life Program (HELP). The primary adaptation entailed an enhanced participation of trained volunteers in HELP interventions designed to prevent and reduce delirium. Integral program elements include detailed volunteer training, required demonstration of competencies, and regular evaluation and feedback of volunteers provided by program staff. Nurse satisfaction with HELP increased from 64% to 91% in the second year of implementation, and a survey of patients and families indicated that 95% were satisfied with HELP. This innovative volunteer-assisted model of elder care support was positively embraced by patients, their families, and the nursing staff and supported by nursing administration. The use of volunteers is a cost-effective method of enhancing the nursing care of vulnerable elders during hospitalization. PMID:20436332

  20. Megaloblastic anemia with hypotension and transient delirium as the primary symptoms: report of a case.

    PubMed

    Zhang, Qin; Lv, Xue-Ying; Yang, Yun-Mei

    2015-01-01

    The present study describes a case of an elderly patient that was hospitalized secondary to hypotension and delirium. Physical examination at admission revealed bilateral positive Babinski's sign. Laboratory examination revealed severe anemia. Bone marrow examination showed megaloblastic changes of the granulocyte and erythroid series, as well as other dyshaematopoiesis. The conditions of the patient rapidly improved after vitamin B12 treatments. Because the clinical manifestations of megaloblastic anemia are complex, this disease is often misdiagnosed in the geriatric population. Bone marrow examinations can aid in the diagnosis of anemia, but the results from these tests cannot always differentiate the type of anemia. Clinical management of the disorder is reliant upon proper classification of the type of anemia. The prognosis of megaloblastic anemia is typically good and a simple regimen of folic acid and/or vitamin B12 is effective. PMID:26770511

  1. 3D-CAM: Derivation and Validation of a 3-Minute Diagnostic Interview for CAM-defined Delirium

    PubMed Central

    Marcantonio, Edward R.; Ngo, Long H.; O’Connor, Margaret; Jones, Richard N.; Crane, Paul K.; Metzger, Eran D.; Inouye, Sharon K.

    2015-01-01

    Background Delirium is common, morbid, and costly, yet remains often unrecognized in most clinical settings. The Confusion Assessment Method (CAM) is the most widely used diagnostic algorithm, and operationalizing its features would represent a substantial advance for clinical care. Objective To derive the 3D-CAM, a new 3-minute diagnostic assessment for CAM-defined delirium, and to validate it against a clinical reference standard. Design Diagnostic test study Setting 4 general medicine units in an academic medical center Participants 201 inpatients aged ≥ 75 years old Measurements We identified 20 items that best operationalized the 4 CAM diagnostic features to create the 3D-CAM. For prospective validation, 3D-CAM assessments were administered by trained research assistants. Independently, clinicians performed an extensive assessment that included patient interviews, family interviews, and review of the medical record. These data were considered by an expert panel to determine the presence or absence of delirium and dementia (reference standard). We compared the 3D-CAM delirium determination to the reference standard in all patients and in subgroups with and without dementia. Results The 201 participants in the prospective validation study had mean age (SD) of 84 (5.5) years, and 27% had dementia. The expert panel identified delirium in 21%. Median administration time for 3D-CAM was 3 minutes (inter-quartile range: 2–5 minutes). The sensitivity [95% CI] of 3D-CAM was 95% [84%, 99%] and the specificity was 94% [90%, 97%]. The 3D-CAM performed well in patients both with dementia (sensitivity=96% [82%, 100%], specificity=86% [67%, 96%]) and without dementia (sensitivity=93% [66%, 100%], specificity=96% [91%,99%]). Limitations Limited to single center, cross-sectional, and medicine patients only Conclusion The 3D-CAM operationalizes the CAM algorithm using a 3-minute structured assessment with high sensitivity and specificity relative to a reference standard and

  2. Interrelationship of Postoperative Delirium and Cognitive Impairment and Their Impact on the Functional Status in Older Patients Undergoing Orthopaedic Surgery: A Prospective Cohort Study

    PubMed Central

    Liang, Chih-Kuang; Chu, Chin-Liang; Chou, Ming-Yueh; Lin, Yu-Te; Lu, Ti; Hsu, Chien-Jen; Chen, Liang-Kung

    2014-01-01

    Background The impact of postoperative delirium on post-discharge functional status of older patients remains unclear, and little is known regarding the interrelationship between cognitive impairment and post-operative delirium. Therefore, the main purpose was to evaluate the post-discharge functional status of patients who experience delirium after undergoing orthopaedic surgery and the interrelationship of postoperative delirium with underlying cognitive impairment. Method This prospective cohort study, conducted at a tertiary care medical center from April 2011 to March 2012, enrolled all subjects aged over 60 years who were admitted for orthopaedic surgery. The baseline characteristics (age, gender, BMI, and living arrangement), surgery-related factors (ASA class, admission type, type of surgery, and length of hospital stay), results of geriatric assessment (postoperative delirium, cognition, depressive mood, comorbidity, pain, malnutrition, polypharmacy, ADL, and instrumental [I]ADL) and 1–12-month postoperative ADL and IADL functional status were collected for analysis. Results Overall, 9.1% of 232 patients (mean age: 74.7±7.8 years) experienced postoperative delirium, which was significantly associated with IADL decline at only 6 and 12 months postoperatively (RR: 6.22, 95% CI: 1.08–35.70 and RR: 12.54, 95% CI: 1.88–83.71, respectively). Delirium superimposed on cognitive impairment was a significant predictor for poor functional status at 6 and 12 months postoperatively (RR: 12.80, 95% CI: 1.65–99.40 for ADL at the 6th month, and RR: 7.96, 95% CI: 1.35–46.99 at the 12th month; RR: 13.68, 95% CI: 1.94–96.55 for IADL at the 6th month, and RR: 30.61, 95% CI: 2.94–318.54 at the 12th month, respectively). Conclusion Postoperative delirium is predictive of IADL decline in older patients undergoing orthopaedic surgery, and delirium superimposed on cognitive impairment is an independent risk factor for deterioration of ADL and IADL functional status

  3. 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

  4. Delirium tremens

    MedlinePlus

    ... heartbeat Problems with eye muscle movement Rapid heart rate Rapid muscle tremors The following tests may be done: Blood magnesium level Blood phosphate level Comprehensive metabolic panel Electrocardiogram (ECG) Electroencephalogram (EEG) Toxicology screen

  5. 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.

  6. A case of topical opioid-induced delirium mistaken as behavioural and psychological symptoms of dementia in demented state.

    PubMed

    Ito, Go; Kanemoto, Kousuke

    2013-06-01

    In Japan, indications for opioid analgesics, once exclusively used as pain killers for patients suffering from malignant cancer, have been expanded for a wide range of pain. Herein we report a patient with opioid-induced delirium associated with the administration of buprenorphine patches that was well below the indicated therapeutic range limit. An 82-year-old woman was referred to us from an orthopaedic practitioner for uncontrollable behavioural problems apparently caused by the beginning of dementia; the patient had gradually developed disorientation, visual hallucinations, and delusions. Laboratory and imaging findings excluded common causes of delirium including Alzheimer's disease and diffuse Lewy body disease. Detailed questioning revealed that the patient's confused state appeared following a buprenorphine patch dose increase and subsequently disappeared after administration was stopped. Delirium has not been reported as a side-effect in clinical trials of buprenorphine patches. However, our findings in this case show that even topical opioids can precipitate the development of a delirious state in elderly patients.

  7. The Prevention of Delirium and Complications Associated with Surgical Treatments (PODCAST) study: protocol for an international multicentre randomised controlled trial

    PubMed Central

    Avidan, Michael S; Fritz, Bradley A; Maybrier, Hannah R; Muench, Maxwell R; Escallier, Krisztina E; Chen, Yulong; Ben Abdallah, Arbi; Veselis, Robert A; Hudetz, Judith A; Pagel, Paul S; Noh, Gyujeong; Pryor, Kane; Kaiser, Heiko; Arya, Virendra Kumar; Pong, Ryan; Jacobsohn, Eric; Grocott, Hilary P; Choi, Stephen; Downey, Robert J; Inouye, Sharon K; Mashour, George A

    2014-01-01

    Introduction Postoperative delirium is one of the most common complications of major surgery, affecting 10–70% of surgical patients 60 years and older. Delirium is an acute change in cognition that manifests as poor attention and illogical thinking and is associated with longer intensive care unit (ICU) and hospital stay, long-lasting cognitive deterioration and increased mortality. Ketamine has been used as an anaesthetic drug for over 50 years and has an established safety record. Recent research suggests that, in addition to preventing acute postoperative pain, a subanaesthetic dose of intraoperative ketamine could decrease the incidence of postoperative delirium as well as other neurological and psychiatric outcomes. However, these proposed benefits of ketamine have not been tested in a large clinical trial. Methods The Prevention of Delirium and Complications Associated with Surgical Treatments (PODCAST) study is an international, multicentre, randomised controlled trial. 600 cardiac and major non-cardiac surgery patients will be randomised to receive ketamine (0.5 or 1 mg/kg) or placebo following anaesthetic induction and prior to surgical incision. For the primary outcome, blinded observers will assess delirium on the day of surgery (postoperative day 0) and twice daily from postoperative days 1–3 using the Confusion Assessment Method or the Confusion Assessment Method for the ICU. For the secondary outcomes, blinded observers will estimate pain using the Behavioral Pain Scale or the Behavioral Pain Scale for Non-Intubated Patients and patient self-report. Ethics and dissemination The PODCAST trial has been approved by the ethics boards of five participating institutions; approval is ongoing at other sites. Recruitment began in February 2014 and will continue until the end of 2016. Dissemination plans include presentations at scientific conferences, scientific publications, stakeholder engagement and popular media. Registration details The study is

  8. 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

  9. Development of an amygdalocentric neurocircuitry-reactive aggression theoretical model of emergence delirium in posttraumatic stress disorder: an integrative literature review.

    PubMed

    McLott, Jason; Jurecic, Jerry; Hemphill, Luke; Dunn, Karen S

    2013-10-01

    The purposes of this integrative literature review were to (1) present a synopsis of current literature describing posttraumatic stress disorder (PTSD), the amygdalocentric neurocircuitry, emergence delirium, reactive aggression, and the interaction of general anesthetics and the amygdalocentric neurocircuitry; (2) synthesize this evidence; and (3) develop a new theoretical model that can be tested in future research studies. Over the past decade, a dramatic rise in PTSD among veterans has been reported because of recent combat deployments. Modern anesthetics alter the function of the amygdalocentric neurocircuitry to produce amnesia and sedation. The etiology of emergence delirium is poorly understood, and the condition is uncommon outside the pediatric population. Emergence delirium among patients with PTSD, however, has been reported by military nurse anesthetists. To date, there have been no scientific studies conducted to identify the cause of emergence delirium in combat veterans with PTSD. This new theoretical model may explain why noxious stimuli at the time of emergence may stimulate the thalamus, leading to activation of an uninhibited amygdalocentric neurocircuitry. Because of the loss of top-down inhibition, the hyperactive amygdala then stimulates the hypothalamus, which is responsible for creating an increase in excitatory activity in the unconscious patient, resulting in emergence delirium. PMID:24354074

  10. Non-Neuronal Acetylcholine: The Missing Link Between Sepsis, Cancer, and Delirium?

    PubMed Central

    Sfera, Adonis; Cummings, Michael; Osorio, Carolina

    2015-01-01

    The interaction between living organisms and the environment requires a balancing act between genomic and epigenomic forces. Inflammation and cellular proliferation are kept in check by the genes, which code for their components and the microRNAs, which are capable of silencing the transcription of these genes. Acetylcholine (ACh) may play a unique role in the maintenance of this equilibrium, as the epigenomic inhibition of the gene coding for nicotinic receptors, and disinhibits the gene causing anergia in immune cells. We hypothesize that age-induced ACh deficiency is the result of an epigenomic dysfunction of microRNA-6775 (miR-6775), which silences the transcription of CHRNA7 gene [coding for alpha 7 nicotinic cholinergic receptors (nAChRs)]. When silenced, this gene induces decreased expression of alpha 7 nAChRs, which may predispose elderly individuals to inflammation, neuroinflammation, and delirium. We hypothesize further that miR-6775-induced hypocholinergia augments the expression of RNF 128, the gene related to anergy in lymphocytes (GRAIL). This gene favors regulatory T cells (Tregs), promoters of immunologic tolerance, which may predispose to both cancer and sepsis-induced immunosuppression. PMID:26347869

  11. A neurologist's approach to delirium: diagnosis and management of toxic metabolic encephalopathies.

    PubMed

    Krishnan, Vaishnav; Leung, Lester Y; Caplan, Louis R

    2014-02-01

    Toxic metabolic encephalopathies (TMEs) present as an acute derangement in consciousness, cognition and behavior, and can be brought about by various triggers, including endocrine and metabolic disturbances, exogenous toxins, pain and infection. Also referred to as "delirium" or "acute confusional states," TMEs are characterized by (1) an altered level of consciousness and activity, (2) global changes in cognition with inattention, (3) a fluctuating course with disturbances in the sleep-wake cycle, and (4) asterixis and myoclonus. The pathophysiology of this syndrome is poorly understood. Imbalanced neurotransmitter signaling and pathologically heightened brain inflammatory cytokine signaling have been proposed as candidate mechanisms. Focal brain lesions can also occasionally mimic TMEs. A neurological examination is required to identify the presence of focal findings, which when present, identify a new focal lesion or the recrudescence of prior ischemic, inflammatory or neoplastic insults. Diagnostic testing must include a search for metabolic and infectious derangements. Offending medications should be withdrawn. Magnetic resonance imaging, cerebrospinal fluid analysis and electroencephalography should be considered in select clinical situations. In addition to being an unpleasant experience for the patient and family, this condition is associated with extended hospital stays, increased mortality and high costs. In individuals with diminished cognitive reserve, episodes of TME lead to an accelerated decline in cognitive functioning. Starting with an illustrative case, this paper provides a neurologist's approach to the diagnosis, differential diagnosis and management of toxic metabolic encephalopathies.

  12. Delirium due to intoxication from the novel synthetic tryptamine 5-MeO-DALT.

    PubMed

    Jovel, Andres; Felthous, Alan; Bhattacharyya, Anjan

    2014-05-01

    Synthetic tryptamines have gained popularity for their hallucinogenic properties, unscheduled status, and availability from "head shops" and through the internet. Here, we present a case of synthetic tryptamine-induced delirium secondary to 5-MeO-DALT ingestion in a previously healthy young male. 5-MeO-DALT led to the hospitalization of our patient after ingestion of a standard dose, presenting with extreme agitation, tachycardia, diaphoresis, and combativeness leading to physical restraint and intravenous sedation. A search of PubMed, Ovid, and Google Scholar for keywords of "5-MeO-DALT," "5-methoxy-N,N-diallyltryptamine," or "Lucy-N-Nate" found no case reports or clinical articles in the literature. Rapid emergence and commercialization of this novel synthetic tryptamine 5-MeO-DALT points to the importance of health care and forensic professionals keeping abreast of the latest drugs of abuse and their clinical features. The authors hope this report leads the way in disseminating the potential risks associated with unscheduled and unregulated substances, synthetic tryptamines such as 5-MeO-DALT in particular. PMID:24329118

  13. Army anesthesia providers' perceptions of emergence delirium after general anesthesia in service members.

    PubMed

    Wilson, John Tyler

    2013-12-01

    The primary aim of this study was to investigate emergence delirium (ED) in service members, through the perceptions of active duty US Army anesthesia providers. The following perceptions were examined: (1) the extent and seriousness of ED in service members, (2) effects of ED on the safety of service members and operating room/postanesthesia care unit personnel, and (3) behaviors relevant to ED in service members. The study also explored the relationships between the perceived seriousness of ED, reported case experiences, and behaviors and consequences relevant to ED. This research used a descriptive correlational study design with a questionnaire survey and a convenience sample technique totaling 89 active duty Army anesthesia providers. This study found that more than 78% of active duty Army anesthesia providers have witnessed ED in their particular practice. Approximately 38% of the respondents believed that ED was a moderate problem. There was a statistically significant association between perceived severity of ED and the ED case experience. The behaviors and consequences that were often or always seen included hyperactive motor behavior, pulling at the monitoring equipment, and making disruptive movements. PMID:24597004

  14. 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. PMID:25842650

  15. Complex Assessment of the Incidence and Risk Factors of Delirium in a Large Cohort of Cardiac Surgery Patients: A Single-Center 6-Year Experience

    PubMed Central

    Krzych, Łukasz J.; Wybraniec, Maciej T.; Krupka-Matuszczyk, Irena; Skrzypek, Michał; Bolkowska, Anna; Wilczyński, Mirosław; Bochenek, Andrzej A.

    2013-01-01

    Background. Previous reports provided inconsistent data on the occurrence of postoperative delirium and emphasized its considerable impact on outcome. This study sought to evaluate the incidence and predictors of delirium, together with its relation to cerebral ischemia in a large cohort of cardiac surgery patients in a tertiary high-volume center. Methods and Results. Consecutive patients (n = 8792) were prospectively enrolled from 2003 to 2008. Exclusion criteria were history of psychiatric disorders, use of psychoactive drugs, alcohol abuse, and data incompleteness. Finally, 5781 patients were analyzed in terms of 100 perioperative patient-specific and treatment variables. The incidence of postoperative delirium (DSM IV criteria) was 4.1% and it coexisted with cerebral ischemia in 1.1% of patients. In bivariate analysis, 49 variables were significantly linked to postoperative delirium. Multivariate analysis confirmed that delirium was independently associated with postoperative stroke (logistic odds ratio (logOR) = 2.862, P = 0.004), any blood transfusions (logOR = 4.178, P < 0.0001), age > 65 years (logOR = 2.417, P = 0.002), carotid artery stenosis (logOR = 2.15, P = 0.01), urgent/emergent surgery (logOR = 1.982, P = 0.02), fasting glucose level, intraoperative oxygen partial pressure fluctuations, and hematocrit. Area under ROC curve for the model was 0.8933. Conclusions. Early identification of nonpsychiatric perioperative determinants of delirium facilitates its diagnosis and might help develop preventive strategies to improve long-term outcome after cardiac surgery procedures. PMID:24455731

  16. Educational Impact of a Psychiatric Liaison in the Medical Intensive Care Unit: Effects on Attitudes and Beliefs of Trainees and Nurses Regarding Delirium

    PubMed Central

    Chen, Donna T.; Huffman, Jeff C.

    2013-01-01

    Objective: Despite high rates and increased risk of mortality, delirium remains underdiagnosed and a minimal focus of formal medical education. This is the first study to examine the educational impact of a psychiatric liaison on beliefs and knowledge about delirium among both nurses and residents. Method: One psychiatrist spent 9 months rounding weekly in the medical intensive care unit, interacting with critical care nurses and internal medicine residents. Preintervention and postintervention surveys were distributed in July 2009 and June 2010, respectively, to staff (critical care nurses: n = 23 and n = 25, respectively; internal medicine residents: n = 31 and n = 23, respectively) and a comparison group (psychiatry residents: n = 29 and n = 23, respectively). Participants responded to 12 statements regarding delirium on a 5-point Likert scale. Results: There were no statistically significant differences between the presurveys and postsurveys for any item when examining all respondents together, as well as psychiatry and internal medicine residents as individual groups. Critical care nurses showed a significant change between surveys for the statements, “Patients with new-onset anxiety or depression in the intensive care unit most commonly have delirium” (17.4% agree presurvey vs 56.0% agree postsurvey, χ2 = 7.62, P = .006) and “Delirium is diagnosed less often than it actually occurs” (100% agree presurvey vs 80% agree postsurvey, χ2 = 5.13, P = .023). Conclusions: Though introduction of a psychiatric liaison was very well received by clinical staff, we did not meaningfully affect the attitudes and beliefs of trainees and nurses regarding delirium. Robust and lasting changes in attitudes regarding delirium may require more intensive efforts involving longer intervention periods, greater rounding frequency, or additional didactic teaching. PMID:24171148

  17. Study protocol for the recreational stimulation for elders as a vehicle to resolve delirium superimposed on dementia (Reserve For DSD) trial

    PubMed Central

    2011-01-01

    Background Delirium is a state of confusion characterized by an acute and fluctuating decline in cognitive functioning. Delirium is common and deadly in older adults with dementia, and is often referred to as delirium superimposed on dementia, or DSD. Interventions that treat DSD are not well-developed because the mechanisms involved in its etiology are not completely understood. We have developed a theory-based intervention for DSD that is derived from the literature on cognitive reserve and based on our prior interdisciplinary work on delirium, recreational activities, and cognitive stimulation in people with dementia. Our preliminary work indicate that use of simple, cognitively stimulating activities may help resolve delirium by helping to focus inattention, the primary neuropsychological deficit in delirium. Our primary aim in this trial is to test the efficacy of Recreational Stimulation for Elders as a Vehicle to resolve DSD (RESERVE- DSD). Methods/Design This randomized repeated measures clinical trial will involve participants being recruited and enrolled at the time of admission to post acute care. We will randomize 256 subjects to intervention (RESERVE-DSD) or control (usual care). Intervention subjects will receive 30-minute sessions of tailored cognitively stimulating recreational activities for up to 30 days. We hypothesize that subjects who receive RESERVE-DSD will have: decreased severity and duration of delirium; greater gains in attention, orientation, memory, abstract thinking, and executive functioning; and greater gains in physical function compared to subjects with DSD who receive usual care. We will also evaluate potential moderators of intervention efficacy (lifetime of complex mental activities and APOE status). Our secondary aim is to describe the costs associated with RESERVE-DSD. Discussion Our theory-based intervention, which uses simple, inexpensive recreational activities for delivering cognitive stimulation, is innovative because, to

  18. Prehospital Ketamine is a Safe and Effective Treatment for Excited Delirium in a Community Hospital Based EMS System.

    PubMed

    Scaggs, Thomas R; Glass, David M; Hutchcraft, Megan Gleason; Weir, William B

    2016-10-01

    Excited delirium syndrome (ExDS) is defined by marked agitation and confusion with sympathomimetic surge and incessant physical struggle, despite futility, which may lead to profound pathophysiologic changes and sudden death. Severe metabolic derangements, including lactic acidosis, rhabdomyolysis, and hyperthermia, occur. The pathophysiology of excited delirium is a subject of ongoing basic science and clinical research. Positive associations with ExDS include male gender, mental health disorders, and substance abuse (especially sympathomimetics). Excited delirium syndrome patients often exhibit violent, psychotic behavior and have "superhuman" strength which can result in the patient fighting with police and first responders. Continued struggle can cause a patient with ExDS to experience elevated temperature (T) and acidosis which causes enzymes to fail, leading to sudden death from cardiovascular collapse and multi-system organ failure. Therefore, effective early sedation is optimal to stop this fulminant process. Treatment of ExDS must be focused on rapidly, safely, and effectively sedating the patient and providing intensive, supportive care. Benzodiazepines, like midazolam, may not be ideal to sedate ExDS patients since their onset takes several minutes, and their side effects include loss of airway control and respiratory depression. Injectable antipsychotic medications have a relatively slow onset and may cause prolongation of the QTc interval. Ketamine is the ideal medication to sedate patients with ExDS. Ketamine has a rapid, predictable onset within three to four minutes when given by intramuscular (IM) injection. It does not adversely affect airway control, breathing, heart rate, or blood pressure (BP). In this retrospective case series, prehospital scenarios in which ExDS patients received ketamine by paramedics for sedation, and their subsequent treatment in the emergency department (ED) and hospital, are described. It is demonstrated that ketamine

  19. Prehospital Ketamine is a Safe and Effective Treatment for Excited Delirium in a Community Hospital Based EMS System.

    PubMed

    Scaggs, Thomas R; Glass, David M; Hutchcraft, Megan Gleason; Weir, William B

    2016-10-01

    Excited delirium syndrome (ExDS) is defined by marked agitation and confusion with sympathomimetic surge and incessant physical struggle, despite futility, which may lead to profound pathophysiologic changes and sudden death. Severe metabolic derangements, including lactic acidosis, rhabdomyolysis, and hyperthermia, occur. The pathophysiology of excited delirium is a subject of ongoing basic science and clinical research. Positive associations with ExDS include male gender, mental health disorders, and substance abuse (especially sympathomimetics). Excited delirium syndrome patients often exhibit violent, psychotic behavior and have "superhuman" strength which can result in the patient fighting with police and first responders. Continued struggle can cause a patient with ExDS to experience elevated temperature (T) and acidosis which causes enzymes to fail, leading to sudden death from cardiovascular collapse and multi-system organ failure. Therefore, effective early sedation is optimal to stop this fulminant process. Treatment of ExDS must be focused on rapidly, safely, and effectively sedating the patient and providing intensive, supportive care. Benzodiazepines, like midazolam, may not be ideal to sedate ExDS patients since their onset takes several minutes, and their side effects include loss of airway control and respiratory depression. Injectable antipsychotic medications have a relatively slow onset and may cause prolongation of the QTc interval. Ketamine is the ideal medication to sedate patients with ExDS. Ketamine has a rapid, predictable onset within three to four minutes when given by intramuscular (IM) injection. It does not adversely affect airway control, breathing, heart rate, or blood pressure (BP). In this retrospective case series, prehospital scenarios in which ExDS patients received ketamine by paramedics for sedation, and their subsequent treatment in the emergency department (ED) and hospital, are described. It is demonstrated that ketamine

  20. Recognized homonymous hemianopsia and delirium during the admission examination leading to diagnosis and appropriate treatment of a new stroke

    PubMed Central

    Tsymbalov, Konstantin S; Fetkenhour, Douglas R

    2016-01-01

    This case report describes the detection of homonymous hemianopsia and delirium during the admission physical examination of a patient with esophageal adenocarcinoma, resulting in the new diagnosis of subacute hemorrhagic stroke. The poststroke visual field defect can result in significant disability and reduction in quality of life. Patients with visual field cut show a severely reduced quality of life and require additional neuropsychological and visual rehabilitation. Only thorough physical examination is able to challenge prior negative positron emission tomography scan, leading to the diagnosis of subacute stroke and, following appropriate treatment, secondary stroke prophylaxis and rehabilitation, instead of brain radiation and chemotherapy. PMID:27366070

  1. Recognized homonymous hemianopsia and delirium during the admission examination leading to diagnosis and appropriate treatment of a new stroke.

    PubMed

    Tsymbalov, Konstantin S; Fetkenhour, Douglas R

    2016-01-01

    This case report describes the detection of homonymous hemianopsia and delirium during the admission physical examination of a patient with esophageal adenocarcinoma, resulting in the new diagnosis of subacute hemorrhagic stroke. The poststroke visual field defect can result in significant disability and reduction in quality of life. Patients with visual field cut show a severely reduced quality of life and require additional neuropsychological and visual rehabilitation. Only thorough physical examination is able to challenge prior negative positron emission tomography scan, leading to the diagnosis of subacute stroke and, following appropriate treatment, secondary stroke prophylaxis and rehabilitation, instead of brain radiation and chemotherapy. PMID:27366070

  2. 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

  3. Potentially preventable complications of urinary tract infections, pressure areas, pneumonia, and delirium in hospitalised dementia patients: retrospective cohort study

    PubMed Central

    Bail, Kasia; Berry, Helen; Grealish, Laurie; Draper, Brian; Karmel, Rosemary; Gibson, Diane; Peut, Ann

    2013-01-01

    Objectives To identify rates of potentially preventable complications for dementia patients compared with non-dementia patients. Design Retrospective cohort design using hospital discharge data for dementia patients, case matched on sex, age, comorbidity and surgical status on a 1 : 4 ratio to non-dementia patients. Setting Public hospital discharge data from the state of New South Wales, Australia for 2006/2007. Participants 426 276 overnight hospital episodes for patients aged 50 and above (census sample). Main outcome measures Rates of preventable complications, with episode-level risk adjustment for 12 complications that are known to be sensitive to nursing care. Results Controlling for age and comorbidities, surgical dementia patients had higher rates than non-dementia patients in seven of the 12 complications: urinary tract infections, pressure ulcers, delirium, pneumonia, physiological and metabolic derangement (all at p<0.0001), sepsis and failure to rescue (at p<0.05). Medical dementia patients also had higher rates of these complications than did non-dementia patients. The highest rates and highest relative risk for dementia patients compared with non-dementia patients, in both medical and surgical populations, were found in four common complications: urinary tract infections, pressure areas, pneumonia and delirium. Conclusions Compared with non-dementia patients, hospitalised dementia patients have higher rates of potentially preventable complications that might be responsive to nursing interventions. PMID:23794540

  4. The impact of intra- and postoperative albumin levels as a biomarker of delirium after cardiopulmonary bypass: results of an exploratory study.

    PubMed

    Baranyi, Andreas; Rothenhäusler, Hans-Bernd

    2012-12-30

    In this prospective study the frequency of delirium after cardiac surgery with cardiopulmonary bypass (CPB) was determined. Furthermore, we investigated the impact of intra- and postoperative levels of albumin as a biomarker of delirium. Thirty-four patients who underwent elective CPB at the Department of Cardiac Surgery, Ludwig-Maximilians-University of Munich, Germany, were enroled in this prospective study. During the intensive care unit (ICU) stay and shortly after discharge from the ICU, delirious state was evaluated daily using the Delirium-Rating-Scale. Albumin was assayed pre-anaesthesia, immediately after induction of anaesthesia, at the beginning of the heart-lung-apparatus period, immediately before the opening and 5min after the opening of the aortic clamp, 24h and 48h postoperatively and on the day before discharge. After CPB, a clinical significant delirious state was observed in 11 patients (32.4%). The albumin level decreased during the surgical intervention and increased postoperatively with a maximum level at the time of discharge. CPB patients with delirious state showed a significantly lower albumin level 24h and 48h postoperatively than those without delirium. A low level of postoperative albumin seems to be a useful biomarker to identify patients with high risk of delirious state after CPB.

  5. 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

  6. Observational, longitudinal study of delirium in consecutive unselected acute medical admissions: age-specific rates and associated factors, mortality and re-admission

    PubMed Central

    Pendlebury, ST; Lovett, NG; Smith, SC; Dutta, N; Bendon, C; Lloyd-Lavery, A; Mehta, Z; Rothwell, PM

    2015-01-01

    Objectives We aimed to determine age-specific rates of delirium and associated factors in acute medicine, and the impact of delirium on mortality and re-admission on long-term follow-up. Design Observational study. Consecutive patients over two 8-week periods (2010, 2012) were screened for delirium on admission, using the confusion assessment method (CAM), and reviewed daily thereafter. Delirium diagnosis was made using the Diagnostic and Statistical Manual Fourth Edition (DSM IV) criteria. For patients aged ≥65 years, potentially important covariables identified in previous studies were collected with follow-up for death and re-admission until January 2014. Participants 503 consecutive patients (age median=72, range 16–99 years, 236 (48%) male). Setting Acute general medicine. Results Delirium occurred in 101/503 (20%) (71 on admission, 30 during admission, 17 both), with risk increasing from 3% (6/195) at <65 years to 14% (10/74) for 65–74 years and 36% (85/234) at ≥75 years (p<0.0001). Among 308 patients aged >65 years, after adjustment for age, delirium was associated with previous falls (OR=2.47, 95% CI 1.45 to 4.22, p=0.001), prior dementia (2.08, 1.10 to 3.93, p=0.024), dependency (2.58, 1.48 to 4.48, p=0.001), low cognitive score (5.00, 2.50 to 9.99, p<0.0001), dehydration (3.53, 1.91 to 6.53, p<0.0001), severe illness (1.98, 1.17 to 3.38, p=0.011), pressure sore risk (5.56, 2.60 to 11.88, p<0.0001) and infection (4.88, 2.85 to 8.36, p<0.0001). Patients with delirium were more likely to fall (OR=4.55, 1.47 to 14.05, p=0.008), be incontinent of urine (3.76, 2.15 to 6.58, p<0.0001) or faeces (3.49, 1.81–6.73, p=0.0002) and be catheterised (5.08, 2.44 to 10.54, p<0.0001); and delirium was associated with stay >7 days (2.82, 1.68 to 4.75, p<0.0001), death (4.56, 1.71 to 12.17, p=0.003) and an increase in dependency among survivors (2.56, 1.37 to 4.76, p=0.003) with excess mortality still evident at 2-year follow-up. Patients with

  7. 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

  8. 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.

  9. 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

  10. The Lunch Bunch: an innovative strategy to combat depression and delirium through socialization in elderly sub-acute medicine patients.

    PubMed

    Feyerer, Margot; Kruk, Dawn; Bartlett, Nicole; Rodney, Kathy; McKenzie, Cyndi; Green, Patrice; Keller, Lisa; Adcroft, Pat

    2013-01-01

    Hospitalized sub-acute medicine patients face challenges to their functional and cognitive abilities as they await transfer to long-term care facilities or return home. The Continuous Quality Improvement (CQI) Council, representing a multidisciplinary team of healthcare professionals working in the Sub-Acute Medicine Unit (SAMU), implemented a twice-weekly lunch program called the Lunch Bunch in order to combat depression and delirium in our elderly and cognitively impaired patients. The Lunch Bunch initiative includes chaplains, nurses and physiotherapists who have provided a framework through which essential socialization and exercise for this vulnerable population is facilitated. Providing a means for both mental and physical stimulation also allows patients to open up and discuss hidden feelings of loneliness and isolation, thereby beginning a journey of spiritual and emotional healing. PMID:24860951

  11. 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.

  12. Symptom profile and etiology of delirium in a referral population in northern india: factor analysis of the DRS-R98.

    PubMed

    Mattoo, Surendra K; Grover, Sandeep; Chakravarty, Kaustav; Trzepacz, Paula T; Meagher, David J; Gupta, Nitin

    2012-01-01

    Delirium is understudied in developing countries, where there tends to be a lower proportion of older persons and comorbid dementia. The authors assessed 100 consecutive cases of DSM-IV delirium (patients' mean age: 44.4 [standard deviation: 19.4] years; mean DRS-R98 score: 25.6 [3.6]) referred to an adult Consultation-Liaison Psychiatry service in Northern India. Disturbances of attention, orientation, visuospatial ability, and sleep disturbance were the most frequent symptoms, followed by language, thought-process abnormality, and motor agitation. A three-factor solution was identified, representing domains for cognition, higher-order thinking, and circadian rhythm/psychosis. These domains can guide studies addressing the relationship between symptom profile, therapeutic needs, and outcomes and are consistent with core domains previously identified in other countries. PMID:22450619

  13. Implementation of the Pain, Agitation, and Delirium Clinical Practice Guidelines and promoting patient mobility to prevent post-intensive care syndrome.

    PubMed

    Davidson, Judy E; Harvey, Maurene A; Bemis-Dougherty, Anita; Smith, James M; Hopkins, Ramona O

    2013-09-01

    Surviving critical illness is associated with persistent and severe physical, cognitive, and psychological morbidities. The Society of Critical Care Medicine has developed pain, agitation, and delirium guidelines and promoted mobility to improve care of critically ill patients. A task force has developed tools to facilitate and rapidly implement the translation of guideline care recommendations into practice. The Society of Critical Care Medicine has also assembled a task force to assess the long-term consequences of critical illness. This article will explore relationships between the pain, agitation, and delirium guidelines, mobility recommendations, and post-intensive care syndrome initiative. Implementation of the pain, agitation, and delirium guidelines taking into account current data regarding post-intensive care syndrome outcomes and potential interventions are an important first step toward improving outcomes for patients and their families. Research is needed to reduce the impact of long-term negative consequences of critical illness and to fully understand the best within- and post-ICU interventions, along with the optimal timing and dose of such interventions to produce the best long-term outcomes.

  14. 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

  15. 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

  16. Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care – short version

    PubMed Central

    Martin, Jörg; Heymann, Anja; Bäsell, Katrin; Baron, Ralf; Biniek, Rolf; Bürkle, Hartmut; Dall, Peter; Dictus, Christine; Eggers, Verena; Eichler, Ingolf; Engelmann, Lothar; Garten, Lars; Hartl, Wolfgang; Haase, Ulrike; Huth, Ralf; Kessler, Paul; Kleinschmidt, Stefan; Koppert, Wolfgang; Kretz, Franz-Josef; Laubenthal, Heinz; Marggraf, Guenter; Meiser, Andreas; Neugebauer, Edmund; Neuhaus, Ulrike; Putensen, Christian; Quintel, Michael; Reske, Alexander; Roth, Bernard; Scholz, Jens; Schröder, Stefan; Schreiter, Dierk; Schüttler, Jürgen; Schwarzmann, Gerhard; Stingele, Robert; Tonner, Peter; Tränkle, Philip; Treede, Rolf Detlef; Trupkovic, Tomislav; Tryba, Michael; Wappler, Frank; Waydhas, Christian; Spies, Claudia

    2010-01-01

    Targeted monitoring of analgesia, sedation and delirium, as well as their appropriate management in critically ill patients is a standard of care in intensive care medicine. With the undisputed advantages of goal-oriented therapy established, there was a need to develop our own guidelines on analgesia and sedation in intensive care in Germany and these were published as 2nd Generation Guidelines in 2005. Through the dissemination of these guidelines in 2006, use of monitoring was shown to have improved from 8 to 51% and the use of protocol-based approaches increased to 46% (from 21%). Between 2006–2009, the existing guidelines from the DGAI (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin) and DIVI (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin) were developed into 3rd Generation Guidelines for the securing and optimization of quality of analgesia, sedation and delirium management in the intensive care unit (ICU). In collaboration with another 10 professional societies, the literature has been reviewed using the criteria of the Oxford Center of Evidence Based Medicine. Using data from 671 reference works, text, diagrams and recommendations were drawn up. In the recommendations, Grade “A” (very strong recommendation), Grade “B” (strong recommendation) and Grade “0” (open recommendation) were agreed. As a result of this process we now have an interdisciplinary and consensus-based set of 3rd Generation Guidelines that take into account all critically illness patient populations. The use of protocols for analgesia, sedation and treatment of delirium are repeatedly demonstrated. These guidelines offer treatment recommendations for the ICU team. The implementation of scores and protocols into routine ICU practice is necessary for their success. PMID:20200655

  17. Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care--short version.

    PubMed

    Martin, Jörg; Heymann, Anja; Bäsell, Katrin; Baron, Ralf; Biniek, Rolf; Bürkle, Hartmut; Dall, Peter; Dictus, Christine; Eggers, Verena; Eichler, Ingolf; Engelmann, Lothar; Garten, Lars; Hartl, Wolfgang; Haase, Ulrike; Huth, Ralf; Kessler, Paul; Kleinschmidt, Stefan; Koppert, Wolfgang; Kretz, Franz-Josef; Laubenthal, Heinz; Marggraf, Guenter; Meiser, Andreas; Neugebauer, Edmund; Neuhaus, Ulrike; Putensen, Christian; Quintel, Michael; Reske, Alexander; Roth, Bernard; Scholz, Jens; Schröder, Stefan; Schreiter, Dierk; Schüttler, Jürgen; Schwarzmann, Gerhard; Stingele, Robert; Tonner, Peter; Tränkle, Philip; Treede, Rolf Detlef; Trupkovic, Tomislav; Tryba, Michael; Wappler, Frank; Waydhas, Christian; Spies, Claudia

    2010-01-01

    Targeted monitoring of analgesia, sedation and delirium, as well as their appropriate management in critically ill patients is a standard of care in intensive care medicine. With the undisputed advantages of goal-oriented therapy established, there was a need to develop our own guidelines on analgesia and sedation in intensive care in Germany and these were published as 2(nd) Generation Guidelines in 2005. Through the dissemination of these guidelines in 2006, use of monitoring was shown to have improved from 8 to 51% and the use of protocol-based approaches increased to 46% (from 21%). Between 2006-2009, the existing guidelines from the DGAI (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin) and DIVI (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin) were developed into 3(rd) Generation Guidelines for the securing and optimization of quality of analgesia, sedation and delirium management in the intensive care unit (ICU). In collaboration with another 10 professional societies, the literature has been reviewed using the criteria of the Oxford Center of Evidence Based Medicine. Using data from 671 reference works, text, diagrams and recommendations were drawn up. In the recommendations, Grade "A" (very strong recommendation), Grade "B" (strong recommendation) and Grade "0" (open recommendation) were agreed. As a result of this process we now have an interdisciplinary and consensus-based set of 3(rd) Generation Guidelines that take into account all critically illness patient populations. The use of protocols for analgesia, sedation and treatment of delirium are repeatedly demonstrated. These guidelines offer treatment recommendations for the ICU team. The implementation of scores and protocols into routine ICU practice is necessary for their success. PMID:20200655

  18. Involvement of the NADPH Oxidase NOX2-Derived Brain Oxidative Stress in an Unusual Fatal Case of Cocaine-Related Neurotoxicity Associated With Excited Delirium Syndrome.

    PubMed

    Schiavone, Stefania; Riezzo, Irene; Turillazzi, Emanuela; Trabace, Luigia

    2016-10-01

    Here, we investigated the possible role of the Nicotinamide Adenine Dinucleotide Phosphate oxidase NOX2-derived brain oxidative stress in a fatal case of cocaine-related neurotoxicity, associated to excited delirium syndrome. We detected a strong NOX2 immunoreactivity, mainly in cortical GABAergic neurons and astrocytes, with a minor presence in microglia, glutamatergic and dopaminergic neurons as well as a significant immunostaining for other markers of oxidative stress (8OhDG, HSP70, HSP90, and NF-κB) and apoptotic phenomena. These results support a crucial role of NOX2-derived brain oxidative stress in cocaine-induced brain dysfunctions and neurotoxicity. PMID:27533346

  19. 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

  20. 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

    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.

  1. The role of the NADPH oxidase derived brain oxidative stress in the cocaine-related death associated with excited delirium: A literature review.

    PubMed

    Schiavone, Stefania; Neri, Margherita; Mhillaj, Emanuela; Pomara, Cristoforo; Trabace, Luigia; Turillazzi, Emanuela

    2016-09-01

    Excited delirium syndrome (ExDS) is a term used to describe a clinical condition characterized by bizarre and aggressive behaviour, commonly associated with the use of psychoactive compounds, especially cocaine. The pathophysiology of ExDS is complex and not yet fully understood. In addition to a central dopamine hypothesis, other mechanisms are thought to be involved in cocaine-related ExDS, such as increased reactive oxygen species production by the family of the NADPH oxidase NOX enzymes. In this review, we will summarize current knowledge on the crucial contribution of brain NADPH oxidase derived oxidative stress in the development of cocaine-induced ExDS. Data from animal models as well as human evidence will be discussed. PMID:27265246

  2. Low Mass Ratio Contact Binary Systems HN UMa and II UMa - III

    NASA Astrophysics Data System (ADS)

    Lee, Woo-Baik; Kim, Ho-Il; Kang, Young Woon; Oh, Kyu-Dong

    2006-09-01

    We present newly observed BVRI CCD light curves for low mass ratio contact binaries, HN UMa and II UMa. The absolute dimensions of these objects were obtained by applying the Wilson-Devinney program to previously published spectroscopic analysis and to our observed photometric data. The evolutionary status of all 21 low mass ratio contact binary system including HN UMa and II UMa was then considered. The secondaries of all low mass ratio contact binaries are located below the zero age main sequence in HR diagram. This phenomenon could be explained by mass loss from the secondary component in the low mass contact binary system because even small mass loss affects luminosity decrease in the low mass stars.

  3. Delirium (Beyond the Basics)

    MedlinePlus

    ... the Licensed Materials from any location via the Internet. b. STANDALONE WORKSTATION: A standalone subscription permits multiple ... computer. A Standalone Workstation license does not include Internet access to the Licensed Materials. c. INSTITUTIONAL SUBSCRIPTION: ...

  4. 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).

  5. Disruption of Circadian Rhythms and Delirium, Sleep Impairment and Sepsis in Critically ill Patients. Potential Therapeutic Implications for Increased Light-Dark Contrast and Melatonin Therapy in an ICU Environment.

    PubMed

    Madrid-Navarro, Carlos J; Sanchez-Galvez, Rosa; Martinez-Nicolas, Antonio; Marina, Ros; Garcia, Jose A; Madrid, Juan A; Rol, Maria A

    2015-01-01

    The confinement of critically ill patients in intensive care units (ICU) imposes environmental constancy throughout both day and night (continuous light, noise, caring activities medications, etc.), which has a negative impact on human health by inducing a new syndrome known as circadian misalignment, circadian disruption or chronodisruption (CD). This syndrome contributes to poor sleep quality and delirium, and may impair septic states frequently observed in critically ill patients. However, and although the bidirectional crosstalk between CD with sleep impairment, delirium and inflammation in animal models has been known for years and has been suspected in ICU patients, few changes have been introduced in the environment and management of ICU patients to improve their circadian rhythmicity. Delirium, the most serious condition because it has a severe effect on prognosis and increases mortality, as well as sleep impairment and sepsis, all three of them linked to disorganization of the circadian system in critically ill patients, will be revised considering the functional organization of the circadian system, the main input and output signals that synchronize the clock, including a brief description of the molecular circadian clock machinery, the non-visual effects of light, and the ICU light environment. Finally, the potential usefulness of increased light/dark contrast and melatonin treatment in this context will be analyzed, including some practical countermeasures to minimize circadian disruption and improve circadian system chronoenhancement, helping to make these units optimal healing environments for patients.

  6. Improving patient care through the prism of psychology: application of Maslow's hierarchy to sedation, delirium, and early mobility in the intensive care unit.

    PubMed

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

    2014-06-01

    The intensive care unit (ICU) 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 although the overall number of hospital beds remains stable in the United States, the percentage of that total devoted to ICU beds is rising. These 2 realities engender a demographic imperative to address patient safety in the critical care setting. This article 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 article 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 health care professionals toward comprehensive care of the whole person not merely for survival but toward restoration of pre-illness function of mind, body, and spirit.

  7. 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

  8. SU UMa stars: Rebrightenings after superoutburst

    NASA Astrophysics Data System (ADS)

    Meyer, Friedrich; Meyer-Hofmeister, Emmi

    2015-06-01

    SU UMa stars after their long superoutbursts often show single or multiple rebrightenings. We show how this phenomenon can be understood as repeated reflections of transition waves which mediate changes between the hot and the cool state of the accretion disk and travel back and forth in the outer disk region, leaving an inner part permanently hot. This points to a temporarily increased viscosity, possibly related to the formation of large-scale and longer persisting magnetic fields by the dynamo operation during the long superoutburst. The "mini-rebrightenings" in the early post-outburst light curve of V585 Lyr discovered by Kato and Osaki (2013, PASJ, 65, 97) in Kepler observations seem to be understandable as a small limit cycle of low-luminosity changes originating from a "wiggle" feature in the thermal equilibrium curve of the cool, optically thick disk.

  9. Discovery of a New Deeply Eclipsing SU UMa-Type Dwarf Nova, IY UMa (= TmzV 85)

    NASA Astrophysics Data System (ADS)

    Uemura, Makoto; Kato, Taichi; Matsumoto, Katsura; Takamizawa, Kesao; Schmeer, Patrick; Jensen, Lasse Teist; Vanmunster, Tonny; Novák, Rudolf; Martin, Brian; Pietz, Jochen; Buczynski, Denis; Kinnunen, Timo; Moilanen, Marko; Oksanen, Arto; Cook, Lewis M.; Watanabe, Tsutomu; Maehara, Hiroyuki; Itoh, Hiroshi

    2000-04-01

    We discovered a new deeply eclipsing SU UMa-type dwarf nova, IY UMa, which experienced a superoutburst in 2000 January. Our monitoring revealed two distinct outbursts, which suggest a superoutburst interval of ~ 800 d, or its half, and an outburst amplitude of 5.4 mag. From time-series photometry during the superoutburst, we determined a superhump and orbital period of 0.07588 d and 0.0739132 d, respectively.

  10. 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.

  11. Period Variations in the Close Binary BM UMa

    NASA Astrophysics Data System (ADS)

    Virnina, Natalia A.; Panko, Elena; Sergienko, O. G.; Murnikov, Boris A.; Gubin, E. G.; Klabukova, A. V.; Movchan, A. I.

    2010-12-01

    We present the results of analysing of the light curve and O-C variations in the eclipsing system BM UMa, based on V-band observations which cover the period from JD 2454933 to 2454961 using two robotic remotely-controlled telescopes of Tzec Maun Observatory (USA) along with observations made with the RK-600 telescope of Odessa Astronomical Observatory. The full light curve displays a total primary eclipse with a duration 0.06 of the period, or 24 minutes, and a partial secondary eclipse, with both maxima of equal magnitude. For our obesrvations, we determined the statistically optimal values of the initial epoch of T0 = 2454944.2814 ± 0.0001 and orbital period of P = 0.d271226± 0.000002. The depths of primary and secondary minima are nearly equal, 0.m838 ± 0.006 and 0.m748 ± 0.006, respectively. The physical parameters of the system were calculated using the Wilson-Devinney code, appended with the Monte Carlo search algorithm. The result establishes BM UMa as a contact system (fillout factor 10.7%) with parameters: mass ratio 0.538 ± 0.001, inclination 86.°815 ± 0.005, and temperatures of components 4700 ± 20 K and 4510 ± 10 K. The more massive component is larger and cooler. The 72 archival and 11 newly-obtained times of light minimum cover the interval 1961-2010 and allowed us to exclude possible systematic period variations in BM UMa and to determine an initial epoch of HJD 2447927.382 and orbital period of P = 0.d2712209± 0.0000006.

  12. Perspectivas Futuras para o Observatório do Pico dos Dias

    NASA Astrophysics Data System (ADS)

    Bruch, Albert

    2004-02-01

    Com o Observatório Gemini plenamente operacional e o telescópio SOAR iniciando suas operações em breve, a astronomia observacional brasileira encontra-se no auge de uma transformação profunda que terá um impacto grave no Observatório do Pico dos Dias - OPD. Refletimos aqui sobre a natureza desse impacto e estratégias para manter a competitividade do OPD. Não queremos apresentar receitas prontas, mas idéias que poderão servir como base de discussão sobre o uso inteligente dos telescópios do OPD como parte do conjunto de instrumentos disponíveis à comunidade astronômica brasileira.

  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. First photometric study of W UMa binary star LU Lac

    NASA Astrophysics Data System (ADS)

    Liao, W.-P.; Qian, S.-B.; Zhao, E.-G.; Jiang, L.-Q.

    2014-08-01

    LU Lac is a neglected W UMa binary star in photometric investigations. In this paper, we present BVRI CCD photometric light curves obtained on one night in 2012. The first photometric solutions of this system are computed by using the Wilson-Devinney code. It is shown that LU Lac is a marginal contact W-type system with a degree of contact factor of f=8.9%, a mass ratio of q=2.085 and a high inclination of i=82°.20. From the first analyses of orbital period changes, we found the period variation of the system includes an oscillation (A3=0.0125 days and T3=51.92 years). The cyclic change may be attributed to the light-travel time effect through the presence of a third body.

  15. Recent developments on SU UMa stars - theory vs. observation

    NASA Astrophysics Data System (ADS)

    Cannizzo, John K.

    2015-01-01

    Kepler light curves of short period dwarf novae have resparked interest in the nature of superoutbursts and led to the question: Is the thermal-tidal instability needed, or can the plain vanilla version of the accretion disk limit cycle do the job all by itself? A detailed time-resolved study of an eclipsing SU UMa system during superoutburst onset should settle the question - if there is a dramatic contraction of the disk at superoutburst onset, Osaki's thermal-tidal model would be preferred; if not, the plain disk instability model would be sufficient. I will present recent results that support the contention by Osaki & Kato that the time varying negative superhump frequencies can be taken as a surrogate for the outer disk radius variations. Finally, it may be necessaryto look beyond the short period dwarf novae to gain perspective on the nature of embedded precursors in long outbursts.

  16. 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).

  17. Fundamental data for contact binaries: RZ Comae, RZ Tauri, and AW UMa

    NASA Technical Reports Server (NTRS)

    Wilson, R. E.; Devinney, E. J.

    1972-01-01

    Differential corrections analyses of three W UMa type binaries show that RZ Tau and AW UMa have common envelopes and the relatively small gravity darkening predicted by Lucy, while RZ Comae seems to have a larger gravity effect and is only marginally in contact. Some details of the method for computing contact binary light curves are given. It is suggested that W UMa binaries which have occultation primary eclipses may, in general, have large amplitudes for gravity darkening or a photometric surface brightness effect which simulates large gravity darkening.

  18. Superoutbursts of selected new SU UMa-type and WZ Sge-type stars

    NASA Astrophysics Data System (ADS)

    Katysheva, N.; Chochol, D.; Shugarov, S.

    2010-11-01

    We present the results of our observations of selected new SU UMa-type and WZ Sge-type stars, which underwent their super-outbursts during the years 2007-2009. Photometric observations of SU UMa-type stars V632 Cyg, OT J080714.2+113812 and two WZ Sge-type stars V466 And and Nova Triangulum 2008 were carried out with the telescopes of the Crimean Laboratory of the SAI and StarA LesnA Observatory of the Astronomical Institute of the SAS. Photometric behaviour of SU UMa-type and WZ Sge-type stars during their superoutbursts is discussed.

  19. Spectroscopic Metallicity Determinations for W UMa-type Binary Stars

    NASA Astrophysics Data System (ADS)

    Rucinski, Slavek M.; Pribulla, Theodor; Budaj, Ján

    2013-09-01

    This study is the first attempt to determine the metallicities of W UMa-type binary stars using spectroscopy. We analyzed about 4500 spectra collected at the David Dunlap Observatory. To circumvent problems caused by the extreme spectral line broadening and blending and by the relatively low quality of the data, all spectra were subject to the same broadening function (BF) processing to determine the combined line strength in the spectral window centered on the Mg I triplet between 5080 Å and 5285 Å. All individual integrated BFs were subsequently orbital-phase averaged to derive a single line-strength indicator for each star. The star sample was limited to 90 W UMa-type (EW) binaries with the strict phase-constancy of colors and without spectral contamination by spectroscopic companions. The best defined results were obtained for an F-type sub-sample (0.32 < (B - V)0 < 0.62) of 52 binaries for which integrated BF strengths could be interpolated in the model atmosphere predictions. The logarithmic relative metallicities, [M/H], for the F-type sub-sample indicate metal abundances roughly similar to the solar metallicity, but with a large scatter which is partly due to combined random and systematic errors. Because of the occurrence of a systematic color trend resulting from inherent limitations in our approach, we were forced to set the absolute scale of metallicities to correspond to that derived from the m 1 index of the Strömgren uvby photometry for 24 binaries of the F-type sub-sample. The trend-adjusted metallicities [M/H]1 are distributed within -0.65 < [M/H]1 < +0.50, with the spread reflecting genuine metallicity differences between stars. One half of the F-sub-sample binaries have [M/H]1 within -0.37 < [M/H]1 < +0.10, a median of -0.04 and a mean of -0.10, with a tail toward low metallicities, and a possible bias against very high metallicities. A parallel study of kinematic data, utilizing the most reliable and recently obtained proper motion and radial

  20. Superhumps in a Rarely Outbursting SU UMa-Type Dwarf Nova, HO Delphini

    NASA Astrophysics Data System (ADS)

    Kato, Taichi; Nogami, Daisaku; Moilanen, Marko; Yamaoka, Hitoshi

    2003-10-01

    We observed the 1994, 1996, and 2001 outbursts of HO Del. From the detection of secure superhumps, HO Del is confirmed to be an SU UMa-type dwarf nova with a superhump period of 0.06453(6)d. Based on recent observations and past records, the outbursts of HO Del are found to be relatively rare, with the shortest intervals of superoutbursts being ˜ 740d. Among SU UMa-type dwarf novae with similar outburst intervals, the outburst amplitude (˜ 5.0mag) is unusually small. HO Del showed a rather rapid decay of the superhump amplitudes, and no regrowth of the amplitudes during the later stage, in contrast to the commonly observed behavior in SU UMa-type dwarf novae with long outburst intervals. We positively identified HO Del with a ROSAT X-ray source, and obtained a relatively large X-ray luminosity of 1031.1±0.2erg s-1. We also performed a literature survey of SU UMa-type dwarf novae and presented a new set of basic statistics. The SU UMa-type dwarf novae with a brightening trend or with a regrowth of superhumps near the termination of a superoutburst are found to be rather tightly confined in a small region on the (superhump period-supercycle length) plane. These features may provide a better observational distinction for the previously claimed subgroup of dwarf novae (Tremendous Outburst Amplitude Dwarf Novae).

  1. 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.

  2. [Inside the labyrinth of feminine delirium.].

    PubMed

    Boulay, A

    1979-01-01

    In order to understand the problem of the relationship between woman and madness, it is important to take history into account. Mental illness consists in the difficulty to express one's sexual difference in a wide sense (economic, political, ideological, imaginary and symbolical), this is where history comes into consideration. Woman, relegated in the far recess of history, deprived of the possibility to express herself, is today searching for her true expression. As far as the man's confusion of ideas is concerned, because of his denial of woman, all he had left was to differentiate himself from himself and therefore creates symbolic social classes ; this thesis is not an idealistic one - it goes without saying that this symbolical evolution develops itself in interrelation with economic and material development of society. The masculine confusion of ideas (délire) is historical while the feminine one is hysterical. This view of mental illness has political and ideological consequences. The annihilation of the roots of mental illness will come about only through the elimination of social classes and the real liberation of woman. This does not mean the rejection of therapeutic work, revolutions never cured anybody, but the extension of the clinical world to politics, the breaking down of established practices and interdisciplinarity. In short term, we have to deal with individuals who feel in themselves the after effects of an aged social structure, therefore not strictly individual but collective behaviors. In the long term, only a profound social transformation can limit the number of victims of the situation. One day maybe every one will be able to express and achieve themselves in a fully realised communism. This text wanted to be a locus of information on the historical and political basis of mental illness and the interconnected role played by the feminine 'délire' (madness). PMID:17093681

  3. "Doom anxiety" and delirium in lidocaine toxicity.

    PubMed

    Saravay, S M; Marke, J; Steinberg, M D; Rabiner, C J

    1987-02-01

    Of 15 patients with psychiatric reactions to lidocaine, 12 (80%) had mood changes, 11 (73%) had "doom anxiety," eight (53%) had overt confusional states, and six (40%) had hallucinations and delusions. The authors contend that morbid fears of impending doom or the belief that death has occurred are specific manifestations of lidocaine toxicity and may be mistakenly attributed to "understandable" fears about death during the course of recovery from a myocardial infarction on the coronary care unit.

  4. 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

  5. [Delirium caused by nonconvulsive status epilepticus].

    PubMed

    Pittermann, Patrick; Gabriel, Susanne; Röschke, Joachim

    2012-05-01

    We report about a patient (66 years) who was referred to our psychiatric hospital because of a progressive confusional state with acute onset. The colleagues of the referring psychiatric hospital considered a first manic episode as the cause of the symptoms and under therapy with haloperidol the confusional state had shown a progression.The clinical examination's findings were a mild central facial paresis on the right side and a mild hemiparesis on the right side with elevated reflex levels.The patient was disoriented, he had cognitive and mnestic deficits. His reasoning was slowed, incoherent and perseverating. The patient had a slight euphoria.An EEG recording showed a continuous regional EEG-seizure pattern. In combination with the clinical symptoms we diagnosed a nonconvulsive status epilepticus. Under anticonvulsive treatment with Lorazepam and Valproic acid the status epilepticus sustended but a control EEG recording showed signs of a Valproate-encephalopathy. Under treatment with Topiramate symptoms ameliorated but due to a vascular dementia the patient still showed fluctuating symptoms of cognitive and mnestic disturbances. PMID:22473464

  6. High-frequency variations of hydrogen spectral lines in the B3V star η UMa

    NASA Astrophysics Data System (ADS)

    Pokhvala, S. M.

    2015-09-01

    We reported the detection of high-frequency variations in the hydrogen Balmer lines in the hot star η UMa of spectral class B3V. Spectral observations of η UMa were carried out with slitless spectrograph (R˜100) installed on the 60 cm Carl Zeiss telescope in the Andrushivka Observatory. Spectra were obtained with a time resolution in the sub-second range. It has been found that the η UMa shows rapid variations in the hydrogen lines Hα, Hβ, Hγ, as well as variations in the atmospheric oxygen lines. The intensity variations in the hydrogen lines varies from 0.2% to 0.5% , and that of the oxygen lines is approximately 2%.

  7. Analysis of Positive Superhump Shapes Near Superoutburst Maximum in CV SU UMa-like Systems

    NASA Astrophysics Data System (ADS)

    Bobertz, Michele; Voloshina, Irina; Goel, Amit

    2016-01-01

    Positive superhumps are hump-shaped modulations in light curves of some Cataclysmic Variables (CVs) that have a period that is slightly longer than the orbital period. In CV SU UMa-like systems, the shape of the positive superhump is known to change throughout the superoutburst, which thus slightly changes the published, observed, positive superhump period. In this presentation, we analyze numerical simulations of prograde precession in accretion disks of CV SU UMa-like systems near superoutburst maximum. We compare the simulated positive superhump shapes with the shapes obtained from observations, using AW Sge as our model. Similarly, we compare associated Fourier Transforms with associated periodograms. We conclude with our analysis of the likely sources that generate the shape of the positive superhump in CV SU UMa-like systems near superoutburst maximum.

  8. Detailed modelling and dynamic simulation of the deployment of the MBB unfurlable antenna UMA

    NASA Astrophysics Data System (ADS)

    Bjorset, L. E.; Krabberod, J.; Sivertsen, O. I.

    1993-09-01

    The purpose of this study was to investigate the dynamics during deployment of large antenna reflectors with the multi body simulation code FEDEM (Finite Element Dynamics in Elastic Mechanisms). The 'Unfurlable Mesh Antenna' (UMA) from MBB was taken as an example to encounter and solve real problems. The UMA has a ribmesh type reflector. The design concept consists of 8 double foldable ribs spreading the reflector out. A motor in the center drives a cable drum. The drum transmits the driving force to pulleys mounted on the ribs.

  9. FUSE Observations of the Bright, Eclipsing Nova-like Cataclysmic Variable, UX UMa (FUSE 2000)

    NASA Technical Reports Server (NTRS)

    Long, Knox; Froning, Cynthia

    2004-01-01

    This was a project to study the disk and wind of the eclipsing nova-like variable UX UMa, in order to better define the wind geometry of the system, including the nature of the transition region between the disk photosphere and the supersonic wind. We proposed to use phase resolved spectroscopy of the system, taking advantage of the fact that UX UMa is an eclipsing system, to isolate different regions of the wind and to use a Monte Carlo radiative transfer code to simulate the spectra through the eclipse.

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

    PubMed

    Pope, Welkin H; 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

    2016-06-30

    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.

  11. 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

  12. Discovery of a New SU UMa-Type Dwarf Nova, V 1028 Cygni

    NASA Astrophysics Data System (ADS)

    Baba, Hajime; Kato, Taichi; Nogami, Daisaku; Hirata, Ryuko; Matsumoto, Katsura; Sadakane, Kozo

    2000-06-01

    V-band high-speed CCD photometry of V 1028 Cyg revealed that hump structures existed in the early stage of its 1995 July outburst. We obtained 0.06154 (+/- 0.00002) d as the best estimated period of superhumps. We confirmed that this dwarf nova belongs to the SU UMa stars. A re-brightening occurred after the superoutburst, and may be associated with a normal outburst. An analysis of the timings of superhump maxima showed clear evidence for an increase of the superhump period (P_dot = .P/P) with 7.54 x 10-6. Only a few stars (AL Com, T Leo, SW UMa, etc.) are reported to have such an increase of the superhump period. At the end of the superoutburst, we detected that the amplitude of the superhumps increased considerably. Both of these properties are not typical features of ordinary SU UMa stars. The connection between the WZ Sge-type and the SU UMa-type dwarf novae is briefly discussed.

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

    PubMed

    Pope, Welkin H; 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

  14. 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.

  15. GSC 4181-0713 - a new W UMa type eclipsing binary

    NASA Astrophysics Data System (ADS)

    Monninger, Gerold

    2009-12-01

    GSC 4181-0713 is identifed as an eclipsing binary for the first time. Ten times of primary and secondary minima were obtained. The shape and amplitude of the light curve and the period P=0.258742d implies that GSC 4181-0713 is a short-period W UMa type eclipsing binary. The system shows clearly an O'Connell effect delta m<0 in its light curve.

  16. X-ray and optical measurements of the cataclysmic variable CH UMa

    NASA Technical Reports Server (NTRS)

    Becker, R. H.; Chanan, G. A.; Wilson, A. S.; Pravdo, S. H.

    1982-01-01

    A program to identify optical counterparts of X-ray sources discovered with the Einstein Observatory has resulted in an independent identification of CH UMa as a cataclysmic variable. Spectrophotometric observations made with the Intensified Image Dissector Scanner on the 2.1-m telescope at KPNO revealed an emission line spectrum from an approximately 15 mag object similar to the spectra of cataclysmic variables. A subsequent search of the Harvard photographic plate collection revealed outbursts of 4 mag in amplitude.

  17. 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.

  18. The absolute parameters of two W UMa type binaries in Ursa Majoris

    NASA Astrophysics Data System (ADS)

    Yılmaz, M.; Baştürk, Ö.; Özavcı, İ.; Şenavcı, H. V.; Selam, S. O.

    2015-01-01

    We present the results of simultaneous Wilson-Devinney analyses of light and radial velocity curves of two contact binaries in the constellation Ursa Majoris. We found that HH UMa is an A-subtype W UMa binary, which conflicts with the classification of Han et al. (2014) as a W-subtype. Seasonal variations observed in the light curves of the system are well explained with two cool stellar spots in our solution as opposed to the hot-spot based solution by Han et al. (2014), the presence of which would not cause such rapid period variations. The evolutionary status of the system is in agreement with the findings of our study. We modeled II UMa, another A-subtype overcontact binary, without surface spots and found that its both components have rather low surface gravities indicating an advanced state of evolution pointing to evolved subgiants. The high contact degree (f=74%) supports this viewpoint. Our analysis shows that there is a significant third light contribution, contradicting some of the previous analyses, which lack the detection of the secondary minima as total eclipses because they were not as evident as they are in our light curves.

  19. 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).

  20. 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.

  1. 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.

  2. Chromospheric activity on late-type star DM UMa using high-resolution spectroscopic observations

    NASA Astrophysics Data System (ADS)

    Zhang, LiYun; Pi, QingFeng; Han, Xianming L.; Chang, Liang; Wang, Daimei

    2016-06-01

    We present new 14 high-resolution echelle spectra to discuss the level of chromospheric activity of DM UMa in {He I} D3, {Na I} D1, D2, Hα, and {Ca II} infrared triplet lines (IRT). It is the first time to discover the emissions above the continuum in the {He I} D3 lines on 2015 February 9 and 10. The emission on February 9 is the strongest one ever detected for DM UMa. We analysed these chromospheric active indicators by employing the spectral subtraction technique. The subtracted spectra reveal weak emissions in the {Na I} D1, D2 lines, strong emission in the Hα line, and clear excess emissions in the {Ca II} IRT lines. Our values for the EW8542/EW8498 ratio are on the low side, in the range of 1.0-1.7. There are also clear phase variations of the level of chromospheric activity in equivalent width (EW) light curves in these chromospheric active lines (especially the Hα line). These phenomena might be explained by flare events or rotational modulations of the level of chromospheric activity.

  3. FUSE Observations of the Dwarf Novae UU Aql, BV Cen, and CH UMa in Quiescence

    NASA Astrophysics Data System (ADS)

    Sion, Edward M.; Godon, Patrick; Cheng, Fuhua; Szkody, Paula

    2007-08-01

    We report on FUSE spectra of three U Gem-type, long-period dwarf novae, UU Aql, BV Cen, and CH UMa, taken during their quiescence intervals. We discuss the line identifications in their spectra and attempt to characterize the source(s) of their FUV flux distribution. Archival IUE spectra of CH UMa and BV Cen in quiescence were identified as having a matching flux level with the FUSE spectra, and these were combined with each FUSE spectrum to broaden the wavelength coverage and further constrain model fits. Multicomponent synthetic spectral fits from our model grids, consisting of single-temperature white dwarfs, two-temperature white dwarfs, accretion disks, and white dwarfs plus accretion disks, were applied to the FUSE spectra alone and to the combined FUSE + IUE spectra. We present the results of our model analyses and their implications. Based on observations made with the NASA-CNES-CSA Far-Ultraviolet Spectroscopic Explorer. FUSE is operated for NASA by the Johns Hopkins University under NASA contract NAS5-32985.

  4. 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.

  5. Three X-ray flares near primary eclipse of the RS CVn binary XY UMa

    NASA Astrophysics Data System (ADS)

    Gong, Hang; Osten, Rachel; Maccarone, Thomas; Reale, Fabio; Liu, Ji-Feng; Heckert, Paul A.

    2016-08-01

    We report on an archival X-ray observation of the eclipsing RS CVn binary XY UMa (P orb ≈ 0.48 d). In two Chandra ACIS observations spanning 200 ks and almost five orbital periods, three flares occurred. We find no evidence for eclipses in the X-ray flux. The flares took place around times of primary eclipse, with one flare occurring shortly (< 0.125 P orb) after a primary eclipse, and the other two happening shortly (< 0.05 P orb) before a primary eclipse. Two flares occurred within roughly one orbital period (Δα ≈ 1.024 P orb) of each other. We analyze the light curve and spectra of the system, and investigate coronal length scales during both quiescence and flares, as well as the timing of the flares. We explore the possibility that the flares are orbit-induced by introducing a small orbital eccentricity, which is quite challenging for this close binary.

  6. Mapping of surface activity on the W UMa-type system VW Cephei

    NASA Technical Reports Server (NTRS)

    Bradstreet, David H.; Guinan, Edward F.

    1988-01-01

    After multifilter photometry of the W UMa-type contact binary VW Cep (P = 6.67 hr; G5V + K0V) in 1986/87 revealed large asymmetries in the light curves believed to be caused by large, cool starspot regions on the surface of the larger stars, in Apr. 1987 it was observed with IUE to study the chromospheres and transition regions of the components. During one complete orbital cycle, three SWP and four LWP low dispersion spectra were obtained, including and then excluding the suspected active region. Phase dependent TR line emission strengths were found, most notably C IV, which is 50 percent stronger when the spot region is most visible. The results could be important because VW Cep represents an extreme case for studying stellar dynamo theory and observations can play a crucial role in the unterstanding of magnetic fields and activity cycles in rapidly rotating solar-like stars.

  7. 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.

  8. Orbital Period Investigations of Two W UMa-type Binaries: AH Aur and V728 Her

    NASA Astrophysics Data System (ADS)

    Yu, Yun-Xia; Xiang, Fu-Yuan; Hu, Ke

    2016-04-01

    The orbital period changes of two W UMa-type binaries, AH Aur and V728 Her, are investigated based on all available times of the light minimum taken from the databases and literature. It is revealed that the orbital period of AH Aur shows a long-term decrease at a rate of {dP}/{dt}=-2.491× {10}-7 days yr-1. For V728 Her, we find that the orbital period exhibits a secular increase at a rate of {dP}/{dt}=3.793× {10}-7 days yr-1. The secular period changes suggest that AH Aur and V728 Her are undergoing rapid mass transfer between the primary star and the secondary companion.

  9. Light Curve Analysis for W UMa-Type Eclipsing Binary Star Systems

    NASA Astrophysics Data System (ADS)

    Henderson, Scott; Peach, N.; Olsen, T.

    2006-12-01

    We report results from summer 2006 in an ongoing study of eclipsing binary stars. Our investigations have focused on the measurement and interpretation of light curves for W UMa-type systems 44i Boötis and VW Cephei. These contact binaries have component stars of spectral type G, and revolve with periods of 6.43 and 6.67 hours. Dome automation and scripting capabilities introduced this summer have significantly reduced experimental uncertainties in our data. In support of previous findings we continue to observe an increase in the orbital period of 44i Boo at a rate of 10.4 µs/epoch or 14.2 ms/yr. Residuals computed after incorporating the increasing period suggest an underlying sinusoidal oscillation with a 61.5 year period and amplitude of 648 seconds. AAPT Member Thomas Olsen is sponsoring the lead presenter, SPS Member Scott Henderson, and the co-presenter, SPS Member Nick Peach.

  10. Precise Orbital Solutions for KEPLER Eclipsing Binaries of W UMa Type Showing Total Eclipses

    NASA Astrophysics Data System (ADS)

    Şenavcı, H. V.; Doǧruel, M. B.; Nelson, R. H.; Yılmaz, M.; Selam, S. O.

    2016-09-01

    We aim to discover the accuracy of photometric mass ratios (q ph) determined for eclipsing binary stars, in the case of the system having at least one `flat bottom' as a minimum profile, as well as the accuracy of data used in that sense. Within this context, we present the results of two-dimensional grid search (q - i) for some W UMa-type eclipsing binaries showing total eclipses, based on the high precision photometric data provided by the KEPLER Mission. The radial velocity data obtained for KIC10618253 in this study, enables us to compare both q ph and the corresponding spectroscopic mass ratio (q sp) values. The results indicate that the high precision photometric data for overcontact eclipsing binaries showing total eclipses allow us to obtain the photometric mass ratios as accurate as the spectroscopic values.

  11. 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.

  12. 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).

  13. 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.

  14. 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.

  15. 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.

  16. 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)

  17. The Multi-color Light Curves of the W UMa type Contact Binary EP Andromedae

    NASA Astrophysics Data System (ADS)

    Liao, W.-P.; Qian, S.-B.; Li, K.; He, J.-J.; Zhao, E.-G.; Zhou, X.

    2013-10-01

    New multi-color CCD photometric light curves of the eclipsing binary EP And were obtained over six nights in 2006, 2011, and 2012. Using the Wilson-Devinney code, we computed the photometric elements of this system. It was discovered that EP And is a W-type W UMa contact binary system with a mass ratio of q = 2.685 and a degree of contact factor f = 24.9%, rather than an A-type system. Combining 28 newly determined times of minimum light derived from 1999 to 2012 with others collected from the literature, a long-term increase (dP/dt = +5.22 × 10-8 days yr-1) with a sinusoidal variation (A = 0.0109 days T = 40.89 yr) in the orbital period was found. The orbital period secular increases may be interpreted as conservative mass transfer from the less massive component to the more massive one, and cyclic variations of the orbital period may be caused by the light-travel time effect through the presence of a third body. The evolutionary status and the age of the system are also discussed.

  18. Ultra-weak magnetic fields in Am stars: β UMa and θ Leo

    NASA Astrophysics Data System (ADS)

    Blazère, A.; Petit, P.; Lignières, F.; Aurière, M.; Ballot, J.; Böhm, T.; Folsom, C.; Ariste, A. López; Wade, G. A.

    2015-10-01

    An extremely weak circularly-polarized signature was recently detected in the spectral lines of the Am star Sirius A. With a prominent positive lobe, the shape of the phase-averaged Stokes V line profile is atypical of stellar Zeeman signatures, casting doubts on its magnetic origin. We report here on ultra-deep spectropolarimetric observations of two more bright Am stars: β Uma and θ Leo. Stokes V line signatures are detected in both objects, with a shape and amplitude similar to the one observed on Sirius A. We demonstrate that the amplitude of the Stokes V line profiles depend on various line parameters (Landé factor, wavelength, depth) as expected from a Zeeman signature, confirming that extremely weak magnetic fields are likely present in a large fraction of Am stars. We suggest that the strong asymmetry of the polarized signatures, systematically observed so far in Am stars and never reported in strongly magnetic Ap stars, bears unique information about the structure and dynamics of the thin surface convective shell of Am stars.

  19. THE MULTI-COLOR LIGHT CURVES OF THE W UMa TYPE CONTACT BINARY EP ANDROMEDAE

    SciTech Connect

    Liao, W.-P.; Qian, S.-B.; Li, K.; He, J.-J.; Zhao, E.-G.; Zhou, X.

    2013-10-01

    New multi-color CCD photometric light curves of the eclipsing binary EP And were obtained over six nights in 2006, 2011, and 2012. Using the Wilson-Devinney code, we computed the photometric elements of this system. It was discovered that EP And is a W-type W UMa contact binary system with a mass ratio of q = 2.685 and a degree of contact factor f = 24.9%, rather than an A-type system. Combining 28 newly determined times of minimum light derived from 1999 to 2012 with others collected from the literature, a long-term increase (dP/dt = +5.22 Multiplication-Sign 10{sup -8} days yr{sup -1}) with a sinusoidal variation (A = 0.0109 days; T = 40.89 yr) in the orbital period was found. The orbital period secular increases may be interpreted as conservative mass transfer from the less massive component to the more massive one, and cyclic variations of the orbital period may be caused by the light-travel time effect through the presence of a third body. The evolutionary status and the age of the system are also discussed.

  20. Orbital Period Variation and Morphological Light Curve Studies for the W UMa Binary BB Pegasi

    NASA Astrophysics Data System (ADS)

    Hanna, Magdy A.; Awadalla, Nabil S.

    2011-06-01

    The photometric light curves of the W-type W UMa eclipsing contact binary system BB Pegasi have been found to be extremely asymmetric over all the observed 63 years in all wavelengths UBVR. The light curves have been characterized by occultation primary minima. So, the morphology of these light curves has been studied in view of these different asymmetric degrees. The system shows a distinct O'Connell effect as well as depth variation. A 22.96 years cycle, of dark spots group, has been determined for the system combined with about the same cycling for the depth variations (22.78 yr). Also, an analysis of the measurements of mid-eclipse times of BB Peg has been presented. The analysis indicates a period decrease of 5.62× 10-8 d/yr, which can be interpreted in terms of mass transfer of rate -4.38 × 10-8 M_⊙/yr, from the more to the less massive component. The O-C diagram shows a damping sine wave covering two different cycles of 17.0 yr and 12.87 yr with amplitudes equal to 0.0071 and 0.0013 day, respectively. These unequal durations show a non periodicity which may be explained as a result of magnetic activity cycling variations due to star spots. The obtained characteristics are consistent when applying Applegate's (1992) mechanism.

  1. 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.

  2. A Photometric Study of the W UMa-Type Contact Binary RZ Com

    NASA Astrophysics Data System (ADS)

    He, Jia-Jia; Qian, Sheng-Bang

    2008-08-01

    We present results of CCD photometric observations of the short-period W UMa-type contact binary system, RZ Com. The light curve of the binary has changed from W-subtype to A-subtype from 1998 to 2003, then back to W-subtype in 2004. An analysis was carried out using the 2003 version of the Wilson-Devinney code. It is confirmed that RZ Com is a low-degree, overcontact f = 20.1% (+/-7.4%) binary system with a high inclination of i = 81.°40 (+/-0.°40), and a mass ratio q = 2.351 (+/-0.031). Combining four newly determined times of light minimum with others in the literature, the variations in orbital period is examined. A small-amplitude oscillation (A=0.0065d), with a period of 41.5 year, is discovered superimposed on a long-term increase at rate dP/dt = +3.97×10-8d yr-1. The period oscillation can be explained either by the light-time effect due to the presence of an unseen third body, or by cycles of magnetic activity on the components. Combining our photometric solution with the spectroscopic elements obtained by Mclean & Hilditch, the absolute dimensions of RZ Com are: M1 = 1.14 (+/-0.19)Modot, M2 = 0.50 (+/-0.09)Modot, R1 = 1.12 (+/-0.01)Rodot, R2 = 0.78 (+/-0.01)Rodot and A = 2.41 (+/-0.02)Rodot.

  3. 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.

  4. BVRI Photometric Analysis of the W UMa Binary, V428, in the field of NGC188

    NASA Astrophysics Data System (ADS)

    Samec, Ronald G.; Maloney, David Edward; Clark, Jeremy; Caton, Daniel B.; Faulkner, Danny R.

    2015-01-01

    V428 is a faint 15th magnitude binary observed in a study of the open cluster NGC188. However, its distance from the core of the cluster might exclude its membership. Its light curve was classified as a short period EB type eclipsing binary with a period of 0.3079 d and amplitude of ~0.7 mags in all curves. V428 was observed as a part of our student/professional collaborative studies of interacting binaries from data taken from Dark Sky Observatory of Appalachian State University, North Carolina. The difference in component temperatures is some DT =180 K and its fill-out is 35%. This undoubtedly has a semi-extreme mass ratio (q) otherwise its fill-out might dictate a smaller △T. A brief, 2.5 year period study gives, as expected, a constant period, P=0.3076789 d. Five times of minimum light were calculated, 3 primary and 2 secondary eclipses from our present observations:HJD I = 2456598.6746±0.0007, 2456599.5990±0.0014, 2456600.8292±0.0013HJD II = 2456598.8299±0.0026, 2456599.7548±0.0025.The improved linear ephemeris is:JD Hel MinI = 2456599.5990(±0.0010) + 0.30767885(±0.00000043)d X E (1)More monitoring is needed to determine its true orbital evolution. The inclination, 80º is not quite enough to produce total eclipses, so a q-search was performed. Our best solution gives a q=0.4. A cool spot was modeled on the primary component to take care of the light curve asymmetries. It is a K-type W UMa contact binary.

  5. 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.

  6. 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.

  7. Photometric Analysis of the Recently Discovered W UMa Star NR Camelopardalis: Period Change and Spot Migration

    NASA Astrophysics Data System (ADS)

    Shoup, Jenae; Reed, Phillip A.; Joner, Michael D.; Jensen, Eric L. N.; Collins, Karen A; Pepper, Joshua

    2014-06-01

    NR Cam is a short period (P=0.26 days) eclipsing binary of the W UMa type that was relatively recently discovered in the ROTSE1 data of the Northern Sky Variability Survey (NSVS) and was originally listed in the New Catalog of Suspected Variable Stars (NSV) with the identifier NSV 3754. Here we present the first known detailed study of NR Cam, which includes multi-band light curves, color curves, and a photometric orbital solution. NR Cam exhibits a strong O'Connell effect that can be attributed to magnetically induced spot activity on one of the components. Absolute photometry was performed in B and V at the Kutztown University Observatory in 2013 October and November and complementary high precision differential light curves were obtained in BVRI at the same time, as part of the KELT follow-up network, at Brigham Young University's West Mountain Observatory, Swarthmore College's Peter Van de Kamp Observatory, and the University of Louisville's Moore Observatory. After the B-V color curves were used to approximate the stellar surface temperatures and spot locations, the Wilson-Devinney code was employed with a differential corrections routine to determine the most likely stellar properties and orbital parameters. Our solution indicates that the two stars are in contact, sharing a common envelope, and their surface temperatures are approximately 4500 K and 4200 K. The inclination of the orbit was determined to be 68.0 (±0.6) degrees. When compared with the NSVS data, we find that the orbital period of NR Cam has changed over the past decade and that the strength of the O'Connell effect, and the associated spot activity, has also varied significantly.

  8. Orbital Solutions and Absolute Elements of the W UMa Binary MW Pavonis

    NASA Astrophysics Data System (ADS)

    Alvarez, Gabriella E.; Sowell, James R.; Williamon, Richard M.; Lapasset, Emilio

    2015-08-01

    We present differential UBV photoelectric photometry obtained by Williamon of the short-period A-type W UMa binary MW Pav. With the Wilson-Devinney analysis program, we obtained a simultaneous solution of these observations with the UBV photometry of Lapasset, the V measurements by the ASAS program, and the double-lined radial velocity measurements of Rucinski and Duerbeck. Our solution indicates that MW Pav is in an overcontact state, where both components exceed their critical Roche lobes. We derive masses of M1 = 1.514 ± 0.063 Msolar and M2 = 0.327 ± 0.014 Msolar, and equal-volume radii of R1 = 2.412 ± 0.034 Rsolar and R2 = 1.277 ± 0.019 Rsolar for the primary and secondary, respectively. The system is assumed to have a circular orbit and is seen at an inclination of 86.39° ± 0.63°. The effective temperature of the primary was held fixed at 6900 K, whereas the secondary's temperature was found to be 6969 ± 10 K. The asymmetry of the light curves requires a large, single star spot on the smaller, less massive secondary component. A consistent base solution, with different spot characteristics for the Williamon, Lapasset, and ASAS data, was found. The modeled spot varied little during the 40-year range of photometric observations. The combined solution utilized a third light component and found that the period is changing at a rate of dP/dt = (6.50 ± 0.19) × 10-10.

  9. Infrasonic harmonic tremor and degassing bursts from Halema'uma'u Crater, Kilauea Volcano, Hawaii

    NASA Astrophysics Data System (ADS)

    Fee, David; GarcéS, Milton; Patrick, Matt; Chouet, Bernard; Dawson, Phil; Swanson, Don

    2010-11-01

    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 × 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.

  10. 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.

  11. 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

  12. [Various aspects of current treatment of patients with alcoholic delirium].

    PubMed

    Gamburg, A L; Aranovich, A G; Rasniuk, V A; Vol'fson, V L

    1983-01-01

    The study is based on the results of clinico-catamnestic evaluation of various methods (two kinds of placebo, antabuse, esperal, and a number of psychotropic drugs and their combinations) of treating 526 chronic alcoholics. Under study there were groups of the addicts comparable in the age, form and duration of the disease, and the degree of personality degradation. The data obtained show that it is preferable to individualize the application of the psychotropic means and combinations with regard to the changes in the addicts' psychics, characteristics of their premorbid personality, and the course of the disease in each particular case.

  13. The Impact of Delirium | NIH MedlinePlus the Magazine

    MedlinePlus

    ... ability to interact Increased likelihood of hospital acquired infections, longer hospital stays, and nursing home placements Side effects of medications used to treat the disorder When to Contact a Medical ... and infections, and using reality orientation programs may reduce the ...

  14. Emergence delirium in children: many questions, few answers.

    PubMed

    Vlajkovic, Gordana P; Sindjelic, Radomir P

    2007-01-01

    The introduction of a new generation of inhaled anesthetics into pediatric clinical practice has been associated with a greater incidence of ED, a short-lived, but troublesome clinical phenomenon of uncertain etiology. A variety of anesthesia-, surgery-, patient-, and adjunct medication-related factors have been suggested to play a potential role in the development of such an event. Restless behavior upon emergence causes not only discomfort to the child, but also makes the caregivers and parents feel unhappy with the quality of recovery from anesthesia. Although the severity of agitation varies, it often requires additional nursing care, as well as treatment with analgesics or sedatives, which may delay discharge from hospital. To reduce the incidence of this adverse event, it is advisable to identify children at risk and take preventive measures, such as reducing preoperative anxiety, removing postoperative pain, and providing a quiet, stress-free environment for postanesthesia recovery. More clinical trials are needed to elucidate the cause as well as provide effective treatment.

  15. 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.

  16. 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

  17. 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

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. The 2006/2007 photometric activity of three chromospherically active stars: V2075 Cyg, FG UMa and BM CVn

    NASA Astrophysics Data System (ADS)

    Erdem, A.; Budding, E.; Soydugan, E.; Bakış, H.; Doğru, D.; Doğru, S. S.; Tüysüz, M.; Kaçar, Y.; Dönmez, A.; Soydugan, F.

    2009-08-01

    We present new multiband CCD photometric observations of three chromospherically active stars with long periods (V2075 Cyg, FG UMa and BM CVn). The observations were made at the Çanakkale Onsekiz Mart University Observatory in 2006 and 2007. We analyzed BVRI (Bessell) CCD observations of these three RS CVn-type SB1 binaries with the following three steps: (i) Photometric rotation periods were obtained by analyzing their light variations with a differential corrections method and a Fourier transform technique. (ii) Light variations, observed over three or more consecutive orbital cycles, were investigated by using dark (cool) spot models with the program SPOT. (iii) Surface differential rotation coefficients for the primary components of these binaries were derived using our own photometric periods together with orbital periods taken from the literature.

  3. 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.

  4. 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

  5. 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.

  6. Photometric investigation of a very short period W UMa-type binary - Does CE Leonis have a large superluminous area?

    NASA Technical Reports Server (NTRS)

    Samec, Ronald G.; Su, Wen; Terrell, Dirk; Hube, Douglas P.

    1993-01-01

    A complete photometric analysis of BVRI Johnson-Cousins photometry of the high northern latitude galactic variable, CE Leo is presented. These observations were taken at Kitt Peak National Observatory on May 31, 1989-June 7, 1989. Three new precise epochs of minimum light were determined and a linear and a quadratic ephemeris were computed from these and previous data covering 28 years of observation. The light curves reveal that the system undergoes a brief 20 min totality in the primary eclipse, indicating that CE Leo is a W UMa W-type binary. A systemic velocity of about -40 km/s was determined. Standard magnitudes were found and a simultaneous solution of the B, V, R, I light curves was computed using the new Wilson-Devinney synthetic light curve code which has the capability of automatically adjusting star spots. The solution indicates that the system consists of two early K-type dwarfs in marginal contact with a fill-out factor less than 3 percent. Evidence for the presence of a large (45 deg radius) superluminous area on the cooler component is given.

  7. 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

  8. 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.

  9. Speciation, population structure, and demographic history of the Mojave Fringe-toed Lizard (Uma scoparia), a species of conservation concern.

    PubMed

    Gottscho, Andrew D; Marks, Sharyn B; Jennings, W Bryan

    2014-06-01

    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

  10. 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

  11. Photometric studies of two W UMa type variables in the field of distant open cluster NGC 6866

    NASA Astrophysics Data System (ADS)

    Joshi, Yogesh Chandra; Jagirdar, Rukmini; Joshi, Santosh

    2016-04-01

    We present photometric analysis of the two W UMa type binaries identified in the field of distant open star cluster NGC 6866. Although these systems, namely ID487 and ID494, were reported by Joshi et al., a detailed study of these stars has not been carried out before. The orbital periods of these stars are found to be 0.415110±0.000001 day and 0.366709±0.000004 day, respectively. Based on the photometric and infrared colors, we find their respective spectral types to be K0 and K3. The photometric light variations of both stars show the O'Connell effect which can be explained by employing a dark spot on the secondary components. The V and I band light curves are analyzed using the Wilson-Devinney (WD) code and relations given by Gazeas which yield radii and masses for the binary components of star ID487 of R1 = 1.24 ± 0.01 R⊙, R2 = 1.11 ± 0.02 R⊙, and M1 = 1.24 ± 0.02 M⊙, M2 = 0.96 ± 0.05 M⊙ and for star ID494 of R1 = 1.22±0.02R⊙, R2 = 0.81±0.01 R⊙, and M1 = 1.20±0.06 M⊙, M2 = 0.47±0.01 M⊙.

  12. Tephra deposits of impulsive explosive events during the 2008 eruption of Halema`uma`u Crater, Kilauea

    NASA Astrophysics Data System (ADS)

    Houghton, B. F.; Swanson, D.; Carey, R. J.; Rausch, J.

    2010-12-01

    Eight short-lived impulsive explosive eruptions of low intensity occurred at Halema`uma`u crater, Kilauea in March-October 2008. Estimated total erupted masses were 10E+5 to 10E+6 kg; using inferred durations of 20-50 s, these equate to eruption rates of c. 10E+3 to 10E+4 kg/s, an order of magnitude lower than typical sustained Hawaiian fountains of the 20th century. Deposits are predominantly lapilli-sized but generally contain two elements: near-circular aprons of ballistic blocks extending to 200-400 m from the vent and wind-attenuated convective fall lobes which extend several tens of kilometers downwind but barely reach single-clast thickness even along the dispersal axes. Thinning half-distances (bt) for the deposits are 10-90 m, consistent with the exceptionally low mass discharges and similar to those of mild Strombolian eruptions. This geometry is essentially cone-like (and consistent with the low discharge rates) but the short duration of the events means no permanent deposit has formed. The deposits are relatively well-sorted yet richer in wall rock than the products of typical Hawaiian or Strombolian explosions.

  13. The orbital period of the dwarf nova HS Virginis, the revised Po-Ps relation and the ``superhump" mass ratio distribution of SU UMa stars

    NASA Astrophysics Data System (ADS)

    Mennickent, R. E.; Matsumoto, K.; Arenas, J.

    1999-08-01

    A spectroscopic study of the SU UMa star HS Vir is presented. From the analysis of the radial velocities of the Hα emission line the most likely orbital period is 0\\fd07692(3), although we cannot discard two aliases at 0\\fd07678 and 0\\fd07709. The Balmer lines follow the orbital period with a radial velocity semiamplitude K = 96 +/- 9 km s(-1) , but the He I lambda 5875 emission line shows a double wave during the orbital cycle. We found that the mean Balmer, He I and He II 4686 lines can be roughly modeled with a disk radial emissivity ~ r(-2) . A revised version of the Po-Ps relation for SU UMa stars is also given, which is relevant for discriminating between +/- 1 c/d aliases of the orbital period. We calculated the mass ratio, derived from the tidal resonance model, of HS Vir (qsh = 0.22 +/- 0.04) and 43 additional SU UMa stars. The qsh distribution has a roughly gaussian shape with a mean 0.14, in sharp contrast with the orbital period distribution. Finally, a discussion of the possible stellar masses and inclination of HS Vir is given. We observe that the mass ratio derived from the dynamic solution is in disagreement with that derived from the tidal resonance model. This fact probably indicates that K does not represent the white dwarf binary motion. Based on observations obtained at ESO La Silla Observatory (ESO Proposal 61.D-0395).

  14. Photometric study and preliminary elements of the low-mass ratio W UMa system ASAS 021209+2708.3

    NASA Astrophysics Data System (ADS)

    Acerbi, Francesco; Barani, Carlo; Martignoni, Massimiliano

    2011-07-01

    We present CCD B and V light curves, obtained in the year 2006, and a photometric solution of the low-mass ratio contact binary ASAS 021209+2708.3. With our data we were able to determine six new times of minimum light and refine the orbital period of the system to 0.3181963 days. The light curves are analyzed using the 2003 version of the Wilson-Devinney program and the analysis was performed with and without adding a spot on the surface of one star because the light curves appear to exhibit a typical O'Connell effect, with Maximum I brighter than Maximum II. The results show that ASAS 021209+2708.3 may be classified as an A-subtype W Ursae Majoris system with a small mass ratio q = 0.1889, a large over-contact degree of f = 0.587, a very small difference between the component temperatures of ΔT = 53 K and an orbital inclination of i = 81°. It is known that deep (f > 50%), low-mass ratio (q < 0.25) overcontact binary stars are a very important resource for understanding the phenomena of Blue Straggler/FK Com-type stars. The formations of Blue Straggler stars and FK Com-type stars are unsolved problems in stellar astrophysics. One of the possible explanations for their formation is from the coalescence of W UMa-type overcontact binary systems. The absolute dimensions of ASAS 021209+2708.3 are estimated and its dynamical evolution is inferred.

  15. 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.

  16. 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.

  17. 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.

  18. The Spot Variability and Related Brightness variations of the Solar Type PreContact W UMa Binary System V1001 Cas

    NASA Astrophysics Data System (ADS)

    Samec, Ronald George; Koenke, Sam S.; Faulkner, Danny R.

    2015-08-01

    A new classification of eclipsing binary has emerged, Pre Contact WUMa Binaries (PCWB’s, Samec et al. 2012). These solar-type systems are usually detached or semidetached with one or both components under filling their critical Roche lobes. They usually have EA or EB-type light curves (unequal eclipse depths, indicating components with substantially different temperatures). The accepted scenario for these W UMa binaries is that they are undergoing steady but slow angular momentum losses due to magnetic braking as stellar winds blow radially away on stiff bipolar field lines. These binaries are believed to come into stable contact and eventually coalesce into blue straggler type, single, fast rotating A-type stars (Guinan and Bradstreet,1988). High precision 2012 and 2009 light curves are compared for the very short period (~0.43d) Precontact W UMa Binary (PCWB), V1001 Cassiopeia. This is the shortest period PCWB found so far. Its short period, similar to the majority of W UMa’s, in contrast to its distinct Algol-type light curve, make it a very rare and interesting system. Our solutions of light curves separated by some three years give approximately the same physical parameters. However the spots radically change, in temperature, area and position causing a distinctive variation in the shape of the light curves. 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.

  19. 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

  20. 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.

  1. 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.

  2. 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.

  3. 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.

  4. Ensino de gravitação clássica no nível médio: uma proposta de abordagem e resultados preliminares

    NASA Astrophysics Data System (ADS)

    Medeiros, G. C. M.; Jafelice, L. C.

    2003-08-01

    O ensino de gravitação clássica é comumente realizado de maneira formal e descontextualizado da experiência com a força-peso e da história do tema. Fustigados por anos de experiência de ensino no assunto, nem sempre com bons resultados, propomos uma abordagem ancorada nos eixos: a) contextualização histórica; e b) reconhecimento do peso como a força de atração gravitacional. O primeiro eixo integra o tema no desenvolvimento cultural do ser humano, praticando a interdisciplinaridade. O segundo eixo embasa construtivamente a abordagem, levando o aluno a realizar experiências e a vivenciar o reconhecimento de uma força universal. A abordagem foi construída através das etapas: 1) análise crítica do tema em livros didáticos; 2) elaboração de um curso para professores das várias disciplinas do ensino médio, identificando conexões para a prática da interdisciplinaridade; 3) elaboração de material didático; e 4) avaliação da eficácia da abordagem. No trabalho discutimos em detalhe as quatro etapas. Como resultados, adiantamos que: tabulamos a abordagem de gravitação nos livros didáticos, ainda muito tradicional e carecedora de atividades criativas que poderiam melhor explorar esse assunto; mapeamos, junto aos professores, padrões de conceitos espontâneos e erros associados ao tema; e, no curso, adaptamos e testamos a eficiência de materiais instrucionais existentes e criamos outros novos (e.g., para trabalhar excentricidades das órbitas planetárias), além disto elaboramos roteiros e figuras para tratamentos qualitativo e quantitativo da lei da gravitação universal. As avaliações feitas pelos professores foram muito animadoras. O espaço da presente reunião será aproveitado para socializar a proposta e os resultados obtidos e para submeter o projeto à análise crítica. (PPGECNM/UFRN; PRONEX/FINEP; NUPA/USP; Temáticos/FAPESP)

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. Posttraumatic stress disorder: a special case of emergence delirium and anesthetic alternatives.

    PubMed

    Shoum, Steven M

    2014-09-01

    Two anesthesia cases are presented involving patients with a history of posttraumatic stress disorder (PTSD). The first patient experienced a prolonged dangerous flashback during emergence. In the second patient, after a thorough review of PTSD and the anesthesia literature, emergence was uneventful. A history of PTSD should be considered a risk factor in the assessment of every patient and anesthetic management designed to best avoid serious and potentially harmful reactions. PMID:25611354

  12. 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…

  13. [The concept of delirium in Spanish psychiatry (19th-20th century)].

    PubMed

    Lázaro, J

    1996-01-01

    The history of psychiatric knowledge in Spain can be divided into four differentiated periods (up to the eighteenth century; nineteenth century; first third of the twentieth century and the two final thirds). These four periods provide a framework within which theories about delusion can be explored. Spanish psychiatrists have not been very original. Nonetheless, some of them (Sanchís Banús, López Ibor, Martín Santos, Llopis, Valenciano, Sarró or Castilla del Pino) have tried to make personal contributions to the subject of delusion that deserve attention. Their theories (and some others) are reviewed in this paper. PMID:8984851

  14. 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

  15. Seasonal exposure of fish to neurotoxic pesticides in an intensive agricultural catchment, Uma-oya, Sri Lanka: linking contamination and acetylcholinesterase inhibition.

    PubMed

    Sumith, Jayakody A; Hansani, P L Chamila; Weeraratne, Thilini C; Munkittrick, Kelly R

    2012-07-01

    The annual cultivation pattern in the Uma-oya catchment in Sri Lanka is characterized by Yala and Maha rainfall periods and associated cropping. Two cultivation seasons were compared for pesticide residues: base flow, field drainage, and the runoff and supplementary sediment data for three sites in the catchment. Organophosphate and N-methyl carbamate pesticide analysis confirmed a higher concentration in the Yala season with low-flow conditions. Acetylcholinesterase (AChE) activity was measured by standard spectrometry in the brain, muscle, and eye tissues of three freshwater cyprinid fishes, Garra ceylonensis, Devario malabaricus, and Rasbora daniconius from three study sites during months overlapping two seasons in 2010 (December) and 2011 (July). Baseline AChE data were measured from fish samples from a forested reserve in the Knuckles. A 73% inhibition in muscle AChE activity in G. ceylonensis was associated with intense pesticide exposure months in the Yala season. The AChE inhibition more than 70% in G. ceylonensis eyes in both Yala (76%) and Maha (72.5%) seasons indicates particular sensitivity of eye tissue to inhibitors. The less dramatic AChE inhibition in the eye tissues in D. malabaricus and R. daniconius in both seasons indicates exemplary protective capacity of muscle AChE in fish. The highest inhibition of AChE (up to 60% in brain and up to 56% in muscle AChE activity in R. daniconius and up to 47.8% in brain and up to 64.6% in muscle AChE activity in D. malabaricus) occurred during the Yala season. Tissue AChE activity and physiological activity in fish were correlated. The results collectively indicate that AChE is a consistent biomarker for diffused contaminant exposure in agricultural catchments.

  16. 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.

  17. 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)

  18. Dynamics of an open basaltic magma system: The 2008 activity of the Halema'uma'u Overlook vent, Kīlauea Caldera

    NASA Astrophysics Data System (ADS)

    Eychenne, Julia; Houghton, Bruce F.; Swanson, Donald A.; Carey, Rebecca J.; Swavely, Lauren

    2015-01-01

    On March 19, 2008 a small explosive event accompanied the opening of a 35-m-wide vent (Overlook vent) on the southeast wall of Halema'uma'u Crater in Kīlauea Caldera, initiating an eruptive period that extends to the time of writing. The peak of activity, in 2008, consisted of alternating background open-system outgassing and spattering punctuated by sudden, short-lived weak explosions, triggered by collapses of the walls of the vent and conduit. Near-daily sampling of the tephra from this open system, along with exceptionally detailed observations, allow us to study the dynamics of the activity during two eruptive sequences in late 2008. Each sequence includes background activity preceding and following one or more explosions in September and October 2008 respectively. Componentry analyses were performed for daily samples to characterise the diversity of the ejecta. Nine categories of pyroclasts were identified in all the samples, including wall-rock fragments. The six categories of juvenile clasts can be grouped in three classes based on vesicularity: (1) poorly, (2) uniformly highly to extremely, and (3) heterogeneously highly vesicular. The wall-rock and juvenile clasts show dissimilar grainsize distributions, reflecting different fragmentation mechanisms. The wall-rock particles formed by failure of the vent and conduit walls above the magma free surface and were then passively entrained in the eruptive plume. The juvenile componentry reveals consistent contrasts in degassing and fragmentation processes before, during and after the explosive events. We infer a crude 'layering' developed in the shallow melt, in terms of both rheology and bubble and volatile contents, beneath a convecting free surface during background activity. A tens-of-centimetres thick viscoelastic surface layer was effectively outgassed and relatively cool, while at depths of less than 100 m, the melt remained slightly supersaturated in volatiles and actively vesiculating. Decoupled metre

  19. 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

  20. 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.

  1. 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

  2. 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

  3. 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

  4. 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 Colorado"…

  5. 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…

  6. 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…

  7. 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…

  8. Eclipsing SU UMa-Type Dwarf Nova 1RXS J003828.7+250920 During thE "Period Gap". I. Multiperiodicity and Color Features in 2011-2012

    NASA Astrophysics Data System (ADS)

    Pavlenko, E. P.; Sosnovskij, A. A.; Katysheva, N. A.; Kato, T.; Littlefield, K.

    2016-09-01

    Results are reported from multicolor photometric observations of the SU UMa-type dwarf nova 1RXS J003828.7+250920 in 2011, roughly a year after the super-outburst of 2010, and in 2012, when the object was in a quiescent state and underwent an outburst. Partial eclipses were observed in the system with depths of about 0m.6 in all color bands, both in the quiescent state and during the outburst. The orbital period of the system, 0.09451001(4) days, was determined for the first time and identifies the object as a dwarf nova in the "gap" in the orbital-period distribution of the cataclysmic variables. The ephemerides for the middle of the eclipse are determined. The average light curve profile resembles the "classical" light curve of U Gem. The orbital periodicity in the brightness variations of 1RXS J003828.7+250920 coexists with another signal with a period of 0.092 days, which we interpret as a period of negative superhumps. The color temperatures derived from the color indices may indicate multicomponent emission from 1RXS J003828.7+250920 by sources which appear to be hot and cold parts of the accretion disk and a hot spot on the accretion disk.

  9. Use of a Multimodal Implementation Strategy to Improve Delirium Screening by Nurses on an Acute Care for Elders Unit.

    PubMed

    Afriyie-Boateng, Mavis; Loftus, Carla; Hamelin, Mary Ann

    2015-12-01

    This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787. PMID:26460598

  10. 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.

  11. 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

  12. First multi-color photometric study and preliminary elements for the low-mass ratio, possible progenitors of merging stars, W UMa systems TYC 3836-0854-1 and TYC 4157-0683-1

    NASA Astrophysics Data System (ADS)

    Acerbi, F.; Barani, C.; Martignoni, M.

    2014-08-01

    Here we present the first CCD multi-color B, V and Ic light curves of the eclipsing binary stars TYC 3836-0854-1 and TYC 4157-0683-1, the data were obtained in four nights in the year 2010 and three nights in the year 2012 for the first one and in four nights in the year 2010 for the second one. Based on our data the short orbital periods of the systems are confirmed and revised to P = 0.4155590 days for TYC 3836-0854-1 and P = 0.3960676 days for TYC 4157-0683-1. Our observations of TYC 3836-0854-1 show symmetric light curves in all passbands with brightness in both maxima at the same level, while the light curve of TYC 4157-0683-1 appear to exhibit the typical O’Connell effect, with Maximum I brighter than Maximum II. By analyzing simultaneously the complete light curves with the 2003 version of the Wilson-Devinney code (2005 revision), photometric solutions were determined. Both the systems shows a small difference between the components temperatures of ΔT = 14 K for TYC 3836-0854-1 and ΔT = 149 K for TYC 4157-0683-1. The orbital inclination is i = 78°.6 and i = 79°.7 respectively. The systems are found to be a high fill-out, extreme mass ratio overcontact binary with a mass ratio of q = 0.206 and a fill-out factor of f = 59.2% for TYC 3836-0854-1 and q = 0.150 and a fill-out factor of f = 76.3% for TYC 4157-0683-1, suggesting that both the systems are in the late stage of overcontact evolution. It is known that deep (f>50%), low-mass ratio (q<0.25) overcontact binary stars (DLMR) are a very important resource for understanding the phenomena of Blue Straggler/FK Com-type stars that is an unsolved problem in stellar astrophysics. One of the possible explanations for their formation is from the coalescence of W UMa-type overcontact binary systems. The absolute dimensions of both the systems are estimated from the logTeff - logL diagram and their dynamical evolution is inferred.

  13. International Psychogeriatrics Paper of the year 2015: the use of modern technology to tackle an old challenge - improving the diagnosis of delirium in the hospital setting.

    PubMed

    Lautenschlager, Nicola T; Ames, David

    2016-06-01

    In 2014, International Psychogeriatrics (IPG) for the first time introduced a "paper of the month" category as part of the 25th year's milestone celebrations. Papers of the month were chosen through an internal selection process by the IPG editorial team. Each month, the seven editors ranked suitable accepted papers from the categories "original research articles" and "reviews" according to scientific quality and clinical relevance. Each paper of the month was accompanied by a brief commentary written by one of the IPG editors, one of the reviewers for the paper, or an international expert on the specific topic of the paper. From the 12 papers of the month, an IPG paper of the year was selected after a ranking process involving three independent expert reviewers. PMID:27053429

  14. Last Days of Life (PDQ)

    MedlinePlus

    ... for more information. Symptoms During the Final Months, Weeks, and Days of Life Key Points Delirium Delirium ... may get worse during the final days or weeks of life. Shortness of breath or not being ...

  15. 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,...

  16. Aging changes in the nervous system

    MedlinePlus

    ... in the brain and the buildup of lipofuscin. Delirium is sudden confusion that leads to changes in ... Saunders; 2007:chap 25. Rudolph JL, Marcantonio ER. Delirium. In: Duthie EH, Katz PR, Malone ML, eds. ...

  17. [An insane dialogue].

    PubMed

    Boer, Max; Brignole, Éric

    2015-01-01

    How should madness and in particular delusional manifestations be considered? The caregiver's perception of delirium has an impact on how they view the function of the caregiver in psychiatry. Should delirium be suppressed? Delirium is an individual phenomenon but the themes are linked to social issues. Must we not take into account everyone's "thresholds" with regard to the place of delirium, in order to make it part of "living together". Two patients of a psychiatric care system discuss these issues.

  18. [An insane dialogue].

    PubMed

    Boer, Max; Brignole, Éric

    2015-01-01

    How should madness and in particular delusional manifestations be considered? The caregiver's perception of delirium has an impact on how they view the function of the caregiver in psychiatry. Should delirium be suppressed? Delirium is an individual phenomenon but the themes are linked to social issues. Must we not take into account everyone's "thresholds" with regard to the place of delirium, in order to make it part of "living together". Two patients of a psychiatric care system discuss these issues. PMID:26564489

  19. 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.

  20. 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

  1. Estudios de clima espacial basados en observaciones solares históricas: recientes progresos y perspectivas

    NASA Astrophysics Data System (ADS)

    Vaquero, J. M.

    During the last decades, an effort has been made to improve the sunspot number time-series, one of the more useful data set for space climate stud- ies, using historical solar observations. Moreover, not only the sunspot number can be studied using these early solar records. During the last years, historical sources (i.e., sunspot drawings and solar radius measurements) have been also used to study the space climate. Here, I review some recent progress on these issues. In a hand, there are some periods with very few sunspot records and sunspot numbers are not so reliable in these intervals. I discuss the quality of sunspot records during these interesting periods: (a) 1610-1645, (b) 1721-1761, and (c) 1779-1795. On the other hand, I dis- cuss the reliability of early sunspot drawings, sunspot position data, and solar diameter determinations to study long-term variations in our Sun. Fi- nally, some information on historical documents from Argentina and Chile related with space climate are summarised. FULL TEXT IN SPANISH

  2. 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

  3. Eyecciones coronales de masa observadas en cuadratura exhibiendo sus perspectivas axial y lateral

    NASA Astrophysics Data System (ADS)

    Cabello, I.; Cremades, H.; Balmaceda, L.; Dohmen, I.

    2016-08-01

    Observations from different viewpoints provided by STEREO and SOHO allow us to simultaneously study the lateral and axial perspectives of a given coronal mass ejection. Following the exhaustive analysis of a case study, this work focuses on the analysis of similar events which exhibit the two perspectives as seen by the different instruments. Angular width estimates for both, the lateral and axial directions obtained in an indirect way, i.e. applying the graduated cylindrical shell model, allowed us to obtain a ratio / in agreement with results previously obtained in a direct way, i.e. when and were measured either separately for different events or when they were estimated for a single event from multi-point observations.

  4. 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...

  5. 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…

  6. 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)

  7. 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…

  8. 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…

  9. W UMA-Type Binary Stars in Globular Clusters

    NASA Astrophysics Data System (ADS)

    Rucinski, Slavek M.

    2000-07-01

    A sample of 86 contact binary systems in 14 globular clusters with available color index data in B-V or in V-I has been analyzed. A large fraction of all systems (at least one-third) are numerous foreground Galactic disk projections over long lines of sight to the clusters. Since the selection of the cluster members has been based on the MV(logP,color) calibrations, the matter of a metallicity correction required particular attention with the result that such a correction is apparently not needed at the present level of accuracy. Analysis of the color-magnitude and period-color relations shows that globular cluster members have different properties from the Galactic disk contact systems: They are underluminous mainly because of the smaller sizes and, consequently, have shorter orbital periods; the color-index effect of the diminished blanketing is relatively less important, especially for V-I. Among the class 1 members (deviations in MV smaller than 0.5 mag), the most common are blue straggler (BS) systems. The variability amplitudes for the BS systems show a significantly different distribution from that for systems below the turn-off point (TOP): The BS systems in the sample have only small amplitudes (which may be an indication of small mass ratios), while the distribution for the systems below the TOP is peculiar in containing only large-amplitude systems. This difference may be linked to the relatively small number of the detected main-sequence contact systems below the TOP as resulting from an observational selection effect due to the rapidly increasing measurement difficulties below the TOP. As a consequence, efforts at determining the frequency of occurrence of the contact systems below the TOP have been judged to be premature. The frequency among the BS stars could be moderately well established at about 45+/-10 BS stars per one contact BS binary; thus, contact binaries are about 3 times more common among the BS stars than among the disk population dwarfs. Contact binary systems with periods longer than 0.6 days are absent in the sample, possibly because the more massive stars have left the contact binary domain.

  10. A HOLISTIC VIEW OF THE W UMA TYPE TY BOO

    SciTech Connect

    Christopoulou, P.-E.; Papageorgiou, A.; Vasileiadis, T.; Tsantilas, S.

    2012-11-01

    New CCD four-color light curves of TY Boo made on eight nights over 2010-2011 were analyzed in comparison with historical light curves obtained from 1969 through 2011. The light curves could all be represented by a unique geometry and by wavelength consistent phototometric parameters of a two-spot model on either stellar component. It is confirmed that TY Boo is a shallow W-type contact binary system with a degree of contact factor of f = 7.6% ({+-}0.8). A period investigation based on all available data shows a long-term decrease (dP/dt = -3.65 Multiplication-Sign 10{sup -8} days yr{sup -1}) and an oscillation (P{sub 3} = 58.9 yr, A = 0.0254 days). Without ruling out the presence of a tertiary companion, the weight of evidence points to an active cyclic magnetic activity that causes spot formation rather than an unseen companion. Mass transfer between the components and angular momentum loss are also considered as possible mechanisms.

  11. 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.

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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.

  17. Reye Syndrome

    MedlinePlus

    ... without warning. It is most common during flu season. Symptoms include Nausea and vomiting Listlessness Personality change - such as irritability, combativeness or confusion Delirium Convulsions ...

  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. MedlinePlus: Cancer--Living with Cancer

    MedlinePlus

    ... Cardiopulmonary Syndrome Overview (National Cancer Institute) Also in Spanish Chemo Brain (Mayo Foundation for Medical Education and Research) Chemotherapy Effects (American Cancer Society) Delirium ( ...

  20. Blue nightshade poisoning

    MedlinePlus

    Bittersweet poisoning; Bitter nightshade poisoning; Scarlet berry poisoning; Weedy nightshade poisoning ... slow Shock LUNGS Slow breathing NERVOUS SYSTEM Delirium Fever Hallucinations Headache Loss of sensation Paralysis WHOLE BODY ...

  1. Alcohol detoxification in Ysbyty Gwynedd: Two small sips or one big gulp? Two-step screening more reliable for identification of alcohol dependency syndrome at risk of delirium tremens for routine care.

    PubMed

    Salman, Muhammad; Subbe, Christian

    2015-01-01

    Compliance with pathways for hospitalised patients with alcohol dependency syndrome is often poor. A pathway for recognition and treatment of alcohol dependency was redesigned as part of a 12 month service improvement project in the acute medical unit using plan, do, study, act (PDSA) cycles. A needs assessment was undertaken: Audit data from 2013 showed over-prescription of chlordiazepoxide for detoxification treatment (DT) leading to prolonged hospital admissions with an average length of stay of 5.5 days in 2012/2013. Acceptability of screening tools was tested: Common screening tools (CEWA, AUDIT) were rejected by junior doctors due to the high number of questions as too cumbersome for routine practice. Compliance with usage in random samples over a three month period was persistently (n=10%. Testing of an abbreviated AUDIT questionnaire with only two questions and a specified threshold showed a AUROC of 1 (p<0.001 for correct identification). The screening tool was implemented in several PDSAs cycles. After the final cycle a random sample of 100 patients was reviewed for pathway compliance over a three months period. Eighty-six patients were screened with the two-question tool of these 18 were identified as possible risk. Of these 16 patients had the full AUDIT questionnaire, only eight with elevated values were started on DT. Overall compliance with the pathway increased to 84%.

  2. 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 ...

  3. 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

  4. 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)

  5. 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)

  6. 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.

  7. 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.

  8. [Community-acquired pneumonia in the elderly].

    PubMed

    Füri, Julia; Oestmann, Andreas; Repond, Fernand

    2016-04-13

    We report the case of a 88 years old patient with cough and new onset confusion. Delirium was caused by a necrotizing Methicillin-sensible staphylococcus aureus pneumonia with bacteremia. Despite antibiotic therapy for several weeks and fall of inflammatory markers the patient died from consequences of delirium. PMID:27078731

  9. 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

  10. Controls on lava lake level at Halema`uma`u Crater, Kilauea Volcano

    NASA Astrophysics Data System (ADS)

    Patrick, M. R.; Orr, T. R.

    2013-12-01

    Lava level is a fundamental measure of lava lake activity, but very little continuous long-term data exist worldwide to explore this aspect of lava lake behavior. The ongoing summit eruption at Kilauea Volcano began in 2008 and is characterized by an active lava lake within the eruptive vent. Lava level has been measured nearly continuously at Kilauea for several years using a combination of webcam images, laser rangefinder, and terrestrial LIDAR. Fluctuations in lava level have been a common aspect of the eruption and occur over several timescales. At the shortest timescale, the lava lake level can change over seconds to hours owing to two observed shallow gas-related processes. First, gas pistoning is common and is driven by episodic gas accumulation and release from the surface of the lava lake, causing the lava level to rise and fall by up to 20 m. Second, rockfalls into the lake trigger abrupt gas release, and lava level may drop as much as 10 m as a result. Over days, cyclic changes in lava level closely track cycles of deflation-inflation (DI) deformation events at the summit, leading to level changes up to 50 m. Rift zone intrusions have caused large (up to 140 m) drops in lava level over several days. On the timescale of weeks to months, the lava level follows the long-term inflation and deflation of the summit region, resulting in level changes up to 140 m. The remarkable correlation between lava level and deflation-inflation cycles, as well as the long-term deformation of the summit region, indicates that the lava lake acts as a reliable 'piezometer' (a measure of liquid pressure in the magma plumbing system); therefore, assessments of summit pressurization (and rift zone eruption potential) can now be carried out with the naked eye. The summit lava lake level is closely mirrored by the lava level within Pu`u `O`o crater, the vent area for the 30-year-long eruption on Kilauea's east rift zone, which is 20 km downrift of the summit. The coupling of these lava levels implies an efficient hydraulic connection between the summit and east rift zone vents. This connection has been indicated previously with geophysical data and is reinforced in a new quantitative manner with lava level data. Lastly, the current lava level at the summit is significantly lower than the mean level measured in the crater during continuous lava lake activity in the early 1900s. This is probably because the ongoing eruption at Pu`u `O`o 'taps' the magma supplied to the summit reservoir. Should the Pu`u `O`o eruption stop, the lava level at the summit would certainly rise in response. The precise correspondence between lava lake level and deformation of the summit implies that the lake level is a good indication of the pressure state of the magma reservoir. Tracking lava level over time may therefore provide an indication of the potential for future changes in eruptive activity. Such an observation has clear relevance for monitoring analogous open-vent basaltic volcanoes, especially where other measures of volcanic activity, like seismic or deformation measurements, may be lacking.

  11. A photometric study of the W UMa-type binary DF Canum Venaticorum

    NASA Astrophysics Data System (ADS)

    Dai, H.-F.; Yang, Y.-G.; Yin, X.-G.

    2011-04-01

    We present new photometric observations for the eclipsing binary DF CVn, and determined five light minimum times. By using the Wilson-Devinney code, two sets of photometric solutions were deduced from our observations in 2009. The asymmetric light curves obtained on 2009 March 5 were modeled by a dark spot on the more massive component. The results indicate that DF CVn is a W-type weak-contact binary, with a mass ratio of q ˜ 0.28 and an overcontact degree of f ˜ 20%. From the O - C curve of minimum times, it is found that there exists a cyclic variation, whose period and semi-amplitude are P3 = 17.2(±0.9) year and A = 0. d0070(±0. d0008), respectively. This kind of cyclic oscillation may possibly result from the light-time effect due to the presence of an unseen third body. This kind of additional body may extract angular momentum from the central system. The low-amplitude changes of the light curves on a short-time scale (e.g., half a month) may be attributed to the dark spot activity, which may result in angular momentum loss via magnetic breaking. With angular momentum loss, the weak-contact binary DF CVn will evolve into a deep-contact configuration.

  12. The First Photometric Investigation of the Neglected W-UMa-Type Binary Star V532 Monocerotis

    NASA Astrophysics Data System (ADS)

    He, J.-J.; Qian, S.-B.; Soonthornthum, B.

    2016-11-01

    The first two sets of complete charge-coupled device light curves in the B and V bands of the short-period binary system, V532 Mon, are presented. The light curves are analyzed with spot models using the Wilson–Devinney code. V532 Mon is found to be an A-subtype intermediate-contact binary with a degree of contact factor of f=47.1 % (+/- 2.7 % ), a mass ratio of q=0.2502(+/- 0.0019), and a cool spot on the primary component. The period changes of the system are investigated by combining newly determined times of light minimum with others published in the literature. We found that the general trend of the observed-calculated (O-C) curve shows a downward parabolic variation that corresponds to a long-term decrease in the orbital period at a rate of {dP}/{dt}=-1.716(+/- 0.002)× {10}-7{dyr} ‑1. The long-term decrease of the orbital period can be explained by mass transfer from the more-massive component to the less massive one. The long-time period decrease, the intermediate-contact configuration, and the astrophysical parameters of the binary system suggest that V532 Mon will evolve into high fill-out, extreme mass-ratio overcontact binaries.

  13. The photometric investigation of the newly discovered W UMa type binary system GSC 03122-02426

    NASA Astrophysics Data System (ADS)

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

    2016-10-01

    The B V Rc Ic bands light curves of the newly discovered binary system GSC 03122-02426 are obtained and analyzed using the Wilson-Devinney (W-D) code. The solutions suggest that the mass ratio of the binary system is q = 2.70 and the less massive component is 422 K hotter than the more massive one. We conclude that GSC 03122-02426 is a W-subtype shallow contact (with a contact degree of f = 15.3 %) binary system. It may be a newly formed contact binary system which is just under geometrical contact and will evolve to be a thermal contact binary system. The high orbital inclination (i = 81 .6∘) implies that GSC 03122-02426 is a total eclipsing binary system and the photometric parameters obtained by us are quite reliable. We also estimate the absolute physical parameters of the two components in GSC 03122-02426, which will provide fundamental information for the research of contact binary systems. The formation and evolutionary scenario of GSC 03122-02426 is discussed.

  14. VizieR Online Data Catalog: Radial velocities of TX UMa (Komzik+, 2008)

    NASA Astrophysics Data System (ADS)

    Komzik, R.; Chochol, D.; Grygar, J.

    2012-03-01

    Our spectroscopy of TXUMa consist of: * 96 spectra taken by JG with the Cassegrain spectrograph of the 1.8m telescope at the DAO Observatory in the period December 1969 - July 1970. * 52 spectra taken by JG in 1972-80 and 7 spectra taken by RK in 1992-93 with the coude spectrograph of the 2.0m telescope at the Ondrejov Observatory. (1 data file).

  15. 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

  16. Spot activity on HD 89546 (FG UMa) from long-term photometry

    NASA Astrophysics Data System (ADS)

    Özdarcan, O.; Evren, S.; Henry, G. W.

    2012-02-01

    We present the analysis of 20 years of time-series BV photometry of the SB1 RS CVn binary HD 89546. The system's yearly mean V brightness, the B-V color index, the photometric period, and the light curve amplitude all show clear cyclic variability with an ≈9-year time scale. We also find some evidence for brightness variability on a time scale longer than the 20-year time span of our observations, perhaps indicating a longer cycle analogous to the solar Gleissberg cycle. We estimate the unspotted V magnitude of HD 89546 to be 7.154m, which is ≈0.2m brighter than the observed maximum brightness. Spot modelling of the system shows that spot temperature variations affect the observed B-V color as well as the V brightness. Two active longitudes are observed, centered around 180° and 360° longitude on the G9 III primary, each covering a longitude range of 120°. Furthermore, two inactive longitude zones are seen spanning only 60° between the two active longitudes. The longitudinal distribution of the spots exhibits no strong cyclic variability but does show rapid jumps of 120° that look like the flip-flop phenomenon. We estimate the differential rotation coefficient of the star as k=0.086 by considering the range of observed photometric period variations and assumed latitudinal spot variations over 45°. Based on data obtained with the Tennessee State University T3 0.4 m APT at Fairborn Observatory, operated by Tennessee State University, and T30 0.3 m telescope of the Ege University Observatory in Izmir.

  17. 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.

  18. Discovery of four W UMa type eclipsing binaries in the field of open cluster ASCC 5

    NASA Astrophysics Data System (ADS)

    Fang, Xiang-Song; Gu, Sheng-Hong; Zhang, Li-Yun; Pi, Qing-Feng

    2013-09-01

    We carried out time-series photometric observations in the Rc-band of the young, poorly studied open cluster ASCC 5 during November and December, 2012, to search for magnetically active stars, and discovered four eclipsing binary stars in this field. In order to characterize these four newly discovered binaries, we derived their orbital periods by their times of light minimum, estimated their effective temperatures based on their (J — H) colors and analyzed their light curves using the Wilson-Devinney light curve modeling technique. Our analyses reveal that all of them are contact binaries with short orbital periods of less than 0.5 d, with spectral types from late-F to mid-K. Among them, one is a typical A subtype contact binary with a mass ratio around 0.5 and a period of 0.44 d, and one is an H subtype contact binary with a high mass ratio around 0.9 and a short period of about 0.27 d. The other two systems show low amplitudes of light variation (ARc <=0.11m) their actual photometric mass ratios could not be determined by the light curve modelings, probably due to their attributes of being partially eclipsing stars. A preliminary analysis for these two systems indicates that both of them are likely to be W subtype contact binaries with low orbital inclinations. In addition, both of these two low amplitude variables show asymmetric distorted light curves (e.g., O'Connell effect of ΔRc ≃0.02m) during the observing runs, suggesting the presence of starspots on these two systems. More interestingly, the one showing a large case of the O'Connell effect presented a remarkable variation in the shape of the light curve on a time scale of one day, indicating that this star is in a very active state. Therefore, these two stars need spectroscopic observations to precisely determine their parameters, as well as further photometric observations to understand the properties of their magnetic activity, e.g., the evolution of starspots.

  19. 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.

  20. 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.

  1. 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.

  2. DEL-FINE: a new tool for assessing the delirogenic properties of drugs of relevance for European pharmacotherapy.

    PubMed

    Böhmdorfer, Birgit; Rohleder, Sonja; Wawruch, Martin; van der Cammen, T J M; Frühwald, Thomas; Jagsch, Christian; Janowitz, Susanne Melitta Maria; Nagano, Marietta; Petrovic, Mirko; Sommeregger, Ulrike; Iglseder, Bernhard

    2016-07-01

    This article presents a list of potentially delirogenic properties of drugs that are currently of relevance to drug therapy in Europe, which was created through a Delphi process including experts from professions relevant to diagnosis and treatment of delirium. The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5) defines delirium as a disturbance in attention, awareness and cognition that develops over a short period of time and fluctuates. Possible causes of delirium are manifold: usually delirium is considered to develop in a multifactorial way, caused by inalterable parameters, such as advanced age and pre-existing cognitive impairment and precipitated by modifiable parameters, such as the use of certain drugs or substance withdrawal. Delirium is a serious condition with a pronounced impact on morbidity, mortality and costs to the healthcare system. Circumstances and drugs that might precipitate or worsen delirium should therefore be avoided whenever possible. A list of drugs that might have a detrimental influence on the emergence and duration of delirium has been created using the terms "delirogenity" and "delirogenic" to describe the potential of a drug or withdrawal to cause or worsen delirium. The results are novel and noteworthy, as their focus is on substances relevant to European pharmacotherapy. Furthermore, they represent a methodical consensus from a group of experts of a wide variety of professions relevant to the prevention, diagnosis and treatment of delirium, such as nursing, pharmacy, pharmacology, surgical and internal medicine, neurology, psychiatry, intensive care and medicine, with working, teaching and scientific experience in several European countries practicing both in primary and secondary care. PMID:26286077

  3. DEL-FINE: a new tool for assessing the delirogenic properties of drugs of relevance for European pharmacotherapy.

    PubMed

    Böhmdorfer, Birgit; Rohleder, Sonja; Wawruch, Martin; van der Cammen, T J M; Frühwald, Thomas; Jagsch, Christian; Janowitz, Susanne Melitta Maria; Nagano, Marietta; Petrovic, Mirko; Sommeregger, Ulrike; Iglseder, Bernhard

    2016-07-01

    This article presents a list of potentially delirogenic properties of drugs that are currently of relevance to drug therapy in Europe, which was created through a Delphi process including experts from professions relevant to diagnosis and treatment of delirium. The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5) defines delirium as a disturbance in attention, awareness and cognition that develops over a short period of time and fluctuates. Possible causes of delirium are manifold: usually delirium is considered to develop in a multifactorial way, caused by inalterable parameters, such as advanced age and pre-existing cognitive impairment and precipitated by modifiable parameters, such as the use of certain drugs or substance withdrawal. Delirium is a serious condition with a pronounced impact on morbidity, mortality and costs to the healthcare system. Circumstances and drugs that might precipitate or worsen delirium should therefore be avoided whenever possible. A list of drugs that might have a detrimental influence on the emergence and duration of delirium has been created using the terms "delirogenity" and "delirogenic" to describe the potential of a drug or withdrawal to cause or worsen delirium. The results are novel and noteworthy, as their focus is on substances relevant to European pharmacotherapy. Furthermore, they represent a methodical consensus from a group of experts of a wide variety of professions relevant to the prevention, diagnosis and treatment of delirium, such as nursing, pharmacy, pharmacology, surgical and internal medicine, neurology, psychiatry, intensive care and medicine, with working, teaching and scientific experience in several European countries practicing both in primary and secondary care.

  4. 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.

  5. [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).

  6. 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

  7. 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 Vargas; (2)…

  8. 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.

  9. 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.

  10. 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…

  11. 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)…

  12. 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…

  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. 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…

  15. 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…

  16. 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

  17. Anxiety

    MedlinePlus

    ... the Experts Tools & Tips Latest Research Related Topics COPD Delirium Dementia Depression Drug and Substance Abuse High Blood Pressure Join our e-newsletter! Aging & Health A to Z Anxiety Basic Facts & Information ...

  18. 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

  19. 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

  20. 75 FR 3165 - Vocational Rehabilitation and Employment Program-Periods of Eligibility

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-20

    ... (74 FR 9975). We proposed to amend VA's regulations in 38 CFR Part 21, Subpart A--Vocational... habitual intoxication, withdrawal, delirium, amnesia, dementia, and other like manifestations that:...

  1. American Academy of Child and Adolescent Psychiatry

    MedlinePlus

    ... aacap.org for questions. Be CAPtivated - Child and Adolescent Psychiatry as a Career AACAP's Current Award Opportunities ... More... AACAP Workforce Maps More... Delirium in Children & Adolescents More... Issues to Consider When Engaging Asian American ...

  2. 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.

  3. 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

  4. 38 CFR 4.126 - Evaluation of disability from mental disorders.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ..., dementia, and amnestic and other cognitive disorders shall be evaluated under the general rating formula...., a head injury) shall be evaluated separately and combined with the evaluation for delirium,...

  5. 38 CFR 4.126 - Evaluation of disability from mental disorders.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ..., dementia, and amnestic and other cognitive disorders shall be evaluated under the general rating formula...., a head injury) shall be evaluated separately and combined with the evaluation for delirium,...

  6. 38 CFR 4.126 - Evaluation of disability from mental disorders.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ..., dementia, and amnestic and other cognitive disorders shall be evaluated under the general rating formula...., a head injury) shall be evaluated separately and combined with the evaluation for delirium,...

  7. 38 CFR 4.126 - Evaluation of disability from mental disorders.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ..., dementia, and amnestic and other cognitive disorders shall be evaluated under the general rating formula...., a head injury) shall be evaluated separately and combined with the evaluation for delirium,...

  8. 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 ...

  9. 21 CFR 250.12 - Stramonium preparations labeled with directions for use in self-medication regarded as misbranded.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... purpose of producing hallucinations. Reports of such use have been received from physicians and police and... including toxic delirium, visual disturbances, fever, and coma. A number of serious reactions have...

  10. 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.

  11. 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

  12. A Proposta Jesuitica de Educacao: Uma Leitura das Constituicoes (The Jesuit Proposal of Education: A Reading of the Constitutions).

    ERIC Educational Resources Information Center

    de Paiva, Jose Maria; Puentes, Roberto Valdes

    2000-01-01

    Seeks to understand the Jesuit education proposal in the reforming context from which it came. States that the Constitutions established the renewing function of school education based on the sacred vision of the world: God is placed as the ultimate end, and objectives are learning, formation of good customs, and apostleship. (BT)

  13. Fast stochastic variability study of two SU UMa systems V1504 Cyg and V344 Lyr observed by Kepler satellite

    NASA Astrophysics Data System (ADS)

    Dobrotka, A.; Ness, J.-U.; Bajčičáková, I.

    2016-07-01

    We analysed Kepler data of two similar dwarf novae V344 Lyr and V1504 Cyg in order to study optical fast stochastic variability (flickering) by searching for characteristic break frequencies in their power density spectra. Two different stages of activity were analysed separately, i.e. regular outbursts and quiescence. Both systems show similar behaviour during both activity stages. The quiescent power density spectra show a dominant low break frequency which is also present during outburst with a more or less stable value in V344 Lyr while it is slightly higher in V1504 Cyg. The origin of this variability is probably the whole accretion disc. Both outburst power density spectra show additional high-frequency components which we interpret as generated by the rebuilt inner disc that was truncated during quiescence. Moreover, V344 Lyr shows the typical linear rms-flux relation which is strongly deformed by a possible negative superhump variability.

  14. 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

  15. BVRI Photometric Study of the Totally Eclipsing Short Period Solar Type, Near-Contact W UMA Binary, NSVS 5066754

    NASA Astrophysics Data System (ADS)

    Caton, Daniel B.; Samec, Ronald G.; Nyaude, Ropafadzo; Faulkner, Danny R.

    2016-06-01

    High precision BVRcIc light curves of NSVS 5066754 were observed on May 17-20, 2014 at Dark Sky Observatory in North Carolina with the 0.81-m reflector of Appalachian State University. It is a solar type eclipsing binary (T1~5750 K) with a period of only 0.375132 (1) d. In fact, it appeared as one of the shortest period in Shaw’s list of near contact binaries. Therefore, we initially believed this to be a pre-contact WUMa Binary (PCWB’s). However, the Binary Maker fits and our Wilson-Devinney solutions show that the binary could have either a semi-detached or a contact binary configuration.Five times of minimum light were calculated, for 3 primary and 2 secondary eclipses from our present observations: In addition, observations at minima were introduced from archived All Sky Automated Survey Data along with the discovery ephemeris. The following decreasing quadratic ephemeris was determined from all available times of minimum light:JDHelMinI=2456797.63848±0.00047d + 0.3747796± 0. 0000068 X E --0.0000000241± 0.0000000005X E2Our contact solution, with a sum of square residuals = 0.49, gave a mass ratio of 0.50, and a component temperature difference of ~360 K, somewhat large for a contact binary. Two substantial cool spots were determined in this solution of 37 deg and 28 deg radius with a t-factor or 0.92 and 0.78 respectively. The fill-out is very shallow, ~6%.The semi-detached solution (mode 4: V1010 Oph configuration, meaning the system is approaching first contact) is of poorer quality with a sum of square residuals = 0.87. It has a mass ratio of 0.63, and a component temperature of ~460 K. The fill-outs are 100% and 97% for the primary and secondary components, respectively. Two spots were determined, one hot (t-factor of 1.16, 14 deg radius, colatitude 101 deg) and one cool spot (t-factor of 0.94, 48 deg radius, colatitude 90 deg). The models in both cases are total eclipsing with high inclinations in the 86-89 deg range, and a time of constant light is found in the secondary eclipse. Since the period study would indicate that the binary may be coalescing, both solutions fit that scenario. The system may have just come into contact or is approaching contact. The first model is more probable.

  16. A clinical study of febrile myoclonus in children.

    PubMed

    Onoe, Sachiko; Nishigaki, Toshinori

    2004-08-01

    Fever is sometimes associated with chill, myoclonus, delirium and convulsion. We previously reported EEG findings of febrile delirium, when we found that 18% of patients showed febrile myoclonus simultaneously with febrile delirium. The purpose of this study is to clarify the clinical features of febrile myoclonus and to investigate the relation to febrile convulsion. Myoclonic episodes were studied in 11 patients, aged 8 months to 11 years. EEG was recorded in eight patients. In the past history, febrile convulsion was noted in two patients and one of them also had febrile delirium. The age range of patients with febrile myoclonus was similar to those developing febrile convulsion except for one case. The duration of febrile myoclonus was usually from several to 30 min, but was longer than 2 h in four patients. Seventy-three percent of patients showed fear, surprise and shouting. EEG was abnormal in four patients and spike components were found in two patients. Myoclonic jerks were seen during the EEG recording in two patients and EEG findings were not concordant with epileptic myoclonic attack. Ten patients were followed for 1-2 years, and none had afebrile seizures. Febrile myoclonus is a benign symptom associated with fever. Mood change, fear or surprise and shouting with myoclonic jerks may suggest action of cytokine on the hypothalamus induced by infection. Febrile myoclonus, delirium and convulsion were seen in one patient in his first 3 years of life. These three symptoms seem to appear in children depending on their predisposition. PMID:15165673

  17. 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

  18. 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.

  19. 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.

  20. [Drug-induced Cognitive Impairment].

    PubMed

    Shinohara, Moeko; Yamada, Masahito

    2016-04-01

    Elderly people are more likely than young people to develop cognitive impairments associated with medication use. One of the reasons for this is that renal and liver functions are often impaired in elderly people. Dementia and delirium (an acute confused state) are known to be associated with drug toxicity. Anticholinergic medications are common causes of both acute and chronic cognitive impairment. Psychoactive drugs, antidepressants and anticonvulsants can cause dementia and delirium. In addition, non-psychoactive drugs such as histamine H2 receptor antagonists, corticosteroids, NSAIDs (nonsteroidal anti-inflammatory agent), and cardiac medications, may cause acute or chronic cognitive impairment. Early diagnosis and withdrawal of the offending agent are essential for the prevention of drug-induced dementia and delirium. PMID:27056860

  1. Psychiatric complications in the critically ill cardiac patient.

    PubMed Central

    Sanders, K M; Cassem, E H

    1993-01-01

    Psychiatric consultation to the critically ill cardiac patient focuses on several common problems: anxiety, delirium, depression, personality reactions, and behavioral disturbances. A review of the causes and treatment of anxiety in the coronary care unit is followed by a discussion of delirium in the critically ill cardiac patient. A description of delirium associated with the use of the intraaortic balloon pump and its treatment with high doses of intravenous haloperidol is also included. After the initial crisis has been stabilized in the critical care unit, the premorbid personality traits of the patient may emerge as behavioral disturbances--particularly as the duration of stay increases. The use of psychiatric consultation completes the discussion. PMID:8219821

  2. 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

  3. Withdrawal syndrome after donepezil cessation in a patient with dementia.

    PubMed

    Bidzan, Leszek; Bidzan, Mariola

    2012-12-01

    We describe a 62-year-old female diagnosed with Alzheimer's disease, who had been treated with donepezil for approximately 1 year. When she developed a low-grade fever and digestive complaints, her family physician interpreted these symptoms as side effects of the drug and ordered donepezil to be discontinued. Not only was there no improvement of the somatic symptoms after discontinuation of donepezil, but there was also a worsening of the dementia symptoms, culminating in delirium. When donepezil was re-prescribed, the delirium resolved and the patient's mental state stabilized. The authors urge great caution in discontinuing treatment with acetylcholinesterase inhibitors such as donepezil. PMID:22249402

  4. 'Alice in Wonderland' syndrome and Lilliputian hallucinations in a patient with a substance-related disorder.

    PubMed

    Takaoka, K; Takata, T

    1999-01-01

    The present paper describes a patient who exhibited 'Alice in Wonderland' (AIW) syndrome as well as Lilliputian hallucinations. The patient regularly consumed a cough syrup that contained dihydrocodein phosphate and dl-methylephedrine hydrochloride over 3 years. At the age of 46, he developed AIW syndrome. The patient ingested a large dose of triazolam and exhibited delirium. Even after the disappearance of symptoms associated with AIW syndrome and delirium, the patient continued to experience Lilliputian hallucinations. We believe that these hallucinations were caused by some of the components of the cough syrup. PMID:9885400

  5. Central pontine myelinolysis in a case of alcohol dependence syndrome

    PubMed Central

    Chatterjee, Kaushik; Fernandes, Austin B.; Goyal, Sunil; Shanker, Sunitha

    2015-01-01

    Osmotic Demyelination Syndrome includes Central Pontine Myelinolysis and Extrapontine Myelinolysis. This condition has been described in cases of chronic Alcohol Dependence Syndrome and in rapid correction of hyponatremia. Though we frequently see patients with Alcohol Dependence Syndrome presenting with complicated withdrawal, Central Pontine Myelinolysis remains largely undetected and under-reported in literature. We present here a case of protracted Delirium Tremens where MRI brain revealed Central Pontine Myelinolysis. Subsequently cognitive assessment revealed significant dysfunction and brain SPECT showed hypo-perfusion of the frontal lobes. Osmotic Demyelination Syndrome should be suspected in protracted Delirium Tremens. PMID:27212829

  6. [Sultopride in acute manic psychoses (author's transl)].

    PubMed

    Rappard, P; Parr, N

    Sultopride, a benzamide derivative, provides rapid sedation. This makes it one of the main drugs used in psychiatric emergencies. Our study includes 26 cases of psychomotor hyperactivity originating in manic-depressive psychosis of schizophrenia. The medication had no effect on wakefulness. It was always effective on agitation but not on delusion or hallucinations. Manic forms of primary delirious experiences are the best indication for sultopride. It is mainly effective on delirium as a state rather than on delirium as an idea (Wahn, Delusion) which is secondary from a pathogenetic standpoint.

  7. Intensive Care Unit Psychosis

    PubMed Central

    Monks, Richard C.

    1984-01-01

    Patients who become psychotic in intensive care units are usually suffering from delirium. Underlying causes of delirium such as anxiety, sleep deprivation, sensory deprivation and overload, immobilization, an unfamiliar environment and pain, are often preventable or correctable. Early detection, investigation and treatment may prevent significant mortality and morbidity. The patient/physician relationship is one of the keystones of therapy. More severe cases may require psychopharmacological measures. The psychotic episode is quite distressing to the patient and family; an educative and supportive approach by the family physician may be quite helpful in patient rehabilitation. PMID:21279016

  8. Inclusion of carers when confused relatives are admitted to hospital.

    PubMed

    Barber, Jeanette

    2015-06-01

    It is well recognised that many older people have dementia but have never been investigated or received a formal diagnosis. If they are admitted to acute hospitals from their own homes or long-term care settings with confusion and little background information about their usual condition, it can be challenging for staff to determine if they have dementia, delirium, delirium superimposed on pre-existing dementia or confusion with a reversible cause such as vitamin deficiency. A careful history and information seeking from carers or family members about their loved one's pre-admission baseline can inform nursing and medical assessments and help nurses to provide high quality care. PMID:26018488

  9. Sedation options for intubated intensive care unit patients.

    PubMed

    Lacoske, Jennifer

    2015-03-01

    A common requirement for intubated patients in the intensive care unit (ICU) is sedation and pain management to facilitate patient safety and timely, atraumatic healing. The Society of Critical Care Medicine guidelines for management of pain, sedation, and delirium in adult ICU patients provide assessment scales for pain, sedation, and delirium; medications for sedation and pain management, and protocols for weaning sedation, are discussed. Proficient assessment skills, pharmacologic knowledge of medications administered to provide sedation, and an understanding of the importance of nonpharmacologic interventions can help the registered nurse provide patient advocacy, safety, and improved outcomes.

  10. A case of psychosis due to Fahr's syndrome and response to behavioral disturbances with risperidone and oxcarbazepine

    PubMed Central

    Faye, Abhijeet Dhawalram; Gawande, Sushil; Tadke, Rahul; Kirpekar, Vivek C.; Bhave, Sudhir H.

    2014-01-01

    Calcification of basal ganglia or Fahr's syndrome is a rare disease characterized by bilateral and symmetrical intracranial deposition of calcium mainly in cerebral basal ganglia. Motor and neuropsychiatric symptoms are prominent features. We report a case presented with a few motor symptoms, features of delirium and prominent psychiatric symptoms (disorganized behavior) predominantly evident after the improvement in delirium. Radiological findings were suggestive of bilateral basal ganglia calcification. Parathyroid hormone levels were low with no significant findings in other investigations and negative family history. Patient showed significant improvement in behavioral disturbances with risperidone, low dose of lorazepam, oxcarbazepine, and memantine. PMID:24891710

  11. 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.

  12. 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…

  13. 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…

  14. 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'…

  15. 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…

  16. 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…

  17. Ensino de astronomia no 1o. e 2o. ciclos do nível fundamental e na educação de jovens e adultos: exemplos e discussões

    NASA Astrophysics Data System (ADS)

    Queiroz, A. S. B.; Jafelice, L. C.

    2003-08-01

    Tem-se constatado uma preocupante carência no ensino de astronomia nos diversos níveis de escolaridade. Neste trabalho discutimos várias práticas didático-pedagógicas que vimos desenvolvendo para crianças, jovens e adultos em processo de alfabetização, visando contribuir para reparar aquela carência. Propomos uma metodologia que incorpora as recentes exigências das políticas públicas educacionais, estimula o desenvolvimento de textos e materiais instrucionais, é compatível com a realidade desse público e é adaptável às respectivas faixas etárias. A observação do céu sempre esteve presente na vida de nossos antepassados, dando suporte à compreensão do ser humano como integrante da natureza. Visamos com este trabalho suprir a deficiência encontrada para se tratar a relação do ser humano com o céu, no ambiente escolar. Os resultados são animadores e envolvem práticas e textos que desenvolvemos e atividades realizadas pelos alunos. No primeiro grupo destacamos o desenvolvimento de várias práticas: "viagem aos planetas" (construímos o "foguete", os planetas em escala, contamos história e redigimos texto de orientação para os professores); "gnômon humano" (os próprios corpos dos alunos são usados para registrar o movimento aparente do Sol); "crateras da Lua" (concretização de "meteoritos" e "solo lunar" de gesso e exploração da relação entre energia cinética do bólido e tamanho da cratera formada); etc. No segundo grupo, produções de desenhos e redações e discussões dos alunos após a realização de cada prática, revelam que estas têm se mostrado muito eficientes, tanto para estimular a imaginação e a fantasia dos envolvidos, como para trabalhar-se habilidades, competências e conteúdos relacionados à astronomia, segundo uma perspectiva interdisciplinar contextualizada. (PPGECNM/UFRN; NUPA/USP; Temáticos/FAPESP)

  18. Drug and Substance Abuse

    MedlinePlus

    ... Latest Research Getting More Help Related Topics Anxiety COPD Delirium Depression Pain Management Prevention Related News Older Adults Who Drink Alcohol at Risk for Drug Interactions Monday, November 23, 2015 Join our e-newsletter! Aging & Health A to Z Drug and Substance Abuse ...

  19. 75 FR 73104 - Clinical Development Programs for Sedation Products; Request for Assistance

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-29

    ... trials? Are subjective and objective assessments of memory, recall, anxiety, agitation, delirium, among... purposes and not to treat an anxiety disorder or agitation? Should there be different scales for assessing... affect anxiety in a procedural sedation setting that would have to be standardized (e.g., physician...

  20. 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...

  1. 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 contemporary…

  2. 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…

  3. 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

  4. Cerebellar ataxia with recovery related to central pontine myelinolysis.

    PubMed

    Steller, U; Koschorek, F; Strenge, H

    1988-07-01

    Development of severe ataxia and mild pyramidal signs without mental deterioration, tetraparesis or pseudobulbar palsy during recovery from withdrawal delirium and initial hyponatraemia are unusual clinical features consistent with central pontine myelinolysis. This diagnosis was confirmed by magnetic resonance imaging (MRI) in an alcoholic man. Clinical and electrodiagnostic improvement occurred, whereas the MRI findings remained unchanged in a follow-up study. PMID:3171622

  5. “I Can Remember Sort of Vivid People…but to Me They Were Plasticine.” Delusions on the Intensive Care Unit: What Do Patients Think Is Going On?

    PubMed Central

    Greig, Paul R.; Vollam, Sarah; Young, J. Duncan; Hinton, Lisa

    2016-01-01

    Introduction Patients who develop intensive care unit (ICU) acquired delirium stay longer in the ICU, and hospital, and are at risk of long-term mental and physical health problems. Despite guidelines for patient assessment, risk limitation, and treatment in the ICU population, delirium and associated delusions remain a relatively common occurrence on the ICU. There is considerable information in the literature describing the incidence, suspected causes of, and discussion of the benefits and side-effects of the various treatments for delirium in the ICU. But peer-reviewed patient-focused research is almost non-existent. There is therefore a very limited understanding of the reality of delusions in the intensive care unit from the patient’s point of view. Method A secondary analysis of the original interviews conducted by the University of Oxford Health Experiences Research Group was undertaken to explore themes relating specifically to sleep and delirium. Results Patients describe a liminal existence on the ICU. On the threshold of consciousness their reality is uncertain and their sense of self is exposed. Lack of autonomy in an unfamiliar environment prompts patients to develop explanations and understandings for themselves with no foothold in fact. Conclusion Patients on the ICU are perhaps more disoriented than they appear and early psychological intervention in the form of repeated orientation whilst in the ICU might improve the patient experience and defend against development of side-effects. PMID:27096605

  6. Clinical pharmacology of old age syndromes

    PubMed Central

    Broadhurst, C; Wilson, K C M; Kinirons, M T; Wagg, A; Dhesi, J K

    2003-01-01

    Several syndromes occur in old age. They are often associated with increased mortality and in all there is a paucity of basic and clinical research. The recent developments in the clinical pharmacology of three common syndromes of old age (delirium, urinary incontinence, and falls) are discussed along with directions for future research. PMID:12919174

  7. 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.…

  8. 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)

  9. 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…

  10. Severe psychological disturbance resulting from abuse of nasal decongestants.

    PubMed

    Blackwood, G W

    1982-04-01

    A case is reported in which a lady suffered long-term personality change, a paranoid psychosis of several months duration, and an acute delirium, secondary to abuse of Vicks Sinex Nasal Spray and Vicks Vaporub. The problems were reversible on withdrawal of these well used products which have not previously been reported to cause psychological disturbance.

  11. 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…

  12. Excelência em bancos de leite humano: uma visão do futuro--the First International Congress on Human Milk Banking.

    PubMed

    Tully, M R

    2001-02-01

    The first International Congress of Human Milk Banks--Excellence in Human Milk Banking: A Vision of the Future, held in Brazil in June 2000 and sponsored by the Brazilian Association of Milk Banks, had representation from milk banks in Argentina, Chile, Costa Rica, Venezuela, France, the United Kingdom, and North America as well as Brazil. A recurring theme in the discussion of donor milk banking was the role of each country's milk banks in the promotion and support of breastfeeding. The Brazilian National Reference Milk Bank and the growth of donor milk banking in Brazil over the past 15 years were described, including federal regulation that all milk bank directors be trained and certified. Milk banking systems in France, the United Kingdom, Venezuela and the Caribbean, and North America were also discussed. Similarities and differences in the donor screening process and the regulation of milk banks in the countries is presented.

  13. Uma Comparação entre Técnicas de Propagação de Erros em Astrofísica: Monte Carlo x Bootstrap

    NASA Astrophysics Data System (ADS)

    Zabot, Alexandre; Baptista, Raymundo

    2005-07-01

    Neste trabalho é feito um estudo comparativo entre dois algoritmos numéricos usados para propagação de erros em dados experimentais. Um deles é conhecido por Método de Monte carlo e o outro por Método de Bootstrap. Recentemente, Dhullon & Watson argüiram que a aplicação do método de Monte Carlo introduz ruído nos dados, e propuseram então a utilização do Bootstrap como alternativa capaz de produzir resultados superiores. O objetivo deste trabalho é testar a validade dessa afirmação. As duas técnicas foram aplicadas a três problemas diferentes: o ajsute de modelos de emissão LTE simples e atmosfera estelar a espectros estelares observados e o ajuste de curvas de luz de eclipses de Variáveis Cataclísmicas para a detemrinação da distribuição radial de brilho dos seus discos de acréscimo. Os métodos foram testados quanto à sua robusteza, ou seja, a capacidade de prover resultados coerentes enre si. Além disso, as soluções dos métodos foram comparadas. Os resultados indicam que não existe evidência de superioridade de um métodos em relação ao outro.

  14. Photometric solution and evolutionary state for the newly discovered W UMa systems GSC-02137-0222 and USNO-A2.0 1200-18678842

    NASA Astrophysics Data System (ADS)

    Elkhateeb, M. M.; Nouh, M. I.

    2015-01-01

    Photometric analysis for the newly discovered systems GSC-02137-0222 and USNO-A2.0 1200-18678842 were carried out using the most recent version of the Wilson and Devinney code based on model atmospheres by Kurucz (1993) and a pass band prescription has been used for the radiative treatment. Parameters of the accepted solution were calculated for both systems and the spectral type of the components of the studied systems were adopted. Distance to each system was calculated and physical properties were estimated. Locations of the two systems on the theoretical mass-luminosity and mass radius relations revealed good fit for both components of GSC-02137-0222, good fit for the primary and poor fir for the secondary component of the system USNO-A2.0 1200-18678842.

  15. "Canteiro Escola"--Uma Resposta da Industria da Construcao no Contexto Produtivo Atual (The "Building Site" School--A Construction Industry Answer in the Actual Productive Context).

    ERIC Educational Resources Information Center

    Barone, Rosa Elisa; Letelier, Maria Eugenia

    1995-01-01

    Presents examples of the discourse of construction industry personnel involved in workplace basic education in Brazil. Reports on the perspective of the workers/students and on the experiences and the vision of those who implement the educational programs. Identifies the limits of the schooling process and the difficulties inherent in the present…

  16. The effect of a quality improvement intervention on perceived sleep quality and cognition in a medical ICU

    PubMed Central

    Kamdar, Biren B.; King, Lauren M.; Collop, Nancy A.; Sakamuri, Sruthi; Colantuoni, Elizabeth; Neufeld, Karin J.; Bienvenu, O. Joseph; Rowden, Annette M.; Touradji, Pegah; Brower, Roy G.; Needham, Dale M.

    2012-01-01

    Objective To determine if a quality improvement (QI) intervention improves sleep and delirium/cognition. Design Observational, pre-post design. Setting A tertiary academic hospital in the US. Patients 300 medical ICU (MICU) patients. Interventions This MICU-wide project involved a “usual care” baseline stage, followed by a QI stage incorporating multi-faceted sleep-promoting interventions implemented with the aid of daily reminder checklists for ICU staff. Measurements and Main Results Primary ICU outcomes were perceived sleep quality and noise ratings (measured on a 0-100 scale using the valid and reliable Richards-Campbell Sleep Questionnaire [RCSQ]) and delirium/coma-free days. Secondary outcomes included ICU and hospital length of stay and mortality. Post-ICU measures of cognition and perceived sleep quality were evaluated in an ICU patient subset. During the baseline and sleep QI stages there were 122 and 178 patients, respectively, with >1 night in the ICU, accounting for 634 and 826 patient-days. Within the groups, 78 (63.9%) and 83 (46.6%) patients received mechanical ventilation. Over the 826 patient-day QI period, checklist item completion rates ranged from 86-94%. In multivariable regression analysis of the QI vs. baseline stages, improvements in overall RCSQ sleep quality ratings did not reach statistical significance, but there were significant improvements in daily noise ratings (mean ± standard deviation: 65.9 ± 26.6 vs. 60.5 ± 26.3, P=0.001), incidence of delirium/coma (odds ratio: 0.46; 95% confidence interval, 0.23-0.89; P=0.02), and daily delirium/coma-free status (odds ratio: 1.64; 95% confidence interval, 1.04-2.58; P=0.03). Improvements in secondary ICU outcomes and post-ICU outcomes did not reach statistical significance. Conclusions An ICU-wide QI intervention to improve sleep and delirium is feasible and associated with significant improvements in perceived nighttime noise, incidence of delirium/coma, and daily delirium

  17. Safety and short-term outcomes of endoscopic submucosal dissection for early gastric cancer in elderly patients

    PubMed Central

    Kato, Minoru; Michida, Tomoki; Kusakabe, Akira; Sakai, Ayako; Hibino, Chihiro; Kato, Mina; Tokuda, Yuki; Kawai, Tomoyo; Hamano, Mina; Chiba, Miho; Maeda, Kosaku; Yamamoto, Katsumi; Naito, Masafumi; Ito, Toshifumi

    2016-01-01

    Background and study aims: Endoscopic submucosal dissection (ESD) has become widely accepted as a minimally invasive treatment for early gastric cancer (EGC), and opportunities to use ESD to treat EGC in elderly patients are increasing. The objective of this study was to elucidate the safety and efficacy of ESD in elderly patients. Patients and methods: Between April 2006 and March 2013, a total of 892 patients with EGC were prospectively recruited to undergo ESD according to definite inclusion criteria. The short-term outcomes and incidence of complications in 345 of these patients who were 75 years of age or older (elderly group) were compared with the short-term outcomes and incidence of complications in the remaining 547 patients (non-elderly group). Factors associated with the occurrence of pneumonia and delirium were also investigated. Results: The R0 resection rate did not differ between the two groups (96.2 % in the elderly group vs. 96.7 % in the non-elderly group; P = 0.65). The incidence of pneumonia (7.5 % vs. 1.8 %; P < 0.01) and incidence of delirium (10.1 % vs. 1.1 %; P < 0.01) were significantly higher in the elderly group. The incidence of post-ESD bleeding and incidence of perforation were similar in the two groups. No emergency surgery was required, but one patient in the non-elderly group died of aspiration pneumonia. On multivariate analysis, age 75 years or older, cerebrovascular disease, chronic obstructive pulmonary disease, delirium, and remnant stomach or gastric tube were independent risk factors for pneumonia, and age 75 years or older, diabetes, dementia, and pneumonia were independent risk factors for delirium. Conclusion: ESD for EGC was feasible for elderly patients in good condition. However, pneumonia and delirium may develop more frequently after ESD in elderly patients with co-morbidities. PMID:27227108

  18. The effect of a pre- and post-operative orthogeriatric service on cognitive function in patients with hip fracture. The protocol of the Oslo Orthogeriatrics Trial

    PubMed Central

    2012-01-01

    Background Hip fractures mainly affect older people. It is associated with high morbidity and mortality, and in particular a high frequency of delirium. Incident delirium following hip fracture is associated with an increased risk of dementia in the following months, but it is still not firmly established whether this is an association or a causal relationship. Orthogeriatric units vary with respect to content and timing of the intervention. One main effect of orthogeriatric care may be the prevention of delirium, especially if preoperative and postoperative care are provided. Thus, the aim of Oslo Orthogeriatric Trial, is to assess whether combined preoperative and postoperative orthogeriatric care can reduce the incidence of delirium and improve cognition following hip fracture. Methods/design Inclusion and randomisation will take place in the Emergency Department, as soon as possible after admission. All patients with proximal femur fractures are eligible, irrespective of age, pre-fracture function and accommodation, except if the fracture is caused by a high energy trauma or the patient is terminally ill. The intervention is pre-and post-operative orthogeriatric care delivered on a dedicated acute geriatric ward. The primary outcome measure is a composite endpoint combining the Clinical Dementia Rating Scale (CDR) and the 10 word memory task at four months after surgery. Secondary outcomes comprise incident delirium, length of stay, cognition, mobility, place of residence, activities of daily living and mortality, measured at 4 and 12 months after surgery. We have included 332 patients in the period 17th September 2009 to 5th January 2012. Discussion Our choice of outcome measures and our emphasis of orthogeriatric care in the preoperative as well as the postoperative phase will enable us to provide new knowledge on the impact of orthogeriatric care on cognition. Trials registration ClinicalTrials.gov NCT01009268 PMID:22817102

  19. Protocol for the Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) study: a pragmatic, randomised clinical trial

    PubMed Central

    Wildes, T S; Winter, A C; Maybrier, H R; Mickle, A M; Lenze, E J; Stark, S; Lin, N; Inouye, S K; Schmitt, E M; McKinnon, S L; Muench, M R; Murphy, M R; Upadhyayula, R T; Fritz, B A; Escallier, K E; Apakama, G P; Emmert, D A; Graetz, T J; Stevens, T W; Palanca, B J; Hueneke, R L; Melby, S; Torres, B; Leung, J; Jacobsohn, E; Avidan, M S

    2016-01-01

    Introduction Postoperative delirium, arbitrarily defined as occurring within 5 days of surgery, affects up to 50% of patients older than 60 after a major operation. This geriatric syndrome is associated with longer intensive care unit and hospital stay, readmission, persistent cognitive deterioration and mortality. No effective preventive methods have been identified, but preliminary evidence suggests that EEG monitoring during general anaesthesia, by facilitating reduced anaesthetic exposure and EEG suppression, might decrease incident postoperative delirium. This study hypothesises that EEG-guidance of anaesthetic administration prevents postoperative delirium and downstream sequelae, including falls and decreased quality of life. Methods and analysis This is a 1232 patient, block-randomised, double-blinded, comparative effectiveness trial. Patients older than 60, undergoing volatile agent-based general anaesthesia for major surgery, are eligible. Patients are randomised to 1 of 2 anaesthetic approaches. One group receives general anaesthesia with clinicians blinded to EEG monitoring. The other group receives EEG-guidance of anaesthetic agent administration. The outcomes of postoperative delirium (≤5 days), falls at 1 and 12 months and health-related quality of life at 1 and 12 months will be compared between groups. Postoperative delirium is assessed with the confusion assessment method, falls with ProFaNE consensus questions and quality of life with the Veteran's RAND 12-item Health Survey. The intention-to-treat principle will be followed for all analyses. Differences between groups will be presented with 95% CIs and will be considered statistically significant at a two-sided p<0.05. Ethics and dissemination Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES) is approved by the ethics board at Washington University. Recruitment began in January 2015. Dissemination plans include presentations at scientific conferences

  20. [Pharmacological therapies for alcohol use disorder in Japan].

    PubMed

    Yumoto, Yosuke; Higuchi, Susumu

    2015-09-01

    We reviewed the available pharmacological therapies for alcohol use disorder in Japan. For treatment of withdrawal delirium, therapists prefer to use antipsychotic drugs rather than benzodiazepines, which is different from other countries. Japan does not have any substantial treatment guidelines for withdrawal delirium. Therefore, so treatment strategies matching the environment of each facility need to be formulated. Moreover, current choices for prescribing anti-alcoholic drugs to cope with alcohol craving are limited to drugs such as cyanamide and disulfiram. However, the use of acamprosate has recently begun and a clinical trial for nalmefene is starting soon. We anticipate that these newer pharmacological therapies will contribute to better treatment of alcohol use disorder also in Japan.