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A world-wide study on delirium assessments and presence of protocols.
No full textBACKGROUND
Delirium is a common complication of older people in hospitals, rehabilitation and long-term facilities.
OBJECTIVE
To assess the worldwide use of validated delirium assessment tools and the presence of delirium management protocols.
DESIGN
Secondary analysis of a worldwide one-day point prevalence study on World Delirium Awareness Day, 15 March 2023.
SETTING
Cross-sectional online survey including hospitals, rehabilitation and long-term facilities.
METHODS
Participating clinicians reported data on delirium, the presence of protocols, delirium assessments, delirium-awareness interventions, non-pharmacological and pharmacological interventions, and ward/unit-specific barriers.
RESULTS
Data from 44 countries, 1664 wards/units and 36 048 patients were analysed. Validated delirium assessments were used in 66.7% (n = 1110) of wards/units, 18.6% (n = 310) used personal judgement or no assessment, and 10% (n = 166) used other assessment methods. A delirium management protocol was reported in 66.8% (n = 1094) of wards/units. The presence of protocols for delirium management varied across continents, ranging from 21.6% (on 21/97 wards/units) in Africa to 90.4% (235/260) in Australia, similar to the use of validated delirium assessments with 29.6% (29/98) in Africa to 93.5% (116/124) in North America. Wards/units with a delirium management protocol [n = 1094/1664, 66.8%] were more likely to use a validated delirium test than those without a protocol [odds ratio 6.97 (95% confidence interval 5.289-9.185)]. The presence of a delirium protocol increased the chances for valid delirium assessment and, likely, evidence-based interventions.
CONCLUSION
Wards/units that reported the presence of delirium management protocols had a higher probability of using validated delirium assessments tools to assess for delirium
The fountains of the Fugger family’s gardens in sixteenth-century Augsburg
No full textThis article focuses on the gardens laid out by the Fugger family of merchant-bankers in the Free Imperial City of Augsburg in the first half of the sixteenth century. These forgotten gardens have received little attention both by historians of Augsburg and the Fugger, and by scholars of garden history more generally. A close reading of contemporary descriptions of these gardens, and especially of their hydraulic infrastructure, allows this article to identify their precise location within the urban space and immediate surroundings of Augsburg, correcting earlier interpretations. Using published accounting sources, this article identifies the sculptors responsible for the fountain statuary, the hydraulic experts who designed the water-raising machinery and fountains, and the provenance of the water itself. Establishing a clear link with the municipal drinking water supply system in all three cases, this article argues that the urban gardens of the Fugger should be rescued from oblivion and reintegrated in histories of early modern gardens and hydraulics
Beyond Mining: Physical commodity traders, market intermediation and the role of (de-)coupling
No full textCharacterization of the Surfaces and Near-Surface Atmospheres of Ganymede, Europa and Callisto by JUICE.
Get PDFWe present the state of the art on the study of surfaces and tenuous atmospheres of the icy Galilean satellites Ganymede, Europa and Callisto, from past and ongoing space exploration conducted with several spacecraft to recent telescopic observations, and we show how the ESA JUICE mission plans to explore these surfaces and atmospheres in detail with its scientific payload. The surface geology of the moons is the main evidence of their evolution and reflects the internal heating provided by tidal interactions. Surface composition is the result of endogenous and exogenous processes, with the former providing valuable information about the potential composition of shallow subsurface liquid pockets, possibly connected to deeper oceans. Finally, the icy Galilean moons have tenuous atmospheres that arise from charged particle sputtering affecting their surfaces. In the case of Europa, plumes of water vapour have also been reported, whose phenomenology at present is poorly understood and requires future close exploration. In the three main sections of the article, we discuss these topics, highlighting the key scientific objectives and investigations to be achieved by JUICE. Based on a recent predicted trajectory, we also show potential coverage maps and other examples of reference measurements. The scientific discussion and observation planning presented here are the outcome of the JUICE Working Group 2 (WG2): "Surfaces and Near-surface Exospheres of the Satellites, dust and rings"
Sex-specific association of cardiovascular drug doses with adverse outcomes in atrial fibrillation.
Get PDFOBJECTIVES
Sex differences occur in atrial fibrillation (AF), including age at first manifestation, pathophysiology, treatment allocation, complication rates and quality of life. However, optimal doses of cardiovascular pharmacotherapy used in women with AF with or without heart failure (HF) are unclear. We investigated sex-specific associations of beta-blocker and renin-angiotensin system (RAS) inhibitor doses with cardiovascular outcomes in patients with AF or AF with concomitant HF.
METHODS
We used data from the prospective Basel Atrial Fibrillation and Swiss Atrial Fibrillation cohorts on patients with AF. The outcome was major adverse cardiovascular events (MACEs), including death, myocardial infarction, stroke, systemic embolisation and HF-related hospitalisation. Predictors of interest were spline (primary analysis) or quartiles (secondary analysis) of beta-blocker or RAS inhibitor dose in per cent of the maximum dose (reference), in interaction with sex. Cox models were adjusted for demographics, comorbidities and comedication.
RESULTS
Among 3961 patients (28% women), MACEs occurred in 1113 (28%) patients over a 5-year median follow-up. Distributions of RAS inhibitor and beta-blocker doses were similar in women and men. Cox models revealed no association between beta-blocker dose or RAS inhibitor dose and MACE. In a subgroup of patients with AF and HF, the lowest hazard of MACE was observed in women prescribed 100% of the RAS inhibitor dose. However, there was no association between RAS dose quartiles and MACE.
CONCLUSIONS
In this study of patients with AF, doses of beta-blockers and RAS inhibitors did not differ by sex and were not associated with MACE overall
A unified generation-registration framework for improved MR-based CT synthesis in proton therapy.
Get PDFBACKGROUND
The use of magnetic resonance (MR) imaging for proton therapy treatment planning is gaining attention as a highly effective method for guidance. At the core of this approach is the generation of computed tomography (CT) images from MR scans. However, the critical issue in this process is accurately aligning the MR and CT images, a task that becomes particularly challenging in frequently moving body areas, such as the head-and-neck. Misalignments in these images can result in blurred synthetic CT (sCT) images, adversely affecting the precision and effectiveness of the treatment planning.
PURPOSE
This study introduces a novel network that cohesively unifies image generation and registration processes to enhance the quality and anatomical fidelity of sCTs derived from better-aligned MR images.
METHODS
The approach synergizes a generation network (G) with a deformable registration network (R), optimizing them jointly in MR-to-CT synthesis. This goal is achieved by alternately minimizing the discrepancies between the generated/registered CT images and their corresponding reference CT counterparts. The generation network employs a UNet architecture, while the registration network leverages an implicit neural representation (INR) of the displacement vector fields (DVFs). We validated this method on a dataset comprising 60 head-and-neck patients, reserving 12 cases for holdout testing.
RESULTS
Compared to the baseline Pix2Pix method with MAE 124.95 30.74 HU, the proposed technique demonstrated 80.98 7.55 HU. The unified translation-registration network produced sharper and more anatomically congruent outputs, showing superior efficacy in converting MR images to sCTs. Additionally, from a dosimetric perspective, the plan recalculated on the resulting sCTs resulted in a remarkably reduced discrepancy to the reference proton plans.
CONCLUSIONS
This study conclusively demonstrates that a holistic MR-based CT synthesis approach, integrating both image-to-image translation and deformable registration, significantly improves the precision and quality of sCT generation, particularly for the challenging body area with varied anatomic changes between corresponding MR and CT
Not Wholly White: Enslaved Labour in the Colonial Printing Workshops of the Southern Cone
No full textEx vivo MRI and histological comparison of the canine adrenal glands.
Get PDFCross-sectional imaging is widely used to characterize adrenal gland tumors in humans. In small animal veterinary medicine, while some studies have attempted to distinguish between types of adrenal gland neoplasia using CT, peer-reviewed studies investigating canine adrenal glands on MRI are scant. This prospective, pilot, single-center, method comparison, cadaveric study aimed to assess the agreement between ex vivo MRI findings and analogous histopathological findings of the adrenal glands in dogs. The adrenal glands of randomly selected dogs presented for necropsy were examined by MRI (n = 31). Additionally, five adrenal masses in dogs who underwent invasive adrenalectomy (including three adrenocortical carcinomas, one pheochromocytoma, and one adenoma) were imaged. Subsequently, gross pathology and histopathology of all the specimens were performed and correlated with the imaging findings. Adrenal gland lesions were identified on MRI with a sensitivity of 24%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 31%, and an accuracy of 45%. The present study provides MRI features of multiple adrenal gland lesions that had never been described in dogs, including cortical hyperplasia, nodular fibrosis, hemorrhage, or multiple tumors, such as adenoma, carcinoma, and hemangiosarcoma. While MRI identified numerous adrenal gland lesions, a significant portion of those went undetected. Therefore, the absence of adrenal gland lesions on MRI does not exclude the possibility of histological lesions being present
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