A review of delirium rating scales

Delirium is a severe psychiatric syndrome that is highly prevalent in elderly general hospital patients. However, the diagnosis of delirium is often missed. The use of rating scales can be helpful in detecting and measuring delirium symptom severity. This article reviews recent developments with regard to psychometric qualities, measurement goal, content and rating procedures of some of the available rating scales in clinical practise. Studies that used delirium rating scales were searched for using the MEDLINE and subsequent examination of reference lists. Ten rating scales were selected for further evaluation. The Confusional Assessment Method (CAM), NEECHAM Confusion Scale (NEECHAM) and Delirium Observation Scale (DOS) appear to be most suitable as a screening instrument, depending on the type of rater (physician or nurse). The (revised) Delirium Rating Scale (DRS(-R-98)) seems to be particularly useful for measuring delirium severity or monitoring change.     

Thermal sensation and cell adaptability

Whole person adaptive comfort is discussed with reference to recent findings in molecular scale systems biology. The observations are upscaled to hypotheses relating to less traditional interpretations of thermal processes, which have new implications for indoor climate management and design. Arguments are presented for a revision of current focus, model and paradigm. The issue is seen as a problem of integrating theoretical development, conceptual modeling and as an investigation of the extent to which environments and acclimatization can be used to achieve individual fitness and health, not only at the subjective comfort level, as hitherto promoted. It is argued that there are many questions yet to be asked about adaptability before celebrating a particular adaptive state.     

A comparison between the full diallel cross and the simplified triple-test cross

Summary The simplified triple-test cross (sTTC) is a mating design that, because of its economic use of the experimental material as compared with other designs, seems very attractive. In theory, its power is almost equal to that of more elaborate designs such as the diallel cross. To evaluate the merits of both designs in a genetic analysis of mouse behavior, the results of a previous replicated 4×4 diallel cross (Crusio and van Abeelen 1986) were reanalyzed as a sTTC. We found that, at least with the fairly low number of strains employed, the sTTC analysis is clearly inferior to the diallel cross. This finding, in combination with some theoretical considerations, leads to the conclusion that the sTTC design is not a very useful one for such studies.     

Thermal sensation and thermophysiological responses to metabolic step-changes

This study investigated the effect on thermal perception and thermophysiological variables of controlled metabolic excursions of various intensities and durations. Twenty-four subjects were alternately seated on a chair or exercised by walking on a treadmill at a temperature predicted to be neutral at sedentary activity. In a second experimental series, subjects alternated between rest and exercise as well as between exercise at different intensities at two temperature levels. Measurements comprised skin and oesophageal temperatures, heart rate and subjective responses. Thermal sensation started to rise or decline immediately (within 1 min) after a change of activity, which means that even moderate activity changes of short duration affect thermal perceptions of humans. After approximately 15–20 min under constant activity, subjective thermal responses approximated the steady-state response. The sensitivity of thermal sensation to changes in core temperature was higher for activity down-steps than for up-steps. A model was proposed that estimates transient thermal sensation after metabolic step-changes. Based on predictions by the model, weighting factors were suggested to estimate a representative average metabolic rate with varying activity levels, e.g. for the prediction of thermal sensation by steady-state comfort models. The activity during the most recent 5 min should be weighted 65%, during the prior 10–5 min 25% and during the prior 20–10 min 10%.     

Observer-rated ataxia: rating scales for assessment of genetic differences in ethanol-induced intoxication in mice.

Identification of genetic and physiological mechanisms underlying a drug's or mutation's effects on motor performance could be aided by the existence of a simple observation-based rating scale of ataxia for mice. Rating scales were developed to assess ataxia after ethanol (2.75, 3.0, and 3.25 g/kg) in nine inbred mouse strains. Each scale independently rates a single behavior. Raters, blinded to dose, scored four behaviors (splay of hind legs, wobbling, nose down, and belly drag) at each of four time points after injection. The severities of hind leg splaying and wobbling were quantifiable, whereas nose down and belly dragging were expressed in all-or-none fashion. Interrater reliabilities were substantial (0.75 0 at some time), but all doses were equally effective. Incidence of nose down and belly dragging behaviors increased strain dependently after ethanol, but strains did not differentially respond to dose. Ethanol-induced splaying was modestly, and negatively, genetically correlated with wobbling. Nose down and belly dragging tended to be associated with splaying and wobbling at later times. Four distinct ataxia-related behaviors were sensitive to ethanol. Strains differed in ethanol sensitivity for all measures. Modest strain mean correlations among behaviors indicate that these behaviors are probably under control of largely different genes and that ataxia rating scales should rate separate behaviors on discrete scales.     

Thermal sensation and the thermoregulatory vascular reactions in man]

It was shown by the method of continuous highly sensitive thermometry of the human skin with a simultaneous recording of the verbal reports of the thermal feeling that the most important thermoregulatory reactions of the dermal vessels of the limbs were definitely related to the particular temperature sense.     

A comparison of cross sectional surface area densities between adult and juvenile porcine islets of Langerhans.

The object of this study was to evaluate differences in islet diameters, their distribution and both cross sectional surface areas and densities of insulin containing islets between adult and juvenile porcine pancreata using a computerised image analysis system (Improvision). Five adult (A) (2-3 yrs) and 5 juvenile (J) (< 12 mths) Large White pancreata were assessed. Biopsies were taken from 5 different regions (posterior lobe, duodenal lobe, along with the head, body and tail regions of the splenic lobe) of the pancreas and tissue sections stained for insulin. In both A and J pancreata islet numbers increased with decreasing islet diameter, showing a skewed distribution. There was no statistical significance between the cross sectional surface area within A (mean 5.04 x 10(3) microm2) or J (mean 5.99 x 10(3) microm2) pancreata. Assuming islets are spherical, extrapolation from pir2 showed that the mean diameter for A was 80 microm and 87 microm in J. These compared with A 77 microm and J 86 microm diameters using conventional microscopic techniques. The percentage islet volume density relative to exocrine tissue, derived from the principle of Delesse (Area density = volume density), did not significantly differ between each of the 5 areas studied, either in A or J. The percentage islet volume densities did show a significant difference between A (mean 1.83%) (P = 0.001) but not between J pancreata (mean 2.13 %). In conclusion poor islet yields can be attributed to differences in islet volume density of islets within porcine pancreata. These results also suggest that the posterior and duodenal lobes should be used along with the splenic lobe in order to improve porcine islet yields. Furthermore, the current practise of reporting porcine islet yields and the isolation index relative to 150 microm (IEQs) needs to be redefined, based on the assumption that the average size of an adult porcine islet is 80 microm.     

A comparison of physiological responses and rating of perceived exertion between high-impact and low-impact aerobic dance sessions

The aim of this study was to compare the exercise intensity and rating of perceived exertion (RPE) of a high-impact (HIP) and a low-impact (LIP) university aerobic dance session. Ten women [mean (SD) age 22.9 (2.6) years] took part in the study. An incremental treadmill test was performed by each subject to determine maximum oxygen consumption (V˙O_{2 max} ) and maximum heart rate (HR _max ). The measured V˙O_{2 max} [mean (SD)] was 49.0 (7.5) ml · kg⁻¹ · min⁻¹. The subjects were randomly assigned to LIP and HIP sessions (i.e. five of the subjects participated in the HIP session first, and the other five participated in the LIP session first). In a laboratory, heart rate, oxygen uptake and RPE were measured throughout each session for each subject. Expired air was collected continuously throughout the sessions using Douglas bags (ten bags over a 30-min period). The sessions consisted of 20 min of aerobic exercise (bags 1–7) followed by 5 min of local muscular endurance exercise (bags 8 and 9) and 5 min of flexibility exercises (bag 10). The mean intensity of the aerobic section of the LIP and HIP sessions was 51.6% and 64.7% V˙O_{2 max} , respectively. Ninety-five percent confidence intervals for the average difference between the HIP and LIP sessions demonstrate that the %V˙O_{2 max} was between 12% and 14% higher for the HIP session. The mean %HR _max for the LIP and HIP sessions was 71.4% and 76.7%, respectively, with the %HR _max in the HIP session being between 5.4% and 7.2% higher on average than that of the LIP session. On average, the RPE for the aerobic section of the HIP session (12.1) was consistently higher than that of the LIP session (11.1). HIP activity has the potential to maintain/improve the aerobic fitness of its participants. According to the literature, the exercise intensity elicited by LIP activity may have a limited training effect for the population utilised in this study, and for some individuals may result in detraining. Conversely, LIP activities may be an appropriate mode of exercise for overweight and unfit individuals. Accepted: 5 January 1998     

Thermal sensation and comfort during exposure to local airflow to face or legs

The present study examined the contribution of local airflow temperature to thermal sensation and comfort in humans. Eight healthy male students were exposed to local airflow to their faces (summer condition) or legs (winter condition) for 30 minutes. Local airflow temperature (Tf) was maintained at 18 degrees C to 36 degrees C, and ambient temperature (Ta) was maintained at 17.4 degrees C to 31.4 degrees C. Each subject was exposed to 16 conditions chosen from the combination of Tf and Ta. Based on the results of multiple regression analysis, the standardized partial regression coefficient of Tf and Ta were determined to be 0.93 and 0.13 in the summer condition, and 0.71 and 0.36 in the winter condition at the end of the exposure. Also, thermal comfort was observed to depend closely on the interrelation between Tf and Ta. The present data suggested that local airflow temperature is an important thermal factor regarding thermal sensation and comfort.     

Protein structure topological comparison, discovery and matching service

We describe a fold level fast protein comparison and motif matching facility based on the TOPS representation of structure. This provides an update to a previous service at the EBI, with a better graph matching with faster results and visualization of both the structures being compared against and the common pattern of each with the target domain. AVAILABILITY: Web service at http://balabio.dcs.gla.ac.uk/tops or via the main TOPS site at http://www.tops.leeds.ac.uk. Software is also available for download from these sites.     

A comparison of machine learning algorithms and covariate balance measures for propensity score matching and weighting

Propensity score matching (PSM) and propensity score weighting (PSW) are popular tools to estimate causal effects in observational studies. We address two open issues: how to estimate propensity scores and assess covariate balance. Using simulations, we compare the performance of PSM and PSW based on logistic regression and machine learning algorithms (CART; Bagging; Boosting; Random Forest; Neural Networks; naive Bayes). Additionally, we consider several measures of covariate balance (Absolute Standardized Average Mean (ASAM) with and without interactions; measures based on the quantile‐quantile plots; ratio between variances of propensity scores; area under the curve (AUC)) and assess their ability in predicting the bias of PSM and PSW estimators. We also investigate the importance of tuning of machine learning parameters in the context of propensity score methods. Two simulation designs are employed. In the first, the generating processes are inspired to birth register data used to assess the effect of labor induction on the occurrence of caesarean section. The second exploits more general generating mechanisms. Overall, among the different techniques, random forests performed the best, especially in PSW. Logistic regression and neural networks also showed an excellent performance similar to that of random forests. As for covariate balance, the simplest and commonly used metric, the ASAM, showed a strong correlation with the bias of causal effects estimators. Our findings suggest that researchers should aim at obtaining an ASAM lower than 10% for as many variables as possible. In the empirical study we found that labor induction had a small and not statistically significant impact on caesarean section.     

Path matching and graph matching in biological networks.

We develop algorithms for the following path matching and graph matching problems: (i) given a query path p and a graph G, find a path p' that is most similar to p in G; (ii) given a query graph G (0) and a graph G, find a graph G (0)' that is most similar to G (0) in G. In these problems, p and G (0) represent a given substructure of interest to a biologist, and G represents a large network in which the biologist desires to find a related substructure. These algorithms allow the study of common substructures in biological networks in order to understand how these networks evolve both within and between organisms. We reduce the path matching problem to finding a longest weighted path in a directed acyclic graph and show that the problem of finding top k suboptimal paths can be solved in polynomial time. This is in contrast with most previous approaches that used exponential time algorithms to find simple paths which are practical only when the paths are short. We reduce the graph matching problem to finding highest scoring subgraphs in a graph and give an exact algorithm to solve the problem when the query graph G (0) is of moderate size. This eliminates the need for less accurate heuristic or randomized algorithms.We show that our algorithms are able to extract biologically meaningful pathways from protein interaction networks in the DIP database and metabolic networks in the KEGG database. Software programs implementing these techniques (PathMatch and GraphMatch) are available at http://faculty.cs.tamu.edu/shsze/pathmatch and http://faculty.cs.tamu.edu/shsze/graphmatch.