Hospital costs associated with delirium in older medical patients

Introduction

Delirium is a common and serious complication in older patients, associated with increased, potentially preventable, morbidity and mortality. The aim of this study was to evaluate the associated costs of delirium during hospitalization in a university affiliated hospital in Chile.

Materials and methods

Prospective cohort study of consecutive patients 65 years and older, admitted to a medical ward. A psychogeriatric team assessed patients during the first and every 48 h until discharge using the Confusion Assessment Method (CAM-S), length of hospital stay, pharmacy and total hospitalization costs were analyzed. Statistical analysis was performed using bivariate and multivariate analysis according to delirium diagnosis.

Results

Data from 454 patients was analyzed, 160 of them in a delirium cohort (35.2%) and 294 in a non-delirium cohort (64.8%). The delirium cohort had a longer hospital stay (DATA) and higher mortality (7.0% versus 1.7%). The median of total costs of delirium during hospital stay was 38.7% higher than the non-delirium cohort (P < .001). Total costs were significantly higher in the delirium cohort after adjustment of covariables (P = .01).

Conclusions

This study confirms that delirium is associated with significantly greater costs. Considering that effective delirium prevention is possible, the knowledge of associated costs can help health care providers to justify prevention strategies and finally give better care for older patients.     

Increasing Anaerobic Acetate Consumption and Ethanol Yields in Saccharomyces cerevisiae with NADPH-Specific Alcohol Dehydrogenase

Saccharomyces cerevisiae has recently been engineered to use acetate, a primary inhibitor in lignocellulosic hydrolysates, as a cosubstrate during anaerobic ethanolic fermentation. However, the original metabolic pathway devised to convert acetate to ethanol uses NADH-specific acetylating acetaldehyde dehydrogenase and alcohol dehydrogenase and quickly becomes constrained by limited NADH availability, even when glycerol formation is abolished. We present alcohol dehydrogenase as a novel target for anaerobic redox engineering of S. cerevisiae. Introduction of an NADPH-specific alcohol dehydrogenase (NADPH-ADH) not only reduces the NADH demand of the acetate-to-ethanol pathway but also allows the cell to effectively exchange NADPH for NADH during sugar fermentation. Unlike NADH, NADPH can be freely generated under anoxic conditions, via the oxidative pentose phosphate pathway. We show that an industrial bioethanol strain engineered with the original pathway (expressing acetylating acetaldehyde dehydrogenase from Bifidobacterium adolescentis and with deletions of glycerol-3-phosphate dehydrogenase genes GPD1 and GPD2) consumed 1.9 g liter⁻¹ acetate during fermentation of 114 g liter⁻¹ glucose. Combined with a decrease in glycerol production from 4.0 to 0.1 g liter⁻¹, this increased the ethanol yield by 4% over that for the wild type. We provide evidence that acetate consumption in this strain is indeed limited by NADH availability. By introducing an NADPH-ADH from Entamoeba histolytica and with overexpression of ACS2 and ZWF1, we increased acetate consumption to 5.3 g liter⁻¹ and raised the ethanol yield to 7% above the wild-type level.     

ABCG transporters export cutin precursors for the formation of the plant cuticle

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Milk ejection in mice LG/J x SM/J

In mammals, milk provision is crucial to offspring survival and growth from birth to weaning. Milk deficiency early in life may cause death or changes in the progeny metabolism that later may lead to obesity and metabolic disorders. This study investigates milk ejection (ME) the first day after birth (D1) in F₂ females from the intercross of LG/J and SM/J inbred mice strains. The absence of milk in F₃ pups?? stomach at D1 is directly associated with their survival (p?<?0.001) and growth pattern (p?<?0.001) in the early stages of life. Furthermore, late growth pattern is also affected by this lack of nutrients at D1 because pups that survive this absence, mostly males, are heavier at weaning (p?<?0.001) which, after necropsy, is shown to be due to significant higher total fat deposition (p?<?0.01). We performed QTL analysis for ME at D1 in these F₂ females. Maternal performance of ME revealed a complex genetic architecture which even though it contains only a single QTL (accounting for 8?% of the variation in ME), it is totally context-dependent on the genetic background. We discovered many regions involved in epistatic interactions that together with the single QTL explain 19?% of the genetic variation for this trait. Milk ejection is an important component of maternal care, and understanding the mechanisms modulating its variation, along with other maternal features, may help to disentangle the complexity that is the mother/offspring relationship.     

Effect of long‐term injection of dopamine on the ovarian growth of Cherax quadricarinatus juvenile females (Parastacidae,Decapoda)

The neurotransmitter dopamine (DA) modulates many physiological processes in decapod crustaceans, including reproduction. This study was aimed at evaluating whether the long‐term injection of DA affects ovarian growth in the freshwater crayfish Cherax quadricarinatus. Three experiments were performed with females of different mean initial size: 4.15 g (Group A); 9.65 g (Group B); and 13.98 g (Group C). Treated females were injected with DA and control females with physiological saline twice a week for 90 (Group B), 105 (Group A) and 120 (Group C) days. At the end of the experiments, the animals were killed, and the stage of ovarian development, gonadosomatic index, and mean oocyte diameter were determined. DA had a differential effect according to female size: it negatively affected ovarian growth of females in a weight range of 4–14 g and had no effect on ovarian maturation when injected to females with an initial weight of 14 g. The results are compared with previous reports in freshwater decapod crustaceans.     

Observations of daytime births in two groups of red-handed howlers (Alouatta belzebul) on an island in the Tucuruí reservoir in eastern Brazilian Amazonia

Births were observed in two free-ranging groups of red-handed howlers (Alouatta belzebul) in eastern Brazilian Amazonia. Both events occurred in the early afternoon, and were relatively rapid and discrete. No other group members approached the females during parturition, nor attempted to interfere with the neonate in any way. Only one of the mothers ingested the placenta. This same female carried the neonate ventrally during the first month of life and then it was carried dorsally. The other infant was carried by its mother in a dorsal position from birth onward. Both infants survived their first month, but subsequently disappeared, in the second and fourth months of life. The precise causes of their death are unknown. In one case, we speculate that the infant's death was due to infestation by botfly larvae.     

Direct and indirect landscape effects on Quercus ilex regeneration in heterogeneous environments

Understanding how plant–animal interactions shape plant regeneration is traditionally examined at local scales. In contrast, landscape ecologists working at regional scales often have to infer the mechanisms underlying vegetation patterns. In this study, we empirically explored how landscape attributes (patch connectivity, size, shape, irradiance, slope, and elevation) influence biotic interactions in 1- and 2-year seedlings and saplings of Quercus ilex. We combined field data and GIS-based information under a set of five connectivity scenarios, presuming low, intermediate, and long-distance seed dispersal. Our study emphasizes that landscape, apart from its direct effects on plants, plays a key, albeit indirect, role in plant demography through its effects on seed dispersers and predators. Moreover, the effects of landscape on recruitment differed between plant life stages. One-year seedlings and saplings appear to depend more on plant–animal interactions, while 2-year seedlings depend more on irradiance. Differences in patch connectivity resulted in direct and indirect effects on biotic interactions, which, in turn, produced contrasting positive and negative effects on regeneration at different stages of the life cycle. While jays and wild boars seem crucial to all life stages and most of the connectivity scenarios, rodents and herbivores affected only 1-year seedlings and saplings, respectively, and only a few of the connectivity scenarios. By simultaneously including an ensemble of explanatory factors, our study emphasizes that regeneration depends on a set of key drivers, both abiotic (i.e. irradiance) and biotic (i.e. jays and wild boars), whose effects are greatly modulated by landscape traits.     

Macular Microcysts in Mitochondrial Optic Neuropathies: Prevalence and Retinal Layer Thickness Measurements

Purpose

To investigate the thickness of the retinal layers and to assess the prevalence of macular microcysts (MM) in the inner nuclear layer (INL) of patients with mitochondrial optic neuropathies (MON).

Methods

All patients with molecularly confirmed MON, i.e. Leber’s Hereditary Optic Neuropathy (LHON) and Dominant Optic Atrophy (DOA), referred between 2010 and 2012 were enrolled. Eight patients with MM were compared with two control groups: MON patients without MM matched by age, peripapillary retinal nerve fiber layer (RNFL) thickness, and visual acuity, as well as age-matched controls. Retinal segmentation was performed using specific Optical coherence tomography (OCT) software (Carl Zeiss Meditec). Macular segmentation thickness values of the three groups were compared by one-way analysis of variance with Bonferroni post hoc corrections.

Results

MM were identified in 5/90 (5.6%) patients with LHON and 3/58 (5.2%) with DOA. The INL was thicker in patients with MON compared to controls regardless of the presence of MM [133.1±7μm vs 122.3±9μm in MM patients (p<0.01) and 128.5±8μm vs. 122.3±9μm in no-MM patients (p<0.05)], however the outer nuclear layer (ONL) was thicker in patients with MM (101.4±1mμ) compared to patients without MM [77.5±8mμ (p<0.001)] and controls [78.4±7mμ (p<0.001)]. ONL thickness did not significantly differ between patients without MM and controls.

Conclusion

The prevalence of MM in MON is low (5-6%), but associated with ONL thickening. We speculate that in MON patients with MM, vitreo-retinal traction contributes to the thickening of ONL as well as to the production of cystic spaces.     

Factors controlling the stable isotope composition and C:N ratio of seston and periphyton in shallow lake mesocosms with contrasting nutrient loadings and temperatures

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