77 INCONTINENCE AND DECONDITIONING IN A NONFRAIL SAMPLE OF INPATIENTS AT A UNIVERSITY TEACHING HOSPITAL

Background

Incontinence occurs in 26% of hospitalised adults1. Deconditioning in hospitalised adults is common and contributes to increased hospital stay2. The #endpjparalysis movement motivates us to reduce harms of hospitalisation older adults.

Methods

We surveyed inpatients to capture the point prevalence of incontinence. We also collected information regarding functional status, continence status and use of continence wear. Local ethical review-board approval was obtained. All participants provided informed consent.

Results

There were 86 responses. Mean age of participants was 71.5 years. 45.4% were female, >95% were admitted from home and were functionally independent. Mean length of stay for respondents was 7.4 days ±12. The median Clinical Frailty Scale, for respondents aged >65 years, was 3, indicating this cohort is not frail.

17 respondents reported incontinence on the day of survey; 8 of these reported that incontinence was a new experience for them since their admission. 24 respondents wore incontinence wear at home, 31 were wearing incontinence wear on the day of survey.

Of 80 respondents who could toilet independently at home, 23 (26%) reported a new dependency to toilet. Of 83 respondents who mobilised independently at home (with or without an aid), 11 reported needing assistance of one-person to walk, 3 needed the assistance of two-people to walk or stand, five people required a hoist, while 3 were bedbound on the day of survey.

Conclusion

We describe increased dependency in mobility, toileting and increased use of continence wear in non-frail hospitalised older adults. Future work is needed to maintain function during admission to hospital.

References

1. Condon, M., et al. (2019). ‘Urinary and Faecal Incontinence: Point Prevalence and Predictors in a University Hospital.’ Int J Environ Res Public Health 16.

2. Guilcher, S., et al. (2021). ‘A qualitative study exploring the lived experiences of deconditioning in hospital in Ontario, Canada.’ BMC Geriatrics 21.

Strong coupling theory of heavy fermion criticality II

We present a theory of the scaling behavior of the thermodynamic, transport and dynamical properties of a three-dimensional metal governed by d-dimensional fluctuations at a quantum critical point, where the electron quasiparticle effective mass diverges. We determine how the critical bosonic order parameter fluctuations are affected by the effective mass divergence. The coupled system of fermions and bosons is found to be governed by two stable fixed points: the conventional weak-coupling fixed point and a new strong-coupling fixed point, provided the boson-boson interaction is irrelevant. The latter fixed point supports hyperscaling, characterized by fractional exponents. The theory is applied to the antiferromagnetic critical point in certain heavy fermion compounds, in which the strong-coupling regime is reached.

Anisotropic in-plane resistivity in the nematic phase of the iron pnictides

We show that the interference between scattering by impurities and by critical spin fluctuations gives rise to anisotropic transport in the Ising-nematic state of the iron pnictides. The effect is closely related to the non-Fermi-liquid behavior of the resistivity near an antiferromagnetic quantum critical point. Our theory not only explains the observed sign of the resistivity anisotropy Δρ in electron-doped systems but also predicts a sign change of Δρ upon sufficient hole doping. Furthermore, our model naturally addresses the changes in Δρ upon sample annealing and alkaline-earth substitution.

Quantum criticality in the iron pnictides and chalcogenides

Superconductivity in the iron pnictides and chalcogenides arises at the border of antiferromagnetism, which raises the question of the role of quantum criticality. In this topical review, we describe the theoretical work that led to the prediction of a magnetic quantum critical point arising out of a competition between electronic localization and itinerancy, and the proposal for accessing it by using isoelectronic P substitution for As in the undoped iron pnictides. We go on to compile the emerging experimental evidence in support of the existence of such a quantum critical point in isoelectronically tuned iron pnictides. We close by discussing the implications of these results for the physics of the iron pnictides and chalcogenides.

Band narrowing and Mott localization in iron oxychalcogenides La2O2Fe2O(Se,S)2

Bad metal properties have motivated a description of the parent iron pnictides as correlated metals on the verge of Mott localization. What has been unclear is whether interactions can push these and related compounds to the Mott-insulating side of the phase diagram. Here we consider the iron oxychalcogenides La2O2Fe2O(Se,S)2, which contain an Fe square lattice with an expanded unit cell. We show theoretically that they contain enhanced correlation effects through band narrowing compared to LaOFeAs, and we provide experimental evidence that they are Mott insulators with moderate charge gaps. We also discuss the magnetic properties in terms of a Heisenberg model with frustrating J1-J2-J2' exchange interactions on a "doubled" checkerboard lattice.

Critical behavior at the mott-anderson transition: a typical-medium theory perspective

We present a detailed analysis of the critical behavior close to the Mott-Anderson transition. Our findings are based on a combination of numerical and analytical results obtained within the framework of typical-medium theory-the simplest extension of dynamical mean field theory capable of incorporating Anderson localization effects. By making use of previous scaling studies of Anderson impurity models close to the metal-insulator transition, we solve this problem analytically and reveal the dependence of the critical behavior on the particle-hole symmetry. Our main result is that, for sufficiently strong disorder, the Mott-Anderson transition is characterized by a precisely defined two-fluid behavior, in which only a fraction of the electrons undergo a "site selective" Mott localization; the rest become Anderson-localized quasiparticles.

Iron pnictides as a new setting for quantum criticality

Two major themes in the physics of condensed matter are quantum critical phenomena and unconventional superconductivity. These usually occur in the context of competing interactions in systems of strongly correlated electrons. All this interesting physics comes together in the behavior of the recently discovered iron pnictide compounds that have generated enormous interest because of their moderately high-temperature superconductivity. The ubiquity of antiferromagnetic ordering in their phase diagrams naturally raises the question of the relevance of magnetic quantum criticality, but the answer remains uncertain both theoretically and experimentally. Here, we show that the undoped iron pnictides feature a unique type of magnetic quantum critical point, which results from a competition between electronic localization and itinerancy. Our theory provides a mechanism to understand the experimentally observed variation of the ordered moment among the undoped iron pnictides. We suggest P substitution for As in the undoped iron pnictides as a means to access this example of magnetic quantum criticality in an unmasked fashion. Our findings point to the iron pnictides as a much-needed setting for quantum criticality, one that offers a unique set of control parameters.

Strong correlations and magnetic frustration in the high Tc iron pnictides

We consider the iron pnictides in terms of a proximity to a Mott insulator. The superexchange interactions contain competing nearest-neighbor and next-nearest-neighbor components. In the undoped parent compound, these frustrated interactions lead to a two-sublattice collinear antiferromagnet (each sublattice forming a Néel ordering), with a reduced magnitude for the ordered moment. Electron or hole doping, together with the frustration effect, suppresses the magnetic ordering and allows a superconducting state. The exchange interactions favor a d-wave superconducting order parameter; in the notation appropriate for the Fe square lattice, its orbital symmetry is dxy. A number of existing and future experiments are discussed in light of the theoretical considerations.

Multiple Energy Scales at a Quantum Critical Point

We report thermodynamic measurements in a magnetic-field-driven quantum critical point of a heavy fermion metal, YbRh2Si2. The data provide evidence for an energy scale in the equilibrium excitation spectrum that is in addition to the one expected from the slow fluctuations of the order parameter. Both energy scales approach zero as the quantum critical point is reached, thereby providing evidence for a new class of quantum criticality.

Nonexponential relaxation and hierarchically constrained dynamics in a protein

A scaling analysis within a model of hierarchically constrained dynamics is shown to reproduce the main features of nonexponential relaxation observed in kinetic studies of carbonmonoxymyoglobin.

Disorder screening in strongly correlated systems

Electron-electron interactions generally reduce the low temperature resistivity due to the screening of the impurity potential by the electron gas. In the weak-coupling limit, the magnitude of this screening effect is determined by the thermodynamic compressibility which is proportional to the inverse screening length. We show that when strong correlations are present, although the compressibility is reduced, the screening effect is nevertheless strongly enhanced. This phenomenon is traced to the same nonperturbative Kondo-like processes that lead to strong mass enhancements, but which are absent in weak-coupling approaches. We predict metallicity to be strongly stabilized in an intermediate regime where the interactions and the disorder are of comparable magnitude.

Calculated phonon spectra of plutonium at high temperatures

We constructed computer-based simulations of the lattice dynamical properties of plutonium using an electronic structure method, which incorporates correlation effects among the f-shell electrons and calculates phonon spectra at arbitrary wavelengths. Our predicted spectrum for the face-centered cubic delta phase agrees well with experiments in the elastic limit and explains unusually large shear anisotropy of this material. The spectrum of the body-centered cubic phase shows an instability at zero temperature over a broad region of the wave vectors, indicating that this phase is highly anharmonic and can be stabilized at high temperatures by its phonon entropy.

Effective Lorentz force due to small-sngle impurity scattering: magnetotransport in high- Tc superconductors

We show that a scattering rate which varies with angle around the Fermi surface has the same effect as a periodic Lorentz force on magnetotransport coefficients. This effect, together with the marginal Fermi liquid inelastic scattering rate, gives a quantitative explanation of the temperature dependence and the magnitude of the observed Hall effect and magnetoresistance with just the measured zero-field resistivity as input.

Correlated electrons in delta-plutonium within a dynamical mean-field picture

Given the practical importance of metallic plutonium, there is considerable interest in understanding its fundamental properties. Plutonium undergoes a 25 per cent increase in volume when transformed from its alpha-phase (which is stable below 400 K) to the delta-phase (stable at around 600 K), an effect that is crucial for issues of long-term storage and disposal. It has long been suspected that this unique property is a consequence of the special location of plutonium in the periodic table, on the border between the light and heavy actinides-here, electron wave-particle duality (or itinerant versus localized behaviour) is important. This situation has resisted previous theoretical treatment. Here we report an electronic structure method, based on dynamical mean-field theory, that enables interpolation between the band-like and atomic-like behaviour of the electron. Our approach enables us to study the phase diagram of plutonium, by providing access to the energetics and one-electron spectra of strongly correlated systems. We explain the origin of the volume expansion between the alpha- and delta-phases, predict the existence of a strong quasiparticle peak near the Fermi level and give a new viewpoint on the physics of plutonium, in which the alpha- and delta-phases are on opposite sides of the interaction-driven localization-delocalization transition.

What angle-resolved photoemission experiments tell about the microscopic theory for high-temperature superconductors

Recent angular-resolved photoemission experiments on high-temperature superconductors are consistent with a phenomenological description of the normal state of these materials as marginal Fermi liquids. The experiments also provide constraints on microscopic theories.

Isolation of Angiostrongylus costaricensis first-stage larvae from rodent feces on a Percoll gradient

Several density gradients were tested for the isolation of parasitic nematode, Angiostrongylus costaricensis, first-stage larvae from rodent feces. With a 45/72% Percoll gradient, 83-99% (89.56+/-6.57%) of the larvae were recovered in a clean preparation.

Effect of Trypanosoma lewisi (Kinetoplastida: Trypanosomatidae) on the infection of white rats with Toxoplasma gondii (Eucoccidia: Sarcocystidae) oocysts

White rats were inoculated with 10(6) trypomastigotes of Trypanosoma lewisi, simultaneously or two days before and after inoculation with 10(5) oocysts of T. gondii. A greater number of cysts was found in the brain of the animals having concomitant inoculations, as compared with rats inoculated with either one of the two parasites. An apparent immunosuppressive effect is likely. Since both organisms can be found in rats, it is possible that infections with T. lewisi, could make this rodent another intermediate host for Toxoplasma infections.

Insult after injury: pressure ulcers in trauma patients

DESIGN

Nonexperimental-Descriptive.

SAMPLE

The inclusion criteria were trauma patients, ages 15 and older, who were hospitalized for > 2 days, and who did not have preexisting skin breakdown. A total of 148 consecutive trauma patients admitted to the study institution meeting the inclusion criteria were prospectively enrolled.

METHODS

Patients were assessed every 3 days for skin breakdown. Information on the patient's bed type, therapies, medical devices, and nutrition was collected. The Braden Scale for predicting pressure ulcer risk was completed at each assessment.

FINDINGS

Of the 148 patients enrolled, 30 developed at least one area of skin breakdown for a prevalence of 20.3% in patients hospitalized more than 2 days. The most common cause of breakdown was positional pressure (47.4%). Cervical collars were the second leading cause at 23.7%, followed by tracheostomy/endotracheal tubes at 10.5%. The mobility subscale of the Braden Pressure Ulcer Risk Assessment tool was significantly predictive of skin breakdown (p < .001).

IMPLICATIONS FOR NURSING RESEARCH

Skin breakdown is a significant problem in trauma patients who are hospitalized for more than 2 days. Aggressive protocols on positioning, cervical collar use, and airway adjuncts, as well as additional active nursing interventions for immobile patients, may be ways to decrease the skin breakdown prevalence in this population.

[A simple method for determining the presence of Toxoplasma gondii (Eucoccidia: Sarcocystidae) in meat]

Presence of T. gondii in meat from several sources was determined by traditional methods and by a new simplified method in which animals are fed meat directly without any previous treatment with artificial gastric fluid. Tissues are ground and the animals ingest them naturally. Determination of Toxoplasma in lungs or brain (as well as by specific antibody test), showed no statistically significant differences between both methods.

Increasing of Toxoplasma gondii (Coccidia, Sarcocystidae) infections by Trypanosoma lewisi (Kinetoplastida, Trypanosomatidae) in white rats

To demonstrate that T. lewisi infection increases T. gondii multiplication in white rats, groups of five Wistar or Sprague Dawley rats were inoculated with 10(6) T. lewisi trypomastigotes and four or seven days later infected with Toxoplasma tachyzoites. Host survival time was monitored, and the presence of T. gondii was confirmed in all dead rats by studying peritoneal exudate smears and lung tissue sections stained with haematoxylin-eosin. The presence of Toxoplasma cysts or antibodies was checked in the brain of surviving rats. The increase is observed four days after trypanosome inoculation and is dependent on rat strain, but not on inoculum size or rat age. Humoral and cellular factors may have a role in the increase as has been reported for other experimental infections with African trypanosomes and T. cruzi.

[Susceptibility of Sigmodon hispidus (Rodentia: Cricetidae) to Toxoplasma gondii (Eucoccidia: Sarcocystidae)]

Sigmodon hispidus, a cotton rat, was inoculated with tachyzoites or oocysts of Costa Rican strains of Toxoplasma gondii to demonstrate the resistance to this parasite, as compared with mice, hamster and white rat infection. Susceptibility to tachyzoite inoculation was higher in this animal than in white rats but lower than in the other animals. Independent to the Toxoplasma strain studied, oocyst infection was less lethal for S. hispidus when compared with mice and hamsters; the results were similar to those observed for white rats. There is a probable participation of this wild animal in the natural Toxoplasma life cycle.

Age influence in the natural resistance of white rat and mice to the protozoan Toxoplasma gondii

Groups of 1, 5, 10, 15 and 30 day old rats (Sprague Dawley) and Wistar mice were infected per os with different inocula of Toxoplasma gondii oocysts from an avirulent strain. Infection pattern was followed by determination of survival time, tissue lesions, parasite presence and serology. Although all the animals survived the total experimental period (30 day), there were important differences between both rodents regarding to Toxoplasma natural resistance. Brain cysts, as well as tachyzoites in other organs were regularly present in mice but not in rats. On the other hand, most of the organs from mice presented characteristic T. gondii lesions, while in rats a normal tissues were observed, with the exception of an acute reaction found in the brain of a 15d old animal.

Case-control evaluation of a school-age BCG vaccination programme in subtropical Australia

In 1956 a programme was initiated to vaccinate all children aged 12-14 years who were attending schools in Queensland, Australia. In view of the declining incidence of tuberculosis in Australia as a whole, there was a need to evaluate the effectiveness of the programme and its procedures. We therefore carried out a case-control study of Queensland's population, excluding certain known high-risk groups. Cases were Queensland residents with notified tuberculosis and of the appropriate age; two controls per case were chosen from the electoral roll. Information on vaccination status was obtained mainly from questionnaires and school records, where available. The results show that at best BCG vaccination had a modest protective effect, approximately 30% when the patients were diagnosed, which was on average 15 years after they had been vaccinated in the school programme. In the north the climate of Queensland is tropical, while in the more heavily populated south it is subtropical. A substantial proportion of the school records reported weak positive reactions to preliminary tuberculin testing, believed to be due largely to atypical mycobacteria. A similar phenomenon has been observed in other tropical regions, and may help to explain the apparent absence of a strongly protective effect for BCG vaccination.