Risk factors of delirium in elderly patients with hip fracture

Background: Delirium is a leading cause of death and disability in the elderly with hip fracture. Identifying reliable risk factors for delirium is critical to support optimal outcomes for prevention and reducing delirium. Objective: To quantify the reported factors associated to delirium for patients with hip fracture. Methods: Electronic databases were searched (including Medline, Pub Med, CINAHL, EMBASE, Evidence Based Medicine Reviews, Cochrane Review, Web of Science, and PsycINFO) to identify all studies, published in English language that evaluated the risk factors of delirium hospitalized people with hip fracture. Two reviewers independently assessed methodology quality and extracted relevant data. The data from the included studies were summarized, and pooled estimates were calculated for 12 risk factors. Results: Thirty-seven studies were included in the review and 25 in the meta-analysis. The incidence of delirium was 32.4% (95% confidence interval [CI] = 25.9%–39.5%). Six predisposing and four precipitating factors predicted delirium among older patients with hip fracture confirmed. The predisposing factors included advanced age (ES = 1.06, 95% CI = 1.03–1.09), male sex (ES = 1.34, 95% CI = 1.08–1.68), impairment of cognition (ES = 2.91, 95% CI = 1.91–4.42), and function (ES = 1.75, 95% CI = 1.39–2.2), comorbidity (ES = 1.59, 95% CI = 1.30–1.96), and health problems (ES = 2.64, 95% CI = 2.04–3.42). Precipitating factors were hypo- or hypernatremia (ES = 1.73, 95% CI = 1.14–2.64), depression (ES = 4.07, 95% CI = 1.95–8.49), more than three prescribed drugs (ES = 1.28, 95% CI = 1.10–1.49), and drugs including opioids (ES = 2.13, 95% CI = 1.42–3.18) and anticholinergic agents (ES = 2.10, 95% CI = 1.60–2.75). Conclusion: This meta-analysis result provides evidence that these risk factors have a significant impact on delirium in elders with hip fracture during hospitalization. Developing formal screening, and effective preventive and management strategies for delirium is important. Keywords: Delirium, elderly, hip fracture, risk factors, systematic revie

Empirical Studies on Governance - Performance Interplay: The Investors' Perspective

Aquesta tesi té com objectiu entendre la relació entre la governança corporativa i el rendiment de les accions en el mercat financer, estudiant l’evolució al llarg del temps i revisant els problemes metodològics en la mesura de la governança corporativa. La literatura empírica sobre la governança corporativa mostra que el valor de les accions d’empreses amb bona governança supera el de les accions d’empreses amb mala governança. Això passa fins el moment en que els inversors paren atenció a la informació relativa a la governança, moment en que aquesta anomalia desapareix. La primera part d’aquesta tesi revela que, al contrari del que mostra la literatura, el valor de les accions d’empreses amb mala governança supera el de les accions d’empreses amb bona governança durant els darrers anys. Per explicar aquest resultat novell, el primer estudi examina si els inversors prenen consciència dels riscos associats amb la mala governança després de la crisi financera global del 2008, i integren aquesta informació en les decisions d’inversió. L’evidència empírica recolza aquesta explicació. En la segona part de la tesi, proposem un mesura de governança corporativa que utilitza una metodologia amb ponderacions desiguals sobre las provisions contra l’adquisició. En comparació amb les mesures existents de governança corporativa, les quals utilitzen ponderacions amb igual pes, aquest és el primer estudi que explora l’ús de metodologies amb ponderacions desiguals. Els resultats mostren que la relació entre la governança corporativa i el rendiment de les accions s’explica millor quan els pesos de l’índex de governança corporativa reflecteixen l’heterogeneïtat de las provisions per neutralitzar ofertes publiques d’adquisició. Mentre que els dos primers estudis es basen en la visió que els accionistes tenen sobre la governança corporativa, el tercer estudi d’aquesta tesi es basa en la perspectiva de tots els actors involucrats, ja que considera les característiques mediambientals, socials i de governança (ESG en anglès) juntes. Mentre que la literatura ha utilitzat mesures inclusives de la orientació ESG de l’empresa, aquest estudi presenta una mesura selectiva de sostenibilitat corporativa com a subconjunt de ESG. L’estudi revela com la sostenibilitat corporativa es l’impulsor principal de la relació entre la orientació ESG i el rendiment financer de les empreses. En resum, aquesta tesi destaca la importància de la governança i de la informació ESG (i la manera en com es mesuren) tan per l’empresa com pels inversors. La governança està relacionada de forma significativa amb el rendiment de les accions de l’empresa i la seva valoració, però condicionada a la manera en que es mesura. Això, en conseqüència, té implicacions pràctiques tant pels directius, com per les agències de qualificació d’empreses i els reguladors.Esta tesis tiene como objetivo entender la relación entre la gobernanza corporativa y el rendimiento de las acciones en el mercado financiero, estudiando la evolución a lo largo del tiempo y revisando los problemas metodológicos en la medida de la gobernanza corporativa. La literatura empírica sobre la gobernanza corporativa muestra que el valor de las acciones de empresas con buena gobernanza supera el de las acciones de empresas con mala gobernanza. Esto ocurre hasta el momento en que los inversores paran atención a la información relativa a la gobernanza, momento en que dicha anomalía desaparece. La primera parte de esta tesis revela que, al contrario de lo que muestra la literatura, el valor de las acciones de empresas con mala gobernanza supera el de las acciones de empresas con buena gobernanza en los últimos años. Para explicar este resultado novedoso, el primer estudio examina si los inversores toman conciencia de los riesgos asociados con la mala gobernanza después de la crisis financiera global del 2008, e integran dicha información en las decisiones de inversión. La evidencia empírica apoya dicha explicación. En la segunda parte de la tesis, proponemos una medida de gobernanza corporativa que utiliza una metodología con ponderaciones desiguales sobre las provisiones contra la adquisición. En comparación con las medidas existentes de gobernanza corporativa, las cuales utilizan ponderaciones con igual peso, éste es el primer estudio que explora el uso de metodologías con ponderaciones desiguales. Los resultados muestran que la relación entre la gobernanza corporativa y el rendimiento de las acciones se explica mejor cuando los pesos del índice de gobernanza corporativa reflejan la heterogeneidad de las provisiones para neutralizar ofertas públicas de adquisición. Mientras que los dos primeros estudios se basan en la visión que los accionistas tienen sobre la gobernanza corporativa, el tercer estudio de esta tesis se basa en la perspectiva de todos los actores involucrados, ya que considera las características medioambientales, sociales y de gobernanza (ESG en inglés) juntas. Mientras que la literatura ha utilizado medidas inclusivas de la orientación ESG de la empresa, este estudio presenta una medida selectiva de sostenibilidad corporativa como subconjunto de ESG. El estudio revela como la sostenibilidad corporativa es el impulsor principal de la relación entre la orientación ESG y el rendimiento financiero de las empresas. En resumen, esta tesis destaca la importancia de la gobernanza y de la información ESG (y la manera de medirlas) tanto para la empresa como para los inversores. La gobernanza está relacionada de forma significativa con el rendimiento de las acciones de la empresa y su valoración, pero condicionada a la manera de medirla. Esto, en consecuencia, tiene implicaciones prácticas tanto para los directivos, como para las agencias de calificación de empresas y los reguladores.This thesis aims to understand the relationship between corporate governance and performance by tracing its evolution over time and revisiting the methodological issues faced in measuring corporate governance. Empirical corporate governance literature shows that good governance stocks outperformed poor ones until investors’ increased attention to governance information made this anomaly disappear. On the contrary, first part of this thesis reveals that poor governance stocks have outperformed good ones in recent years. To explain this novel result, we examine whether investors become aware of the risks associated with poor governance after the 2008 global financial crisis and integrate this information into their investment decisions. Empirical evidence supports this explanation. In the second part of the thesis, we propose an unequal-weighted measure of corporate governance using anti-takeover provisions. In comparison with existing measures of governance that employ equal weighting methodology, this is the first study to explore multiple unequal weighting methodologies. Results show that the relationship between governance and performance is better explained when individual anti-takeover provisions’ heterogeneity is captured in the weights of the governance index. While the first two studies take the shareholders’ view of corporate governance, the third study of this thesis takes a stakeholders’ view by considering environmental, social and governance (ESG) characteristics together. Unlike prior literature that applies kitchen-sink measures of firms’ ESG-orientation, this study introduces a selective approach to measure corporate sustainability as an ESG subset. We show that corporate sustainability is the main driver of ESG’s relationship with financial performance. Overall, this thesis highlights the importance of governance and ESG information (and the way they are both measured) for both the firms and their investors. Governance is significantly related to performance and valuation, but conditional on the way it is measured. This, in turn, has important implications for managers, governance rating agencies, and regulators

Learning to Unpermute

This paper investigates the effectiveness of deep learning models in matching distributions, using the problem of unpermuting images as a case study. Unpermuting an image refers to the process of reversing the effects of image permutation, which involves randomly shuffling the pixels of an image.The research is divided into two phases. The first phase involves the development of a supervised learning model that trains a neural network on a paired data set of original and permuted images.The second phase focuses on the development of an unsupervised deep learning model that trains the network on unpaired images. The study demonstrates the ability of deep learning models to match distributions and address the problem of unpermuting images. The findings of this study can provide insights into the general problem of distribution matching in deep learning

The Hip Fracture Surgery in Elderly Patients (HIPELD) study: protocol for a randomized, multicenter controlled trial evaluating the effect of xenon on postoperative delirium in older patients undergoing hip fracture surgery

BackgroundStrategies to protect the brain from postoperative delirium (POD) after hip fracture are urgently needed. The development of delirium often is associated with the loss of independence, poor functional recovery, and increased morbidity, as well as increases in length of hospital stay, discharges to nursing facilities, and healthcare costs. We hypothesize that xenon may reduce the burden of POD, (i) by avoiding the need to provide anesthesia with a drug that targets the γ-amino-butyric acid (GABA)A receptor and (ii) through beneficial anesthetic and organ-protective effects.Methods and designAn international, multicenter, phase 2, prospective, randomized, blinded, parallel group and controlled trial to evaluate the incidence of POD, diagnosed with the Confusion Assessment Method (CAM), in older patients undergoing hip fracture surgery under general anesthesia with xenon or sevoflurane, for a period of 4 days post surgery (primary outcome) is planned. Secondary objectives are to compare the incidence of POD between xenon and sevoflurane, to evaluate the incidence of POD from day 5 post surgery until discharge from hospital, to determine the time to first POD diagnosis, to evaluate the duration of POD, to evaluate the evolution of the physiological status of the patients in the postoperative period, to evaluate the recovery parameters, to collect preliminary data to evaluate the economical impact of POD in the postoperative period and to collect safety data. Patients are eligible if they are older aged (≥ 75 years) and assigned to a planned hip fracture surgery within 48 h after the hip fracture. Furthermore, patients need to be willing and able to complete the requirements of this study including the signature of the written informed consent. A total of 256 randomized patients in the 10 participating centers will be recruited, that is, 128 randomized patients in each of the 2 study groups (receiving either xenon or sevoflurane).Trial registrationEudraCT Identifier: 2009-017153-35; ClinicalTrials.gov Identifier: NCT0119927

Quantitative assessment of the biochemical composition of equine cartilage using 7T ultra-high field magnetic resonance imaging (MRI) techniques

No abstract available

Topographical anatomy of the mandibular foramen in the dromedary camels (Camelus dromedarius): an extraoral approach for the inferior alveolar nerve blocks

Understanding the clinical anatomy of the head is essential for performing proper inferior alveolar nerve (IAN) block anesthesia to facilitate invasive dental procedures in camels. However, osteometric data related to the IAN in camels are lacking. This study was carried out to accurately locate the mandibular foramen (MF) and the course of the IAN in the camel head and to establish an approach for its localization in clinical practice. To achieve these aims, eight osteometric measurements were used to determine the location of the MF in relation to its surrounding structures in six cadaveric skulls of adult camels. Four camel heads were dissected, and the course of the IAN inside the mandibular canal was studied. In addition, four heads were used as a trial for the extraoral approach to the IAN block using contrast radiographs based on established metric indices. Dissection of the four camel heads revealed that the MF was located near the intersection of two lines passing through the occlusal surface of the mandibular cheek teeth and at the midpoint of the zygomatic process of the temporal bone. Significant differences were not observed between the right and left mandibles. Successful deposition of the contrast medium near the MF was observed in all examined specimens. This study reports a new, simple approach to reaching the IAN at the MF. However, further clinical validation of the proposed technique is required

Predictors of functional outcome following femoral neck fractures treated with an arthroplasty: limitations of the Harris hip score

Introduction To study the association between potential prognostic factors and functional outcome at 1 and 5 year follow-up in patients with femoral neck fractures treated with an arthroplasty. To analyze the reliability of the Harris hip score (HHS). Materials and methods A multicenter analysis which included 252 patients who sustained a femoral neck fracture treated with an arthroplasty. Functional outcome after surgery was assessed using a modified HHS and was evaluated after 1 (HHS1) and 5 (HHS5) years. Several prognostic factors were analyzed and reliability of the HHS was assessed. Results After 1 year the presence of co-morbidities was a significant (p = 0.002) predictor for a poor functional outcome (mean HHS1 71.8 with co-morbidities, and 80.6 without co-morbidities). After 5 years none of the potential prognostic factors had significant influence on functional outcome. Internal consistency testing of the HHS showed that when pain and function of the HHS were analyzed together, the internal consistency was poor (HHS1 0.38 and HHS5 0.20). The internal consistency of the HHS solely in function (without pain) improved to 0.68 (HHS1) and 0.46 (HHS5). Analyzing the functional aspect exclusively, age and the existence of co-morbidities could be defined as predictors for functional outcome of femoral neck fractures after 1 and 5 years. Conclusion After using the HHS in a modification, age and the existence of pre-operative co-morbidities appeared to be predictors of the functional outcome after 1 and 5 years. The HHS, omitting pain, is a more reliable score to estimate the functional outcome, than HHS analyzing pain and function in one scoring syste

Ultrasonography of the normal donkey tarsus (equus asinus)

Abstract Tarsal joint illness is a frequent source of hind limb lameness due to the complex anatomy of the region and the presence of numerous bony and soft tissue structures. Proper lameness diagnosis aims to discover the structure provoking lameness. Ultrasonography documents valuable information of soft tissues and characterizes soft tissue injuries that have heretofore been difficult to obtain either noninvasively or via radiography. The objectives of the current study were to develop and describe a standardized ultrasonographic protocol for investigation of the tarsal region in donkeys. The donkey tarsal anatomy was investigated in 5 cadavers and the tarsi of 11 healthy lameness free adult donkeys were echographically investigated. The dorsal, plantar, lateral and medial aspects of the tarsal region were substantially evaluated at four anatomical landmarks in both the longitudinal and horizontal planes using a multi-frequency 5–12 MHz linear transducer. Sonoanatomy of the extensor and flexor tarsal tendons, collateral and plantar ligaments, and synovial pouches was delineated and described. Systematic echography of the tarsal region allowed accurate localization and thorough exploration of various soft tissues of clinical interest in the donkey tarsus. Sonograms provided in this study should serve as a reference database for tarsal ultrasonography in clinical circumstances

Empirical Studies on Governance - Performance Interplay: The Investors' Perspective

Aquesta tesi té com objectiu entendre la relació entre la governança corporativa i el rendiment de les accions en el mercat financer, estudiant l’evolució al llarg del temps i revisant els problemes metodològics en la mesura de la governança corporativa. La literatura empírica sobre la governança corporativa mostra que el valor de les accions d’empreses amb bona governança supera el de les accions d’empreses amb mala governança. Això passa fins el moment en que els inversors paren atenció a la informació relativa a la governança, moment en que aquesta anomalia desapareix. La primera part d’aquesta tesi revela que, al contrari del que mostra la literatura, el valor de les accions d’empreses amb mala governança supera el de les accions d’empreses amb bona governança durant els darrers anys. Per explicar aquest resultat novell, el primer estudi examina si els inversors prenen consciència dels riscos associats amb la mala governança després de la crisi financera global del 2008, i integren aquesta informació en les decisions d’inversió. L’evidència empírica recolza aquesta explicació. En la segona part de la tesi, proposem un mesura de governança corporativa que utilitza una metodologia amb ponderacions desiguals sobre las provisions contra l’adquisició. En comparació amb les mesures existents de governança corporativa, les quals utilitzen ponderacions amb igual pes, aquest és el primer estudi que explora l’ús de metodologies amb ponderacions desiguals. Els resultats mostren que la relació entre la governança corporativa i el rendiment de les accions s’explica millor quan els pesos de l’índex de governança corporativa reflecteixen l’heterogeneïtat de las provisions per neutralitzar ofertes publiques d’adquisició. Mentre que els dos primers estudis es basen en la visió que els accionistes tenen sobre la governança corporativa, el tercer estudi d’aquesta tesi es basa en la perspectiva de tots els actors involucrats, ja que considera les característiques mediambientals, socials i de governança (ESG en anglès) juntes. Mentre que la literatura ha utilitzat mesures inclusives de la orientació ESG de l’empresa, aquest estudi presenta una mesura selectiva de sostenibilitat corporativa com a subconjunt de ESG. L’estudi revela com la sostenibilitat corporativa es l’impulsor principal de la relació entre la orientació ESG i el rendiment financer de les empreses. En resum, aquesta tesi destaca la importància de la governança i de la informació ESG (i la manera en com es mesuren) tan per l’empresa com pels inversors. La governança està relacionada de forma significativa amb el rendiment de les accions de l’empresa i la seva valoració, però condicionada a la manera en que es mesura. Això, en conseqüència, té implicacions pràctiques tant pels directius, com per les agències de qualificació d’empreses i els reguladors.Esta tesis tiene como objetivo entender la relación entre la gobernanza corporativa y el rendimiento de las acciones en el mercado financiero, estudiando la evolución a lo largo del tiempo y revisando los problemas metodológicos en la medida de la gobernanza corporativa. La literatura empírica sobre la gobernanza corporativa muestra que el valor de las acciones de empresas con buena gobernanza supera el de las acciones de empresas con mala gobernanza. Esto ocurre hasta el momento en que los inversores paran atención a la información relativa a la gobernanza, momento en que dicha anomalía desaparece. La primera parte de esta tesis revela que, al contrario de lo que muestra la literatura, el valor de las acciones de empresas con mala gobernanza supera el de las acciones de empresas con buena gobernanza en los últimos años. Para explicar este resultado novedoso, el primer estudio examina si los inversores toman conciencia de los riesgos asociados con la mala gobernanza después de la crisis financiera global del 2008, e integran dicha información en las decisiones de inversión. La evidencia empírica apoya dicha explicación. En la segunda parte de la tesis, proponemos una medida de gobernanza corporativa que utiliza una metodología con ponderaciones desiguales sobre las provisiones contra la adquisición. En comparación con las medidas existentes de gobernanza corporativa, las cuales utilizan ponderaciones con igual peso, éste es el primer estudio que explora el uso de metodologías con ponderaciones desiguales. Los resultados muestran que la relación entre la gobernanza corporativa y el rendimiento de las acciones se explica mejor cuando los pesos del índice de gobernanza corporativa reflejan la heterogeneidad de las provisiones para neutralizar ofertas públicas de adquisición. Mientras que los dos primeros estudios se basan en la visión que los accionistas tienen sobre la gobernanza corporativa, el tercer estudio de esta tesis se basa en la perspectiva de todos los actores involucrados, ya que considera las características medioambientales, sociales y de gobernanza (ESG en inglés) juntas. Mientras que la literatura ha utilizado medidas inclusivas de la orientación ESG de la empresa, este estudio presenta una medida selectiva de sostenibilidad corporativa como subconjunto de ESG. El estudio revela como la sostenibilidad corporativa es el impulsor principal de la relación entre la orientación ESG y el rendimiento financiero de las empresas. En resumen, esta tesis destaca la importancia de la gobernanza y de la información ESG (y la manera de medirlas) tanto para la empresa como para los inversores. La gobernanza está relacionada de forma significativa con el rendimiento de las acciones de la empresa y su valoración, pero condicionada a la manera de medirla. Esto, en consecuencia, tiene implicaciones prácticas tanto para los directivos, como para las agencias de calificación de empresas y los reguladores.This thesis aims to understand the relationship between corporate governance and performance by tracing its evolution over time and revisiting the methodological issues faced in measuring corporate governance. Empirical corporate governance literature shows that good governance stocks outperformed poor ones until investors’ increased attention to governance information made this anomaly disappear. On the contrary, first part of this thesis reveals that poor governance stocks have outperformed good ones in recent years. To explain this novel result, we examine whether investors become aware of the risks associated with poor governance after the 2008 global financial crisis and integrate this information into their investment decisions. Empirical evidence supports this explanation. In the second part of the thesis, we propose an unequal-weighted measure of corporate governance using anti-takeover provisions. In comparison with existing measures of governance that employ equal weighting methodology, this is the first study to explore multiple unequal weighting methodologies. Results show that the relationship between governance and performance is better explained when individual anti-takeover provisions’ heterogeneity is captured in the weights of the governance index. While the first two studies take the shareholders’ view of corporate governance, the third study of this thesis takes a stakeholders’ view by considering environmental, social and governance (ESG) characteristics together. Unlike prior literature that applies kitchen-sink measures of firms’ ESG-orientation, this study introduces a selective approach to measure corporate sustainability as an ESG subset. We show that corporate sustainability is the main driver of ESG’s relationship with financial performance. Overall, this thesis highlights the importance of governance and ESG information (and the way they are both measured) for both the firms and their investors. Governance is significantly related to performance and valuation, but conditional on the way it is measured. This, in turn, has important implications for managers, governance rating agencies, and regulators