How do predisposing factors differ between delirium motor subtypes? A systematic review and meta-analysis.

BACKGROUND: Delirium is a common neurocognitive disorder in hospitalised older adults with vast negative consequences. The predominant method of subtyping delirium is by motor activity profile into hypoactive, hyperactive and mixed groups. OBJECTIVE: This systematic review and meta-analysis investigated how predisposing factors differ between delirium motor subtypes. METHODS: Databases (Medline, PsycINFO, Embase) were systematically searched for studies reporting predisposing factors (prior to delirium) for delirium motor subtypes. A total of 61 studies met inclusion criteria (N = 14,407, mean age 73.63 years). Random-effects meta-analyses synthesised differences between delirium motor subtypes relative to 22 factors. RESULTS: Hypoactive cases were older, had poorer cognition and higher physical risk scores than hyperactive cases and were more likely to be women, living in care homes, taking more medications, with worse functional performance and history of cerebrovascular disease than all remaining subtypes. Hyperactive cases were younger than hypoactive and mixed subtypes and were more likely to be men, with better cognition and lower physical risk scores than all other subtypes. Those with no motor subtype (unable to be classified) were more likely to be women and have better functional performance. Effect sizes were small. CONCLUSIONS: Important differences in those who develop motor subtypes of delirium were shown prior to delirium occurrence. We provide robust quantitative evidence for a common clinical assumption that indices of frailty (institutional living, cognitive and functional impairment) are seen more in hypoactive patients. Motor subtypes should be measured across delirium research. Motor subtyping has great potential to improve the clinical risk assessment and management of delirium.

The Pandemic as a Portal: Reimagining Psychological Science as Truly Open and Inclusive.

Psychological science is at an inflection point: The COVID-19 pandemic has exacerbated inequalities that stem from our historically closed and exclusive culture. Meanwhile, reform efforts to change the future of our science are too narrow in focus to fully succeed. In this article, we call on psychological scientists-focusing specifically on those who use quantitative methods in the United States as one context for such conversations-to begin reimagining our discipline as fundamentally open and inclusive. First, we discuss whom our discipline was designed to serve and how this history produced the inequitable reward and support systems we see today. Second, we highlight how current institutional responses to address worsening inequalities are inadequate, as well as how our disciplinary perspective may both help and hinder our ability to craft effective solutions. Third, we take a hard look in the mirror at the disconnect between what we ostensibly value as a field and what we actually practice. Fourth and finally, we lead readers through a roadmap for reimagining psychological science in whatever roles and spaces they occupy, from an informal discussion group in a department to a formal strategic planning retreat at a scientific society.

Dietary Guidelines for Americans: Implications for Primary Care Providers.

In the United States, high rates of obesity and chronic disease impose serious consequences on the population's health and health care system. Primary care providers are critical to broad prevention efforts aiming to reduce the burden of chronic disease in the nation and play an important role in addressing lifestyle behaviors that can result in illness and premature death. Unhealthy dietary behaviors largely contribute to morbidity and mortality in the United States despite national efforts to improve the nutritional quality of the typical American diet. This article discusses a comprehensive set of national evidence-based recommendations known as the Dietary Guidelines for Americans that can support primary care providers' efforts to improve patient outcomes through optimal nutrition and healthy lifestyle behaviors. This article also describes basic behavioral counseling techniques primary care providers can incorporate into time-limited patient encounters to help improve the dietary and physical activity behaviors of their patients.

Calorie for Calorie, Dietary Fat Restriction Results in More Body Fat Loss than Carbohydrate Restriction in People with Obesity.

Dietary carbohydrate restriction has been purported to cause endocrine adaptations that promote body fat loss more than dietary fat restriction. We selectively restricted dietary carbohydrate versus fat for 6 days following a 5-day baseline diet in 19 adults with obesity confined to a metabolic ward where they exercised daily. Subjects received both isocaloric diets in random order during each of two inpatient stays. Body fat loss was calculated as the difference between daily fat intake and net fat oxidation measured while residing in a metabolic chamber. Whereas carbohydrate restriction led to sustained increases in fat oxidation and loss of 53 ± 6 g/day of body fat, fat oxidation was unchanged by fat restriction, leading to 89 ± 6 g/day of fat loss, and was significantly greater than carbohydrate restriction (p = 0.002). Mathematical model simulations agreed with these data, but predicted that the body acts to minimize body fat differences with prolonged isocaloric diets varying in carbohydrate and fat.

A randomized clinical trial of intravitreal bevacizumab versus intravitreal dexamethasone for diabetic macular edema: the BEVORDEX study.

OBJECTIVE: To report the 12-month results of the first head-to-head comparison of a dexamethasone implant (Ozurdex; Allergan, Inc., Irvine, CA) versus bevacizumab (Avastin; Genentech, South San Francisco, CA) for center-involving diabetic macular edema (DME). DESIGN: Phase 2, prospective, multicenter, randomized, single-masked clinical trial (clinicaltrials.gov identifier NCT01298076). PARTICIPANTS: We enrolled 88 eyes of 61 patients with center-involving DME. METHODS: Forty-two eyes were randomized to receive bevacizumab every 4 weeks and 46 eyes were randomized to receive a dexamethasone implant every 16 weeks, both pro re nata. Results were analyzed using linear regression with generalized estimation equation methods to account for between-eye correlation. MAIN OUTCOME MEASURES: The primary outcome was the proportion of eyes that improved vision by 10 logarithm of minimum angle of resolution letters. Secondary outcomes included mean change in best-corrected visual acuity (BCVA), change in central macular thickness (CMT), injection frequency, and adverse events. Patient-reported outcomes were measured using the Impact of Vision Impairment (IVI) questionnaire. RESULTS: Improvement in BCVA of 10 or more letters was found in 17 of 42 eyes (40%) treated with bevacizumab compared with 19 of 46 dexamethasone implant-treated eyes (41%; P = 0.83). None of the 42 bevacizumab eyes lost 10 letters or more, whereas 5 of 46 (11%) dexamethasone implant eyes did, mostly because of cataract. Mean CMT decreased by 122 µm for bevacizumab eyes and by 187 µm for dexamethasone implant eyes (P = 0.015). Bevacizumab-treated eyes received a mean of 8.6 injections compared with 2.7 injections for dexamethasone implant eyes. Significant improvement in IVI scores occurred for both treatment groups. CONCLUSIONS: Dexamethasone implant achieved similar rates of visual acuity improvement compared with bevacizumab for DME, with superior anatomic outcomes and fewer injections. Both treatments were associated with improvement in visual quality-of-life scores. However, more dexamethasone implant-treated eyes lost vision, mainly because of cataract.

Warmth Trumps Competence in Evaluations of Both Ingroup and Outgroup.

Research from a number of social psychological traditions suggests that social perceivers should be more concerned with evaluating others' intentions (i.e., warmth) relative to evaluating others' ability to act on those intentions (i.e., competence). The present research examined whether warmth evaluations have cognitive primacy over competence evaluations in a direct reaction-time comparison and whether the effect is moderated by ingroup versus outgroup membership. Participants evaluated as quickly as possible whether warmth versus competence traits described photographs of racial ingroup versus outgroup members expressing neutral emotions. Responses supported the hypothesis that evaluations of warmth take precedence over evaluations of competence; participants were faster to evaluate others on warmth-related traits compared to competence-related traits. Moreover, this primacy effect was not moderated by racial group membership. The data from this research speak to the robustness of the primacy of warmth in social evaluation.

Gender differences in automatic in-group bias: why do women like women more than men like men?

Four experiments confirmed that women's automatic in-group bias is remarkably stronger than men's and investigated explanations for this sex difference, derived from potential sources of implicit attitudes (L. A. Rudman, 2004). In Experiment 1, only women (not men) showed cognitive balance among in-group bias, identity, and self-esteem (A. G. Greenwald et al., 2002), revealing that men lack a mechanism that bolsters automatic own group preference. Experiments 2 and 3 found pro-female bias to the extent that participants automatically favored their mothers over their fathers or associated male gender with violence, suggesting that maternal bonding and male intimidation influence gender attitudes. Experiment 4 showed that for sexually experienced men, the more positive their attitude was toward sex, the more they implicitly favored women. In concert, the findings help to explain sex differences in automatic in-group bias and underscore the uniqueness of gender for intergroup relations theorists.