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Objectives: During the coronavirus disease (COVID‐19) pandemic, patients with altered mental status (AMS: dementia, delirium and delirium superimposed on dementia) were profoundly affected by an abrupt transformation in healthcare systems. Here, we evaluated quality‐care outcomes, including length of stay (LOS), in‐hospital mortality, early readmission and mortality after hospital discharge, in older adults admitted for AMS during the pandemic and compared them to patients admitted prior to the pandemic. Methods: Chi‐squared and Fisher's exact tests were used to examine changes to admissions for AMS before and during the pandemic, and their outcomes. Logistic regression analyses, with reference to pre‐pandemic data, were conducted to examine the impact of the pandemic on outcomes. Design: Prospective data of 21,192 non‐COVID admissions to an acute general medical department in a Surrey (UK) hospital were collected from patients admitted before (1st April 2019 to 29th February 2020) and during the pandemic (1st March 2020 to 31st March 2021). Results: There were 10,173 (47.7% men) from the pre‐pandemic and 11,019 (47.5% men) from the pandemic periods; overall mean age = 68.3yr. During the pandemic AMS patients had significantly higher admission rates (1.1% vs 0.6%, P < 0.001). However, median LOS in hospital was shorter (9.0 days [IQR = 5.3–16.2] vs 15.5 days [IQR = 6.2–25.7], P < 0.001) and thus were less likely to stay in hospital >3 weeks: adjusted OR = 0.26 (95%CI = 0.12–0.57). In‐hospital mortality and readmission within 28 days of discharge did not change during the pandemic, but were less likely to die within 30 days of discharge: adjusted OR = 0.32 (95%CI = 0.11–0.96). Conclusions: This combination of higher admission rate, shorter LOS, and an unchanging early readmission suggests a higher admission‐discharge turnover of different patients with AMS and provides important insights into the potential impact of the COVID‐19 pandemic on healthcare delivery to individuals with AMS. Key points: During the coronavirus disease (COVID‐19) pandemic, patients with altered mental status (AMS: dementia, delirium and delirium superimposed on delirium) were profoundly affected by an abrupt transformation in healthcare systems.Patients admitted with AMS during the pandemic had higher admission rates but shorter length of stay (LOS) in hospital, whilst mortality in hospital and readmission within 28 days of discharge did not change during the pandemicThese observations suggest a higher admission‐discharge turnover of different patients with AMS and provide important insights into the potentially impact of the COVID‐19 pandemic on healthcare delivery to individuals with AMS. [ABSTRACT FROM AUTHOR]

This systematic review critically appraises the literature on the psychometric properties and clinical utility of evaluative activity limitation outcome measures used for children with cerebral palsy (CP). The search strategy yielded 29 articles for eight outcome measures that met the inclusion criteria for the review. The Gross Motor Function Measure and Activities Scale for Kids were found to have sound psychometric properties in most areas. Reliability was found to be adequate for all tools. For the CP population, further examination of some aspects of validity is required for the Child Health Questionnaire (CHQ), Functional Assessment Questionnaire (FAQ), Functional Mobility Scale (FMS), Pediatric Evaluation of Disability Inventory, Pediatric Outcomes Data Collection Instrument (PODCI), and the Functional Independence Measure for Children. The FAQ, CHQ, FMS, and PODCI were found to require further examination for responsiveness. Clinical utility of the measures varied. The FMS was the only one to differentiate between function in the home, school, and community and to consider different assistive devices. These findings suggest that a range of measures is required to evaluate activity, and assessment should be tailored to the individual needs of children with CP.

During compatible interactions with their host plants, biotrophic plant pathogens subvert host metabolism to ensure the sustained provision of nutrient assimilates by the colonized host cells. To investigate, whether common motifs can be revealed in the response of primary carbon and nitrogen metabolism towards colonization with biotrophic fungi in cereal leaves, we have conducted a combined metabolome and transcriptome study of three quite divergent pathosystems, the barley powdery mildew fungus (Blumeria graminis f.sp. hordei), the corn smut fungus Ustilago maydis and the maize anthracnose fungus Colletotrichum graminicola, the latter being a hemibiotroph that only exhibits an initial biotrophic phase during its establishment.Based on the analysis of 42 water-soluble metabolites, we were able to separate early biotrophic from late biotrophic interactions by hierarchical cluster analysis and principal component analysis, irrespective of the plant host. Interestingly, the corresponding transcriptome dataset could not discriminate between these stages of biotrophy, irrespective, of whether transcript data for genes of central metabolism or the entire transcriptome dataset was used. Strong differences in the transcriptional regulation of photosynthesis, glycolysis, the TCA cycle, lipid biosynthesis, and cell wall metabolism were observed between the pathosystems. Increased contents of Gln, Asn, and glucose as well as diminished contents of PEP and 3-PGA were common to early post-penetration stages of all interactions. On the transcriptional level, genes of the TCA cycle, nucleotide energy metabolism and amino acid biosynthesis exhibited consistent trends among the compared biotrophic interactions, identifying the requirement for metabolic energy and the rearrangement of amino acid pools as common transcriptional motifs during early biotrophy. Both metabolome and transcript data were employed to generate models of leaf primary metabolism during early biotrophy.