BackgroundCaring for older patients can be challenging in the Emergency Department (ED). A > 12 hr ED stay could lead to incident episodes of delirium in those patients. The aim of this study was to assess the incidence and impacts of ED-stay associated delirium.MethodsA historical cohort of patients who presented to a Canadian ED in 2009 and 2011 was randomly constituted. Included patients were aged ≥ 65 years old, admitted to any hospital ward, non-delirious upon arrival and had at least a 12-hour ED stay. Delirium was detected using a modified chart-based Confusion Assessment Method (CAM) tool. Hospital length of stay (LOS) was log-transformed and linear regression assessed differences between groups. Adjustments were made for age and comorbidity profile.Results200 records were reviewed, 55.5% were female, median age was 78.9 yrs (SD:7.3). 36(18%) patients experienced ED-stay associated delirium. Nearly 50% of episodes started in the ED and within 36 hours of arrival. Comorbidity profile was similar between the positive CAM group and the negative CAM group. Mean adjusted hospital LOS were 20.5 days and 11.9 days respectively (p<.03).Conclusions1 older adult out of 5 became delirious after a 12 hr ED stay. Since delirium increases hospital LOS by more than a week, better screening and implementation of preventing measures for delirium could reduce LOS and overcrowding in the ED.

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A two dimensional model of bread baking was developed including, for the first time, the dependence of dough viscosity on both temperature and moisture content, the carbon dioxide dissolved from liquid water together with gas generation from yeast at the beginning of baking and the shrinkage due to dough drying. Particular attention was paid to experimental validation of both overall and local variables such as local temperature, overall mass loss, and local moisture content, overall CO 2 released into the oven, and overall deformation and local expansion or shrinkage. Sensitivity studies on generation of carbon dioxide, gravity, and shrinkage are presented to discuss their influences on bread geometry, porosity (reflecting the alveolar structure) and gas pressure.Profiles along the line of symmetry at 2.5 (line 1), 7 (line 2), and 15 min (line 3) of baking for the reference simulation; "1" and "2" signs delimit the areas where pressure is higher or lower than gravity stress, respectively.

Background: This literature review describes the evolution during baking of the three main components in dough (starch, proteins, and the aqueous phase) in order to understand what causes gas cells to open. To date, most of the literature has focused on the role played by proteins, gluten having received most attention in the last decades (strain hardening properties, ability to stretch without rupturing etc.). The possible role of a liquid lamella has more recently been proposed. While a number of articles directly evidence its existence, indirect results also provide proof of its presence. The role of starch in the mechanisms of gas cell stabilization/destabilisation has been little considered. The multiple actions of starch described in this review may offer an explanation for this. Scope and approach:The authors have set out to consider all phases and to understand how they may interact during baking in such a way as to lead eventually to gas cell wall rupture. Key findings and conclusions:The four most likely situations are presented and discussed:• gluten with poor ability to stretch: rupture occurs too early during baking.• gluten with poor ability to stretch but assisted by a liquid lamella: rupture is delayed; extent of delay is dependent on starch's sorption of water. • gluten with good ability to stretch, starch granules soften early during baking but do not fuse (ideal situation): structure opens late in baking when loaf is able to sustain its own weight. • too many fusing starch granules: gas cell walls fail to rupture and loaf shrinks during cooling.J o u r n a l P r e -p r o o f Highlights • Gas cell wall (GCW) rupture in bread dough during baking results from multiple physics.• Changes in dough phase interactions modify GCW rupture mechanisms.• The scale of dough constituents lacks knowledge of mechanical properties.• Each GCW phase plays a role in the GCW stabilization.• The role of starch is antagonistic, first destabilizing GCWs and then stabilizing them.