Statin Use and Risk of Delirium in the Critically Ill

Rationale: Delirium is common in intensive care unit (ICU) patients and is a predictor of worse outcomes and neuroinflammation is a possible mechanism. The antiinflammatory actions of statins may reduce delirium.

Objectives: To determine whether critically ill patients receiving statin therapy had a reduced risk of delirium than those not on statins.

Methods: A prospective cohort analysis of data from consecutive ICU patients admitted to a UK mixed medical and surgical critical care unit between August 2011 and February 2012; the Confusion Assessment Method for ICU was used to determine the days each patient was assessed as being free of delirium during ICU admission.

Measurements and Main Results: Delirium-free days, daily administration of statins, and serum C-reactive protein (CRP) were recorded. Four hundred and seventy consecutive critical care patients were followed, of whom 151 patients received statins. Using randomeffects multivariable logistic regression, statin administration the previous evening was associated with the patient being assessed as free of delirium (odds ratio, 2.28; confidence interval, 1.01-5.13; P , 0.05) and with lower CRP (b = 20.52; P , 0.01) the following day. When the association between statin and being assessed as free of delirium was controlled for CRP, the effect size became nonsignificant (odds ratio, 1.56; confidence interval, 0.64-3.79; P = 0.32).

Conclusions: Ongoing statin therapy is associated with a lower daily risk of delirium in critically ill patients. An ongoing clinical trial, informed by this study, is investigating if statins are a potential therapy for delirium in the critically ill.Copyright © 2014 by the American Thoracic Society.

Two Trilogies:On Stewart Parker and Tom Murphy

This chapter discusses the relations between Irish cinema and the other arts- chiefly, literature, theatre, painting, and photography. It provides a critical overview of the main scholarly approaches to those forms of adaptation and citation that have tended to dominate Irish film production. It argues that factors such as the historic marginalization of non-literary modernist art in Ireland, a deep cultural resistance to intellectual and politically-engaged filmmaking, and a commercially-driven attachment to formulaic narrative structures, are among the reasons why Ireland has generally failed to produce a distinctive and successful cinema. The chapter concludes by discussing some films that have resisted this trend by offering their audiences a more creative approach to -- or poetics of -- adaptation that has more in common with the visual -- rather than literary -- arts in Ireland.

Parker Morris and the economies of the Fordist house

The Parker Morris report of 1961 attempted, through the application of scientific principles, to define the minimum living space standards needed to accommodate household activities. But while early modernist research into ideas of existenzminimum were the work of avant-garde architects and thinkers, this report was commissioned by the British State. This normalization of scientific enquiry into space can be considered not only a response to new conditions in the mass production of housing – economies of scale, prefabrication, system-building and modular coordination – but also to the post-war boom in consumer goods. The domestic interior was assigned a key role as a privileged site of mass consumption as the production and micro-management of space in Britain became integral to the development of a planned national economy underpinned by Fordist principles. The apparently placeless and scale-less diagrams executed by Gordon Cullen to illustrate Parker Morris emblematize these relationships. Walls dissolve as space flows from inside to outside in a homogenized and ephemeral landscape whose limits are perhaps only the boundaries of the nation state and the circuits of capital.

Parker Morris and the Fordist House

6.00 pm. If people like watching T.V. while they are eating their evening meal, space for a low table is needed (Ministry of Housing and Local Government, Space in the Home, 1963, p. 4).

This paper re-examines the 1961 Parker Morris report on housing standards in Britain. It explores the origins, scope, text and iconography of the report and suggests that these not only express a particularly modernist conception of space but one which presupposed very specific economic conditions and geographies.

Also known as Homes for Today and Tomorrow Parker Morris attempted, through the application of scientific principles, to define the minimum living space standards needed to accommodate household activities. But while early modernist research into notions of existenzminimum were the work of avant-garde architects and thinkers, Homes for Today and Tomorrow and its sister design manual Space in the Home were commissioned by the British State. This normalization of scientific enquiry into space can be considered not only as a response to new conditions in the mass production of housing – economies of scale, prefabrication, system-building and modular coordination – but also to the post-war boom in consumer goods. In this, it is suggested that the domestic interior was assigned a key role as a privileged site of mass consumption as the production and micro-management of space in Britain became integral to the development of a planned national economy underpinned by Fordist principles. Parker Morris, therefore, sought to accommodate activities which were pre-determined not so much by traditional social or familial ties but rather by recently introduced commodities such as the television set, white goods, table tennis tables and train sets. This relationship between the domestic interior and the national economy are emblematized by the series of placeless and scale-less diagrams executed by Gordon Cullen in Space in the Home. Here, walls dissolve as space flows from inside to outside in a homogenized and ephemeral landscape whose limits are perhaps only the boundaries of the nation state and the circuits of capital.

In Britain, Parker Morris was the last explicit State-sponsored attempt to prescribe a normative spatial programme for national living. The calm neutral efficiency of family-life expressed in its diagrams was almost immediately problematised by the rise of 1960s counter-culture, the feminist movement and the oil crisis of 1972 which altered perhaps forever the spatial, temporal and economic conditions it had taken for granted. The debate on space-standards, however, continues.