Improving Millennium Bank's personal finance manager

Double Degree

Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008.

OBJECTIVE: To provide an update to the original Surviving Sepsis Campaign clinical management guidelines, "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," published in 2004. DESIGN: Modified Delphi method with a consensus conference of 55 international experts, several subsequent meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. This process was conducted independently of any industry funding. METHODS: We used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations. A strong recommendation (1) indicates that an intervention's desirable effects clearly outweigh its undesirable effects (risk, burden, cost) or clearly do not. Weak recommendations (2) indicate that the tradeoff between desirable and undesirable effects is less clear. The grade of strong or weak is considered of greater clinical importance than a difference in letter level of quality of evidence. In areas without complete agreement, a formal process of resolution was developed and applied. Recommendations are grouped into those directly targeting severe sepsis, recommendations targeting general care of the critically ill patient that are considered high priority in severe sepsis, and pediatric considerations. RESULTS: Key recommendations, listed by category, include early goal-directed resuscitation of the septic patient during the first 6 hrs after recognition (1C); blood cultures before antibiotic therapy (1C); imaging studies performed promptly to confirm potential source of infection (1C); administration of broad-spectrum antibiotic therapy within 1 hr of diagnosis of septic shock (1B) and severe sepsis without septic shock (1D); reassessment of antibiotic therapy with microbiology and clinical data to narrow coverage, when appropriate (1C); a usual 7-10 days of antibiotic therapy guided by clinical response (1D); source control with attention to the balance of risks and benefits of the chosen method (1C); administration of either crystalloid or colloid fluid resuscitation (1B); fluid challenge to restore mean circulating filling pressure (1C); reduction in rate of fluid administration with rising filing pressures and no improvement in tissue perfusion (1D); vasopressor preference for norepinephrine or dopamine to maintain an initial target of mean arterial pressure > or = 65 mm Hg (1C); dobutamine inotropic therapy when cardiac output remains low despite fluid resuscitation and combined inotropic/vasopressor therapy (1C); stress-dose steroid therapy given only in septic shock after blood pressure is identified to be poorly responsive to fluid and vasopressor therapy (2C); recombinant activated protein C in patients with severe sepsis and clinical assessment of high risk for death (2B except 2C for postoperative patients). In the absence of tissue hypoperfusion, coronary artery disease, or acute hemorrhage, target a hemoglobin of 7-9 g/dL (1B); a low tidal volume (1B) and limitation of inspiratory plateau pressure strategy (1C) for acute lung injury (ALI)/acute respiratory distress syndrome (ARDS); application of at least a minimal amount of positive end-expiratory pressure in acute lung injury (1C); head of bed elevation in mechanically ventilated patients unless contraindicated (1B); avoiding routine use of pulmonary artery catheters in ALI/ARDS (1A); to decrease days of mechanical ventilation and ICU length of stay, a conservative fluid strategy for patients with established ALI/ARDS who are not in shock (1C); protocols for weaning and sedation/analgesia (1B); using either intermittent bolus sedation or continuous infusion sedation with daily interruptions or lightening (1B); avoidance of neuromuscular blockers, if at all possible (1B); institution of glycemic control (1B), targeting a blood glucose < 150 mg/dL after initial stabilization (2C); equivalency of continuous veno-veno hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1A); use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding using H2 blockers (1A) or proton pump inhibitors (1B); and consideration of limitation of support where appropriate (1D). Recommendations specific to pediatric severe sepsis include greater use of physical examination therapeutic end points (2C); dopamine as the first drug of choice for hypotension (2C); steroids only in children with suspected or proven adrenal insufficiency (2C); and a recommendation against the use of recombinant activated protein C in children (1B). CONCLUSIONS: There was strong agreement among a large cohort of international experts regarding many level 1 recommendations for the best current care of patients with severe sepsis. Evidenced-based recommendations regarding the acute management of sepsis and septic shock are the first step toward improved outcomes for this important group of critically ill patients.

Affordable Housing in Iowa: Meeting New Challenges, 2007

Iowa faces a signifi cant challenge over the next decade. In the words of a recent report, “The state faces the danger of worker and skill gaps that could undermine its businesses, erode the earning power of its workers, and slow its economic growth.” (Iowa Works Campaign, 2006) Iowa’s economic and demographic stability depends on attracting new immigrants and slowing the departure of residents. Eroding housing affordability and quality will make this more difficult. Housing alone cannot solve the problem, but it must be part of the solution. This study examines trends in the state’s major housing markets, analyzes the achievements of housing programs in the recent past, and incorporates input from more than 80 housing experts across the state. The second part of this study (included on the attached CD) analyzes housing’s impact on the economy. We developed three major policy recommendations.

Associative Issue Ownership as a Determinant of Voters' Campaign Attention

Campaigns raise public interest in politics and allow parties to convey their messages to voters. However, voters' exposure and attention during campaigns are biased towards parties and candidates they like. This hinders parties' ability to reach new voters. This paper theorises and empirically tests a simple way in which parties can break partisan selective attention: owning an issue. When parties own issues that are important for a voter, that voter is more likely to notice them. Using survey data collected prior to the 2009 Belgian regional elections it is shown that this effect exists independent of partisan preferences and while controlling for the absolute visibility of a party in the media. This indicates that issue ownership has an independent impact on voters' attention to campaigns. This finding shows that owning salient issues yields (potential) advantages for parties, since getting noticed is a prerequisite for conveying electoral messages and increasing electoral success.

Arrêt du conseil d'Etat qui ordonne que le recouvrement de la finance de la vente des offices de greffiers secrétaires et gardes des archives des universités sera fait à la requête de Me E. Bertier

[Acte. 1704-02-16. Versailles]

Arrêt du Conseil d'Etat qui subroge François Fontaine au lieu et place de François Cheron pour faire le recouvrement de la finance qui doit provenir de la vente des offices de conseillers secrétaires de Sa Majesté, créés par édit du mois de décembre 1708

[Acte. 1712-03-15. Versailles]

Édit... portant suppression des offices de conseillers du Roy notaires et secrétaires dans les cours de Parlement, Chambres des Comptes et Cours des Aydes, Grand Conseil, Requestes de l'Hostel et du Palais, Conseils supérieurs et provinciaux, Cours des monnoies et Bureaux des Finances ; ordonne que les greffiers en chef des cours seront tous tenus de se pourvoir de l'un des offices de secrétaires, créez dans les chancelleries près les Cours par édit... de juin 1715 ; que la vente des offices de receveurs et payeurs des gages des officiers desdites chancelleries créez par édits... de novembre 1707 et décembre 1708 sera continuée ; et restablit les gardes des sceaux des chancelleries près les Cours dans leurs offices, en payant un supplément de finance... [Enregistré au Parlement le 13 juin 1716.]

[Acte royal. 1716-05-00. Paris]

Arrêt du conseil d'état qui ordonne que ceux des officiers des chancelleries près les cours et conseils supérieurs du royaume, qui payeront leur supplément de finance dans les termes y indiqués, seront déchargés des 2 sols pour livre

[Acte. 1755-11-25. Versailles]

Arrêt du conseil d'état qui ordonne que les quittances de finance pour l'acquisition des 1800000 livres de rentes héréditaires au denier vingt, créées sur l'imposition des deux sols pour livres en sus du dixième, seront expédiées au choix des acquéreurs en leur nom ou au porteur

[Acte. 1756-08-31. Versailles]

Instruction pour le recouvrement de la finance des jurez des arts et métiers, créez par édit du 12 mars 1691

[Acte. 1691]

« Recueil de matières de finance pour l'instruction du Roy, par M. D. C[HANDÉ]. Tome Ier. — 1722 ».

Contient : Abrégé chronologique des monnoies ; Dissertation sur la livre de compte ; Ferme du tabac ; Francs-fiefs ; Amortissemens ; Huitième et sixième denier ecclésiastique ; Insinuations laïques ; Controlle des actes des notaires ; Petits scels ; Cartes à jouer

Recueil de pièces, manuscrites et imprimées, concernant les relations commerciales et maritimes entre la France et l'Angleterre, avec quelques pièces relatives à des matières de finance. (1559-1605).

Contient : « Parties deues par le Roy à la royne d'Escosse, douairière de France » [cf. ms. français 15972, f. 35] ; « Estat de la despense fournie... par Monsieur de Beaumont, en divers voyages qu'il a faict faire exprès en Escosse..., vers Mr le baron Du Tour [Maupas], pour lui faire tenir les pacquetz de Sa Majesté... », duplicata, 1603 ; « Mémoire des sommes de deniers que la royne d'Angleterre a prestées ou desboursées pour le Roy très-chrestien », 1587-1596 ; « Mémoires touchant les traictez faicts entre les Anglois et François, pour empescher les pirateries et establir la liberté et seureté du commerce et de la navigation entre ces nations » [différents des pièces contenues dans le ms. français 15975, f. 71 et suiv.], et pièces relatives à divers actes de piraterie, états de marchandises, etc., 1559-1605 ; On remarque dans ce dossier : « Mémoire » orig. de Henri IV, « contenant la volonté du Roy sur les articles du règlement de la mer, proposez et traictez en Angleterre par le sieur de Boissize... », 1599 (f. 25), — une lettre orig. de « François Lefort » à Mr de Boissise, 1599 (f. 27), — et une lettre orig. de Henri IV au même, 1601 (f. 86) ; Pièces diverses, relatives au commerce des draps entre la France et l'Angleterre, 1600-1605