Evaluating early administration of the hydroxymethylglutaryl-CoA reductase inhibitor simvastatin in the prevention and treatment of delirium in critically ill ventilated patients (MoDUS trial): Study protocol for a randomized controlled trial

Background: The incidence of delirium in ventilated patients is estimated at up to 82%, and it is associated with longer intensive care and hospital stays, and long-term cognitive impairment and mortality. The pathophysiology of delirium has been linked with inflammation and neuronal apoptosis. Simvastatin has pleiotropic properties; it penetrates the brain and, as well as reducing cholesterol, reduces inflammation when used at clinically relevant doses over the short term. This is a single centre randomised, controlled trial which aims to test the hypothesis that treatment with simvastatin will modify delirium incidence and outcomes. 

Methods/Design: The ongoing study will include 142 adults admitted to the Watford General Hospital Intensive Care Unit who require mechanical ventilation in the first 72 hours of admission. The primary outcome is the number of delirium- and coma-free days in the first 14 days. Secondary outcomes include incidence of delirium, delirium- and coma-free days in the first 28 days, days in delirium and in coma at 14 and 28 days, number of ventilator-free days at 28 days, length of critical care and hospital stay, mortality, cognitive decline and healthcare resource use. Informed consent will be taken from patient's consultee before randomisation to receive either simvastatin (80 mg) or placebo once daily. Daily data will be recorded until day 28 after randomisation or until discharge from the ICU if sooner. Surviving patients will be followed up on at six months from discharge. Plasma and urine samples will be taken to investigate the biological effect of simvastatin on systemic markers of inflammation, as related to the number of delirium- and coma-free days, and the potential of cholinesterase activity and beta-amyloid as predictors of the risk of delirium and long-term cognitive impairment. 

Discussion: This trial will test the efficacy of simvastatin on reducing delirium in the critically ill. If patients receiving the statin show a reduced number of days in delirium compared with the placebo group, the inflammatory theory implicated in the pathogenesis of delirium will be strengthened. 

Flesh of the Law: Material Metaphors

Existing legal metaphors, even the predominantly spatial and corporeal ones, paradoxically perpetuate a dematerialized impression of the law. This is because they depict the law as universal, adversarial, and court-based, thus ignoring alternative legalities. Instead, there is a need to employ more radically material metaphors, in line with the material turn in law and other disciplines, in order to allow law's materiality to come forth. I explore the connection between language and matter (the ‘flesh’ of the law) through legal, linguistic, and art theory, and conclude by suggesting four characteristics of material legal metaphors.

Marking definiteness multiply: evidence from two varieties of Greek

Θέμα της μελέτης μας είναι οι πολυοριστικές δομές σε δύο νεοελληνικές ποικιλίες, την πρότυπη ελληνική (ΠΕ) και την καππαδοκική διάλεκτο (ΚΕ). Παρά την επιφανειακή ομοιότητα, οι δομές αυτές διαφέρουν ως προς τις συντακτικές και σημασιολογικές τους ιδιότητες. Για την ΠΕ υιοθετούμε την ανάλυση των Lekakou & Szendrői (2007, 2009, 2012, 2013), σύμφωνα με την οποία οι πολυοριστικές δομές είναι ένα είδος ονοματικής επεξήγησης, με την ιδιαιτερότητα ότι περιέχουν δομή ονοματικής απαλοιφής (noun ellipsis). Στην ΚΕ, η υποχρεωτική φύση του φαινομένου μας οδηγεί στην πρόταση ότι πρόκειται για ένα είδος μορφοσυντακτικής συμφωνίας. Συγκεκριμένα, τα άρθρα που συνοδεύουν το επίθετο είναι δείκτες ονοματικής συμφωνίας ως προς την οριστικότητα και προκύπτουν μετα-συντακτικά, στο θεωρητικό πλαίσιο της Κατανεμημένης Μορφολογίας. Υποστηρίζουμε ότι μια ενιαία ανάλυση της οριστικότητας στις δύο ποικιλίες είναι εφικτή, εφόσον δεχτούμε ότι σημασιολογική οριστικικότητα δεν εκφράζει κανένα από τα εκπεφρασμένα άρθρα, αλλά ένας φωνολογικά κενός τελεστής.

Men perform comparably to women in a perspective taking task after administration of intranasal oxytocin but not after placebo

Oxytocin (OT) is thought to play an important role in human interpersonal information processing and behavior. By inference, OT should facilitate empathic responding, i.e. the ability to feel for others and to take their perspective. In two independent double-blind, placebo-controlled between-subjects studies, we assessed the effect of intranasally administered OT on affective empathy and perspective taking, whilst also examining potential sex differences (e.g., women being more empathic than men). In study 1, we provided 96 participants (48 men) with an empathy scenario and recorded self reports of empathic reactions to the scenario, while in study 2, a sample of 120 individuals (60 men) performed a computerized implicit perspective taking task. Whilst results from Study 1 showed no influence of OT on affective empathy, we found in Study 2 that OT exerted an effect on perspective taking ability in men. More specifically, men responded faster than women in the placebo group but they responded as slowly as women in the OT group. We conjecture that men in the OT group adopted a social perspective taking strategy, such as did women in both groups, but not men in the placebo group. On the basis of results across both studies, we suggest that self-report measures (such as used in Study 1) might be less sensitive to OT effects than more implicit measures of empathy such as that used in Study 2. If these assumptions are confirmed, one could infer that OT effects on empathic responses are more pronounced in men than women, and that any such effect is best studied using more implicit measures of empathy rather than explicit self-report measures.

Stolen past: Shattered futures, aboriginal justice in Canada

It is acknowledged that Canada's criminal justice system has some major flaws, particularly with respect to its application to various ethnic subgroups. Aboriginal Canadians are one subgroup particularly sensitive to the problems in the system as is reflected by their disproportionately high rates of criminality and incarceration. Over the past 50 years many programs have been developed and recommendations have been made to alleviate the tensions Aboriginals find within the system. However, the situation today is essentially the same. Aboriginals are still overrepresented within the system and solutions that have been brought forward have had little success in stemming their flow into the system. Blame for Aboriginal mistreatment in the system has been placed at all levels from line police officers to high-level officials and politicians and attempts to resolve problems continue as an on going process. However, many of the recommendations and reforms have revolved around culture conflict. Although this thesis recognizes the importance of culture conflict in the overrepresentation of Aboriginals within the Canadian criminal justice system, it has also recognized that culture conflict alone is not responsible for all the flaws within the system as it pertains to Aboriginals. This thesis is of the opinion that in order for reforms to the criminal justice system to be successful, the context in which the system is operating must also be considered. Variables such as geographic isolation, economic disparity and social/political stability are viewed as operating in conjunction with culture, ultimately influencing Aboriginal treatment within the system. The conclusions drawn from this study confirm that when these factors operate together, the overrepresentation of Aboriginals within the Canadian criminal justice system is inevitable. Thus all three variables, culture conflict (social/political stability being part), geographic isolation and economic disparity must be address within the system if any significant changes in the crime rates or incarceration rates of Aboriginals is to be expected. In addition, primary research indicated the influence of cooperation as a factor in moderating the effects of criminality; not just cooperation among Aboriginals and non-Aboriginals, but also cooperation among differing Aboriginal communities. It was argued that when all these issues are addressed, Aboriginal peoples in Canada will have the strength to repair their shattered futures.

Letter from the Secretary of War, transmitting a return of the arms and military stores furnished to the respective states, under the provisions of the law of one thousand eight hundred and twelve.

At head of title: [107].

An examination of how youth understand their rights during the criminal process

In order for young people to meaningfully participate in the criminal justice system they must possess an understanding of their rights and legal procedures. To examine their understanding, 50 young people between the ages of 13-17 who received an extrajudicial sanction or were sentenced to probation, were recruited from the Finch Courthouse in Toronto, Ontario. Semi-structured interviews were conducted with participants regarding their understanding of their due process rights and their rights under the United Nations Convention on the Rights of the Child. Youth who indicated involvement in plea bargaining were also asked about their experiences during this procedure. In addition, the present study examined youths' perceptions of power differences in their interactions with criminal justice officials working within an institution that has tremendous control over offenders' lives. The results indicate that while youth seem to have some understanding oftheir rights and legal procedures, they nevertheless feel ill-equipped to invoke their rights in an adult-led criminal justice system. Furthermore, while past literature has often conceptualized youth understanding based on age (e.g., Crawford & Bull, 2006) the findings of the present study demonstrate that while age plays some role, the lack of power experienced by youth vis-a-vis adults, and specifically criminal justice professionals, has the most bearing on the inability of youth to exercise their rights.

Letter from the Secretary of War, transmitting a return of the arms and military stores furnished to the respective states, under the provisions of the law of one thousand eight hundred and twelve

At head of title: [107]. 15th Congress, 1st session, 1817-1818. House. February 20, 1818. Read, and ordered to lie upon the table.

Repeal of by-law XXIII. This is signed by J.I. Mackenzie, secretary and treasurer

Repeal of by-law XXIII. This is signed by J.I. Mackenzie, secretary and treasurer (1 printed page), Sept. 6, 1879.