Power of Attorney Handbook, June 2006, revised

This booklet is designed to assist those who have been appointed as an attorney-in-fact, those who are considering the need for a power of attorney, or those who have an interest in the subject. This is a general overview of the laws governing powers of attorney and, like most general overviews it will apply in most situations, but not all. Small differences and individual circumstances can be very important in resolving legal problems and the general guidance provided by this booklet cannot take such differences into account. Keep in mind that the laws continually change and information in this booklet is not designed to take the place of legal counsel.

Sensitivity and specificity of NT-proBNP to detect heart failure at post mortem examination.

NT-proBNP, a marker of cardiac failure, has been shown to be stable in post mortem samples. The aim of this study was to assess the accuracy of NT-proBNP to detect heart failure in the forensic setting. One hundred sixty-eight consecutive autopsies were included in the study. NT-proBNP blood concentrations were measured using a chemiluminescent immunoassay kit. Cardiac failure was assessed by three independent forensic experts using macro- and microscopic findings complemented by information about the circumstances of body discovery and the known medical story. Area under the receiving operator curve was of 65.4% (CI 95%, from 57.1 to 73.7). Using a standard cut-off value of >220 pg/mL for NT-proBNP blood concentration, heart failure was detected with a sensitivity of 50.7% and a specificity of 72.6%. NT-proBNP vitreous humor values were well correlated to the ones measured in blood (r (2) = 0.658). Our results showed that NT-proBNP can corroborate the pathological findings in cases of natural death related to heart failure, thus, keeping its diagnostic properties passing from the ante mortem to the post mortem setting. Therefore, biologically inactive polypeptides like NT-proBNP seem to be stable enough to be used in forensic medicine as markers of cardiac failure, taking into account the sensitivity and specificity of the test.

Palliative and supportive care: at the frontier of medical omnipotence.

Cancer patients have physical, social, spiritual an emotional needs. They may suffer from severe physical symptoms, from social isolation and a sense of spiritual abandonment, and emotions such as sadness and anxiety, or feeling of deception, helplessness, anger and guilt. In some of them, the disease is rapidly progressive and they ultimately die. Their demanding care evokes intense feelings in health care providers, the more so since these incurable patients represent a challenge, which can be characterized as one of 'medical omnipotence'. It may be assumed that the way health care providers cope with these circumstances profoundly influences the way these patients are cared for. Attitudes regarding the emerging heterogeneous movement of palliative and supportive care and its different models of implementation can be viewed form this vantage point. Here we look at these interrelations and discuss the potential pitfalls if they are ignored and remain unexamined.

Alcohol-attributable injuries in admissions to a swiss emergency room--an analysis of the link between volume of drinking, drinking patterns, and preattendance drinking.

BACKGROUND: An association between alcohol consumption and injury is clearly established from volume of drinking, heavy episodic drinking (HED), and consumption before injury. Little is known, however, about how their interaction raises risk of injury and what combination of factors carries the highest risk. This study explores which of 11 specified groups of drinkers (a) are at high risk and (b) contribute most to alcohol-attributable injuries. METHODS: In all, 8,736 patients, of whom 5,077 were injured, admitted to the surgical ward of the emergency department of Lausanne University Hospital between January 1, 2003, and June 30, 2004, were screened for alcohol use. Eleven groups were constructed on the basis of usual patterns of intake and preattendance drinking. Odds ratios (ORs) comparing injured and noninjured were derived, and alcohol-attributable fractions of injuries were calculated from ORs and prevalence of exposure groups. RESULTS: Risk of injury increased with volume of drinking, HED, and preattendance drinking. For both sexes, the highest risk was associated with low intake, HED, and 4 (women), 5 (men), or more drinks before injury. At the same level of preattendance drinking, high-volume drinkers were at lower risk than low-volume drinkers. In women, the group of low-risk non-HED drinkers taking fewer than 4 drinks suffered 47.5% of the alcohol-attributable injuries in contrast to only 20.4% for men. Low-volume male drinkers with HED had more alcohol-attributable injuries than that of low-volume female drinkers with HED (46.9% vs 23.2%). CONCLUSIONS: Although all groups of drinkers are at increased risk of alcohol-related injury, those who usually drink little but on occasion heavily are at particular risk. The lower risk of chronic heavy drinkers may be due to higher tolerance of alcohol. Prevention should thus target heavy-drinking occasions. Low-volume drinking women without HED and with only little preattendance drinking experienced a high proportion of injuries; such women would be well advised to drink very little or to take other special precautions in risky circumstances.

Una extensión de la regresión propuesta por Geweke y Porter-Hudak para la estimación del orden de diferenciación en modelos ARFIMA

Recientemente, ha aumentado mucho el interés por la aplicación de los modelos de memoria larga a variables económicas, sobre todo los modelos ARFIMA. Sin duda , el método más usado para la estimación de estos modelos en el ámbito del análisis económico es el propuesto por Geweke y Portero-Hudak (GPH) aun cuando en trabajos recientes se ha demostrado que, en ciertos casos, este estimador presenta un sesgo muy importante. De ahí que, se propone una extensión de este estimador a partir del modelo exponencial propuesto por Bloomfield, y que permite corregir este sesgo.A continuación, se analiza y compara el comportamiento de ambos estimadores en muestras no muy grandes y se comprueba como el estimador propuesto presenta un error cuadrático medio menor que el estimador GPH

Una extensión de la regresión propuesta por Geweke y Porter-Hudak para la estimación del orden de diferenciación en modelos ARFIMA

Recientemente, ha aumentado mucho el interés por la aplicación de los modelos de memoria larga a variables económicas, sobre todo los modelos ARFIMA. Sin duda , el método más usado para la estimación de estos modelos en el ámbito del análisis económico es el propuesto por Geweke y Portero-Hudak (GPH) aun cuando en trabajos recientes se ha demostrado que, en ciertos casos, este estimador presenta un sesgo muy importante. De ahí que, se propone una extensión de este estimador a partir del modelo exponencial propuesto por Bloomfield, y que permite corregir este sesgo.A continuación, se analiza y compara el comportamiento de ambos estimadores en muestras no muy grandes y se comprueba como el estimador propuesto presenta un error cuadrático medio menor que el estimador GPH

Cotton manufacturers as bankers: the textile trade and credit in spain, 1840-1913

[cat] La historiografia ha assenyalat que en el segle XIX el crèdit que els fabricants cotoners catalans oferien als seus clients era de caràcter informal i, per tant, impossible de ser transferit al sistema bancari. Això hauria tingut un efecte negatiu en la rendibilitat de les empreses cotoneres. A partir de l’anàlisi de diversos arxius empresarials, així com de fonts judicials i notarials, aquest treball confirma aquesta descripció dels fets però proposa una interpretació més optimista. Els fabricants feien de banquers dels seus clients perquè eren els millor situats per a exercir aquesta funció. Havien construït una bona estructura d’informació, gestionaven eficientment el risc creditici i obtenien beneficis d’aquesta activitat.

Inaugural adress: The concept of biostratigraphy: the view point of a stratigrapher

Colleagues, Ladies and Gentlemen. My presence here is due to accidental circumstances and I must confess that I feel a little embarassed by the fact Both your scientific quality and the worlwide acceptance of the results achieved by you in your research fields make me prudent and, to a certain extent, cautious.

Stability of a nonequilibrium steady-state interface

We study the interfacial modes of a driven diffusive model under suitable nonequilibrium conditions leading to possible instability. The external field parallel to the interface, which sets up a steady-state parallel flux, enhances the growth or decay rates of the interfacial modes. More dramatically, asymmetry in the model can introduce an oscillatory component into the interfacial dispersion relation. In certain circumstances, the applied field behaves as a singular perturbation.

Multipole surface-plasmon modes on simple metals

The average multipole surface-plasmon energy for simple metals, as well as that of ordinary surface and bulk plasmons, is obtained using energy-weighted moments of the electronic response to sufficiently general external perturbations. A local approximation of exchange and correlation effects is used within a jellium model. Band-structure effects are incorporated through an effective electronic mass. Taking advantage of the transparency of the method, we analyze under what circumstances such modes might be observable. It is shown that due to an interplay between Coulomb and kinetic energies, the multipole modes become unobservable for increasing values of the transferred momentum (q) parallel to the surface. The value of q at which the multipole mode becomes unobservable is much smaller than the cutoff value for Landau damping. The effect of the electronic surface diffuseness is also analyzed. We compare our results with previous density-functional calculations and with recent experimental data for Na, K, and Cs.

Optimal Usage of De-Icing Chemicals when Scraping Ice, November 2003

One of the challenges that faces the winter maintainer is how much chemical to apply to the road under given conditions. Insufficient chemical can lead to the road surface becoming slick, and the road thus becoming unsafe. In all likelihood, additional applications will have to be made, requiring additional effort and use of resources. However, too much chemical can also be bad. While an excess of chemical will ensure (in most circumstances) that a safe road condition is achieved, it may also result in a substantial waste of chemical (with associated costs for this waste) and in ancillary damage to the road itself and to the surrounding environment. Ideally, one should apply what might be termed the “goldilocks” amount of chemical to the road: Not too much, and not too little, but just right. Of course the reality of winter maintenance makes achieving the “goldilocks” application rate somewhat of a fairy tale. In the midst of a severe storm, when conditions are poor and getting worse, the last thing on a plow operator’s mind is a minute adjustment in the amount of chemical being applied to the road. However, there may be considerable benefit and substantial savings to be achieved if chemical applications can be optimized to some degree, so that wastage is minimized without compromising safety. The goal of this study was to begin to develop such information through a series of laboratory studies in which the force needed to scrape ice from concrete blocks was measured, under a variety of chemical application conditions.

Aliments et boissons allégés: qu'en penser [Light food and beverages: what to think about?].

Light food and beverages are increasing on the market for many years, first for economic reasons and, more and more for aesthetisme, however without aimed a defined population. The interest of these products is not evident, reason why it is difficult to get a clear and objective opinion without being influenced by marketing messages. Under what circumstances can they be a solution? Can we advise them? Do they have an influence in the loss or weight control? This article offers some thoughts and suggestions on the use of these specific products.

Mikrovaskulär anastomosierte Transplantate : Verwendung in der Kopf-Hals-Region nach Bestrahlung und Gefäßdepletion [Grafts with microvascular anastomosis : Their use in the head and neck region following radiotherapy and vessel depletion].

Surgical tumor removal is often the treatment of choice in patients with head and neck squamous cell carcinoma. Depending on the extent of tumor resection, large defects are often produced in the individual head and neck regions, necessitating reconstructive surgery to avoid further functional impairment. In principle, this decision depends on the size and location of the defect, the aesthetic importance of the region and the functional significance of the area to be replaced. Reconstructive free flap procedures in patients who have undergone radiotherapy or exhibit vessel depletion in the neck due to multiple previous surgical interventions are particularly challenging. In order to ensure the best possible outcomes of surgical oncology therapies under difficult circumstances, this paper discusses the important factors and variables that can increase the success rate of microvascular grafts in irradiated or multiply resected patients.

Diagnostic and ethical challenges in disorders of consciousness and locked-in syndrome: a survey of German neurologists.

Diagnosis and decisions on life-sustaining treatment (LST) in disorders of consciousness, such as the vegetative state (VS) and the minimally conscious state (MCS), are challenging for neurologists. The locked-in syndrome (LiS) is sometimes confounded with these disorders by less experienced physicians. We aimed to investigate (1) the application of diagnostic knowledge, (2) attitudes concerning limitations of LST, and (3) further challenging aspects in the care of patients. A vignette-based online survey with a randomized presentation of a VS, MCS, or LiS case scenario was conducted among members of the German Society for Neurology. A sample of 503 neurologists participated (response rate 16.4%). An accurate diagnosis was given by 86% of the participants. The LiS case was diagnosed more accurately (94%) than the VS case (79%) and the MCS case (87%, p < 0.001). Limiting LST for the patient was considered by 92, 91, and 84% of the participants who accurately diagnosed the VS, LiS, and MCS case (p = 0.09). Overall, most participants agreed with limiting cardiopulmonary resuscitation; a minority considered limiting artificial nutrition and hydration. Neurologists regarded the estimation of the prognosis and determination of the patients' wishes as most challenging. The majority of German neurologists accurately applied the diagnostic categories VS, MCS, and LiS to case vignettes. Their attitudes were mostly in favor of limiting life-sustaining treatment and slightly differed for MCS as compared to VS and LiS. Attitudes toward LST strongly differed according to circumstances (e.g., patient's will opposed treatment) and treatment measures.

Soliton solutions and cosmological gravitational waves

We examine plane-symmetric cosmological solutions to Einstein's equations which can be generated by the "soliton" technique, using the homogeneous Bianchi solutions as seeds and arbitrary numbers of real or complex poles. In some circumstances, these solutions can be interpreted as "incipient" gravitational waves on the Bianchi background. At early times they look like nonlinear inhomogeneities propagating at nearly the speed of light ("gravisolitons"), while at late times they look like cosmological gravitational waves.