Postoperative delirium. Part 2: detection, prevention and treatment.

To target pharmacological prevention, instruments giving an approximation of an individual patient's risk of developing postoperative delirium are available. In view of the variable clinical presentation, identifying patients in whom prophylaxis has failed (that is, who develop delirium) remains a challenge. Several bedside instruments are available for the routine ward and ICU setting. Several have been shown to have a high specificity and sensitivity when compared with the standard definitions according to DSM-IV-TR and ICD-10. The Confusion Assessment Method (CAM) and a version specifically developed for the intensive care setting (CAM-ICU) have emerged as a standard. However, alternatives allowing grading of the severity of delirium are also available. In many units, the approach to delirium follows a three-step strategy. Initially, non-pharmacological multicomponent strategies are used for primary prevention. As a second step, pharmacological prophylaxis may be added. Perioperative administration of haloperidol has been shown to reduce the severity, but not the incidence, of delirium. Perioperative administration of atypical antipsychotics has been shown to reduce the incidence of delirium in specific groups of patients. In patients with delirium, both symptomatic and causal treatment of delirium need to be considered. So far symptomatic treatment of delirium is primarily based on antipsychotics. Currently, cholinesterase inhibitors cannot be recommended and the data on dexmedetomidine are inconclusive. With the exception of alcohol-withdrawal delirium, there is no role for benzodiazepines in the treatment of delirium. It is unclear whether treating delirium prevents long-term sequelae.

Living Snow Fences, 2006

Blowing snow can cause significant problems for mobility and safety during winter weather in three distinct ways. It may drift onto the road, thus requiring almost continuous plowing while the wind is blowing (which may occur when a given winter storm is over). Snow may drift onto wet pavement (perhaps caused by ice control chemicals) and dilute out the chemicals on the road, creating ice on the road. And sufficient blowing snow can cause a major deterioration in visibility on the road, a factor which has been shown to be significant in winter crashes. The problem of blowing snow can be very effectively addressed by creating a snow storage device upwind of the road that requires protection from snow drifting. Typically, these storage devices are fences. Extensive design guidance exists for the required height and placement of such fences for a given annual snowfall and given local topography. However, the design information on the placement of living snow fences is less complete. The purpose of this report is to present the results of three seasons of study on using standing corn as snow fences. In addition, the experience of using switch grass as a snow storage medium is also presented. On the basis of these experimental data, a design guide has been developed that makes use of the somewhat unique snow storage characteristics of standing corn snow fences. The results of the field tests on using standing corn showed that multiple rows of standing corn store snow rather differently than a traditional wooden snow fence. Specifically, while a traditional fence stores most of the snow downwind from the fence (and thus must be placed a significant distance upwind of the road to be protected, specifically at least 35 times the snow fence height) rows of standing corn store the majority of the snow within the rows. Results from the three winters of testing show that the standing corn snow fences can store as much snow within the rows of standing corn as a traditional fence of typical height for operation in Iowa (4 to 6 feet) can store. This finding is significant because it means that the snow fences can be placed at the edge of the farmer’s field closest to the road, and still be effective. This is typically much more convenient for the farmer and thus may mean that more farmers would be willing to participate in a program that uses standing corn than in traditional programs. ii On the basis of the experimental data, design guidance for the use of standing corn as a snow storage device in Iowa is given in the report. Specifically, it is recommended that if the fetch in a location to be protected is less than 5,000 feet, then 16 rows of standing corn should be used, at the edge of the field adjacent to the right of way. If the fetch is greater than 5,000 feet, then 24 rows of standing corn should be used. This is based on a row spacing of 22 inches. Further, it should be noted that these design recommendations are ONLY for the State of Iowa. Other states of course have different winter weather and without extensive further study, it cannot be said that these guidelines would be effective in other locations with other winter conditions.

Pollicipes caboverdensis sp. nov. (Crustacea: Cirripedia: Scalpelliformes), an intertidal barnacle from the Cape Verde Islands

Recently, genetic evidence supported the existence of a new species of the genus Pollicipes from the Cape Verde Islands, previously considered a population of P. pollicipes. However, P. pollicipes was not sampled at its southern limit of distribution (Dakar, Senegal), which is geographically separated from the Cape Verde Islands by about 500 km. Herein we describe Pollicipes caboverdensis sp. nov. from the Cape Verde Islands and compare its morphology with the other three species of Pollicipes: P. pollicipes, P. elegans and P. polymerus. Pollicipes pollicipes was sampled at both the middle (Portugal) and southern limit (Dakar, Senegal) of its geographical distribution. The genetic divergence among and within these two regions and Cape Verde was calculated through the analysis of partial mtDNA CO1 gene sequences. Pollicipes caboverdensis sp. nov. has a single whorl of capitular plates below the subrostrum, peduncular scales pointing up toward the capitulum and multi-articulate caudal appendages (all characters shared with P. pollicipesand P. elegans), reddish-orange capitular plates (large specimens), a single rostral median latus between the median latus and the rostrolatus (both characters shared with P. elegans), and uniquely possesses peduncular scales that are approximately the same width as height. The genetic distance between the Cape Verde population and the Senegal and Portugal populations is 13–14%, whilst between Senegal and Portugal it is < 1%.

Engineering polyhydroxyalkanoate content and monomer composition in the oleaginous yeast Yarrowia lipolytica by modifying the ß-oxidation multifunctional protein.

Recombinant strains of the oleaginous yeast Yarrowia lipolytica expressing the PHA synthase gene (PhaC) from Pseudomonas aeruginosa in the peroxisome were found able to produce polyhydroxyalkanoates (PHA). PHA production yield, but not the monomer composition, was dependent on POX genotype (POX genes encoding acyl-CoA oxidases) (Haddouche et al. FEMS Yeast Res 10:917-927, 2010). In this study of variants of the Y. lipolytica β-oxidation multifunctional enzyme, with deletions or inactivations of the R-3-hydroxyacyl-CoA dehydrogenase domain, we were able to produce hetero-polymers (functional MFE enzyme) or homo-polymers (with no 3-hydroxyacyl-CoA dehydrogenase activity) of PHA consisting principally of 3-hydroxyacid monomers (>80%) of the same length as the external fatty acid used for growth. The redirection of fatty acid flux towards β-oxidation, by deletion of the neutral lipid synthesis pathway (mutant strain Q4 devoid of the acyltransferases encoded by the LRO1, DGA1, DGA2 and ARE1 genes), in combination with variant expressing only the enoyl-CoA hydratase 2 domain, led to a significant increase in PHA levels, to 7.3% of cell dry weight. Finally, the presence of shorter monomers (up to 20% of the monomers) in a mutant strain lacking the peroxisomal 3-hydroxyacyl-CoA dehydrogenase domain provided evidence for the occurrence of partial mitochondrial β-oxidation in Y. lipolytica.

Spanish monetary policy: A structural VAR analysis

Some past studies analyzed Spanish monetary policy with the standard VAR. Their problem is that this method obliges researchers to impose a certain extreme form of the short run policy rule on their models. Hence, it does not allow researchers to study the possibility of structural changes in this rule, either. This paper overcomes these problems by using the structural VAR. I find that the rule has always been that of partial accommodation. Prior to 1984, it was quite close to money targeting. After 1984, it became closer to the interest rate targeting, with more emphasis on the exchange rate.

Social security in theory and practice (II): Efficiency theories, narrative theories and implications for reform

166 countries have some kind of public old age pension. What economic forcescreate and sustain old age Social Security as a public program? Mulligan and Sala-i-Martin (1999b) document several of the internationally and historically common features of social security programs, and explore "political" theories of Social Security. This paper discusses the "efficiency theories", which view creation of the SS program as a full of partial solution to some market failure. Efficiency explanations of social security include the "SS as welfare for the elderly" the "retirement increases productivity to optimally manage human capital externalities", "optimal retirement insurance", the "prodigal father problem", the "misguided Keynesian", the "optimal longevity insurance", the "governmenteconomizing transaction costs", and the "return on human capital investment". We also analyze four "narrative" theories of social security: the "chain letter theory", the "lump of labor theory", the "monopoly capitalism theory", and the "Sub-but-Nearly-Optimal policy response to private pensions theory".The political and efficiency explanations are compared with the international and historical facts and used to derive implications for replacing the typical pay-as-you-go system with a forced savings plan. Most of the explanations suggest that forced savings does not increase welfare, and may decrease it.

Endogenous bargaining power

We present a novel approach to N-person bargaining, based on the idea thatthe agreement reached in a negotiation is determined by how the directconflict resulting from disagreement would be resolved. Our basic buildingblock is the disagreement function, which maps each set of feasible outcomesinto a disagreement point. Using this function and a weak axiom basedon individual rationality we reach a unique solution: the agreement inthe shadow of conflict, ASC. This agreement may be construed as the limitof a sequence of partial agreements, each of which is reached as a functionof the parties relative power. We examine the connection between ASC andasymmetric Nash solutions. We show the connection between the power ofthe parties embodied in the ASC solution and the bias in the SWF thatwould select ASC as an asymmetric Nash solution.

Highways and Your Land, January 2006

For most people, highway engineering, design and right of way acquisition are not of immediate concern. However, when you own or rent property that will be affected by highway construction, you begin to consider road building from a different and personal viewpoint Right of way is the land on which highways are built. The amount of land needed depends on the engineering standards that must be met for the type of highway that will be built or improved. This booklet will acquaint property owners, tenants and the public with the procedures the Iowa Department of Transportation follows in acquiring right of way for a highway. It is not a source of technical definitions or legal advice. Further, it is not intended to establish a legal standard.

Immigration policy with partisan parties

This paper analyzes the political economy of immigration when the salient electoralissue is the level of immigrants and the relevant immigration policy is the expenditurein immigration control. We consider that immigration affects voters? welfarethrough economic and non economic factors. We model political competition `a laWittman with the ideology of parties endogenously determined at equilibrium. Atequilibrium, parties propose different levels of immigration, located to the left and tothe right of the median voter?s ideal point, and combine skilled and unskilled workersamong their constituencies. Numerical simulations provide the levels of immigrationproposed by the two parties and the composition of parties? constituencies as we varythe efficacy of immigration control and the intensity of immigration aversion.

El dret de préstec a les biblioteques: panorama internacional

The article analyses the functioning of the different systems employed for compensating authors for the right of public lending in libraries. Following a historical review, the text explores the principal aspects covered by standards: libraries included, works affected, methods for calculating the compensations, economic costs of the systems and beneficiaries. The main conclusions make reference to the diversity of legislative approaches in different countries and to the probable increase in the number of countries that will be applying this type of norm in the coming years

Recursos governatius. Doctrina de la Direcció General de Dret i Entitats Jurídiques IV

Comentaris a les Resolucions de la Direcció General de Dret i Entitats Jurídiques 22 de gener 2007, de 24 de gener 2007, de 15 de febrer 2007, de 16 de febrer 200 i de 19 de febrer 2007.

Recursos governatius. Doctrina de la Direcció General de Dret i Entitats Jurídiques (maig 2007-febrer 2008)

Comentaris a les Resolucions de la Direcció General de Dret i Entitats Jurídiques de 2 de maig 2007, de 10 de juliol 2007, d'11 de juliol 2007, de 16 de juliol 2007, de 17 de juliol 2007, de 22 d'octubre 2007, de 21 de desembre 2007 i 4 de febrer 2008.

Recursos governatius. Doctrina de la Direcció General de Dret i Entitats Jurídiques (febrer-abril 2008).

Comentaris a les Resolucions de la Direcció General de Dret i Entitats Jurídiques de 6 de febrer 2008, 8 de febrer 2008, 20 de febrer 2008, 2 d'abril 2008 i 18 d¿abril 2008.

Recursos governatius. Doctrina de la Direcció General de Dret i Entitats Jurídiques V

Comentaris a les Resolucions de la Direcció General de Dret i Entitats Jurídiques de 20 de març 2007, de 26 d'abril 2007, de 27 d'abril 2007 i de 30 d'abril 2007

2012-2016 Iowa Transportation Improvement Program

The Iowa Transportation Improvement Program (Program) is published to inform Iowans of planned investments in our state’s transportation system. The Iowa Transportation Commission (Commission) and Iowa Department of Transportation (Iowa DOT) are committed to programming those investments in a fiscally responsible manner. This document reflects Iowa’s multimodal transportation system by the inclusion of investments in aviation, transit, railroads, trails, and highways. A major component of this program is the highway section that documents programmed investments on the primary highway system for the next five years. A large part of funding available for highway programming comes from the federal government. Accurately estimating future federal funding levels is dependent on having a current enacted multi-year federal transportation authorization. The most recent authorization, Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (SAFETEA-LU), expired September 30, 2009, and to date it has been extended seven times because a new authorization has not yet been enacted. The current extension will expire September 30, 2011. This leads to significant uncertainty in federal funding; however, it is becoming evident that, in Federal Fiscal Year 2012 and beyond, federal funding revenue will likely be reduced by 25 percent from current levels in order to match revenue that flows into the Highway Trust Fund. This Program reflects this anticipated reduction in federal funding. While Iowa law does not require the adoption of a Program when federal transportation funding is being reauthorized, the Commission believes it is important to adopt a Program in order to continue on-going planning and project development efforts so that Iowa will be well positioned when a new authorization is adopted. However, it is important to recognize that, absent a federal authorization bill, there is significant uncertainty in the forecast of federal revenues. The Commission and the Iowa DOT will continue to monitor federal revenues and will adjust future investments as needed to maintain a fiscally responsible Program. For 2012-2016, approximately $2.3 billion is forecast to be available for highway right of way and construction. In developing the highway section of the Program, the Commission’s primary investment objective remains stewardship (i.e. safety, maintenance and preservation) of Iowa’s existing highway system. Over $1.3 billion is programmed in FY2012 through FY2016 for preservation of Iowa’s existing highway system and for enhanced highway safety features. The highway section also includes significant interstate investments on I-29 in Sioux City, I-29/80/480 in Council Bluffs, and I-74 in Bettendorf/Davenport. The FY2016 programming for construction on I-74 in Bettendorf/Davenport is the first of several years of significant investments that will be monitored for available funding. Approximately $200 million of the investments on these three major urban interstate projects address preservation needs. In total, approximately $1.5 billion is programmed for highway preservation activities for 2012- 2016. Another highway programming objective is maintaining the scheduled completion of capacity and economic development projects. Projects that were previously scheduled to be completed within the previous Program continue on their current schedule. However, due to the reduction of projected federal revenues, the Commission has delayed by one year the initiation of construction of all multi-year non-Interstate capacity and economic development projects that cannot be completed within this Program. These projects are U.S. 20 in Woodbury County, U.S. 30 in Benton County, U.S. 61 in Louisa County, and Iowa 100 in Linn County. The Iowa DOT and Commission appreciate the public’s involvement in the state’s transportation planning process. Comments received personally, by letter or through participation in the Commission’s regular meetings or public input meetings held around the state each year, are invaluable in providing guidance for the future of Iowa’s transportation system. It should be noted that this document is a planning guide. It does not represent a binding commitment or obligation of the Commission or Iowa DOT, and is subject to change.