Association between frailty and delirium in older adult patients discharged from hospital.

BACKGROUND: Delirium and frailty - both potentially reversible geriatric syndromes - are seldom studied together, although they often occur jointly in older patients discharged from hospitals. This study aimed to explore the relationship between delirium and frailty in older adults discharged from hospitals. METHODS: Of the 221 patients aged >65 years, who were invited to participate, only 114 gave their consent to participate in this study. Delirium was assessed using the confusion assessment method, in which patients were classified dichotomously as delirious or nondelirious according to its algorithm. Frailty was assessed using the Edmonton Frailty Scale, which classifies patients dichotomously as frail or nonfrail. In addition to the sociodemographic characteristics, covariates such as scores from the Mini-Mental State Examination, Instrumental Activities of Daily Living scale, and Cumulative Illness Rating Scale for Geriatrics and details regarding polymedication were collected. A multidimensional linear regression model was used for analysis. RESULTS: Almost 20% of participants had delirium (n=22), and 76.3% were classified as frail (n=87); 31.5% of the variance in the delirium score was explained by frailty (R (2)=0.315). Age; polymedication; scores of the Confusion Assessment Method (CAM), instrumental activities of daily living, and Cumulative Illness Rating Scale for Geriatrics; and frailty increased the predictability of the variance of delirium by 32% to 64% (R (2)=0.64). CONCLUSION: Frailty is strongly related to delirium in older patients after discharge from the hospital.

Independent and combined associations of risky single-occasion drinking and drinking volume with alcohol use disorder: Evidence from a sample of young Swiss men.

BACKGROUND: Risky single-occasion drinking (RSOD) is a prevalent and potentially harmful alcohol use pattern associated with increased alcohol use disorder (AUD). However, RSOD is commonly associated with a higher level of alcohol intake, and most studies have not controlled for drinking volume (DV). Thus, it is unclear whether the findings provide information about RSOD or DV. This study sought to investigate the independent and combined effects of RSOD and DV on AUD. METHODS: Data were collected in the longitudinal Cohort Study on Substance Use Risk Factors (C-SURF) among 5598 young Swiss male alcohol users in their early twenties. Assessment included DV, RSOD, and AUD at two time points. Generalized linear models for binomial distributions provided evidence regarding associations of DV, RSOD, and their interaction. RESULTS: DV, RSOD, and their interaction were significantly related to the number of AUD criteria. The slope of the interaction was steeper for non/rare RSOD than for frequent RSOD. CONCLUSIONS: RSOD appears to be a harmful pattern of drinking, associated with increased AUD and it moderated the relationship between DV and AUD. This study highlighted the importance of taking drinking patterns into account, for both research and public health planning, since RSO drinkers constitute a vulnerable subgroup for AUD.

Modelling the disability severity score in motor insurance claims: an application to the Spanish case

Bodily injury claims have the greatest impact on the claim costs of motor insurance companies. The disability severity of motor claims is assessed in numerous European countries by means of score systems. In this paper a zero inflated generalized Poisson regression model is implemented to estimate the disability severity score of victims in-volved in motor accidents on Spanish roads. We show that the injury severity estimates may be automatically converted into financial terms by insurers at any point of the claim handling process. As such, the methodology described may be used by motor insurers operating in the Spanish market to monitor the size of bodily injury claims. By using insurance data, various applications are presented in which the score estimate of disability severity is of value to insurers, either for computing the claim compensation or for claim reserve purposes.

Different Plasma Markers of Inflammation Are Influenced by Immune Recovery and cART Composition or Intensification in Treated HIV Infected Individuals

Abstract Background HIV-1 infection increases plasma levels of inflammatory markers. Combination antiretroviral therapy (cART) does not restore inflammatory markers to normal levels. Since intensification of cART with raltegravir reduced CD8 T-cell activation in the Discor-Ral and IntegRal studies, we have evaluated the effect of raltegravir intensification on several soluble inflammation markers in these studies. Methods Longitudinal plasma samples (0–48 weeks) from the IntegRal (n = 67, 22 control and 45 intensified individuals) and the Discor-Ral studies (44 individuals with CD4 T-cell counts<350 cells/µl, 14 control and 30 intensified) were assayed for 25 markers. Mann-Whitney, Wilcoxon, Spearman test and linear mixed models were used for analysis. Results At baseline, different inflammatory markers were strongly associated with HCV co-infection, lower CD4 counts and with cART regimens (being higher in PI-treated individuals), but poorly correlated with detection of markers of residual viral replication. Although raltegravir intensification reduced inflammation in individuals with lower CD4 T-cell counts, no effect of intensification was observed on plasma markers of inflammation in a global analysis. An association was found, however, between reductions in immune activation and plasma levels of the coagulation marker D-dimer, which exclusively decreased in intensified patients on protease inhibitor (PI)-based cART regimens (P = 0.040). Conclusions The inflammatory profile in treated HIV-infected individuals showed a complex association with HCV co-infection, the levels of CD4 T cells and the cART regimen. Raltegravir intensification specifically reduced D-dimer levels in PI-treated patients, highlighting the link between cART composition and residual viral replication; however, raltegravir had little effect on other inflammatory markers.

Importância da logística da via de síntese em Química Verde

The role of the logistics in the design of synthetic pathways aimed at greenish is discussed. The influence on costs (of reagents, solvents and total), as well as on atomic productivity green metrics (atomic economy and E factor), of the position along the pathway of a step with low yield, or involving high dilution of the reagents or expensive reagents, has been evaluated by calculations on a linear pathway model. The results show the economic importance of Green Chemistry and provide useful information for pathway design or improvement.

Etelä-Karjalan sosiaali- ja terveyspiirin kuntakohtaisen kustannuslaskentamallin kehittäminen

Työn tavoitteena oli tutkia Etelä-Karjalan sosiaali- ja terveydenhuollon kuntayhtymän kuntalaskutusta ja rakentaa laskentamalli, jolla kuntakohtaiset kustannukset pystytään laskemaan ja jakamaan. Tutkimusote oli konstruktiivinen. Tiedot kerättiin kuntayhtymän toiminta- ja taloustietojärjestelmistä sekä haastattelemalla organisaation asiantuntijoita. Työn tulokseksi saatu laskentamalli koostuu suoritepohjaisesta, asukaslukupohjaisista ja tarvepainotetuista asukaslukupohjaisista kustannusajureista, joilla kustannukset jaetaan piirin jäsenkunnille. Tällä sekamallilla pystytään toteuttamaan kuntalaskutusta, sillä se täyttää kuntalaskutusmallille asetetut vaatimukset. Työn tulosten perusteella tulo-osuusmalli olisi paras tapa toteuttaa kuntalaskutusta. Yksinkertainen rahoitusmalli mahdollistaa toiminnan vapaamman kehittämisen kuin sekamalli ja on lisäksi selkeämpi ja läpinäkyvämpi. Sekamallissa tulisi painottaa tarvepohjaisia asukaslukuajureita. Tärkeimmät ja suurimpia kustannuksia aiheuttavat alueet kannattaisi tuotteistaa.

REPEATABILITY OF FRUITS AND SEEDS PRODUCTION AND SELECTION OF BRAZIL NUT GENOTYPES IN NATIVE POPULATIONS IN RORAIMA1

ABSTRACT This study estimates the repeatability coefficients of two production traits in two native populations of Brazil nut trees. It determines the number of years of suitable evaluations for an efficient selection process, determines the permanent phenotypic correlation between production traits and also the selection of promising trees in these populations. Populations, located in the Itã region (ITA) and in the in the Cujubim region (CUJ), are both belonging to the municipality of Caracaraí, state of Roraima - Brazil, and consist of 85 and 51 adult trees, respectively. Each tree was evaluated regarding the number of fruits per plant (NFP) and fresh seed weight per plant (SWP), for eight (ITA) and five consecutive years (CUJ). Statistical analyses were performed according to the mixed model methodology, using Software Selegen-REML/BLUP (RESENDE, 2007). The repeatability coefficients were low for NFP (0.3145 and 0.3269 for ITA and CUJ, respectively) and also for SWP (0.2957 and 0.3436 for ITA and CUJ, respectively). It on average takes nine evaluation years to reach coefficients of determination higher than 80%. Permanent phenotypic correlation values higher than 0.95 were obtained for NFP and SWP in both populations. Although trees with a high number of fruits and seed weight were identified, more evaluation years are needed to perform the selection process more efficiently.

Computational modeling for irrigated agriculture planning. Part II: risk analysis

Techniques of evaluation of risks coming from inherent uncertainties to the agricultural activity should accompany planning studies. The risk analysis should be carried out by risk simulation using techniques as the Monte Carlo method. This study was carried out to develop a computer program so-called P-RISCO for the application of risky simulations on linear programming models, to apply to a case study, as well to test the results comparatively to the @RISK program. In the risk analysis it was observed that the average of the output variable total net present value, U, was considerably lower than the maximum U value obtained from the linear programming model. It was also verified that the enterprise will be front to expressive risk of shortage of water in the month of April, what doesn't happen for the cropping pattern obtained by the minimization of the irrigation requirement in the months of April in the four years. The scenario analysis indicated that the sale price of the passion fruit crop exercises expressive influence on the financial performance of the enterprise. In the comparative analysis it was verified the equivalence of P-RISCO and @RISK programs in the execution of the risk simulation for the considered scenario.

Using fraction images derived from modis data for coffee crop mapping

Coffee production was closely linked to the economic development of Brazil and, even today, coffee is an important product of the national agriculture. The State of Minas Gerais currently accounts for 52% of the whole coffee area in Brazil. Remote sensing data can provide information for monitoring and mapping of coffee crops, faster and cheaper than conventional methods. In this context, the objective of this study was to assess the effectiveness of coffee crop mapping in Monte Santo de Minas municipality, Minas Gerais State, Brazil, from fraction images derived from MODIS data, in both dry and rainy seasons. The Spectral Linear Mixing Model was used to derive fraction images of soil, coffee, and water/shade. These fraction images served as input data for the supervised automatic classification using the SVM - Support Vector Machine approach. The best results concerning Overall Accuracy and Kappa Index were obtained in the classification of the dry season, with 67% and 0.41, respectively.

The use of ALOS/PALSAR data for estimating sugarcane productivity

Some models have been developed using agrometeorological and remote sensing data to estimate agriculture production. However, it is expected that the use of SAR images can improve their performance. The main objective of this study was to estimate the sugarcane production using a multiple linear regression model which considers agronomic data and ALOS/PALSAR images obtained from 2007/08, 2008/09 and 2009/10 cropping seasons. The performance of models was evaluated by coefficient of determination, t-test, Willmott agreement index (d), random error and standard error. The model was able to explain 79%, 12% and 74% of the variation in the observed productions of the 2007/08, 2008/09 and 2009/10 cropping seasons, respectively. Performance of the model for the 2008/09 cropping season was poor because of the occurrence of a long period of drought in that season. When the three seasons were considered all together, the model explained 66% of the variation. Results showed that SAR-based yield prediction models can contribute and assist sugar mill technicians to improve such estimates.

Impact of ivermectin-resistant gastrointestinal nematodes in feedlot cattle in Argentina

The aim was to evaluate for 75 days the impact on production of the remaining burden of ivermectin (IVM)-resistant parasites in naturally infected feedlot calves. The herds came from tick-infested areas of cattle breeding where the systematic use of IVM to control tick increases the gastrointestinal parasites resistant to this drug. This investigation was carried out in two commercial feedlots in Buenos Aires province. In feedlot A, two groups of 35 animal each received IVM 1% and the other received ricobendazole (RBZ) 10% respectively. The same was done in feedlot B. On day 0, two groups of 35 animals were made in feedlots A and B. Fecal samples were taken on days 0, 22, 54 and 75 pos-treatment (PT), and body weight was registered, from each animal. Fecal samples were processed for individual count of eggs per gram (EPG) and pooled fecal culture was carried out for identification of the parasite genus in each sampling. Fecal egg count reduction test (FECR) was calculated on day 22 PT. The study design used was a totally randomized block, with commercial feedlot and sex as block variables. For data analysis, a mixed model of the SAS statistical program was used. The FECR average on day 22 was 28.4% in the IVM group, and 94,2 % in the RBZ group . From this date on, significant differences in EPG were kept until day 54. EPG counts were only equal near the end of the trial, on day 75 (p=0.16). In both commercial feedlots, especially in the IVM group, Cooperia spp. was the most prevalent parasite in the fecal cultures. Significant differences in weight (P<0.01) on post-treatment day 75 was found between the average weight in the RBZ and the IVM group (246 vs. 238 kg respectively), what means a difference of 8.3% in gains. The importance for production in the antiparasite failure treatment in commercial feedlots was demonstrated, and the need of pos-treatment controls to evaluate the efficacy of the antiparasitic administered is emphasized.

Exchange rate volatility and the use of foreign currency derivatives: Impact of 2008 global financial crisis

This thesis examines the impact of foreign exchange rate volatility to the extent of use of foreign currency derivatives. Especially the focus is on the impacts of 2008 global financial crisis. The crisis increased risk level in the capital markets greatly. The change in the currency derivatives use is analyzed by comparing means between different periods and in addition, by linear regression that enables to analyze the explanatory power of the model. The research data consists of financial statements figures from fiscal years 2006-2011 published by firms operating in traditional Finnish industrial sectors. Volatilities of the chosen three currency pairs is calculated from the daily fixing rates of ECB. Based on the volatility the sample period is divided into three sub-periods. The results suggest that increased FX market volatility did not increase the use foreign currency derivatives. Furthermore, the increased foreign exchange rate volatility did not increase the power of linear regression model to estimate the use foreign currency derivatives compared to previous studies.

Rocket tracking and decoupling eigenstructure control law

A control law was designed for a satellite launcher ( rocket ) vehicle using eigenstructure assignment in order that the vehicle tracks a reference attitude and also to decouple the yaw response from roll and pitch manoeuvres and to decouple the pitch response from roll and yaw manoeuvres. The design was based on a complete linear coupled model obtained from the complete vehicle non linear model by linearization at each trajectory point. After all, the design was assessed with the vehicle time varying non-linear model showing a good performance and robustness. The used design method is explained and a case study for the Brazilian satellite launcher ( VLS Rocket ) is reported.

Luottamuksen lähteet. Vertaileva tutkimus yleistynyttä luottamusta synnyttävistä mekanismeista

Tutkimuksen aiheena on yleistynyt luottamus. Väitöskirjassa tutkitaan mistä tuntemattomien kansalaisten toisiinsa kohdistama luottamus kumpuaa ja haetaan vastauksia tähän kysymykseen sekä maakohtaisen että vertailevan tutkimuksen avulla. Tutkimus koostuu yhteenvedon lisäksi viidestä tutkimusartikkelista, joissa luottamuksen syntyä tarkastellaan sekä yksilöiden mikrotason vuorovaikutuksen että maiden välisten eroavaisuuksien näkökulmasta. Yleistyneen luottamuksen synnystä on esitetty useita eri teorioita. Tässä tutkimuksessa tarkastellaan näistä kahta keskeisintä. Osa tutkijoista korostaa kansalaisyhteiskunnan ja ruohonjuuritason verkostojen roolia yleistyneen luottamuksen synnyn taustalla. Tämän hypoteesin mukaan kansalaiset, jotka viettävät aikaansa yhdistyksissä tai muissa sosiaalisissa verkostoissa, oppivat muita helpommin luottamaan paitsi täysin tuntemattomiin ihmisiin myös yhteiskunnallisiin instituutioihin (kansalaisyhteiskuntakeskeinen hypoteesi). Toiset taas painottavat yhteiskunnan julkisten instituutioiden merkitystä. Tämä hypoteesi korostaa instituutioiden reiluutta ja oikeudenmukaisuutta (instituutiokeskeinen hypoteesi). Ihmiset pystyvät luottamaan toisiinsa ja ratkaisemaan kollektiivisia ongelmiaan yhdessä silloin kun esimerkiksi poliittiset ja lainsäädännölliset instituutiot pystyvät luomaan tähän tarvittavan toimintaympäristön. Aineistoina käytetään kansallisia (Hyvinvointi- ja palvelut) sekä kansainvälisiä vertailevia kyselytutkimuksia (European Social Survey ja ISSP). Yksilö- ja makrotason analyyseja yhdistämällä selvitetään yleistynyttä luottamusta selittäviä tekijöitä sekä mekanismeja joiden kautta yleistynyt luottamus muodostuu. Väitöskirjan tulokset tukevat suurimmaksi osaksi instituutiokeskeiseen suuntaukseen sisältyviä hypoteeseja yleistyneen luottamuksen kasautumisesta. Kuitenkin myös esimerkiksi yhdistystoiminnalla havaittiin olevan joitakin yhdistysjäsenien ulkopuolelle ulottuvia myönteisiä vaikutuksia kansalaisten luottamukseen, mikä taas tukee kansalaisyhteiskuntakeskeistä hypoteesia. Tutkimuksen keskeinen tulos on, että kaiken kaikkiaan luottamus näyttäisi kukoistavan maissa, joissa kansalaiset kokevat julkiset instituutiot oikeudenmukaisina sekä reiluina, kansalaisyhteiskunnan roolin luottamuksen synnyttämisessä ollessa tälle alisteinen. Syyksi tähän on oletettu, että näissä maissa (erityisesti pohjoismaiset hyvinvointivaltiot) harjoitettu universaali hyvinvointipolitiikka ja palvelut ovat keskeisiä korkeaa yleistynyttä luottamusta selittäviä tekijöitä. Toisaalta maavertailuissa tätä yhteyttä on selitetty myös sillä, että näissä yhteiskunnassa ei ole paikannettavissa selkeää kulttuurisesti erottuvaa alaluokkaa. Tämän tutkimuksen tulokset tukevat enemmän universaalin hyvinvointivaltion oikeudenmukaisuuteen liittyviä ominaisuuksia alaluokkaistumishypoteesin sijaan. Toisaalta mikrotasolla tarkasteltuna yleistyneen luottamuksen ja hyvinvointipalvelujen välinen yhteys liittyy enemmän palveluiden riittävyyteen kuin niiden universaalisuuden asteeseen. Niin ikään maavertailuissa esimerkiksi verotuksen oikeudenmukaisena kokeminen näyttäisi olevan palvelujen saatavuutta tai niihin liittyviä oikeudenmukaisuuden kokemuksia tärkeämpi seikka yleistyneen luottamuksen kannalta.