427 resultados para Pirkanmaan ELY-keskus
Resumo:
Earlier school text book studies (eg Tainio and Teräs 2010, Blumberg 2007; Ohlander 2010) have shown that women are underrepresented in school books, both in illustrations and texts, and the genders are represented stereotyped. The study will examine how gender in seen on pre-school education materials. The aim of this study is to determine what kind of representations, discourses and the subject positions of the gender are presented in pre-school materials. This study utilizes a feminist research method. The theoretical starting points are the social constructivist, poststructuralist theory and gender studies. The concept of gender as a social construct. The research used content analysis as well as discource analysis and deconstructive reading. The material was used four different publishers, WSOY, Tammi, Otava and Lasten Keskus preschool integrated material packages, which contain the child's exercise book or booklet, and teacher's guide. The analysis examined the quantity of gender-specific images and gendered words and phrases, and representations of gender, subject position, and discourses, and what linguistic means had been used for representation of masculinity and femininity. Based on the results there were on average more masculine characters and words as feminine in the illustrations and stories of pre-school materials. Feminine and masculine characters representations emphasized traditional gender stereotypes, especially in external characteristics and clothing. Genders had the highest available, with the subject position of stereotypes with reduced mobility, but also other kinds of subject position was observed. The data found in the following gender discources: difference discource, diversity discource and similarity discource. The highest number occurred in the difference and diversity discources. However, there were differences between the different materials. In some materials there were more diverse gender representations and other materials highlighted the differences between genders. Overall, the genders were represented stereotypically in the pre-school materials.
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Relying on Merleau-Ponty's phenomenology of perception and on Mircea Eliade's works on the Sacred and the Profane, this study explores the river as a perceptual space and as the sacred Center in a cosmic vision of the world in twelve of Jean-Marie Gustave Le Clézio's fictional works, from The Interrogation (1963) to Revolutions (2003). In the first chapter, after introducing the field of study, I discuss the relation between the radical subjectivity and the evasiveness of perceiving subjects in Le Clézio's fiction. Next are some thoughts on the relation between Merleau-Ponty's and Le Clézio's ideas. The second chapter studies the river as an experience in the text, first as a topographical space, then as a sound world. The investigations move on to its water as a visual and a tactile phenomenon. Then follows the human use of the river, the (absence of) baths, and the river as a traveling space. The chapter closes with the study of the metaphorical use of the word, occurring mainly in urban space and for phenomena in the sky. The third chapter is organized around the river as the Center of the world in a religious cosmogony, where the river represents the origin of the world and of the human race. The core analysis shows how the middle of the river is a symbolic space of a new beginning. As a sacred space, the river abolishes time as the object of contemplation and as relative immobility from the point of view of a person drifting downstream. The functions of a new beginning and of abolition of time are combined in the symbolic immersions in the water. Finally, the dissertation explores other symbolical spaces, such as the unknown destination of the drift, and the river as the Center of a utopia. The chapter closes with the existential agony as a result of the elimination of the Center in the urban environment. In the final chapter, the river is compared to other watercourses : the creek, the brook and the rapids. The river is more of a spatial entity, whereas the actual water is more important in the smaller watercourses. The river is more common than the other watercourses as a topographical element in the landscape, whereas the minor watercourses invite the characters to a closer contact with their element, in immersions and in drinking their water. Finally, the work situates the rivers in a broader context of different fictional spaces in Le Clézio's text.
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Foreign compounds, such as drugs are metabolised in the body in numerous reactions. Metabolic reactions are divided into phase I (functionalisation) and phase II (conjugation) reactions. Uridine diphosphoglucuronosyltransferase enzymes (UGTs) are important catalysts of phase II metabolic system. They catalyse the transfer of glucuronic acid to small lipophilic molecules and convert them to hydrophilic and polar glucuronides that are readily excreted from the body. Liver is the main site of drug metabolism. Many drugs are racemic mixtures of two enantiomers. Glucuronidation of a racemic compound yields a pair of diastereomeric glucuronides. Stereoisomers are interesting substrates in glucuronidation studies since some UGTs display stereoselectivity. Diastereomeric glucuronides of O-desmethyltramadol (M1) and entacapone were selected as model compounds in this work. The investigations of the thesis deal with enzymatic glucuronidation and the development of analytical methods for drug metabolites, particularly diastereomeric glucuronides. The glucuronides were analysed from complex biological matrices, such as urine or from in vitro incubation matrices. Various pretreatment techniques were needed to purify, concentrate and isolate the analytes of interest. Analyses were carried out by liquid chromatography (LC) with ultraviolet (UV) or mass spectrometric (MS) detection or with capillary electromigration techniques. Commercial glucuronide standards were not available for the studies. Enzyme-assisted synthesis with rat liver microsomes was therefore used to produce M1 glucuronides as reference compounds. The glucuronides were isolated by LC/UV and ultra performance liquid chromatography (UPLC)/MS, while tandem mass spectrometry (MS/MS) and nuclear magnetic resonance (NMR) spectroscopy were employed in structural characterisation. The glucuronides were identified as phenolic O-glucuronides of M1. To identify the active UGT enzymes in (±)-M1 glucuronidation recombinant human UGTs and human tissue microsomes were incubated with (±)-M1. The study revealed that several UGTs can catalyse (±)-M1 glucuronidation. Glucuronidation in human liver microsomes like in rat liver microsomes is stereoselective. The results of the studies showed that UGT2B7, most probably, is the main UGT responsible for (±)-M1 glucuronidation in human liver. Large variation in stereoselectivity of UGTs toward (±)-M1 enantiomers was observed. Formation of M1 glucuronides was monitored with a fast and selective UPLC/MS method. Capillary electromigration techniques are known for their high resolution power. A method that relied on capillary electrophoresis (CE) with UV detection was developed for the separation of tramadol and its free and glucuronidated metabolites. The suitability of the method to identify tramadol metabolites in an authentic urine samples was tested. Unaltered tramadol and four of its main metabolites were detected in the electropherogram. A micellar electrokinetic chromatography (MEKC) /UV method was developed for the separation of the glucuronides of entacapone in human urine. The validated method was tested in the analysis of urine samples of patients. The glucuronides of entacapone could be quantified after oral entacapone dosing.
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Neurofibromatosis 2 (NF2) is an autosomal dominant disorder manifested by the formation of multiple benign tumors of the nervous system. Affected individuals typically develop bilateral vestibular schwannomas which lead to deafness and balance disorders. The syndrome is caused by inactivation of the NF2 tumor suppressor gene, and mutation or loss of the NF2 product, merlin, is sufficient for tumorigenesis in both hereditary and sporadic NF2-associated tumors. Merlin belongs to the band 4.1 superfamily of cytoskeletal proteins, which also contain the related ezrin, radixin, and moesin (ERM) proteins. The ERM members provide a link between the cell cytoskeleton and membrane by connecting membrane-associated proteins to actin filaments. By stabilizing complexes in the cell cortex, the ERMs modulate morphology, growth, and migration of cells. Despite their structural homology, overlapping subcellular distribution, direct molecular association, and partial overlap of molecular interactions, merlin and ezrin exert opposite effects on cell proliferation. Merlin suppresses cell proliferation, whereas ezrin expression is linked to oncogenic activity. We hypothesized that the regions which differ between the proteins might explain merlin s specificity as a tumor suppressor. We therefore analyzed the regions, which are most diverse between merlin and ezrin; the N-terminal tail and the C-terminus. To determine the properties of the C-terminal region, we studied the two most predominant merlin isoforms together with truncation variants similar to those found in patients. We also focused on the evolutionally conserved C-terminal residues, E545-E547, that harbor disease causing mutations in its corresponding DNA sequence. In addition to inhibiting cell proliferation, merlin regulates cytoskeletal organization. The morphogenic properties of merlin may play a role in tumor suppression, since patient-derived tumor cells demonstrate cytoskeletal abnormalities. We analyzed the mechanisms of merlin-induced extension formation and determined that the C-terminal region of amino acids 538-568 is particularly important for the morphogenic activity. We also characterized the role of C-terminal merlin residues in the regulation of proliferation, phosphorylation, and intramolecular associations. In contrast to previous reports, we demonstrated that both merlin isoforms are able to suppress cell proliferation, whereas C-terminally mutated merlin constructs showed reduced growth inhibition. Phosphorylation serves as a mechanism to regulate the tumor suppressive activity of merlin. The C-terminal serine 518 is phosphorylated in response to both p21-activated kinase (PAK) and protein kinase A (PKA), which inactivates the growth inhibitory function of merlin. However, at least three differentially phosphorylated forms of the protein exist. In this study we demonstrated that also the N-terminus of merlin is phosphorylated by AGC kinases, and that both PKA and Akt phosphorylate merlin at serine 10 (S10). We evaluated the impact of this N-terminal tail phosphorylation, and showed that the phosphorylation state of S10 is an important regulator of merlin s ability to modulate cytoskeletal organization but also regulates the stability of the protein. In summary, this study describes the functional effect of merlin specific regions. We demonstrate that both S10 in the N-terminal tail and residues E545-E547 in the C-terminus are essential for merlin activity and function.
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Tutkielman tutkimusongelmana on hallinnonalariippumattoman palvelumallin toteuttaminen julkisessa hallinnossa. Hallinnonalariippumattomalle palvelumallille määritellään tutkielmassa kolme teoreettista lähtökohtaa, jotka ovat toimivalta, asiakkuus ja hallinnon kehittäminen. Tutkimusongelmaan vastataan ottamalla suomalainen yhteispalvelumalli empiirisen ja aineistolähtöisen tutkimuksen kohteeksi ja peilaamalla siitä saatuja kokemuksia määriteltyihin teoreettisiin lähtökohtiin. Samassa yhteydessä tutkimuksen kohteena oleva suomalainen yhteispalvelumalli asettuu osaksi laajempaa hallinnon tutkimuksen viitekehystä ja teoreettista keskustelua. Tutkielman teoreettisia lähtökohtia koskien aineistona on tutkielmassa tarkemman tarkastelun kohteiksi valittuja käsitteitä käsittelevä hallinto- ja organisaatlotieteellinen kirjallisuus. Empiirinen tutkimuskohde, yhteispalvelu, määritellään hallinnon tuottamia virallisasiakirjoja ja voimassa olevaa lainsäädäntöä aineistona käyttäen. Tutkimuskohteen empiirisen analyysin edellyttämän aineiston keräämisen metodina on sovellettu teemahaastattelua. Haastatteluja on tehty yhteensä kuusi tutkimuskohteena olevan aiheen asiantuntijoille, ja haastatellut edustavat kuntakenttää sekä valtion keskus- ja paikallishallintoa. Empiirisen aineiston analyysissa sovelletaan aineistolähtöisen kuvan muodostamiseksi grounded theorya. Tutkielman johtopäätökset muodostuvat tarkasteltaessa tutkimusongelman teoreettisia lähtökohtia yhteispalvelusta aineistolähtöisesti ja ilman teoriaohjautuvuutta muodostuneen kuvan valossa. Toimivaltaa koskien keskeinen johtopäätös on, että kun tavoitellaan kokonaisvaltaista ja laajasti sovellettavaa hallinnonalariippumatonta palvelumallia, ei toimivallan kysymystä voida jättää huomiotta. Yhtenä ratkaisumahdollisuutena on määritellä perinteisen asiallisen toimivallan ohella hallinnonalariippumattomalle palvelujen tarjoamisen menetelmälle toimivaltainen ja keskitetty omistaja- ja vastuutaho. Asiakkuutta koskien hallinnonalariippumaton palvelumalli edellyttää kokonaisvaltaista Citizen Relationship Management -käsitteen kaltaista ymmärrystä asiakkuuksista ja asiakaslähtöisyydestä. Näin ollen New Public Managementin mukainen kulttuurinen siirtymä pois perinteisestä julkisen hallinnon paradigmasta ei ole riittävä, vaan asiakkuuden suhteen olisi huomioitava myös organisaatio-, teknologia- ja prosessinäkökulmat. Hallinnon kehittämisestä voidaan todeta sen sisältyvän implisiittisesti ajatukseen hallinnonalariippumattomasta palvelumallista. Tämä koskee erityisesti eGovemment -käsitteen mukaista informaatioteknologian hyödyntämistä. Vasta informaatioteknologian kehitys on mahdollistanut hallinnonalariippumattoman palvelumallin visioimisen ja tavoittelemisen käytännössä. Samalla hallinnon kehittäminen kohtaa toimintana kuitenkin monia haasteita, joista hallinnonalariippumattoman palvelumallin tapauksessa erityisen relevantteja ovat yhteispalvelusta saatujen kokemusten perusteella rakenteelliset, kulttuuriset ja toiminnalliset haasteet.
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Sika- ja siipikarjatilojen määrä Suomessa on vähentynyt koko EU-jäsenyyden ajan tuotannon keskittyessä yhä suurempiin yksiköihin. Tuotantomäärät ovat kasvaneet, mutta viljelijöiden tulotaso on alentunut, joten maatalouden ulkopuoliset ammatit houkuttelevat luopumaan eläinten pidosta tai maataloudesta kokonaan. Sika- ja siipikarjatalouden rakennemuutoksen taloudellisena kannustimena otettiin vuonna 2009 käyttöön sika- ja siipikarjatalouden rakennemuutoskorvaus, jota maksetaan kompensaationa sika- ja siipikarjataloudesta luopuville viljelijöille. Tämän työn tarkastelukohteena on rakennemuutoskorvaus C-tukialueella, jossa yksinään on lähes yhtä paljon sika- ja siipikarjatiloja kuin A- ja B-alueilla yhteensä. Tutkimuksen tavoitteena on selvittää, millaiset sika- ja siipikarjatilat sekä koko C-alueella että C-alueen eri osissa ovat hakeneet rakennemuutoskorvausta ja miten tilat ovat alueellisesti sijoittuneet. Maatalouden rakennepolitiikalla pyritään vaikuttamaan maatalouden yhteiskunnalliseen rakenteeseen. Rakennepoliittisilla toimilla pyritään vähentämään viljelijöiden ja tilojen määrää, jolloin maataloustulo jakaantuu pienemmälle viljelijämäärälle taaten heille suuremmat tulot. Maatalouden rakennemuutosta tapahtuu, kun maatalouden rakenteessa tapahtuu tietyllä aikavälillä muutos. Rakennemuutoksessa ja -kehityksessä on alueellisia eroja. Aluetaloustiede pyrkii selittämään, mistä alueelliset erot johtuvat ja miksi alueet erilaistuvat. Suomessa eri maakunnilla on eroja ja omia alueellisia ominaispiirteitään, joilla on suuri merkitys alueen työllisyyteen ja väestön sijoittumiseen alueella. Eri maakunnissa työllisyystilanne on vaihteleva, mutta joka maakunnassa on kuitenkin työvoimapulaa useissa sellaisissa ammateissa, joihin eläinten tai tilan pidon lopettavien viljelijöiden olisi mahdollista työllistyä. Sika- ja siipikarjatalouden rakennemuutoskorvaus on kansallinen kotieläintuki, jota maksetaan tilakohtaisen viitemäärän perusteella tiloille, jotka ovat juuri lopettaneet sika- ja siipikarjatuotantonsa tai aikovat sen lopettaa. Korvausta on voitu maksaa tukiehdot täyttävälle tuenhakijalle joko vuosina 2009–2010 tai vuosina 2010–2011 ja sen maksimimäärä on tilaa kohden enintään 20000 euroa vuodessa. Kahden korvausvuoden jälkeen tilan viitemäärä lakkautetaan ja sen jälkeen tilalle ei enää makseta sika- ja siipikarjatalouden tukia. Tilan on kuitenkin edelleen mahdollista jatkaa sika- ja siipikarjatuotantoaan markkinaehtoisena. Tutkimuksen aineisto on 389 tilan tiedot sisältävä Tiken raportti tukityypin 1612 (sika- ja siipikarjatalouden rakennemuutoskorvaus, pohjoinen) tukihakutiedoista vuodelta 2010. Tutkimusote oli kvantitatiivinen ja koska havaintoaineisto kattaa kaikki C-alueen korvauksenhakijat, tehtiin tutkimus kokonaistutkimuksena. Tutkimustulosten mukaan 63 % korvausta hakeneista tiloista sijoittuu C1-alueelle ja 54 % Etelä-Pohjanmaalle ja Pohjanmaalle. Kuntatasolla eniten rakennemuutoskorvaustiloja oli Närpiössä. C-alueella tuenhakijat olivat iältään 20–71-vuotiaita. Hakijoista 62 % harjoitti päätuotantosuuntanaan viljanviljelyä ja peltoalaa kaikilla hakijoilla oli hallinnassaan lähes 16000 ha. Rakennemuutoskorvausta maksettiin C-alueella yhteensä yli 2,3 miljoonaa euroa. Kun rakennemuutoskorvauksen viitemäärät kahden korvausvuoden jälkeen lakkautetaan, poistuu tuo-tannosta yli 9600 ey. Sekä C-alueella että kaikki ELY-keskukset huomioiden oli korvauksenhakijoita kaikkia ikäluokkia tarkasteltaessa eniten 50–59-vuotiaissa. Eniten hakijoita oli viitemääräluokassa 10,01–20 ey ja viljelyalaluokassa 25,01–40 ha, vähiten luokissa 40,01–50 ey ja 50,01 ey tai enemmän sekä 150,01 ha tai enemmän. Yleisin maksuluokka oli 3000,01–4500 euroa, harvinaisin 15000,01–20000 euroa. Rakennemuutoskorvauksella saavutettuja hyötyjä ja kustannuksia on toistaiseksi vaikea määritellä, koska vuoden 2011 maksatus on vielä kesken.
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O crescente fluxo global de investimentos estrangeiros coloca o tema da regulação dos investimentos estrangeiros no cerne das preocupações do Direito Internacional. Em uma estrutura formal com diversos níveis, o Direito Internacional dos Investimentos passa por constantes readaptações e reconstruções. Diversas alternativas teóricas têm sido propostas para responder aos muitos questionamentos relativos ao futuro do Direito Internacional dos Investimentos. Ao longo das décadas, o Brasil optou por manter-se isolado do regime internacional de regulação de investimentos estrangeiros, de maneira que a questão permaneceu regulada inteiramente por um mosaico normativo disperso entre normas constitucionais e infraconstitucionais. O crescente papel do Brasil como país exportador de capitais especialmente em virtude da expansão da indústria do petróleo e gás levou à recente revisão das diretrizes de política externa em matéria de investimentos estrangeiros. A decisão de negociar acordos internacionais de investimentos pode trazer diversas consequências para o ordenamento jurídico doméstico, dentre as quais se destaca a interferência do padrão de tratamento justo e equitativo no exercício do poder regulatório pelo Estado. A recorrente invocação do padrão de tratamento justo e equitativo contrasta com as incertezas sobre seu conteúdo. Ainda que possa existir uma compatibilidade teórica entre esse padrão de tratamento e o Direito brasileiro, a exposição às interpretações criativas dos tribunais arbitrais pode representar um risco para o Brasil, que deve cuidadosamente avaliar a pertinência de incluir uma cláusula do padrão de tratamento justo e equitativo nos acordos atualmente em negociação.
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A operação para aumento de glúteos com implantes teve início no fim da década de 1960, entretanto a técnica intramuscular, considerada padrão atualmente, foi descrita cerca de 30 anos depois. Cirurgiões e pacientes apresentam crescente interesse na realização do aumento de glúteos haja vista que sua frequência apresenta aumento nos últimos anos. A utilização de implantes intramusculares que superam o volume do músculo em mais de cinquenta por cento configura uma situação nova que deve ser estudada. O tecido muscular estriado esquelético apresenta grande suscetibilidade para atrofia secundariamente à compressão, e sendo o glúteo máximo um músculo importante na manutenção da postura ereta, deambulação, corrida e salto, é necessário pesquisar possíveis alterações musculares decorrentes da operação. O objetivo deste estudo é avaliar o volume e força do músculo glúteo máximo ao longo de 12 meses após a introdução de implantes intramusculares, o posicionamento destes implantes no interior da musculatura e mudanças antropométricas obtidas com a operação. Foram selecionadas 48 mulheres, 24 candidatas a gluteoplastia de aumento com implantes compuseram o grupo de estudo e 24 candidatas a mamoplastia de aumento compuseram o grupo controle de acordo com os critérios de inclusão e exclusão. As pacientes foram avaliadas em quatro momentos diferentes: pré-operatório e após três, seis e 12 meses da operação. Em todas as etapas foi realizada avaliação clínica nutricional, tomografia computadorizada com reconstrução 3D e teste isocinético. Todas as pacientes permaneceram afastadas de atividades físicas durante três meses após a operação. Foram utilizados implantes glúteos em gel coesivo de base oval e superfície lisa com volumes de 350 cm3 e 400 cm3. O nível de significância estatística foi mantido em 5%. As pacientes candidatas a gluteoplastia apresentaram valores da relação entre as medidas da cintura e do quadril maiores que aquelas do grupo controle. A operação de aumento glúteo com implantes demonstrou eficácia na melhora desta relação. Os implantes apresentaram posição obliqua com inclinação semelhante à das fibras musculares após três meses da operação, independente da posição em que foram inseridos. As pacientes do grupo de estudo apresentaram atrofia muscular após 12 meses em 6,14% à esquerda e 6,43% à direita, as pacientes do grupo controle não apresentaram atrofia. A força muscular apresentou redução do valor de torque máximo durante a flexão do quadril a 30 /s em ambos os grupos e aumento do torque máximo durante a adução a 60 /s apenas no grupo de estudo. Concluímos que a introdução de implante de silicone no interior do músculo glúteo máximo causa atrofia muscular após 12 meses. As variações na força deste músculo nesse período não podem ser atribuídas primariamente à operação ou à presença dos implantes em seu interior. Os implantes permaneceram em posição obliqua. O aumento de glúteos com implantes gera mudanças antropométricas nas mulheres submetidas a esta operação.
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EXTRACT (SEE PDF FOR FULL ABSTRACT): We examined atmospheric circulation conditions conducive to occurrence of winter floods that exceed the 10-year peak discharge on rivers in six hydroclimatic subregions in Arizona, southern Utah, Nevada, and California. ... This relationship between flooding and broad-scale atmospheric patterns in the modern record will aid in paleoclimatic interpretations of paleoflood records over the last few thousand years.
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We report on high-frequency (300-700 GHz) ferromagnetic resonance (HF-FMR) measurements on cobalt superparamagnetic particles with strong uniaxial effective anisotropy. We derive the dynamical susceptibility of the system on the basis of an independent-grain model by using a rectangular approach. Numerical simulations give typical line shapes depending on the anisotropy, the gyromagnetic ratio, and the damping constant. HF-FMR experiments have been performed on two systems of ultrafine cobalt particles of different sizes with a mean number of atoms per particles of 150 +/- 20 and 310 +/- 20. In both systems, the magnetic anisotropy is found to be enhanced compared to the bulk value, and increases as the particle size decreases, in accordance with previous determinations from magnetization measurements. Although no size effect has been observed on the gyromagnetic ratio, the transverse relaxation time is two orders of magnitude smaller than the bulk value indicating strong damping effects, possibly originating from surface spin disorders.
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We investigate high-field ferromagnetic resonance of superparamagnetic particles with uniaxial anisotropy, In this case, since the field is large enough to saturate the magnetization, the thermal orientational fluctuations of the magnetic moment of the particle are negligible. Thus, we derive the dynamic susceptibility of the system on the basis of an independent particle model. High-field ferromagnetic resonance has been performed on fine cobalt particles, The analysis of the spectra obtained at different frequencies allows us to estimate the effective magnetic anisotropy, the gyromagnetic ratio, and the transverse relaxation time. (C) 1998 Elsevier Science B.V. All rights reserved.
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We investigate high-field ferromagnetic resonance of superparamagnetic particles with uniaxial anisotropy, In this case, since the field is large enough to saturate the magnetization, the thermal orientational fluctuations of the magnetic moment of the particle are negligible. Thus, we derive the dynamic susceptibility of the system on the basis of an independent particle model. High-field ferromagnetic resonance has been performed on fine cobalt particles, The analysis of the spectra obtained at different frequencies allows us to estimate the effective magnetic anisotropy, the gyromagnetic ratio, and the transverse relaxation time. (C) 1998 Elsevier Science B.V. All rights reserved.
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Apresentação; Dados da IP de Vale dos Vinhedos;Georreferenciamento; relevo; imagens
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Background: Delirium is an acute organ dysfunction common amongst patients treated in intensive care units. The associated morbidity and mortality are known to be substantial. Previous surveys have described which screening tools are used to diagnose delirium and which medications are used to treat delirium, but these data are not available for the United Kingdom. Aim: This survey aimed to describe the UK management of delirium by consultant intensivists. Additionally, knowledge and attitudes towards management of delirium were sought. The results will inform future research in this area. Methods: A national postal survey of members of the UK Intensive Care Society was performed. A concise two page questionnaire survey was sent, with a second round of surveys sent to non-respondents after 6 weeks. The questionnaire was in tick-box format. Results: Six hundred and eighty-one replies were received from 1308 questionnaires sent, giving a response rate of 52%. Twenty-five percent of respondents routinely screen for delirium, but of these only 55% use a screening tool validated for use in intensive care. The majority (80%) of those using a validated instrument used the Confusion Assessment Method for the Intensive Care Unit. Hyperactive delirium is treated pharmacologically by 95%; hypoactive delirium is treated pharmacologically by 25%, with haloperidol the most common agent used in both. Over 80% of respondents agreed that delirium prolongs mechanical ventilation and hospital stay and requires active treatment. Conclusions: This UK survey demonstrates screening for delirium is sporadic. Pharmacological treatment is usually with haloperidol in spite of the limited evidence to support this practice. Hypoactive delirium is infrequently treated pharmacologically.
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Rationale: Delirium is common in intensive care unit (ICU) patients and is a predictor of worse outcomes and neuroinflammation is a possible mechanism. The antiinflammatory actions of statins may reduce delirium.
Objectives: To determine whether critically ill patients receiving statin therapy had a reduced risk of delirium than those not on statins.
Methods: A prospective cohort analysis of data from consecutive ICU patients admitted to a UK mixed medical and surgical critical care unit between August 2011 and February 2012; the Confusion Assessment Method for ICU was used to determine the days each patient was assessed as being free of delirium during ICU admission.
Measurements and Main Results: Delirium-free days, daily administration of statins, and serum C-reactive protein (CRP) were recorded. Four hundred and seventy consecutive critical care patients were followed, of whom 151 patients received statins. Using randomeffects multivariable logistic regression, statin administration the previous evening was associated with the patient being assessed as free of delirium (odds ratio, 2.28; confidence interval, 1.01-5.13; P , 0.05) and with lower CRP (b = 20.52; P , 0.01) the following day. When the association between statin and being assessed as free of delirium was controlled for CRP, the effect size became nonsignificant (odds ratio, 1.56; confidence interval, 0.64-3.79; P = 0.32).
Conclusions: Ongoing statin therapy is associated with a lower daily risk of delirium in critically ill patients. An ongoing clinical trial, informed by this study, is investigating if statins are a potential therapy for delirium in the critically ill.Copyright © 2014 by the American Thoracic Society.