An evaluation of protocolised weaning on the duration of mechanical ventilation

Using a before and after study design, we compared protocolised weaning from mechanical ventilation with usual non-protocolised practice in intensive care. Outcomes (duration of mechanical ventilation, duration of intubation, intensive care stay) and complications (re-intubations, tracheostomy, mortality) were compared between baseline (Phase I) and following implementation of protocolised weaning (Phase II). Over the same period, we collected data in a second (reference) unit to monitor practice changes over time. In the intervention unit, outcomes were longer in Phase II compared with Phase I (all p < 0.005). When adjusted for admission APACHE II score and diagnostic category, only intensive care stay remained significantly longer (p = 0.002). There were significantly more tracheostomies in Phase II (p = 0.004). The reference unit demonstrated no statistically significant differences in study outcomes or complications between Phases. Protocolised weaning did not reduce the duration of mechanical ventilation and was not associated with an increased rate of re-intubation or intensive care unit mortality.

Charge exchange emission from solar wind helium ions

Charge exchange X-ray and far-ultraviolet (FUV) aurorae can provide detailed insight into the interaction between solar system plasmas. Using the two complementary experimental techniques of photon emission spectroscopy and translation energy spectroscopy, we have studied state-selective charge exchange in collisions between fully ionized helium and target gasses characteristic of cometary and planetary atmospheres (H2O, CO2, CO, and CH4). The experiments were performed at velocities typical for the solar wind (200-1500 km s(-1)). Data sets are produced that can be used for modeling the interaction of solar wind alpha particles with cometary and planetary atmospheres. These data sets are used to demonstrate the diagnostic potential of helium line emission. Existing Extreme Ultraviolet Explorer (EUVE) observations of comets Hyakutake and Hale-Bopp are analyzed in terms of solar wind and coma characteristics. The case of Hale-Bopp illustrates well the dependence of the helium line emission to the collision velocity. For Hale-Bopp, our model requires low velocities in the interaction zone. We interpret this as the effect of severe post-bow shock cooling in this extraordinary large comet.

Dissociative charge exchange and ionization of O-2 by fast H+ and O+ ions: Energetic ion interactions in Europa's oxygen atmosphere and neutral torus

Measurements of electron capture and ionization of O-2 molecules in collisions with H+ and O+ ions have been made over an energy range 10 - 100 keV. Cross sections for dissociative and nondissociative interactions have been separately determined using coincidence techniques. Nondissociative channels leading to O-2(+) product formation are shown to be dominant for both the H+ and the O+ projectiles in the capture collisions and only for the H+ projectiles in the ionization collisions. Dissociative channels are dominant for ionizing collisions involving O+ projectiles. The energy distributions of the O+ fragment products from collisions involving H+ and O+ have also been measured for the first time using time-of-flight methods, and the results are compared with those from other related studies. These measurements have been used to describe the interaction of the energetic ions trapped in Jupiter's magnetosphere with the very thin oxygen atmosphere of the icy satellite Europa. It is shown that the ionization of oxygen molecules is dominated by charge exchange plus ion impact ionization processes rather than photoionization. In addition, dissociation is predominately induced through excitation of electrons into high-lying repulsive energy states ( electronically) rather than arising from momentum transfer from knock-on collisions between colliding nuclei, which are the only processes included in current models. Future modeling will need to include both these processes.

Exploration of the Kuiper Belt by High-Precision Photometric Stellar Occultations: First Results

We report here the first detection of hectometer-size objects by the method of serendipitous stellar occultation. This method consists of recording the diffraction shadow created when an object crosses the observer's line of sight and occults the disk of a background star. One of our detections is most consistent with an object between Saturn and Uranus. The two other diffraction patterns detected are caused by Kuiper Belt objects beyond 100 AU from the Sun and hence are the farthest known objects in the solar system. These detections show that the Kuiper Belt is much more extended than previously believed and that the outer part of the disk could be composed of smaller objects than the inner part. This gives critical clues to understanding the problem of the formation of the outer planets of the solar system.

The Diversity of Type Ia Supernovae: Evidence for Systematics?

The photometric and spectroscopic properties of 26 well-observed Type Ia Supernovae (SNe Ia) were analyzed with the aim of exploring SN Ia diversity. The sample includes (Branch) normal SNe, as well as extreme events such as SN 1991T and SN 1991bg, while the truly peculiar SNe Ia, SN 2000cx and SN 2002cx, are not included in our sample. A statistical treatment reveals the existence of three different groups. The first group (FAINT) consists of faint SNe Ia similar to SN 1991bg, with low expansion velocities and rapid evolution of Si II velocity. A second group consists of normal SNe Ia, also with high temporal velocity gradient (HVG), but with brighter mean absolute magnitude =-19.3 and higher expansion velocities than the FAINT SNe. The third group includes both normal and SN 1991T-like SNe Ia: these SNe populate a narrow strip in the Si II velocity evolution plot, with a low-velocity gradient (LVG), but have absolute magnitudes similar to HVGs. While the FAINT and HVG SNe Ia together seem to define a relation between R(Si II) and ���m15(B), the LVG SNe either do not conform to that relation or define a new, looser one. The R(Si II) premaximum evolution of HVGs is strikingly different from that of LVGs. We discuss the impact of this evidence on the understanding of SN Ia diversity, in terms of explosion mechanisms, degree of ejecta mixing, and ejecta-circumstellar material interaction.

Optimal Body Size and Energy Expenditure during Winter: Why are voles smaller in declining populations?

Winter is energetically challenging for small herbivores because of greater energy requirements for thermogenesis at a time when little energy is available. We formulated a model predicting optimal wintering body size, accounting for the scaling of both energy expenditure and assimilation to body size, and the trade-off between survival benefits of a large size and avoiding survival costs of foraging. The model predicts that if the energy cost of maintaining a given body mass differs between environments, animals should be smaller in the more demanding environments, and there should be a negative correlation between body mass and daily energy expenditure (DEE) across environments. In contrast, if animals adjust their energy intake according to variation in survival costs of foraging, there should be a positive correlation between body mass and DEE. Decreasing temperature always increases equilibrium DEE, but optimal body mass may either increase or decrease in colder climates depending on the exact effects of temperature on mass-specific survival and energy demands. Measuring DEE with doubly labeled water on wintering Microtus agrestis at four field sites, we found that DEE was highest at the sites where voles were smallest despite a positive correlation between DEE and body mass within sites. This suggests that variation in wintering body mass between sites was due to variation in food quality/availability and not adjustments in foraging activity to varying risks of predation.

Molecular Hydrogen Emission from Protoplanetary Disks: Effects of X-ray Irradiation and Dust Evolution

Detailed models for the density and temperature profiles of gas and dust in protoplanetary disks are constructed by taking into account X-ray and UV irradiation from a central T Tauri star, as well as dust size growth and settling toward the disk midplane. The spatial and size distributions of dust grains are numerically computed by solving the coagulation equation for settling dust particles, with the result that the mass and total surface area of dust grains per unit volume of the gas in the disks are very small, except at the midplane. The H2 level populations and line emission are calculated using the derived physical structure of the disks. X-ray irradiation is the dominant heating source of the gas in the inner disk and in the surface layer, while the UV heating dominates otherwise. If the central star has strong X-ray and weak UV radiation, the H2 level populations are controlled by X-ray pumping, and the X-rayinduced transition lines could be observable. If the UV irradiation is strong, the level populations are controlled by thermal collisions or UV pumping, depending on the dust properties. As the dust particles evolve in the disks, the gas temperature at the disk surface drops because the grain photoelectric heating becomes less efficient. This makes the level populations change from LTE to non-LTE distributions, which results in changes to the line ratios. Our results suggest that dust evolution in protoplanetary disks could be observable through the H2 line ratios. The emission lines are strong from disks irradiated by strong UV and X-rays and possessing small dust grains; such disks will be good targets in which to observe H2 emission.

Detection of C8H- and Comparison with C8H toward IRC+10216

We report the detection of new transitions of octatetraynyl (C8H) toward the circumstellar envelope IRC +10 216 using data taken with the 100 m Green Bank Telescope (GBT). In addition, we report five features from the Ku, K, and Q bands that have been identified as transitions of the octatetraynyl anion (C8H-). From a rotational temperature diagram and an assumed source size of 30", we find a total C8H column density of 8(3)×10^12 cm-2 and a rotational temperature of ~13 K. From the five detected transitions of C8H-, we find a total C8H- column density of ~2.1×10^12 cm-2 consistent with a rotational temperature of ~34 K for a total C8H/C8H- column density ratio of ~3.8. This observed C8H/C8H- column density ratio is similar to the theoretical prediction of 3.6, while the observed column densities were lower than that predicted by a factor of ~30. This prompted us to reinvestigate the initial conditions of the circumstellar envelope (CSE) model. The new model results are presented, and they more closely match the C8H and C8H- abundances observed with the GBT. Finally, we use the new CSE model results to predict the abundance of decapentaynyl (C10H), and we compare them with the measured upper limit found from the GBT observations.

Galactic Edge Clouds I. Molecular Line Observations and Chemical Modelling of Edge Cloud 2

Edge Cloud 2 (EC2) is a molecular cloud, about 35 pc in size, with one of the largest galactocentric distances known to exist in the Milky Way. We present observations of a peak CO emission region in the cloud and use these to determine its physical characteristics. We calculate a gas temperature of 20 K and a density of n(H2)~10^4 cm-3. Based on our CO maps, we estimate the mass of EC2 at around 10^4 Msolar and continuum observations suggest a dust-to-gas mass ratio as low as 0.001. Chemical models have been developed to reproduce the abundances in EC2, and they indicate that heavy element abundances may be reduced by a factor of 5 relative to the solar neighborhood (similar to dwarf irregular galaxies and damped Lya systems), very low extinction (A_V <4 mag) due to a very low dust-to-gas mass ratio, an enhanced cosmic-ray ionization rate, and a higher UV field compared to local interstellar values. The reduced abundances may be attributed to the low level of star formation in this region and are probably also related to the continuing infall of primordial (or low-metallicity) halo gas since the Milky Way formed. Finally, we note that shocks from the old supernova remnant GSH 138-01-94 may have determined the morphology and dynamics of EC2.

A prospective clinical trial of a real-time polymerase chain reaction assay for the diagnosis of candidemia in nonneutropenic, critically ill adults

Background. Invasive Candida infection among nonneutropenic, critically ill adults is a clinical problem that has received increasing attention in recent years. Poor performance of extant diagnostic modalities has promoted risk-based, preemptive prescribing in view of the poor outcomes associated with inadequate or delayed antifungal therapy; this risks unnecessary overtreatment. A rapid, reliable diagnostic test could have a substantial impact on therapeutic practice in this patient population.

Methods. Three TaqMan-based real-time polymerase chain reaction assays were developed that are capable of detecting the main medically important Candida species, categorized according to the likelihood of fluconazole susceptibility. Assay 1 detected Candida albicans, Candida parapsilosis, Candida tropicalis, and Candida dubliniensis. Assays 2 and 3 detected Candida glabrata and Candida krusei, respectively. The clinical performance of these assays, applied to serum, was evaluated in a prospective trial of nonneutropenic adults in a single intensive care unit.

Results. In all, 527 specimens were obtained from 157 participants. All 3 assays were run in parallel for each specimen; they could be completed within 1 working day. Of these, 23 specimens were obtained from 23 participants categorized as having proven Candida infection at the time of sampling. If a single episode of Candida famata candidemia was excluded, the estimated clinical sensitivity, specificity, and positive and negative predictive values of the assays in this trial were 90.9%, 100%, 100% and 99.8%, respectively.

Conclusions. These data suggest that the described assays perform well in this population for enhancing the diagnosis of candidemia. The extent to which they may affect clinical outcomes, prescribing practice, and cost-effectiveness of care remains to be ascertained.

Educating for peace? Citizenship education in Quebec and Northern Ireland

The article explores particularities of citizenship education in divided societies by comparing key concepts and theoretical frameworks underpinning citizenship education curricula in two divided societies, one of which could be described as relatively peaceful and the other as slowly emerging from political violence. A document analysis of the citizenship education curricula in both societies is conducted to compare differences and commonalities of attempts to promote citizenship and peaceful community relations. Conceptualizations of and interrelationships between citizenship, human rights, and peace education are explored in theory and curricular documents in both societies. The discussion reflects on the value of citizenship education in the context of community divisions and its possible impact on sustainable peace in divided societies.