984 resultados para Small volume resuscitation


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This dissertation combines three separate studies that measure coastal change using airborne laser data. The initial study develops a method for measuring subaerial and subaqueous volume change incrementally alongshore, and compares those measurements to shoreline change in order to quantify their relationship in Palm Beach County, Florida. A poor correlation (R2 = 0.39) was found between shoreline and volume change before the hurricane season in the northern section of Palm Beach County because of beach nourishment and inlet dynamics. However, a relatively high R2 value of 0.78 in the southern section of Palm Beach County was found due to little disturbance from tidal inlets and coastal engineering projects. The shoreline and volume change caused by the 2004 hurricane season was poorly correlated with R2 values of 0.02 and 0.42 for the north and south sections, respectively. The second study uses airborne laser data to investigate if there is a significant relationship between shoreline migration before and after Hurricane Ivan near Panama City, Florida. In addition, the relationship between shoreline change and subaerial volume was quantified and a new method for quantifying subaqueous sediment change was developed. No significant spatial relationship was found between shoreline migration before and after the hurricane. Utilization of a single coefficient to represent all relationships between shoreline and subaerial volume change was found to be problematic due to the spatial variability in the linear relationship. Differences in bathymetric data show only a small portion of sediment was transported beyond the active zone and most sediment remained within the active zone despite the occurrence of a hurricane. The third study uses airborne laser bathymetry to measure the offshore limit of change, and compares that location with calculated depth of closures and subaqueous geomorphology. There appears to be strong geologic control of the depth of closure in Broward and Miami-Dade Counties. North of Hillsboro Inlet, hydrodynamics control the geomorphology which in turn indicates the location of the depth of closure.

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BACKGROUND: Fluid resuscitation is a cornerstone of intensive care treatment, yet there is a lack of agreement on how various types of fluids should be used in critically ill patients with different disease states. Therefore, our goal was to investigate the practice patterns of fluid utilization for resuscitation of adult patients in intensive care units (ICUs) within the USA. METHODS: We conducted a cross-sectional online survey of 502 physicians practicing in medical and surgical ICUs. Survey questions were designed to assess clinical decision-making processes for 3 types of patients who need volume expansion: (1) not bleeding and not septic, (2) bleeding but not septic, (3) requiring resuscitation for sepsis. First-choice fluid used in fluid boluses for these 3 patient types was requested from the respondents. Descriptive statistics were performed using a Kruskal-Wallis test to evaluate differences among the physician groups. Follow-up tests, including t tests, were conducted to evaluate differences between ICU types, hospital settings, and bolus volume. RESULTS: Fluid resuscitation varied with respect to preferences for the factors to determine volume status and preferences for fluid types. The 3 most frequently preferred volume indicators were blood pressure, urine output, and central venous pressure. Regardless of the patient type, the most preferred fluid type was crystalloid, followed by 5 % albumin and then 6 % hydroxyethyl starches (HES) 450/0.70 and 6 % HES 600/0.75. Surprisingly, up to 10 % of physicians still chose HES as the first choice of fluid for resuscitation in sepsis. The clinical specialty and the practice setting of the treating physicians also influenced fluid choices. CONCLUSIONS: Practice patterns of fluid resuscitation varied in the USA, depending on patient characteristics, clinical specialties, and practice settings of the treating physicians.

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A pressurized core with CH4 hydrate or dissolved CH4 should evolve gas volumes in a predictable manner as pressure is released over time at isothermal conditions. Incremental gas volumes were collected as pressure was released over time from 29 pressure core sampler (PCS) cores from Sites 994, 995, 996, and 997 on the Blake Ridge. Most of these cores were kept at or near 0ºC with an ice bath, and many of these cores yielded substantial quantities of CH4. Volume-pressure plots were constructed for 20 of these cores. Only five plots conform to expected volume and pressure changes for sediment cores with CH4 hydrate under initial pressure and temperature conditions. However, other evidence suggests that sediment in these five and at least five other PCS cores contained CH4 hydrate before core recovery and gas release. Detection of CH4 hydrate in a pressurized sediment core through volume-pressure relationships is complicated by two factors. First, significant quantities of CH4-poor borehole water fill the PCS and come into contact with the core. This leads to dilution of CH4 concentration in interstitial water and, in many cases, decomposition of CH4 hydrate before a degassing experiment begins. Second, degassing experiments were conducted after the PCS had equilibrated in an ice-water bath (0ºC). This temperature is significantly lower than in situ values in the sediment formation before core recovery. Our results and interpretations for PCS cores collected on Leg 164 imply that pressurized containers formerly used by the Deep Sea Drilling Project (DSDP) and currently used by ODP are not appropriately designed for direct detection of gas hydrate in sediment at in situ conditions through volume-pressure relationships.

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Our Standardized Unexpected Price (SUP) metric continues to show a decline in the price of large hotels, and now also the price of small hotels has eased—even though hotel transaction volume has increased. Although debt and equity financing for hotels remain relatively inexpensive, we are concerned that the total volatility of hotel returns is greater relative to the return volatility for other commercial real estate. If this trend continues, lenders will eventually start to tighten hotel lending standards. Our early warning indicators all continue to suggest that the downward trend in hotel prices should continue into the next quarter. This is report number 19 of the index series.

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This paper presents a three dimensional, thermos-mechanical modelling approach to the cooling and solidification phases associated with the shape casting of metals ei. Die, sand and investment casting. Novel vortex-based Finite Volume (FV) methods are described and employed with regard to the small strain, non-linear Computational Solid Mechanics (CSM) capabilities required to model shape casting. The CSM capabilities include the non-linear material phenomena of creep and thermo-elasto-visco-plasticity at high temperatures and thermo-elasto-visco-plasticity at low temperatures and also multi body deformable contact with which can occur between the metal casting of the mould. The vortex-based FV methods, which can be readily applied to unstructured meshes, are included within a comprehensive FV modelling framework, PHYSICA. The additional heat transfer, by conduction and convection, filling, porosity and solidification algorithms existing within PHYSICA for the complete modelling of all shape casting process employ cell-centred FV methods. The termo-mechanical coupling is performed in a staggered incremental fashion, which addresses the possible gap formation between the component and the mould, and is ultimately validated against a variety of shape casting benchmarks.

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A number of research groups are now developing and using finite volume (FV) methods for computational solid mechanics (CSM). These methods are proving to be equivalent and in some cases superior to their finite element (FE) counterparts. In this paper we will describe a vertex-based FV method with arbitrarily structured meshes, for modelling the elasto-plastic deformation of solid materials undergoing small strains in complex geometries. Comparisons with rational FE methods will be given.

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This paper is the second in a series of studies working towards constructing a realistic, evolving, non-potential coronal model for the solar magnetic carpet. In the present study, the interaction of two magnetic elements is considered. Our objectives are to study magnetic energy build-up, storage and dissipation as a result of emergence, cancellation, and flyby of these magnetic elements. In the future these interactions will be the basic building blocks of more complicated simulations involving hundreds of elements. Each interaction is simulated in the presence of an overlying uniform magnetic field, which lies at various orientations with respect to the evolving magnetic elements. For these three small-scale interactions, the free energy stored in the field at the end of the simulation ranges from 0.2 – 2.1×1026 ergs, whilst the total energy dissipated ranges from 1.3 – 6.3×1026 ergs. For all cases, a stronger overlying field results in higher energy storage and dissipation. For the cancellation and emergence simulations, motion perpendicular to the overlying field results in the highest values. For the flyby simulations, motion parallel to the overlying field gives the highest values. In all cases, the free energy built up is sufficient to explain small-scale phenomena such as X-ray bright points or nanoflares. In addition, if scaled for the correct number of magnetic elements for the volume considered, the energy continually dissipated provides a significant fraction of the quiet Sun coronal heating budget.

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Epigenetic inheritance is more widespread in plants than in mammals, in part because mammals erase epigenetic information by germline reprogramming. We sequenced the methylome of three haploid cell types from developing pollen: the sperm cell, the vegetative cell, and their precursor, the postmeiotic microspore, and found that unlike in mammals the plant germline retains CG and CHG DNA methylation. However, CHH methylation is lost from retrotransposons in microspores and sperm cells and restored by de novo DNA methyltransferase guided by 24 nt small interfering RNA, both in the vegetative nucleus and in the embryo after fertilization. In the vegetative nucleus, CG methylation is lost from targets of DEMETER (DME), REPRESSOR OF SILENCING 1 (ROS1), and their homologs, which include imprinted loci and recurrent epialleles that accumulate corresponding small RNA and are premethylated in sperm. Thus genome reprogramming in pollen contributes to epigenetic inheritance, transposon silencing, and imprinting, guided by small RNA.

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The aim of this project was to investigate very small strain elastic behaviour of soils under unsaturated conditions, using bender/extender element (BEE) testing. The behaviour of soils at very small strains has been widely studied under saturated conditions, whereas much less work has been performed on very small strain behaviour under unsaturated conditions. A suction-controlled double wall triaxial apparatus for unsaturated soil testing was modified to incorporate three pairs of BEEs transmitting both shear and compression waves with vertical and horizontal directions of wave transmission and wave polarisation. Various different techniques for measuring wave travel time were investigated in both the time domain and the frequency domain and it was concluded that, at least for the current experimental testing programme, peak-to-first-peak in the time domain was the most reliable technique for determining wave travel time. An experimental test programme was performed on samples of compacted speswhite kaolin clay. Two different forms of compaction were employed (i.e. isotropic and anisotropic). Compacted kaolin soil samples were subjected to constant suction loading and unloading stages at three different values of suction, covering both unsaturated conditions (s= 50kPa and s= 300kPa) and saturated conditions (s=0). Loading and unloading stages were performed at three different values of stress ratio (η=0, η=1 and η=-1 ). In some tests a wetting-drying cycle was performed before or within the loading stage, with the wetting-drying cycles including both wetting-induced swelling and wetting-induced collapse compression. BEE tests were performed at regular intervals throughout all test stages, to measure shear wave velocity Vs and compression wave velocity Vp and hence to determine values of shear modulus G and constrained modulus M. The experimental test programme was designed to investigate how very small strain shear modulus G and constrained modulus M varied with unsaturated state variables, including how anisotropy of these parameters developed either with stress state (stress-induced anisotropy) or with previous straining (strain-induced anisotropy). A new expression has been proposed for the very small strain shear modulus G of an isotropic soil under saturated and unsaturated conditions. This expression relates the variation of G to only mean Bishop’s stress p* and specific volume v, and it converges to a well-established expression for saturated soils as degree of saturation approaches 1. The proposed expression for G is able to predict the variation of G under saturated and unsaturated conditions at least as well as existing expressions from the literature and it is considerably simpler (employing fewer state variables and fewer soil constants). In addition, unlike existing expressions from the literature, the values of soil constants in the proposed new expression can be determined from a saturated test. It appeared that, in the current project at least, any strain-induced anisotropy of very small strain elastic behaviour was relatively modest, with the possible exception of loading in triaxial extension. It was therefore difficult to draw any firm conclusion about evolution of strain-induced anisotropy and whether it depended upon the same aspects of soil fabric as evolution of anisotropy of large strain plastic behaviour. Stress-induced anisotropy of very small strain elastic behaviour was apparent in the experimental test programme. An attempt was made to extend the proposed expression for G to include the effect of stress-induced anisotropy. Interpretation of the experimental results indicated that the value of shear modulus was affected by the values of all three principal Bishop’s stresses (in the direction of wave transmission, the direction of wave polarisation and the third mutually perpendicular direction). However, prediction of stress-induced anisotropy was only partially successful, and it was concluded that the effect of Lode angle was also significant.

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The challenge for wastewater professionals is to design and operate treatment processes that support human well being and are environmentally sensitive throughout the life-cycle. This research focuses on one technology for small-scale wastewater treatment: the vertical flow constructed wetland (VFCW), which is herein investigated for the capacity to remove ammonium and nitrate nitrogen from wastewater. Hydraulic regime and presence/absence of vegetation are the basis for a three-phase bench scale experiment to determine oxygen transfer and nitrogen fate in VFCWs. Results show that 90% NH4+-N removal is achieved in aerobic downflow columns, 60% NO3--N removal occurs in anaerobic upflow columns, and 60% removal of total nitrogen can be achieved in downflow-upflow in-series. The experimental results are studied further using a variably saturated flow and reactive transport model, which allows a mechanistic explanation of the fate and transport of oxygen and nitrogen. The model clarifies the mechanisms of oxygen transport and nitrogen consumption, and clarifies the need for readily biodegradable COD for denitrification. A VFCW is then compared to a horizontal flow constructed wetland (HFCW) for life cycle environmental impacts. High areal emissions of greenhouse gases from VFCWs compared to HFCWs are the driver for the study. The assessment shows that because a VFCW is only 25% of the volume of an HFCW designed for the same treatment quality, the VFCW has only 25-30% of HFCW impacts over 12 impact categories and 3 damage categories. Results show that impacts could be reduced by design improvements. Design recommendations are downflow wetlands for nitrification, upflow wetlands for denitrification, series wetlands for total nitrogen removal, hydraulic load of 142 L/m2d, 30 cm downflow wetland depth, 1.0 m upflow wetland depth, recycle, vegetation and medium-grained sand. These improvements will optimize nitrogen removal, minimize gaseous emissions, and reduce wetland material requirements, thus reducing environmental impact without sacrificing wastewater treatment quality.

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Epigenetic inheritance is more widespread in plants than in mammals, in part because mammals erase epigenetic information by germline reprogramming. We sequenced the methylome of three haploid cell types from developing pollen: the sperm cell, the vegetative cell, and their precursor, the postmeiotic microspore, and found that unlike in mammals the plant germline retains CG and CHG DNA methylation. However, CHH methylation is lost from retrotransposons in microspores and sperm cells and restored by de novo DNA methyltransferase guided by 24 nt small interfering RNA, both in the vegetative nucleus and in the embryo after fertilization. In the vegetative nucleus, CG methylation is lost from targets of DEMETER (DME), REPRESSOR OF SILENCING 1 (ROS1), and their homologs, which include imprinted loci and recurrent epialleles that accumulate corresponding small RNA and are premethylated in sperm. Thus genome reprogramming in pollen contributes to epigenetic inheritance, transposon silencing, and imprinting, guided by small RNA.

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The aim of the study was to analyze the frequency of epidermal growth factor receptor (EGFR) mutations in Brazilian non-small cell lung cancer patients and to correlate these mutations with response to benefit of platinum-based chemotherapy in non-small cell lung cancer (NSCLC). Our cohort consisted of prospective patients with NSCLCs who received chemotherapy (platinum derivates plus paclitaxel) at the [UNICAMP], Brazil. EGFR exons 18-21 were analyzed in tumor-derived DNA. Fifty patients were included in the study (25 with adenocarcinoma). EGFR mutations were identified in 6/50 (12 %) NSCLCs and in 6/25 (24 %) adenocarcinomas; representing the frequency of EGFR mutations in a mostly self-reported White (82.0 %) southeastern Brazilian population of NSCLCs. Patients with NSCLCs harboring EGFR exon 19 deletions or the exon 21 L858R mutation were found to have a higher chance of response to platinum-paclitaxel (OR 9.67 [95 % CI 1.03-90.41], p = 0.047). We report the frequency of EGFR activating mutations in a typical southeastern Brazilian population with NSCLC, which are similar to that of other countries with Western European ethnicity. EGFR mutations seem to be predictive of a response to platinum-paclitaxel, and additional studies are needed to confirm or refute this relationship.

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This study aimed to evaluate long-term atrophy in contralateral hippocampal volume after surgery for unilateral MTLE, as well as the cognitive outcome for patients submitted to either selective transsylvian amygdalohippocampectomy (SelAH) or anterior temporal lobe resection (ATL). We performed a longitudinal study of 47 patients with MRI signs of unilateral hippocampal sclerosis (23 patients with right-sided hippocampal sclerosis) who underwent surgical treatment for MTLE. They underwent preoperative/postoperative high-resolution MRI as well as neuropsychological assessment for memory and estimated IQ. To investigate possible changes in the contralateral hippocampus of patients, we included 28 controls who underwent two MRIs at long-term intervals. The volumetry using preoperative MRI showed significant hippocampal atrophy ipsilateral to the side of surgery when compared with controls (p<0.0001) but no differences in contralateral hippocampal volumes. The mean postoperative follow-up was 8.7 years (± 2.5 SD; median=8.0). Our patients were classified as Engel I (80%), Engel II (18.2%), and Engel III (1.8%). We observed a small but significant reduction in the contralateral hippocampus of patients but no volume changes in controls. Most of the patients presented small declines in both estimated IQ and memory, which were more pronounced in patients with left TLE and in those with persistent seizures. Different surgical approaches did not impose differences in seizure control or in cognitive outcome. We observed small declines in cognitive scores with most of these patients, which were worse in patients with left-sided resection and in those who continued to suffer from postoperative seizures. We also demonstrated that manual volumetry can reveal a reduction in volume in the contralateral hippocampus, although this change was mild and could not be detected by visual analysis. These new findings suggest that dynamic processes continue to act after the removal of the hippocampus, and further studies with larger groups may help in understanding the underlying mechanisms.