Dysfunction of respiratory muscles in critically ill patients on the intensive care unit.

Muscular weakness and muscle wasting may often be observed in critically ill patients on intensive care units (ICUs) and may present as failure to wean from mechanical ventilation. Importantly, mounting data demonstrate that mechanical ventilation itself may induce progressive dysfunction of the main respiratory muscle, i.e. the diaphragm. The respective condition was termed 'ventilator-induced diaphragmatic dysfunction' (VIDD) and should be distinguished from peripheral muscular weakness as observed in 'ICU-acquired weakness (ICU-AW)'. Interestingly, VIDD and ICU-AW may often be observed in critically ill patients with, e.g. severe sepsis or septic shock, and recent data demonstrate that the pathophysiology of these conditions may overlap. VIDD may mainly be characterized on a histopathological level as disuse muscular atrophy, and data demonstrate increased proteolysis and decreased protein synthesis as important underlying pathomechanisms. However, atrophy alone does not explain the observed loss of muscular force. When, e.g. isolated muscle strips are examined and force is normalized for cross-sectional fibre area, the loss is disproportionally larger than would be expected by atrophy alone. Nevertheless, although the exact molecular pathways for the induction of proteolytic systems remain incompletely understood, data now suggest that VIDD may also be triggered by mechanisms including decreased diaphragmatic blood flow or increased oxidative stress. Here we provide a concise review on the available literature on respiratory muscle weakness and VIDD in the critically ill. Potential underlying pathomechanisms will be discussed before the background of current diagnostic options. Furthermore, we will elucidate and speculate on potential novel future therapeutic avenues.

Folio from a Guy u Chawgan (The ball and the polo-mallet), verso: A polo game: the dervish and the shah on the polo field

7 41/64 in.x 4 27/32 in.; ink, opaque watercolor and gold on paper

Laboratory studies on the effects of laboratory simulated earthquake loadings on cohesive soil strength, San Luis Dam and Canal, San Luis Unit Central Valley Project, California.

"Report no. EM-715."

Observations on fevers : especially those of the continued type and on the scarlet fever attended with ulcerated sore-throat /

Mode of access: Internet.

The Dameron-Damron genealogy; the descendants of Lawrence Dameron of Virginia, with notes on the related Northumberland county families of Gaskins, Harvey, Bledsoe, Tignor, Ball, Coppedge-Coppage, Waddy, Taylor, Smith, and the John Ladd Family originating Lower Norfolk county, Virginia.

Kept up by appendices issued at irregular intervals.

Welcome to Charles Dickens : the Boz ball : to be given under the direction of a committee of citizens of New York, at the Park Theatre, on the evening of the fourteenth of February next.

Cover title.

An analysis of country dancing, wherein all the figures used in that polite amusement are rendered familiar by engraved lines; containing also, directions for composing almost any number of figures to one tune, with some entire new reels; together with the complete etiquette on the ball-room.

Mode of access: Internet.

A graphic summary of the number, size, and type of farm, and value of products : (based largely on the census of 1930 and 1935) /

"Issued October 1937."

Judging dairy cattle on the basis of type and records of production /

"Issued January 1941."

On the Geometry of Rectifiable Sets with Carleson and Poincare-type inequlaities

Thesis (Ph.D.)--University of Washington, 2016-06

The effect of resin type on the sintering of freeformed maraging steel

The role of the resin type on the sintering of maraging steel with boron additions has been investigated. Two different resins were added to the steel mixture and their subsequent debinding was evaluated and sintering responses compared with that of a resin-free alloy. The two resins used, nylon and a mixture of phenolic resin and synthetic wax, possessed different debinding behaviour, with the latter causing significant carbon contamination of the parts. This caused the formation of a Ti-Mo carbide, depleting the matrix of these elements. Consequently, the microstructure consisted of the equilibrium Fe-Fe2B eutectic, as well as a Mo-rich boride. The liquid phase also appeared to contain significant amounts of carbon, which lowered the temperature at which the liquid formed, resulting in high density occurring at a much lower temperature. When nylon was used as the binder, a similar sintering response to the resin-free alloy was observed. (C) 2002 Published by Elsevier Science B.V.

On the nonlinear Neumann problem involving the critical Sobolev exponent on the boundary

in this paper we investigate the solvability of the Neumann problem (1.1) involving the critical Sobolev exponents on the right-hand side of the equation and in the boundary condition. It is assumed that the coefficients Q and P are smooth. We examine the common effect of the mean curvature of the boundary a deltaOhm and the shape of the graph of the coefficients Q and P on the existence of solutions of problem (1.1). (C) 2003 Published by Elsevier Inc.