Abundance of two Dendrocincla woodcreepers (aves: Dendrocolaptidae) in relation to forest structure in Central Amazonia

Few studies have been conducted to verify how the structure of the forest affects the occurence and abundance of neotropical birds. Our research was undertaken between January 2002 and July 2004 at the Reserva Ducke, near Manaus (02º55',03º01'S; 59º53',59º59'W) in central Amazonia, to verify how the forest structure affects the occurrence and abundance of two bird species: the Plain-brown Woodcreeper Dendrocincla fuliginosa and the White-chinned Woodcreeper Dendrocincla merula. Bird species occurrence was recorded using lines of 20 mist-nets (one sample unit), along 51 1-km transects distributed along 9 pararel 8 km trails covering an area of 6400 ha. Along these transects, we placed 50 x 50m plots where we recorded forest structure components (tree abundance, canopy openness, leaf litter, standing dead trees, logs, proximity to streams, and altitude). We then related these variables to bird occurence and abundance using multiple logistic and multiple linear regression models, respectively. We found that D. fuliginosa frequently used plateau areas; being more abundant in areas with more trees. On the other hand, D. merula occurred more frequently and was more abundant in areas with low tree abundance. Our results suggest that although both species overlap in the reserve (both were recorded in at least 68% of the sampled sites), they differ in the way they use the forest microhabitats. Therefore, local variation in the forest structure may contribute to the coexistence of congeneric species and may help to maintain local alpha diversity.

Effects of forest structure components on the occurence, group size and density of groups of bare-face tamarin (Saguinus bicolor - primates: Callitrichinae) in Central Amazonia

This study analyzed the influence of forest structural components on the occurence, size and density of groups of Bare-face Tamarin (Saguinus bicolor) - the most threatened species in the Amazon - and produced the first map of distribution of groups in large-scale spatial within the area of continuous forest. Population censuses were conducted between November 2002 and July 2003, covering 6400 hectares in the Ducke Reserve, Manaus-AM, Brazil. Groups of S. bicolor were recorded 41 times accordingly distributed in the environments: plateau (20); slopes (12); and lowlands (09). The mean group size was 4.8 indiv./group, and ranged from 2 to 11 individuals. In the sites where the groups were recorded, and in an equivalent number of sites where no tamarins were found located at least 500 m from those where they had been recorded, we placed 50 m x 50 m plots to record the following forest structural components: abundance of trees; abundance of lianas; abundance of fruiting trees and lianas; abundance of snags; abundance of logs; percentage of canopy opening; leaf litter depth; and altitude. Bare-face Tamarin more often uses areas with lower abundance of forest logs, smaller canopy opening and with higher abundance of snags, areas in the forest with smaller canopy opening present higher density of S. bicolor groups. Apparently this species does not use the forest in a random way, and may select areas for its daily activities depending on the micro-environmental heterogeneity produced by the forest structural components.

Measurement of charged-particle spectra in Pb+Pb collisions at √sNN = 2.76TeV with the ATLAS detector at the LHC

Charged-particle spectra obtained in 0.15nb−1 of Pb+Pb interactions at sNN−−−√=2.76TeV and 4.2pb−1 of pp interactions at s√=2.76TeV with the ATLAS detector at the LHC are presented in a wide transverse momentum (0.5plateau at a centrality-dependent value, within the uncertainties. The value is 0.55±0.01(stat.)±0.04(syst.) in the most central collisions. The RAA distribution is consistent with flat |η| dependence over the whole transverse momentum range in all centrality classes.

Soil CO2 efflux in central Amazonia: environmental and methodological effects

Soil respiration plays a significant role in the carbon cycle of Amazonian rainforests. Measurements of soil respiration have only been carried out in few places in the Amazon. This study investigated the effects of the method of ring insertion in the soil as well as of rainfall and spatial distribution on CO2 emission in the central Amazon region. The ring insertion effect increased the soil emission about 13-20% for sandy and loamy soils during the firsts 4-7 hours, respectively. After rainfall events below 2 mm, the soil respiration did not change, but for rainfall greater than 3 mm, after 2 hours there was a decrease in soil temperature and respiration of about 10-34% for the loamy and sand soils, with emissions returning to normal after around 15-18 hours. The size of the measurement areas and the spatial distribution of soil respiration were better estimated using the Shuttle Radar Topographic Mission (SRTM) data. The Campina reserve is a mosaic of bare soil, stunted heath forest-SHF and tall heath forest-THF. The estimated total average CO2 emissions from the area was 3.08±0.8 µmol CO2 m-2 s-1. The Cuieiras reserve is another mosaic of plateau, slope, Campinarana and riparian forests and the total average emission from the area was 3.82±0.76 µmol CO2 m-2 s-1. We also found that the main control factor of the soil respiration was soil temperature, with 90% explained by regression analysis. Automated soil respiration datasets are a good tool to improve the technique and increase the reliability of measurements to allow a better understanding of all possible factors driven by soil respiration processes.

Metabolic profiling and classification of propolis samples from Southern Brazil: an NMR-based platform coupled with machine learning

The chemical composition of propolis is affected by environmental factors and harvest season, making it difficult to standardize its extracts for medicinal usage. By detecting a typical chemical profile associated with propolis from a specific production region or season, certain types of propolis may be used to obtain a specific pharmacological activity. In this study, propolis from three agroecological regions (plain, plateau, and highlands) from southern Brazil, collected over the four seasons of 2010, were investigated through a novel NMR-based metabolomics data analysis workflow. Chemometrics and machine learning algorithms (PLS-DA and RF), including methods to estimate variable importance in classification, were used in this study. The machine learning and feature selection methods permitted construction of models for propolis sample classification with high accuracy (>75%, reaching 90% in the best case), better discriminating samples regarding their collection seasons comparatively to the harvest regions. PLS-DA and RF allowed the identification of biomarkers for sample discrimination, expanding the set of discriminating features and adding relevant information for the identification of the class-determining metabolites. The NMR-based metabolomics analytical platform, coupled to bioinformatic tools, allowed characterization and classification of Brazilian propolis samples regarding the metabolite signature of important compounds, i.e., chemical fingerprint, harvest seasons, and production regions.

Biodegradable drug-eluting stents: Targeting urothelial tumors of upper urinary tract

INTRODUCTION & OBJECTIVES: Urothelial tumors of upper urinary tract are ranked among the most common types of cancers worldwide. The current standard therapy to prevent recurrence is intravesical Bacillus Calmetteâ Guerin (BCG) immunotherapy, but it presents several disadvantages such as BCG failure and intolerance. Another way is to use chemotherapy, which is generally better tolerated that BCG. In this case, drugs such as epirubicin, doxorubicin, paclitaxel and gemcitabine are used. Nevertheless, intravesical chemotherapy only prevents recurrence in the short-term. These failings can be partially attributed to the short residence time and low bioavailability of the drug within the upper urinary tract and the cancer cells, resulting in a need for frequent drug instillation. To avoid these problems, biodegradable ureteral stents impregnated by supercritical fluid CO2 (SCF) with each of the four anti-cancer drugs were produced. MATERIAL & METHODS: Four formulations with different concentrations of gelatin and alginate and crosslink agent were tested and bismuth was added to confer radiopaque properties to the stent. The preliminary in vivo validation studies in female domestic pigs was conducted at the University of Minho, Braga, after formal approval by the institutionâ s review board and in accordance with its internal ethical protocol for animal experiments. Paclitaxel, epirubicin, doxorubicin and gemcitabine were impregnated in the stents and the release kinetics was measured in artificial urine solution (AUS) for 9 days by UV spectroscopy in a microplate reader. The anti-tumoral effect of the developed stents in transitional cell carcinoma (TCC) and HUVEC primary cells, used as control, was evaluated. RESULTS: The in vivo validation of this second-generation of ureteral stents performed was herein demonstrated. Biodegradable ureteral stents were placed in the ureters of a female pigs, following the normal surgical procedure. The animals remained asymptomatic, with normal urine flow. The in vitro release study in AUS of the stent impregnated showed a higher release in the first 72h for the four anti-cancer drugs impregnated after this time the plateau was achieved and the stent degraded after 9 days. The direct and indirect contact of the anti-cancer biodegradable stents with the TCC and HUVEC cell lines confirm the anti-tumor effect of the stents impregnated with the four anti-cancer drugs, reducing around 75% of the viability of the TCC cell line after 72h and no killing effect in the HUVEC cells. CONCLUSIONS: The use of biodegradable ureteral stent in urology clinical practice not only reduce the stent-related symptoms but also open new treatment therapyâ s, like in urothelial tumors of upper urinary tract. Furthermore, we have demonstrated the clinical validation in vivo pig model. This study has thus shown the killing efficacy of the anti-cancer drug eluting biodegradable stents in vitro for the TCC cell line, with no toxicity observed in the control, non-cancerous cells.The direct and indirect contact of the anti-cancer biodegradable stents with the TCC and HUVEC cell lines confirm the anti-tumor effect of the stents impregnated with the four anti-cancer drugs, reducing around 75% of the viability of the TCC cell line after 72h and no killing effect in the HUVEC cells. This study has thus shown the killing efficacy of the anti-cancer drug eluting biodegradable stents in vitro for the TCC cell line, with no toxicity observed in the control, non-cancerous cells.

Critical events in mechanically ventilated patients

Mechanical Ventilation is an artificial way to help a Patient to breathe. This procedure is used to support patients with respiratory diseases however in many cases it can provoke lung damages, Acute Respiratory Diseases or organ failure. With the goal to early detect possible patient breath problems a set of limit values was defined to some variables monitored by the ventilator (Average Ventilation Pressure, Compliance Dynamic, Flow, Peak, Plateau and Support Pressure, Positive end-expiratory pressure, Respiratory Rate) in order to create critical events. A critical event is verified when a patient has a value higher or lower than the normal range defined for a certain period of time. The values were defined after elaborate a literature review and meeting with physicians specialized in the area. This work uses data streaming and intelligent agents to process the values collected in real-time and classify them as critical or not. Real data provided by an Intensive Care Unit were used to design and test the solution. In this study it was possible to understand the importance of introduce critical events for Mechanically Ventilated Patients. In some cases a value is considered critical (can trigger an alarm) however it is a single event (instantaneous) and it has not a clinical significance for the patient. The introduction of critical events which crosses a range of values and a pre-defined duration contributes to improve the decision-making process by decreasing the number of false positives and having a better comprehension of the patient condition.

Estudio de las presiones intergranulares de contacto en loees semisaturado

El comportamiento mecánico (deformación y resistencia al corte) de los suelos es gobernado principalmente por las presiones de contacto entre las partículas que lo componen. Estas presiones se las denomina también como tensiones efectivas o presiones intergranulares de contacto. (...) El presente proyecto tiene por objeto el estudio de las presiones efectivas en suelos colapsables como loess en estado saturado. Se propone determinar la velocidad de propagación de ondas de corte en muestra de suelo semisaturado [de la Ciudad de Córdoba], [en] los cuales previamente se han determinado sus relaciones humedad-succión en cámaras de succión controlada. Los resultados serán estudiados a los fines de determinar los modelos teóricos que expliquen las relaciones entre la humedad, la succión, las tensiones efectivas y la velocidad de propagación de ondas. El estudio propuesto permitirá comprender la elevada rigidez de los loess en estado de humedad natural (semisaturados), comportamientos atípicos como el colapso, cementación de los agregados y comportamiento dinámico.

Desarrollos estadísticos para el procesamiento de información genómica masiva en agro-biotecnología. Statistical developments for processing massive genomic information in agro-biotechnology.

Nuevas biotecnologías, como los marcadores de la molécula de ADN, permiten caracterizar el genoma vegetal. El uso de la información genómica producida para cientos o miles de posiciones cromosómicas permite identificar genotipos superiores en menos tiempo que el requerido por la selección fenotípica tradicional. La mayoría de los caracteres de las especies vegetales cultivadas de importancia agronómica y económica, son controlados por poli-genes causantes de un fenotipo con variación continua, altamente afectados por el ambiente. Su herencia es compleja ya que resulta de la interacción entre genes, del mismo o distinto cromosoma, y de la interacción del genotipo con el ambiente, dificultando la selección. Estas biotecnologías producen bases de datos con gran cantidad de información y estructuras complejas de correlación que requieren de métodos y modelos biométricos específicos para su procesamiento. Los modelos estadísticos focalizados en explicar el fenotipo a partir de información genómica masiva requieren la estimación de un gran número de parámetros. No existen métodos, dentro de la estadística paramétrica capaces de abordar este problema eficientemente. Además los modelos deben contemplar no-aditividades (interacciones) entre efectos génicos y de éstos con el ambiente que son también dificiles de manejar desde la concepción paramétrica. Se hipotetiza que el análisis de la asociación entre caracteres fenotípicos y genotipos moleculares, caracterizados por abundante información genómica, podría realizarse eficientemente en el contexto de los modelos mixtos semiparamétricos y/o de métodos no-paramétricos basados en técnicas de aprendizaje automático. El objetivo de este proyecto es desarrollar nuevos métodos para análisis de datos que permitan el uso eficiente de información genómica masiva en evaluaciones genéticas de interés agro-biotecnológico. Los objetivos específicos incluyen la comparación, respecto a propiedades estadísticas y computacionales, de estrategias analíticas paramétricas con estrategias semiparamétricas y no-paramétricas. Se trabajará con aproximaciones por regresión del análisis de loci de caracteres cuantitativos bajo distintas estrategias y escenarios (reales y simulados) con distinto volúmenes de datos de marcadores moleculares. En el área paramétrica se pondrá especial énfasis en modelos mixtos, mientras que en el área no paramétrica se evaluarán algoritmos de redes neuronales, máquinas de soporte vectorial, filtros multivariados, suavizados del tipo LOESS y métodos basados en núcleos de reciente aparición. La propuesta semiparamétrica se basará en una estrategia de análisis en dos etapas orientadas a: 1) reducir la dimensionalidad de los datos genómicos y 2) modelar el fenotipo introduciendo sólo las señales moleculares más significativas. Con este trabajo se espera poner a disposición de investigadores de nuestro medio, nuevas herramientas y procedimientos de análisis que permitan maximizar la eficiencia en el uso de los recursos asignados a la masiva captura de datos genómicos y su aplicación en desarrollos agro-biotecnológicos.

Исследование инжинерно-геолргических и гидрогеологических условии Бакурианского плато экспресс-методом электроразведки с использованием программного обеспечения IPI2WIN

ელექტროძიების ექსპრეს-მეთოდით პროგრამული უზრუნველყოფის IPI2WIN გამოყენებით კვლევის მიზანს წარმოადგენს ბაკურიანის პლატოზე გავრცელებული ნალექების საინჟინრო-გეოლოგიური და ჰიდროგეოლოგიური პირობების დაზუსტება ცენტრალური პროფილის მაგალითზე. IPI2WIN პროგრამული უზრუნველყოფით მიღებული კუთრი ელექტრული წინაღობის ჭრილი კარგ თანხვედრაშია ტრადიციული პალეტური ინტერპრეტაციის შედეგად მიღებულ (I-I’) გეოელექტრულ ჭრილთან.

Thermal biology, activity, and population parameters of Cnemidophorus vacariensis (Squamata, Teiidae), a lizard endemic to southern Brazil

We investigated the following aspects of the biology of a population of Cnemidophorus vacariensis Feltrim & Lema, 2000 during the four seasons: thermal biology, relationship with the thermal environment, daily and seasonal activity, population structure and growth rate. Cnemidophorus vacariensis is restricted to rocky outcrops of the "campos de cima da serra" grasslands on the Araucaria Plateau, southern Brazil, and is currently listed as regionally and nationally threatened with extinction. Data were collected from October 2004 through September 2007 in the state of Rio Grande do Sul. Sampling was conducted randomly from 08:00 a.m. to 6:00 p.m. The capture-mark-recapture method was employed. The lizards were captured by hand, and their cloacal temperature, sex, snout-ventral length (SVL), mass, and the temperature of their microhabitat (substrate temperature and air temperature) were recorded. Individuals were then marked by toe-clipping and released at the site of capture. Body temperatures were obtained for 175 individuals, activity data for 96 individuals, and data on population structure and growth for 59 individuals. All data were obtained monthly, at different times of the day. Cnemidophorus vacariensis average body temperature was 23.84ºC, ranging between 9.6 and 38.2ºC. Temperatures ranged between 21 and 29ºC. The correlation between external heat sources, substrate and air were positive and significant and there was a greater correlation between lizard's temperature and the temperature of the substrate (tigmothermic species). The relatively low body temperatures of individuals are associated with the climate of their environment (altitude up to 1,400 m), with large variations in temperature throughout the day and the year, and low temperatures in winter. The average body temperature observed for C. vacariensis was low when compared with that of phylogenetically related species, suggesting that the thermal biology of this species reflects adaptations to the temperate region where it lives. The monthly rates of activity of lizards were related to monthly variations in the ambient temperatures. Our data suggest that the daily and seasonal activity of C. vacariensis result from the interaction between two factors: changes in the environment temperature and the relationship between individuals and their thermal environment. The population structure of C. vacariensis varied throughout the study period, with maximum biomass in January and maximum density in February (recruitment period). The sex ratio diverged from the expected 1:1. The growth analysis showed a negative relationship between the growth rate of individuals and the SVL, revealing that young individuals grow faster than adults, a typical pattern for short-lived species. The population studied showed a seasonal and cyclical variation associated with the reproductive cycle. The life strategy of C. vacariensis seems to include adaptations to the seasonal variations in temperature, typical of its environment.

An 40Ar/39Ar, Rb/Sr, and stable isotope study of micas in low-grade fold-and-thrust belt: An example from the Swiss Helvetic Alps

White micas in carbonate-rich tectonites and a few other rock types of large thrusts in the Swiss Helvetic fold-and-thrust belt have been analyzed by Ar-40/Ar-39 and Rb/Sr techniques to better constrain the timing of Alpine deformation for this region. Incremental Ar-40/Ar-39 heating experiments of 25 weakly metamorphosed (anchizone to low greenschist) samples yield plateau and staircase spectra. We interpret most of the staircase release spectra result from variable mixtures of syntectonic (neoformed) and detrital micas. The range in dates obtained within individual spectra depends primarily on the duration of mica nucleation and growth, and relative proportions of neoformed and detrital mica. Rb/Sr analyses of 12 samples yield dates of ca. 10-39 Ma (excluding one anomalously young sample). These dates are slightly younger than the Ar-40/Ar-39 total gas dates obtained for the same samples. The Rb/ Sr dates were calculated using initial Sr-87/Sr-86 ratios obtained from the carbonate-dominated host rocks, which are higher than normal Mesozoic carbonate values due to exchange with fluids of higher Sr-87/Sr-86 ratios (and lower O-18/O-16 ratios). Model dates calculated using Sr-87/Sr-86 values typical of Mesozoic marine carbonates more closely approximate the Ar-40/Ar-39 total gas dates for most of the samples. The similarities of Rb/Sr and Ar-40/Ar-39 total gas dates are consistent with limited amounts of detrital mica in the samples. The delta(18)O values range from 24-15%. (VSMOW) for 2-6 mum micas and 27-16parts per thousand for the carbonate host rocks. The carbonate values are significantly lower than their protolith values due to localized fluid-rock interaction and fluid flow along most thrust surfaces. Although most calcite-mica pairs are not in oxygen isotope equilibrium at temperatures of ca. 200-400 degreesC, their isotopic fractionations are indicative of either 1) partial exchange between the minerals and a common external fluid, or 2) growth or isotopic exchange of the mica with the carbonate after the carbonate had isotopically exchanged with an external fluid. The geological significance of these results is not easily or uniquely determined, and exemplifies the difficulties inherent in dating very fine-grained micas of highly deformed tectonites in low-grade metamorphic terranes. Two generalizations can be made regarding the dates obtained from the Helvetic thrusts: 1) samples from the two highest thrusts (Mt. Gond and Sublage) have all of their Ar-40/Ar-39 steps above 20 Ma, and 2) most samples from the deepest Helvetic thrusts have steps (often accounting for more than 80% of Ar-39 release) between 15 and 25 Ma. These dates are consistent with the order of thrusting in the foreland-imbricating system and increase proportions of neoformed to detrital mica in the more metamorphosed hinterland and deeply buried portions of the nappe pile. Individual thrusts accommodated the majority of their displacement during their initial incorporation into the foreland-imbricating system, and some thrusts remained active or were reactivated down to 15 Ma.

Desensitization of thermal hyperemia in the skin is reproducible.

OBJECTIVE: Local heating increases skin blood flow SkBF (thermal hyperemia). In a previous study, we reported that a first local thermal stimulus could attenuate the hyperemic response to a second one applied later on the same skin spot, a phenomenon that we termed desensitization. However, other studies found no evidence for desensitization in similar conditions. The aim of the present work was to test whether it was related to differences in instrumentation. METHODS: Twenty-eight healthy young males were studied. Two pairs of heating chambers, one custom-made (our study) and one commercial (other groups), were affixed to forearm skin. SkBF was measured with single-point laser-Doppler flowmetry (LDF) (780nm) in one pair, and laser-Doppler imaging (LDI) (633nm) in the other. A temperature step from 34 to 41°C, was applied for 30minutes and repeated after two hours. RESULTS: During the second thermal challenge, the plateau SkBF was lower than during the first thermal and was observed with each of the four combinations of SkBF measurement techniques and heating equipment (p<0.05 for all conditions, range -9% to -16% of the initial value). CONCLUSION: Desensitization of thermal hyperemia is not specific to peculiar operating conditions.

Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008.

OBJECTIVE: To provide an update to the original Surviving Sepsis Campaign clinical management guidelines, "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," published in 2004. DESIGN: Modified Delphi method with a consensus conference of 55 international experts, several subsequent meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. This process was conducted independently of any industry funding. METHODS: We used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations. A strong recommendation (1) indicates that an intervention's desirable effects clearly outweigh its undesirable effects (risk, burden, cost) or clearly do not. Weak recommendations (2) indicate that the tradeoff between desirable and undesirable effects is less clear. The grade of strong or weak is considered of greater clinical importance than a difference in letter level of quality of evidence. In areas without complete agreement, a formal process of resolution was developed and applied. Recommendations are grouped into those directly targeting severe sepsis, recommendations targeting general care of the critically ill patient that are considered high priority in severe sepsis, and pediatric considerations. RESULTS: Key recommendations, listed by category, include early goal-directed resuscitation of the septic patient during the first 6 hrs after recognition (1C); blood cultures before antibiotic therapy (1C); imaging studies performed promptly to confirm potential source of infection (1C); administration of broad-spectrum antibiotic therapy within 1 hr of diagnosis of septic shock (1B) and severe sepsis without septic shock (1D); reassessment of antibiotic therapy with microbiology and clinical data to narrow coverage, when appropriate (1C); a usual 7-10 days of antibiotic therapy guided by clinical response (1D); source control with attention to the balance of risks and benefits of the chosen method (1C); administration of either crystalloid or colloid fluid resuscitation (1B); fluid challenge to restore mean circulating filling pressure (1C); reduction in rate of fluid administration with rising filing pressures and no improvement in tissue perfusion (1D); vasopressor preference for norepinephrine or dopamine to maintain an initial target of mean arterial pressure > or = 65 mm Hg (1C); dobutamine inotropic therapy when cardiac output remains low despite fluid resuscitation and combined inotropic/vasopressor therapy (1C); stress-dose steroid therapy given only in septic shock after blood pressure is identified to be poorly responsive to fluid and vasopressor therapy (2C); recombinant activated protein C in patients with severe sepsis and clinical assessment of high risk for death (2B except 2C for postoperative patients). In the absence of tissue hypoperfusion, coronary artery disease, or acute hemorrhage, target a hemoglobin of 7-9 g/dL (1B); a low tidal volume (1B) and limitation of inspiratory plateau pressure strategy (1C) for acute lung injury (ALI)/acute respiratory distress syndrome (ARDS); application of at least a minimal amount of positive end-expiratory pressure in acute lung injury (1C); head of bed elevation in mechanically ventilated patients unless contraindicated (1B); avoiding routine use of pulmonary artery catheters in ALI/ARDS (1A); to decrease days of mechanical ventilation and ICU length of stay, a conservative fluid strategy for patients with established ALI/ARDS who are not in shock (1C); protocols for weaning and sedation/analgesia (1B); using either intermittent bolus sedation or continuous infusion sedation with daily interruptions or lightening (1B); avoidance of neuromuscular blockers, if at all possible (1B); institution of glycemic control (1B), targeting a blood glucose < 150 mg/dL after initial stabilization (2C); equivalency of continuous veno-veno hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1A); use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding using H2 blockers (1A) or proton pump inhibitors (1B); and consideration of limitation of support where appropriate (1D). Recommendations specific to pediatric severe sepsis include greater use of physical examination therapeutic end points (2C); dopamine as the first drug of choice for hypotension (2C); steroids only in children with suspected or proven adrenal insufficiency (2C); and a recommendation against the use of recombinant activated protein C in children (1B). CONCLUSIONS: There was strong agreement among a large cohort of international experts regarding many level 1 recommendations for the best current care of patients with severe sepsis. Evidenced-based recommendations regarding the acute management of sepsis and septic shock are the first step toward improved outcomes for this important group of critically ill patients.

Multifractal portrayal of the Swiss population

Fractal geometry is a fundamental approach for describing the complex irregularities of the spatial structure of point patterns. The present research characterizes the spatial structure of the Swiss population distribution in the three Swiss geographical regions (Alps, Plateau and Jura) and at the entire country level. These analyses were carried out using fractal and multifractal measures for point patterns, which enabled the estimation of the spatial degree of clustering of a distribution at different scales. The Swiss population dataset is presented on a grid of points and thus it can be modelled as a "point process" where each point is characterized by its spatial location (geometrical support) and a number of inhabitants (measured variable). The fractal characterization was performed by means of the box-counting dimension and the multifractal analysis was conducted through the Renyi's generalized dimensions and the multifractal spectrum. Results showed that the four population patterns are all multifractals and present different clustering behaviours. Applying multifractal and fractal methods at different geographical regions and at different scales allowed us to quantify and describe the dissimilarities between the four structures and their underlying processes. This paper is the first Swiss geodemographic study applying multifractal methods using high resolution data.