Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta-analysis.

Objective To investigate the effects of weaning protocols on the total duration of mechanical ventilation, mortality, adverse events, quality of life, weaning duration, and length of stay in the intensive care unit and hospital.

Design Systematic review.

Data sources Cochrane Central Register of Controlled Trials, Medline, Embase, CINAHL, LILACS, ISI Web of Science, ISI Conference Proceedings, Cambridge Scientific Abstracts, and reference lists of articles. We did not apply language restrictions.

Review methods We included randomised and quasi-randomised controlled trials of weaning from mechanical ventilation with and without protocols in critically ill adults.

Data selection Three authors independently assessed trial quality and extracted data. A priori subgroup and sensitivity analyses were performed. We contacted study authors for additional information.

Results Eleven trials that included 1971 patients met the inclusion criteria. Compared with usual care, the geometric mean duration of mechanical ventilation in the weaning protocol group was reduced by 25% (95% confidence interval 9% to 39%, P=0.006; 10 trials); the duration of weaning was reduced by 78% (31% to 93%, P=0.009; six trials); and stay in the intensive care unit length by 10% (2% to 19%, P=0.02; eight trials). There was significant heterogeneity among studies for total duration of mechanical ventilation (I(2)=76%, P

Conclusion There is evidence of a reduction in the duration of mechanical ventilation, weaning, and stay in the intensive care unit when standardised weaning protocols are used, but there is significant heterogeneity among studies and an insufficient number of studies to investigate the source of this heterogeneity. Some studies suggest that organisational context could influence outcomes, but this could not be evaluated as it was outside the scope of this review.

Le 'bon Allemand' dans le roman français de l'immédiat après-Seconde Guerre mondiale: une erreur de casting?

The end of the Occupation, which was much more violent than its beginning, dramatically affected the overall perception of Germans and Germany for many years in post-WWII France. This vision is of course reflected to a large extent in French literature. Yet, paradoxically, many novels—including the ‘best-sellers’ E ´ ducation europe´enne (1945) by Romain Gary, Mon Village a` l’heure allemande (1945) by Jean-Louis Bory or Les Foreˆts de la nuit (1947) by Jean-Louis Curtis—contain a ‘good German’ character. Firstly, this article will give an overview of the dominant representations of Germans in post-WWII France, before suggesting that the ‘good German’ character follows both a literary tradition and the humanist values of the French Resistance, to which these writers claim to subscribe. Finally, it will show how this character, far from blurring the Manichean ideology of the novel in which he appears, actually reinforces it.

Le poeme comme ecriture de vie

This article is a critique of the biographical approach using Celan's notion of Lebensschrift (life writing) to bring forward the life constitutive dimension of poetry.

Apo J/clusterin expression and secretion: Evidence for 15-deoxy-Δ12,14-PGJ2-dependent mechanism

Cyclooxygenase-2 (Cox-2) and Apo J/clusterin are involved in inflammatory resolution and have each been reported to inhibit NF-?B signalling. Using a well-validated rat pheochromocytoma (PC12) cell culture model of Cox-2 over-expression the current study investigated inter-dependence between Cox-2 and clusterin with respect to induction of expression and impact on NF-?B signalling. Both gene expression and immunoblot analysis confirmed that intracellular and secreted levels of clusterin were elevated in Cox-2 over-expressing cells (PCXII). Clusterin expression was increased in control (PCMT) cells in a time- and dose-dependent manner by 15-deoxy-? 12,14-prostaglandin J 2 (15d-PGJ 2), but not PGE 2, and inhibited in PCXII cells by pharmacological Cox inhibition. In PCXII cells, inhibition of two transcription factors known to be activated by 15d-PGJ 2, heat shock factor 1 (HSF-1) and peroxisome proliferator activated receptor (PPAR)?, by transcription factor oligonucleotide decoy and antagonist (GW9662) treatment, respectively, reduced clusterin expression. While PCXII cells exhibited reduced TNF-a-induced cell surface ICAM-1 expression, IkB phosphorylation and degradation were similar to control cells. With respect to the impact of Cox-2-dependent clusterin upregulation on NF-?B signalling, basal levels of I?B were similar in control and PCXII cells, and no evidence for a physical association between clusterin and phospho-I?B was obtained. Moreover, while PCXII cells exhibited reduced NF-?B transcriptional activity, this was not restored by clusterin knock-down. These results indicate that Cox-2 induces clusterin in a 15d-PGJ 2-dependent manner, and via activation of HSF-1 and PPAR?. However, the results do not support a model whereby Cox-2/15d-PGJ 2-dependent inhibition of NF-?B signalling involves clusterin.

A 330-360 GHz spectral survey of G34.3+0.15 - III. The outer halo

We have undertaken a 330-360 GHz molecular line survey of the halo gas surrounding the hot core associated with G34.26+0.15. In contrast to our molecular line survey of the hot core itself, where 338 lines from at least 38 species were detected, only 18 lines from 9 species were detected in the halo. The lines are mainly single transitions of simple di atomic and triatomic molecules. Lower limits to their column densities have been evaluated by an LTE method. In the case of methanol, where four transitions were detected, the rotation temperature and column density have been evaluated by the rotation diagram technique. We have modified the previous depth-dependent chemical model developed in Paper II to calculate the column densities observed along a general line of sight drawn through the model cloud. The model is also extended to produce beam-averaged column densities for better comparison with those observed. We compare the model column densities with those observed and make recommendations for future depth-dependent chemical modelling of hot cores.

DENSE GAS IN NEARBY GALAXIES .9. A SURVEY FOR HNC

Ten detections and five tentative detections of hydrogen isocyanide (HNC) J=1-0 emission are reported from a survey including sixteen galaxies. Full maps are presented for the nuclear regions of NGC 253 and IC 342, partial maps for Maffei 2, M 82, and M 83. Toward IC 342, the HNC and HCO+ distributions differ from those observed in 12CO, 13CO, HCN, CS, and NH3. This is likely a consequence of the density structure. Relative HNC abundances are with 10(-10)-10(-9) much smaller than those measured in nearby dark clouds and appear to be slightly smaller than those in regions of massive star formation of the Galactic disk. This is consistent with the presence of dense warm gas or a frequent occurrence of shocks in the nuclear regions of the galaxies observed. As in prominent Galactic star forming regions, 3 mm HNC line emission tends to be weaker than the corresponding emission from HCN and HCO+. Toward Arp 220, however, the 3 mm HNC/HCN line intensity ratio is > 1. HNC/HCO+, HNC/CO, and HNC to 20 cm radio continuum luminosity ratios are also particularly large. A possible interpretation is the presence of cool quiescent gas outside the central region which contains the starburst. In the other ultraluminous galaxy observed, NGC 6240, X(HNC) 10 smaller than in Arp 220, demonstrating that the molecular composition in ultraluminous galaxies is far from being uniform.

WASP-39b: a highly inflated Saturn-mass planet orbiting a late G-type star

We present the discovery of WASP-39b, a highly inflated transiting Saturn-mass planet orbiting a late G-type dwarf star with a period of 4.055259 +/- 0.000008 d, Transit Epoch T-0 = 2 455 342.9688 +/- 0.0002 (HJD), of duration 0.1168 +/- 0.0008 d. A combined analysis of the WASP photometry, high-precision follow-up transit photometry, and radial velocities yield a planetary mass of M-pl = 0.28 +/- 0.03 M-J and a radius of R-pl = 1.27 +/- 0.04 R-J, resulting in a mean density of 0.14 +/- 0.02 rho(J). The stellar parameters are mass M-star = 0.93 +/- 0.03 M-circle dot, radius R-star = 0.895 +/- 0.23 R-circle dot, and age 9(-4)(+3) Gyr. Only WASP-17b and WASP-31b have lower densities than WASP-39b, although they are slightly more massive and highly irradiated planets. From our spectral analysis, the metallicity of WASP-39 is measured to be [Fe/H] = -0.12 +/- 0.1 dex, and we find the planet to have an equilibrium temperature of 1116(-32)(+33) K. Both values strengthen the observed empirical correlation between these parameters and the planetary radius for the known transiting Saturn-mass planets.

Survey of the anticoccidial feed additive nicarbazin (as dinitrocarbanilide residues) in poultry and eggs

A survey was carried out on the occurrence of dinitrocarbanilide (DNC), the marker residue for nicarbazin, in poultry produced in Ireland during 2002-2004. Liver (n = 736) and breast muscle samples (n = 342) were tested. DNC residues were found in 40 and 26% of liver and breast muscle samples at levels greater than 12.5 and 5 mu g kg(-1), respectively. DNC residues were found at >200 mu g kg(-1) in 12 and 0% of liver and muscle samples, respectively. Samples of breast muscle (n = 217) imported from 11 countries were also tested for DNC residues. A lower incidence of DNC residues (6%) was found in imported breast muscle. Egg samples (n = 546) were tested and DNC residues were found in nine samples, with levels ranging between 14 and 122 mu g kg(-1). Analysis of poultry, carried out as part of official food inspection in the period 2004-2006, indicated a reduction in the number of broiler liver samples containing DNC at >200 mu g kg(-1), to approximately 7%. Low levels of DNC residues continue to be found in