Concomitant and antecedent deep venous thrombosis and cancer survival in male US veterans

Survival is reportedly worse in patients with cancer concurrently diagnosed with deep venous thrombosis. However, information on specific malignancies is limited. From a cohort study of male US veterans we identified incident cancer cases (n aEuroS== aEuroS412 008) and compared survival patterns among those with versus without a history of deep venous thrombosis. Using Cox proportional hazard models, we estimated hazard ratios (HRs) and 95%% confidence intervals as measures of the relative risk of dying. Individuals with (versus without) a concomitant deep venous thrombosis and cancer diagnosis had a higher risk of dying (HR aEuroS== aEuroS1.38; 1.28--1.49). The most prominent excess mortality (HR aEuroS== aEuroS1.29--2.55) was observed among patients diagnosed with deep venous thrombosis at the time of diagnosis of lung, gastric, prostate, bladder, or kidney cancer. Increased risk of dying was also found among cancer patients diagnosed with deep venous thrombosis 1 year (HR aEuroS== aEuroS1.14; 1.07--1.22), 1--5 years (HR aEuroS== aEuroS1.14; 1.10--1.19), and > 5 years (HR aEuroS== aEuroS1.27; 1.23--1.31) before cancer; this was true for most cancer sites (HR aEuroS== aEuroS1.17--1.64). In summary, antecedent deep venous thrombosis confers a worse prognosis upon cancer patients. Advanced stage at diagnosis, treatment effects, lifestyle factors, and comorbidity could explain differences by cancer site and time frame between a prior deep venous thrombosis diagnosis and cancer outcome.

Larval Transport Modeling of Deep-Sea Invertebrates Can Aid the Search for Undiscovered Populations

Background: Many deep-sea benthic animals occur in patchy distributions separated by thousands of kilometres, yet because deep-sea habitats are remote, little is known about their larval dispersal. Our novel method simulates dispersal by combining data from the Argo array of autonomous oceanographic probes, deep-sea ecological surveys, and comparative invertebrate physiology. The predicted particle tracks allow quantitative, testable predictions about the dispersal of benthic invertebrate larvae in the south-west Pacific. Principal Findings: In a test case presented here, using non-feeding, non-swimming (lecithotrophic trochophore) larvae of polyplacophoran molluscs (chitons), we show that the likely dispersal pathways in a single generation are significantly shorter than the distances between the three known population centres in our study region. The large-scale density of chiton populations throughout our study region is potentially much greater than present survey data suggest, with intermediate ‘stepping stone’ populations yet to be discovered. Conclusions/Significance: We present a new method that is broadly applicable to studies of the dispersal of deep-sea organisms. This test case demonstrates the power and potential applications of our new method, in generating quantitative, testable hypotheses at multiple levels to solve the mismatch between observed and expected distributions: probabilistic predictions of locations of intermediate populations, potential alternative dispersal mechanisms, and expected population genetic structure. The global Argo data have never previously been used to address benthic biology, and our method can be applied to any non-swimming larvae of the deep-sea, giving information upon dispersal corridors and population densities in habitats that remain intrinsically difficult to assess.

Protocolized versus non-protocolized weaning for reducing the duration of invasive mechanical ventilation in critically ill paediatric patients (Protocol)

This is the protocol for a review and there is no abstract. The objectives are as follows:

To assess the effects of weaning by protocol for invasively ventilated critically ill children.

To compare the total duration of invasive mechanical ventilation of critically ill children who are weaned using protocols versus usual (non-protocolized) practice.
To ascertain any differences between protocolized weaning and usual care in terms of mortality, adverse events, ICU length of stay, and quality of life.

Effect of intravenous beta-2 agonist treatment on clinical outcomes in acute respiratory distress syndrome (BALTI-2): a multicentre, randomised controlled trial

BACKGROUND:
In a previous randomised controlled phase 2 trial, intravenous infusion of salbutamol for up to 7 days in patients with acute respiratory distress syndrome (ARDS) reduced extravascular lung water and plateau airway pressure. We assessed the effects of this intervention on mortality in patients with ARDS.
METHODS:
We did a multicentre, placebo-controlled, parallel-group, randomised trial at 46 UK intensive-care units between December, 2006, and March, 2010. Intubated and mechanically ventilated patients (aged =16 years) within 72 h of ARDS onset were randomly assigned to receive either salbutamol (15 µg/kg ideal bodyweight per h) or placebo for up to 7 days. Randomisation was done by a central telephone or web-based randomisation service with minmisation by centre, pressure of arterial oxygen to fractional inspired oxygen concentration (PaO(2)/F(I)O(2)) ratio, and age. All participants, caregivers, and investigators were masked to group allocation. The primary outcome was death within 28 days of randomisation. Analysis was by intention-to-treat. This trial is registered, ISRCTN38366450 and EudraCT number 2006-002647-86.
FINDINGS:
We randomly assigned 162 patients to the salbutamol group and 164 to the placebo group. One patient in each group withdrew consent. Recruitment was stopped after the second interim analysis because of safety concerns. Salbutamol increased 28-day mortality (55 [34%] of 161 patients died in the salbutamol group vs 38 (23%) of 163 in the placebo group; risk ratio [RR] 1·47, 95% CI 1·03-2·08).
INTERPRETATION:
Treatment with intravenous salbutamol early in the course of ARDS was poorly tolerated. Treatment is unlikely to be beneficial, and could worsen outcomes. Routine use of ß-2 agonist treatment in ventilated patients with this disorder cannot be recommended.

Oxidative stress and increased type-IV collagenase levels in bronchoalveolar lavage fluid from newborn babies

Oxidative stress may increase lung permeability by upregulation of matrix-metalloproteinase-9 (MMP-8), a type-IV collagenase that can disrupt alveolar basement membranes. We have compared a marker of oxidative stress (protein carbonyl residues) with levels of MMP-8 and its inhibitor, tissue inhibitor of metalloproteinase-1 (TIMP-1), in bronchoalveolar lavage samples from newborn babies. Bronchoalveolar lavage samples (n = 87, two from each time point) were taken in the first 6 postnatal days from 41 ventilated babies: 18 of

Doonloughan: a seasonal settlement site on the Connemara coast

A series of shell middens and miscellaneous habitation sites, located in a dune
system in west County Galway, have been exposed and are slowly disappearing
through wind, wave and surface erosion. In 1992 a project was initiated to
record, sample and date some of these sites and the radiocarbon results
demonstrated that activity in the area spanned the Early Bronze Age through to
the Iron Age and into the early and post medieval periods. This preliminary
fieldwork was succeeded by the excavation of three of the better-preserved sites; a Bronze Age midden in 1994 and two early medieval sites (the subject of this paper), in 1997. The medieval sites dated to the late-seventh to ninth century adand were represented by a sub-circular stone hut with a hearth and the charred remains of a more ephemeral wooden tent-like structure. The discovery of a bronze penannular brooch of ninth/tenth century date at the latter site wouldsuggest that the settlements are not the remains of transient, impoverishedpeoples of the lower classes of society, eking out a living along the coast. The calcareous sands ensured good preservation of organic remains*fish and mammal bones, charred cereal grains, seeds and seaweed, and marine molluscs. Analyses of these indicated exploitation of marine resources but, otherwise, were comparable with the diet and economy represented by assemblages from established contemporary site types of the period. Unlike raths, cranno´gs and monastic settlements, however, the volume of material represented at the Galway sites was slight, despite the excellent preservation conditions. A range of seasonal indicators also suggested temporary habitation: probable latespring/summer occupation of the stone hut site and autumnal occupancy of the second, less substantial site. It is suggested that the machair plain, beside which the dunes are located, was most probably the attraction for settlers to the area and was exploited as an alternative pasture for the seasonal grazing of livestock.
*

Monitoring the moisture transport in building stones using fibre optic relative humidity sensors

Weathering of stone is one of the major reasons for the damage of stone masonry structures and it takes place due to interlinked chemical, physical and biological processes in stones. The key parameters involved in the deterioration processes are temperature, moisture and salt. It is now known that the sudden variations in temperature and moisture greatly accelerate the weathering process of the building stone fabric. Therefore, in order to monitor these sudden variations an effective and continuous monitoring system is needed. Furthermore, it must consist of robust sensors which are accurate and can survive in the harsh environments experienced in and around masonry structures. Although salt penetration is important for the rate of deterioration of stone masonry structures, the processes involved are much slower than the damage associated with temperature and moisture variations. Therefore, in this paper a novel fibre optic temperature cum relative humidity sensor is described and its applicability in monitoring building stones demonstrated. The performance of the sensor is assessed in an experiment comprising wetting and drying of limestone blocks. The results indicate that the novel fibre optic relative humidity sensor which is tailor made for applications in masonry structures performed well in wetting and drying tests, whilst commercial capacitance based sensors failed to recover during the drying regime for a long period after a wetting regime. That is, the fibre optic sensor has the capability to measure both sorption and de-sorption characteristics of stone blocks. This sensor is used in a test wall in Oxford and the data thus obtained strengthened the laboratory observations.

The Lake House Extension

The project comprises of the re-ordering and extension of a 19th century country house in the extreme south west of Ireland. The original house is what can be termed an Irish house of the middle size. A common typology in 19th century Ireland the classical house of the middle size is characterised by a highly ordered plan containing a variety of rooms within a square or rectangular form. A strategy of elaborating the threshold between the reception rooms of the house and the garden was adopted by wrapping the house in a notional forest of columns creating deep verandas to the south and west
of the main living spaces. The grid of structural columns derived its proportions directly from the house. The columns became analogous with the mature oak and pine trees in the garden beyond while the floor and ceiling were considered as landscapes in their own right, with the black floor forming hearth stone, kitchen island and basement cellar and the concrete roof inflected to hold roof lights, a chimney and a landscape of pleasure on the roof above.

Aims / Objectives / Questions
1To restore and extend a “house of the middle size”, a historic Irish typology, in a sympathetic manner.
2To address the new build accommodation in a sustainable manner through strategies associated with orientation, micro climates, materiality and engineering both mechanical and structural.
3To explore and develop an understanding for two spatial orders, the enfilade room and non directional space of the grid.
4The creation of deep threshold space.
5Marbling as a finish in fair faced concrete
6Concrete as a sustainable building material

Low temperature conditions in building sandstone: the role of extreme events in temperate environments

Data on rock temperatures has previously been collected to characterise typical diurnal regimes, and more recently to describe short-term variability in extreme locations. However, there is also the case that little is understood concerning the impact of extreme events in otherwise temperate environments. Internal stone temperatures (5?cm) collected during the atypical cold extreme experienced, throughout the UK, in December 2010 show a difference between ambient air temperatures and aspect-related thermal differences, particularly concerning temperature lows and the influence of radiative heating. In this case, debris release was not visible; however, laboratory simulations have shown that under such conditions, surface loss does not necessarily negate the occurrence of internal stone modifications. This preparatory sequence of change demonstrates that surface loss is not the result of one process, but rather many operating over time to sufficiently decrease stone strength to facilitate obvious damage.

The impedance cardiogram recorded through two electrocardiogram/defibrillator pads as a determinant of cardiac arrest during experimental studies

OBJECTIVE: Laypersons are poor at emergency pulse checks (sensitivity 84%, specificity 36%). Guidelines indicate that pulse checks should not be performed. The impedance cardiogram (dZ/dt) is used to assess stroke volume. Can a novel defibrillator-based impedance cardiogram system be used to distinguish between circulatory arrest and other collapse states?

DESIGN: Animal study.

SETTING: University research laboratory.

SUBJECTS: Twenty anesthetized, mechanically ventilated pigs, weight 50-55 kg.

INTERVENTIONS: Stroke volume was altered by right ventricular pacing (160, 210, 260, and 305 beats/min). Cardiac arrest states were then induced: ventricular fibrillation (by rapid ventricular pacing) and, after successful defibrillation, pulseless electrical activity and asystole (by high-dose intravenous pentobarbitone).

MEASUREMENTS AND MAIN RESULTS: The impedance cardiogram was recorded through electrocardiogram/defibrillator pads in standard cardiac arrest positions. Simultaneously recorded electro- and impedance cardiogram (dZ/dt) along with arterial blood pressure tracings were digitized during each pacing and cardiac arrest protocol. Five-second epochs were analyzed for sinus rhythm (20 before ventricular fibrillation, 20 after successful defibrillation), ventricular fibrillation (40), pulseless electrical activity (20), and asystole (20), in two sets of ten pigs (ten training, ten validation). Standard impedance cardiogram variables were noncontributory in cardiac arrest, so the fast Fourier transform of dZ/dt was assessed. During ventricular pacing, the peak amplitude of fast Fourier transform of dZ/dt (between 1.5 and 4.5 Hz) correlated with stroke volume (r2 = .3, p < .001). In cardiac arrest, a peak amplitude of fast Fourier transform of dZ/dt of < or = 4 dB x ohm x rms indicated no output with high sensitivity (94% training set, 86% validation set) and specificity (98% training set, 90% validation set).

CONCLUSIONS: As a powerful clinical marker of circulatory collapse, the fast Fourier transformation of dZ/dt (impedance cardiogram) has the potential to improve emergency care by laypersons using automated defibrillators.