Fluid resuscitation practice patterns in intensive care units of the USA: a cross-sectional survey of critical care physicians.

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.

Paleomagnetic data and K-Ar ages from Mesozoic units of the Santa Marta massif: A preliminary interpretation for block rotation and translations

We report 6 K-Ar ages and paleomagnetic data from 28 sites collected in Jurassic, Lower Cretaceous and Paleocene rocks of the Santa Marta massif, to test previous hypothesis of rotations and translations of this massif, whose rock assemblage differs from other basement-cored ranges adjacent to the Guyana margin. Three magnetic components were identified in this study. A first component has a direction parallel to the present magnetic field and was uncovered in all units (D 352, I = 25.6, k = 57.35, a95 = 5.3, N = 12). A second component was isolated in Cretaceous limestone and Jurassic volcaniclastic rocks (D = 8.8, I = 8.3, k = 24.71, a95 = 13.7, N = 6), and it was interpreted as of Early Cretaceous age. In Jurassic sites with this component, Early Cretaceous K-Ar ages obtained from this and previous studies are interpreted as reset ages. The third component was uncovered in eight sites of Jurassic volcaniclastic rocks, and its direction indicates negative shallow to moderate inclinations and northeastward declinations. K-Ar ages in these sites are of Early (196.5 +/- 4.9 Ma) to early Late Jurassic age (156.6 +/- 8.9 Ma). Due to local structural complexity and too few Cretaceous outcrops to perform a reliable unconformity test, we only used two sites with (1) K-Ar ages, (2) less structural complexity, and (3) reliable structural data for Jurassic and Cretaceous rocks. The mean direction of the Jurassic component is (D = 20.4, I = -18.2, k = 46.9, a95 = 5.1, n = 18 specimens from two sites). These paleomagnetic data support previous models of northward along-margin translations of Grenvillian-cored massifs. Additionally, clockwise vertical-axis rotation of this massif, with respect to the stable craton, is also documented; the sense of rotation is similar to that proposed for the Perija Range and other ranges of the southern Caribbean margin. More data is needed to confirm the magnitudes of rotations and translations. (C) 2009 Elsevier Ltd. All rights reserved.

Precambrian geotectonic units of the Rio de La Plata craton

The main Precambrian tectonic units of Uruguay include the Piedra Alta tectonostratigraphic terrane (PATT) and Nico Perez tectonostratigraphic terrane (NPTT), separated by the Sarandi del Yi high-strain zone. Both terranes are well exposed in the Rio de La Plata craton (RPC). Although these tectonic units are geographically small, they record a wide span of geologic time. Therefore improved geological knowledge of this area provides a fuller understanding of the evolution of the core of South America. The PATT is constituted by low-to medium-grade metamorphic belts (ca. 2.1 Ga); its petrotectonic associations such as metavolcanic units, conglomerates, banded iron formations, and turbiditic deposits suggest a back-arc or a trench-basin setting. Also in the PATT, a late to post-orogenic, arc-related layered mafic complex (2.3-1.9 Ga), followed by A-type granites (2.08 Ga), and finally a taphrogenic mafic dike swarm (1.78 Ga) occur. The less thoroughly studied NPTT consists of Palaeoproterozoic high-grade metamorphic sequences (ca. 2.2 Ga), mylonites and postorogenic and rapakivi granites (1.75 Ga). The Brasiliano-Pan African orogeny affected this terrane. Neoproterozoic cover occurs in both tectonostratigraphic terranes, but is more developed in the NPTT. Over the past 15 years, new isotopic studies have improved our recognition of different tectonic events and associated processes, such as reactivation of shear zones and fluids circulation. Transamazonian and Statherian tectonic events were recognized in the RPC. Based on magmatism, deformation, basin development and metamorphism, we propose a scheme for the Precambrian tectonic evolution of Uruguay, which is summarized in the first Palaeoproterozoic tectonic map of the Rio de La Plata craton.

Central and peripheral defects in motor units of the diaphragm of spinal muscular atrophy mice.

Spinal muscular atrophy (SMA) is characterized by motoneuron loss and muscle weakness. However, the structural and functional deficits that lead to the impairment of the neuromuscular system remain poorly defined. By electron microscopy, we previously found that neuromuscular junctions (NMJs) and muscle fibres of the diaphragm are among the earliest affected structures in the severe mouse SMA model. Because of certain anatomical features, i.e. its thinness and its innervation from the cervical segments of the spinal cord, the diaphragm is particularly suitable to characterize both central and peripheral events. Here we show by immunohistochemistry that, at postnatal day 3, the cervical motoneurons of SMA mice receive less stimulatory synaptic inputs. Moreover, their mitochondria become less elongated which might represent an early stage of degeneration. The NMJs of the diaphragm of SMA mice show a loss of synaptic vesicles and active zones. Moreover, the partly innervated endplates lack S100 positive perisynaptic Schwann cells (PSCs). We also demonstrate the feasibility of comparing the proteomic composition between diaphragm regions enriched and poor in NMJs. By this approach we have identified two proteins that are significantly upregulated only in the NMJ-specific regions of SMA mice. These are apoptosis inducing factor 1 (AIFM1), a mitochondrial flavoprotein that initiates apoptosis in a caspase-independent pathway, and four and a half Lim domain protein 1 (FHL1), a regulator of skeletal muscle mass that has been implicated in several myopathies.

Geochemistry of metasedimentary units of the Cambro-Ordovician Ross Orogen in North Victoria Land and Oates Land, Antarctica

Metasediments in the three early Palaeozoic Ross orogenic terranes in northern Victoria Land and Oates Land (Antarctica) are geochemically classified as immature litharenites to wackes and moderately mature shales. Highly mature lithotypes with Chemical Index of Weathering values of >=95 are typically absent. Geochemical and Rb-Sr and Sm-Nd isotope results indicate that the turbiditic metasediments of the Cambro-Ordovician Robertson Bay Group in the eastern Robertson Bay Terrane represent a very homogeneous series lacking significant compositional variations. Major variations are only found in chemical parameters which reflect differences in degree of chemical weathering of their protoliths and in mechanical sorting of the detritus. Geochemical data, 87Sr/ 86Sr t=490 Ma ratios of 0.7120 - 0.7174, epsilonNd, t=490 Ma values of -7.6 to -10.3 and single-stage Nd-model ages of 1.7 - 1.9 Ga are indicative of an origin from a chemically evolved crustal source of on average late Palaeoproterozoic formation age. There is no evidence for significant sedimentary infill from primitive "ophiolitic" sources. Metasediments of the Middle Cambrian Molar Formation (Bowers Terrane) are compositionally strongly heterogeneous. Their major and trace element data and Sm-Nd isotope data (epsilonNd, t=500 Ma values of -14.3 to -1.2 and single-stage Nd-model ages of 1.7 - 2.1 Ga) can be explained by mixing of sedimentary input from an evolved crustal source of at least early Palaeoproterozoic formation age and from a primitive basaltic source. The chemical heterogeneity of metasediments from the Wilson Terrane is largely inherited from compositional variations of their precursor rocks as indicated by the Ni vs TiO2 diagram. Single-stage Nd-model ages of 1.6 -2.2 Ga for samples from more western inboard areas of the Wilson Terrane (epsilonNd, t=510 Ma -7.0 to -14.3) indicate a relatively high proportion of material derived from a crustal source with on average early Palaeoproterozoic formation age. Metasedimentary series in an eastern, more outboard position (epsilonNd, t=510 Ma -5.4 to -10.0; single-stage Nd model ages 1.4 - 1.9) on the contrary document stronger influence of a more primitive source with younger formation ages. The chemical and isotopic characteristics of metasediments from the Bowers and Wilson terranes can be explained by variable contributions from two contrasting sources: a cratonic continental crust similar to the Antarctic Shield exposed in Georg V Land and Terre Adélie some hundred kilometers west of the study area and a primitive basaltic source probably represented by the Cambrian island-arc of the Bowers Terrane. While the data for metasediments of the Robertson Bay Terrane are also compatible with an origin from an Antarctic-Shield-type source, there is no direct evidence from their geochemistry or isotope geochemistry for an island-arc component in these series.

Entrance fees and resource protection for units of the national park system : hearing before the Subcommittee on Public Lands, Reserved Water, and Resource Conservation of the Committee on Energy and Natural Resources, United States Senate, Ninety-ninth Congress, second session, on S. 2130 ... S. 2204 ... June 12, 1986.

Mode of access: Internet.

Various authorizations to units of the national park system and an addition to the wild and scenic river system : hearing before the Subcommittee on Public Lands, Reserved Water, and Resource Conservation of the Committee on Energy and Natural Resources, United States Senate, Ninety-ninth Congress, second session ....

Shipping list no.: 86-432-P (pt. 2).

Sediment budget and geomorphic process units of the Swedish Kärkevagge, link to ArcInfo E00 files

Geomorphic process units have been derived in order to allow quantification via GIS techniques at a catchment scale. Mass movement rates based on existing field measurements are employed in the budget calculations. In the Kärkevagge catchment, Northern Sweden, 80% of the area can be identified either as a source area for sediments or as a zone where sediments are deposited. The overall budget for the slopes beneath the rockwalls in the Kärkevagge is approximately 680 t/a whilst about 150 t a-1 are transported into the fluvial system.

Crystal state conformation of three model monomer units for the beta-bend ribbon structure

The molecular and crystal structures of three compounds, representing the repeating units of the -bend ribbon (an approximate 310-helix, with an intramolecular hydrogen-bonding donor every two residues), have been determined by x-ray diffraction. They are Boc-Aib-Hib-NHBzl, Z-Aib-Hib-NHBzl, and Z-L-Hyp-Aib-NHMe (Aib, -aminoisobutyric acid; Bzl, benzyl; Boc, t-butyloxycarbonyl; Hyp, hydroxyproline Hib, -hydroxyisobutyric acid; Z, benzyloxycarbonyl). The two former compounds are folded in a -bend conformation: type III (III) for Boc-Aib-Hib-NHBzl, while type II (II) for the Z analogue. Conversely, the structure of Z-L-Hyp-Aib-NHMe, although not far from a type II -bend, is partially open.

A concise summary of the International System of Units, the SI

The Bureau International des Poids et Mesures, the BIPM, was established by Article 1 of the Convention du Mètre, on 20 May 1875, and is charged with providing the basis for a single, coherent system of measurements to be used throughout the world. The decimal metric system, dating from the time of the French Revolution, was based on the metre and the kilogram. Under the terms of the 1875 Convention, new international prototypes of the metre and kilogram were made and formally adopted by the first Conférence Générale des Poids et Mesures (CGPM) in 1889. Over time this system developed, so that it now includes seven base units. In 1960 it was decided at the 11th CGPM that it should be called the Système International d’Unités, the SI (in English: the International System of Units). The SI is not static but evolves to match the world’s increasingly demanding requirements for measurements at all levels of precision and in all areas of science, technology, and human endeavour. This document is a summary of the SI Brochure, a publication of the BIPM which is a statement of the current status of the SI. The seven base units of the SI, listed in Table 1, provide the reference used to define all the measurement units of the International System. As science advances, and methods of measurement are refined, their definitions have to be revised. The more accurate the measurements, the greater the care required in the realization of the units of measurement.